Category: Covid-19

SAN FRANCISCO (KRON) If the Western Conference Finals are any indication, mass gatherings will continue now that the Warriors are in the NBA Finals. Medical experts say these gatherings come with extreme risk as COVID-19 cases surge again.

We are seeing an awful lot of people get sick and miss work and time with family and travel and this is the time to be careful so as not to get infected, said UC Berkeley Infectious Disease Dr. John Swartzberg.

Swartzberg says the best way to protect yourself from serious illness is to be up to date on the vaccine.

Not just one of two of them but a third one. If you are a candidate for the fourth one, make sure you get that. Thats the most critical thing, Swartzberg said.

Your next step is to reducing your risk is choosing where youll watch the game.

The Chase Center has pretty good ventilation but there will be 19,000-plus people, Swartzberg said. Some will be masked but most will not and the worst thing is that people will be yelling and screaming meaning lots of virus coming out of their mouths.

Swartzberg recommends those inside the Chase Center wear a mask for the duration. Better yet, he says is to watch the game outdoors either on the big screen outside the Chase Center or an outdoor sports bar.

Ultimately, he says the best bet is to have small gathering at your home.

I personally would have a party at my house, invite people I know would not come sick, who I know would test before they come over, then I think we can have a great time and be really safe, Swartzberg said.

Medical experts say everybodys risk tolerance is different. If there was every a time to give it extra special consideration, its now during a surge.

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COVID-19 cases predicted to increase in June - KRON4

COVID-19 therapeutics update: Rebound after Paxlovid, Test to Treat expansion, Paxlovid distribution in WA  Washington State Hospital Association

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COVID-19 therapeutics update: Rebound after Paxlovid, Test to Treat expansion, Paxlovid distribution in WA - Washington State Hospital Association

Research led by the University of Arkansas for Medical Sciences (UAMS) indicates that Hispanic and Black Arkansans had higher COVID-19 infection rates than whites, but the research doesnt provide clear reasons for the higher rates.

The project used seroprevalence of antibodies to COVID as an indicator. Antibodies are created by a persons immune system once they contract a virus or receive a vaccine to help fight a specific illness, according to a UAMS press release.

Dr. Joshua Kennedy, associate professor for the UAMS College of Medicine who treats patients at Arkansas Childrens Hospital, was the lead author of the report. Arkansas minorities getting the virus at such a large rate is problematic, he said.

The higher exposure levels in minorities is not surprising, he said. However, the magnitude of the difference in exposure rates is what was surprising, especially early in the pandemic.

The number of Arkansans, regardless of ethnicity, exposed to COVID increased from 2.6% to 7.4% from August 2020 to December 2020. Researchers studied nearly 6,000 serum samples from Arkansas adult outpatients who had medical appointments for reasons not related to COVID-19. The study focused on three specific time periods during the aforementioned August to December span. Throughout the study, Hispanics and Blacks were more likely than whites to have antibodies to COVID.

According to the U.S. Census Bureau, Arkansas has a population of just over 3 million people. The 2021 Census shows that whites are 79% of the states population. Blacks are 15.7% and Hispanics 7.8% of Arkansas population. There was no difference in the COVID infection rates for minorities who reside in the two population hubs of central and Northwest Arkansas, compared to the rural areas.

Studies are ongoing as for the reasons why Blacks and Hispanics in Arkansas have higher COVID infection rates than whites. Following are possible reasons given by researchers that contribute to the higher COVID infection rates. Structural racism Inadequate food options Being from low-income households Holding jobs that didnt provide the option of working from home Having limited access to a primary care physician Limited access to adequate health care coverage

Additionally, Arkansans 18-29 and 30-39 had the highest infection rates in terms of age. The information also showed that minorities comprised the highest percentage of the cases.

We suspect that the higher level of seroprevalence of antibodies in these populations is secondary to exposure risk, Kennedy said. While we cant say for sure, we think that these groups were the ones that had to continue working during the pandemic, therefore, their risk for exposure was higher.

The studys researchers noted how their info highlights the need to learn why Arkansas minority populations are exposed to COVID far more often than whites. Finding out the concrete reasons why this has occurred would help health officials address the issue.

While we are moving into a period where were seeing a decrease of infections, it is important to remember that COVID-19 is not gone, Kennedy said. We must remain vigilant and follow CDC instructions for masking and limiting our contacts. We should always remember to properly wash our hands.

As of May 31, the latest update from the Arkansas Department of Health, there have been 843,362 known COVID cases in Arkansas since the pandemic began in March 2020, up 2,243 from the previous week. There were 3,760 known active cases, up 50 from the previous week. Also as of May 31, there were 76 Arkansans hospitalized with COVID, up 4 from the previous week.

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Research shows minorities have higher COVID-19 infection rates than whites - talkbusiness.net

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Gov. Jay Inslee today announced the rescission of two COVID-19 emergency orders that are no longer needed to respond to the pandemic.

Proclamation 20-56waived/suspended a statute and certain provisions in agreements between the governor and tribes that restrict the use of fuel tax refund monies to transportation-related purposes.

To foster a smooth transition, the rescission of this order will take effect in 30 days, on July 1, 2022.

Proclamation 20-23addressed public utilities and it waived/suspended certain statutes that regulate the operation of those utilities. Key provisions of this emergency order were previously rescinded, including the utility shutoff moratorium which was rescinded in September 2021.

This rescission is technical in nature and effective immediately.

Public and constituent inquiries | 360.902.4111Press inquiries | 360.902.4136

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Inslee rescinds two proclamations related to COVID-19 | Governor Jay Inslee - Governor Jay Inslee

Good morning, Mission, and welcome to Virus Village, your (somewhat regular) Covid-19 data dump.

Hospitalizations, recorded infections and positivity rates show some stability as R Number models dip below 1. Wastewater monitoring shows a recent decline before levelling off.

Belatedly, local celebrity experts now agree San Francisco has been in the midst of another surge, quickly blaming it on public pandemic fatigue. Once again, arguments over the efficacy of masks and mask mandates generate more than enough controversy to keep everyone distracted.

A new study from Mission and 24th indicates covid has become milder for many but may remain infectious beyond the standard five days (set by the Centers for Disease Control and Prevention). In the Chronicle article, senior author of the study, Dr. Diane Havlir is quoted saying Milder illness does not mean no illness. It does not mean the illness doesnt affect peoples ability to go to work and support their families. And were still seeing hospitalizations. We are still in a pandemic, and we need to keep our response on pace with the virus.

Further down in the article, she observes: The new public health approach is personal responsibility.

Even if you have health care, access to the tools, a ventilated workplace and home and isolation support, its not easy to know what to do.

You may want to reconsider the gym.

During the less severe omicron surge, death rates soared for the elderly.

Public health still seems to fuctioning in Japan where a more cautious and a more consistent approach has promoted public trust and held down the numbers.

A cheerleader for personal responsibility, San Franciscos Department of Public Health suggests you remain covid ready, while providing some testing and vaccination programs. The Department seems to be busy running a PR campaign to cover up the mess at Laguna Honda.

A recent study shows the efficacy of Evushield during the initial omicron surge, while the Paxlovid rebound effect is only an introduction to the drugs mysteries. Another tool, the pulse oximeter, doesnt work well for people of color, with predictable consequences.

There are now 200 symptoms associated with long covid even though we still know next to nothing about it.

The Vaccine continues to work in protecting against severe illness. There is some evidence that Fully vaccinated individuals had a shorter duration of viable viral shedding and a lower rate of secondary transmission than partially vaccinated or unvaccinated individuals.

Although the second booster (4th shot) provides little or no benefit, more evidence suggests repeated vaccination does not exhaust the immune response by T cells.

Scroll down for todays covid numbers.

Over the past week, hospitalizations rose another 12 percent (representing 11 new patients). On May 31, DPH reports there were 100 covid hospitalizations,or about11.4 covid hospitalizations per 100,000 residents (based on an 874,000 population). Though still low, ICU patients rose into double figures during the week. The California Department of Public Health currently reports 96 covid patients in SF hospitals with 11 patients in ICU.

The latest report from the federal Department of Health and Human Services shows Zuckerberg San Francisco General Hospital with 14 covid patients and 8 ICU beds available, while across the Mission, CPMC had 12 covid patients and 4 ICU beds available. Of 98 reported covid patients in the City,29 were at either SFGH or UCSF, with at least 72 ICU beds available among reporting hospitals (which does not include the Veterans Administration or Laguna Honda). The California DPH currently reports 110 ICU beds available in San Francisco.

Between March 28 and May 27, DPH recorded 992 new infections among Mission residents (an increase of 13 percent from last week) or 191 new infections per 10,000 residents. During that period, Mission Bay had the highest rate at 331 new infections per 10,000 residents. Of 38 neighborhoods, 18 had rates above 200 per 10,000 residents, with 12 in the east and southeast sectors of the City. Treasure Island continued with the lowest rate and Lakeshore, the only neighborhood in the City with less than 50 percent of its population vaccinated, continued to have the second lowest rate.

DPH reports on May 24, the 7-day average of daily new infections recorded in the City rose to 481 or approximately 55 new infections per 100,000 residents (based on an 874,000 population), representing a 1.3 percent rise from last week. According to DPH, the 7-day average infection rate among vaccinated residents was 52.2 per 100,000 fully vaccinated residents and 108.1 per 100,000 unvaccinated residents. It is unclear whether fully vaccinated means 2, 3 or 4 doses. According to the New York Times the 7-day average number on May 24 was 569. The latest report from the Times says the 7-day average on May 31 was 519, a 3 percent rise over the past two weeks. State wastewater monitoring at the Citys Southeast sewer shed shows virus prevalence declining for a few days before flattening out at a relatively high level.

As of May 27, Asians have had 3,698 new recorded infections or 30.4 percent of the months cases so far; White 3,052 infections or 25.1 percent; Latinxs 1,444 infections or 11.9 percent; Blacks 434 infections or 3.6 percent; Multi-racials 91 infections or .7 percent; Pacific Islanders 74 infections or .6 percent; and Native Americans have had 23 recorded infections in May or .3 percent of the May totals so far.

The 7-day rolling Citywide average positivity rate dropped about .8 percent during the past week, while average daily testing rose 3 percent. Between March 28 and May 27, DPH reports an 8.1 percent positivity rate in the Mission. During that time, Portola had the highest postivity rate at 10.5 percent and Noe Valley had the lowest rate at 6.4 percent.

Vaccination rates in SF show virtually no change from last week with the number of residents who have received at least one dose rising .064 percent and the number of residents receiving a booster rising .6 percent.

For information on where to get vaccinated in and around the Mission, visit ourVaccination Page.

Four new covid-related deaths, including 3 more in May, have been reported, bringing the total since the beginning of the year to 186. DPH wont say how many were vaccinated. Nor does it provide information on the race/ethnicity or socio-economic status of those who have recently died. According to DPH COVID-19 deaths are suspected to be associated with COVID-19. This means COVID-19 is listed as a cause of death or significant condition on the death certificate. Using a phrase like suspected to be associated with indicates the difficulty in determining a covid death. The fog gets denser as DPH reports, incredibly as it has for months, only 21 of the deaths are known to have had no underlying conditions, or comorbidities. DPH only supplies cumulative figures on deaths.

The lack of reliable infection number data makes R Number estimates very uncertain. Covid R Estimation on May 24 estimated the San Francisco R Number had dropped below 1 to .94 while its estimate for the California R Number on May 30 dropped to .99. The ensemble, as of May 29, lowered its estimate of the San Francisco R Number to .91 and lowered its California R Number to .94. Note: Two models show SF under 1, with one recording a preposterous .19.

As of May 27, DPH has recorded 26 new infections in nursing homes (skilled nursing facilities) and 2 new deaths so far this month. In Single Room Occupancy hotels (SROs), DPH has recorded 181 infections and 0 new deaths so far in May.

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Covid-19 Tracker: On another plateau - Mission Local

Laborers and service industry workers with lower levels of education were about five times more likely to die from COVID-19 than people in higher socioeconomic positions, according to a study co-authored by a University of South Florida professor.

Researchers analyzed nearly 70,000 COVID deaths in 2020 for adults ages 25 to 64 and also looked at whether individuals had any college education and what job sectors they worked in.

The team found 68% of COVID-19 deaths among working age adults during the first year of the pandemic were people in low socioeconomic positions with jobs in labor, retail and the service industry.

These jobs typically required on-site attendance and prolonged close contact with others.

Jason Salemi, an epidemiologist with USFs College of Public Health, is calling for improvements to workplace safety in those industries. Too often, he says, employers and safety officials focus on personal protective equipment like masks to curb infections. That is important, but Salemi argues a lot more needs to be done to protect frontline workers who have a higher chance of being exposed to the coronavirus.

We need to think about ventilation and filtration of the air for those who work in public indoor settings, he suggested, adding, Stressing the importance of testing and not coming into work sick, maybe offering paid sick leave if they [staff] do test positive.

The study was published in the International Journal of Environmental Research and Public Health. It found white women made up the largest population group considered high SEP, or socioeconomic position, which involved having at least a bachelors degree. More than half of Hispanic men analyzed in the data were in a low SEP. According to the study, the mortality rate of low SEP Hispanic men is 27 times higher than high SEP white women.

Salemi said he hopes the study raises awareness that getting back to normal does not mean the same thing for everyone. Workers in high-risk industries continue to face threats as coronavirus cases surge now.

And even if they don't get hospitalized, if they get sick, they might have to go home, they might not be able to make money during that time, he said. So just recognize that the simple steps we're able to take to bring down community transmission does an exceptional job at protecting these individuals.

Salemi authored the study with a team of researchers from the COVKID Project, which monitors data about the pandemics affect on children and teens. In this case, he said, they were studying the toll the virus has taken on the parents and grandparents of many young people.

The team plans to look at 2021 and 2022 data in the future to see how the availability of COVID-19 vaccines affects disparities in mortality.

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A USF study shows retail and service workers have higher COVID-19 death rates - WUSF News

COVID-19 isnt vanishing and probably will require yearly shots like the flu, according to U.S. officials who must decide whether to launch another booster campaign this fall and if a variant-specific booster shot would be an upgrade on existing vaccines.

Unlike vaccines that stave off illness for many years, the protection offered by the first generation of COVID-19 vaccines wanes within several months.

We did not know a year or two ago when vaccines were first available as to what their durability would be in the face of new variants. We now understand that resilience of vaccination is not what wed like it to be. Its not a tetanus vaccine that lasts 10 years, said Cameron Wolfe, an associate professor of medicine at Duke University.

U.S. regulators authorized a second booster shot for people 50 and older earlier this year. Drugmakers and White House officials have signaled that a wider campaign will likely unfold before the winter, when the virus tends to proliferate.

It could become an annual tradition.

Were going to be dealing with this virus on a chronic basis, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told PIX11 over Memorial Day weekend. Depending upon what this virus does, there is certainly a reasonably good chance that we will have the same sort of situation that we have with influenza, where every year you have to re-boost people to keep that protection up.

One of the main challenges will be getting people to take the shots. About two-thirds of the U.S. population is fully vaccinated against COVID-19 but less than a third of the population has received an initial booster.

Also, scientists who advise the Food and Drug Administration will almost certainly demand data that shows giving booster shots to the young and healthy is necessary before endorsing another campaign.

White House COVID coordinator Ashish K. Jha said he wont put his thumb on the scale when it comes to boosters for people younger than 50.

I really do leave that up to FDA to decide, he said Thursday.

Another challenge will be making enough shots while keeping up with the ever-mutating virus. Tailoring the best COVID-19 vaccine is like trying to catch a moving train, with new spinoffs of the highly contagious omicron variation seeming to blanket the nation each month.

Like the influenza vaccine, it will be close to what is circulating but not exactly up to date, William Schaffner, an infectious diseases specialist at Vanderbilt University, said of a reformulated vaccine.

FDA officials will discuss this month whether a variant-specific shot is needed and, if so, how it will attack the dominant omicron strains.

Pfizer and Moderna, the leading COVID-19 vaccine makers in the U.S., are testing bivalent shots that could target both omicron and the original form of the virus that causes the disease.

Drugmakers and regulators will try to get on the same page as the virus mutates from the BA.1 form of omicron to BA.2 and most recently BA.2.12.1, which accounts for 6 in 10 cases in America.

Scientists told The Washington Times the manufacturers will likely target the original form of omicron that appeared around the winter holiday period and hope that the vaccine offers better protection across its sub-lineages than those on offer now.

The vaccines that we developed against the original Wuhan and early variant strains and we will still use are still active against omicron, [but] they must just have lost some of their impact, Dr. Wolfe said. So an omicron-specific [vaccine], even if it doesnt precisely target BA version 2-point-1-point-whatever comes next gives you broad neutralizing activity thats generally better than what we had.

Stephane Bancel, the CEO of Moderna, has said the company will share trial data in the second quarter on a shot that combines its existing booster with an omicron-specific formulation. This version remains our lead candidate for the fall 2022 Northern Hemisphere booster, he said in April.

The companys primary focus has been on the bivalent booster approach to maintain high neutralizing antibody titers while improving breadth of immunity to variants, the company told The Washington Times this week.

Pfizer initiated omicron-specific trials in January.

Our team of experts is working tirelessly to understand how our COVID-19 vaccine may protect against these evolving variant strains and will continue to share results as we have them, the company said in a written statement.

Regulators will use drugmakers filings to guide their thinking on whether vaccines should be fine-tuned or if the current shots are sufficient for stiff-arming severe illness from the virus.

Looking further ahead, some researchers are hoping to land a pan-coronavirus vaccine after at least three pathogens in this family sparked waves of infection over the past two decades. Besides COVID-19, there was the original SARS outbreak in 2003 and Middle East Respiratory Syndrome (MERS) remains a concern.

The ideal vaccine would cover all coronaviruses, but thats a long way off, said Lawrence O. Gostin, a global health professor at Georgetown University. Companies are working on bivalent or multivalent vaccines. FDA will soon meet to decide the optimal vaccine composition for the fall. FDA will have to make a highly consequential decision. The stakes are very high.

For more information, visit The Washington Times COVID-19 resource page.

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COVID-19 boosters on track to join flu shot as annual fall tradition - Washington Times

A University of Queensland-led study has found millions of COVID-19 patients may have undiagnosed acute kidney injury (AKI).

AKI is a condition where the kidneys suddenly fail to filter waste from the blood, which can lead to serious illness or even death.

Existing data indicates approximately 20 per cent of patients admitted to hospital with COVID-19 develop AKI, rising to roughly 40 per cent for those in intensive care.

But UQ PhD candidate and kidney specialist Dr Marina Wainstein said the true numbers could be double those figures.

Doctors look at the amount of urine a patient passes and the level of a compound called creatinine in the blood, which rises when the kidneys aren't working well.

However, if that creatinine rise occurs before a patient presents to hospital, we can miss the AKI diagnosis and fail to manage the patient appropriately in those early, critical days of hospitalization."

Dr Marina Wainstein, UQ PhD candidate and kidney specialist

Dr Wainstein said when researchers also measured the fall in creatinine levels, which often follows the initial rise, the rate of AKI diagnosis in COVID-19 patients doubled.

"That was a pretty shocking finding," she said.

Dr Wainstein said 'missing' AKI in COVID-19 patients is dangerous.

"Even though the AKI is already starting to improve in hospital, our research shows that these patients have worse in-hospital outcomes and are more likely to die compared to patients with no AKI," she said.

Dr Wainstein said treatment for AKI can be as simple as checking a patient's hydration level and stopping medications that can be toxic to the kidneys.

Study supervisor Dr Sally Shrapnel, from UQ's School of Mathematics and Physics, said collecting and analysing data for the project during the pandemic proved challenging.

"Typically data scientists work with complete, well curated registry data, but in this project it was collected by hospital staff working under extremely onerous conditions in a variety of different resource settings," she said.

"Curating and cleaning the data turned out to be a significant part of the project."

Dr Shrapnel said the researchers were able to include data from resource-poor countries, where community-acquired AKI is also more common.

"These people have limited access to healthcare and are more likely to present late in the disease process."

Dr Shrapnel said a more comprehensive definition of AKI one which can detect cases that develop in the community - needs to be implemented as soon as possible.

"Now we have the data showing a large gap in AKI diagnosis exists, it's time to test this definition in a clinical trial so we can identify all AKI patients early and hopefully prevent these awful outcomes."

Source:

Journal reference:

Wainstein, M., et al. (2022) Use of an extended KDIGO definition to diagnose acute kidney injury in patients with COVID-19: A multinational study using the ISARICWHO clinical characterisation protocol. PLOS Medicine. doi.org/10.1371/journal.pmed.1003969.

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Millions of COVID-19 patients may have undiagnosed acute kidney injury, finds study - News-Medical.Net

Recent COVID-19 research has focused on how the disease impacts a persons likelihood to develop other conditions, such as Parkinsons disease, heart disease, and diabetes.

Now researchers from the University of Milan, Italy have found a link between thyroid dysfunction and COVID-19. And one year after infection, scientists found people with moderate-to-severe COVID-19 still had evidence of thyroid dysfunction.

The study was recently presented at the 24th European Congress of Endocrinology in Milan, Italy.

The thyroid is a gland located on the front of the neck. It produces specific hormones that help regulate a variety of body functions, including metabolism, body temperature, heart rate, and digestion.

Thyroid dysfunction occurs when something affects the thyroid, causing it to decrease or increase hormone production. There are four main types of thyroid disease:

Thyroid dysfunction diagnosis occurs through a combination of a physical exam, blood test, and imaging by a thyroid scan or ultrasound. Treatment varies depending on the type of thyroid disease a person has and can include medications, beta-blockers, radioactive iodine, and surgery.

According to the studys lead author Dr. Ilaria Muller, assistant professor in endocrinology, Department of Clinical Sciences and Community Health at the University of Milan, Italy, the purpose of the study was twofold.

One was to prove COVID-19 affected thyroid function and triggered inflammation of the thyroid, causing thyroiditis.

Dr. Muller explained COVID-19 modifies thyroid function on a variety of different levels, including, non-thyroidal illness syndrome a complex combination of adaptive and maladaptive mechanisms inducing transient alterations of thyroid function tests in severely ill people cytokine storm, alterations of the hypothalamus-pituitary-thyroid axis, and by triggering an inflammation of the thyroid gland thyroiditis.

The researchers second goal was to correlate thyroid function with several parameters of COVID-19 disease severity. We finally wanted to monitor the evolution of the thyroid dysfunction over time, up to one year after the SARS-CoV-2 infection, to verify the presence or absence of long-term consequences on the thyroid function, she told MNT.

Dr. Muller and her team studied 100 patients admitted to the hospital for severe COVID-19. Upon analysis of their thyroid stimulating hormone (TSH) and other indicators, they found a frequent occurrence of thyroiditis in the patient population. However, the patients thyroids returned to normal levels shortly after recovery from COVID-19.

The researchers then examined the same patients 12 months later. They found regions of thyroiditis remained visible via thyroid ultrasound in half of the patient population.

Additionally, the scientists found four out of six patients had decreased uptake during thyroid of radiotracers such as technetium or iodine during thyroid scans. The decreased uptake is a hallmark of thyroiditis.

Based on her teams findings, Muller believed it would be useful for healthcare professionals to measure thyroid function in severe COVID-19 patients. This is because the serum concentrations of thyroid hormones TSH and free triiodothyronine (FT3) are prognostic indicators of thyroid disease severity.

Furthermore, this would allow (them) to diagnose the possible presence of thyrotoxicosis excess of thyroid hormones due to atypical thyroiditis, an additional risk factor for a poor outcome in patients already debilitated by severe COVD-19 disease, she explained.

Overall, Dr. Muller said the effects of SARS-CoV-2 infection and COVID-19 disease on thyroid function seem mild and transient.

Even if the areas of thyroiditis within the thyroid gland persist for months after the infection, the thyroid function is promptly restored and no apparent increase of thyroid autoimmunity has been observed. Thus long-term consequences on the thyroid function are unlikely.

Dr. Muller

Dr. Antonio C. Bianco, professor of medicine at the University of Chicago, was also pleased to see that in most cases the function of the thyroid gland returned to normal after 12 months and that residual functional abnormalities were only present in a small number of people.

However, he told MNT that he did not expect to see ultrasonographic signs of thyroiditis in half of the individuals affected. This suggests that the COVID-19-associated thyroiditis was severe in this population, he added.

When asked how this research may impact the treatment of COVID-19 patients with thyroid issues in the future, Bianco said it warrants enhanced follow-up of these patients. I would not be surprised if they were more likely to develop primary hypothyroidism after 5 or 10 years, he added.

Additionally, Bianco noted for the next steps in this research he would like to see a larger follow-up. Right now it seems that their thyroid function tests are normal and the ultrasonographic findings were the only abnormalities, he explained.

A longer follow-up, e.g. five or 10 years, would indicate if these residual ultrasonographic findings will be resolved and everything returned to normal or that some of these patients evolved to become hypothyroid.

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COVID-19 and thyroid dysfunction: Study finds link - Medical News Today

Patients being treated for acute myeloid leukemia (AML) who are diagnosed with COVID-19 may be best served by chemotherapy delay until after COVID-19 has run its course.

Patients undergoing treatment for acute myeloid leukemia (AML) are severely immunocompromised due to both their disease and the intensive chemotherapy regimens typically used to treat AML. This puts them at increased risk of infection, including during seasonal epidemics and throughout the COVID-19 pandemic.

A study published in Haematologica used data from the European Hematology Association (EHA) EPICOVIDEHA survey to characterize the clinical features of COVID-19 in patients with AML and long-term outcomes.

COVID-19 is already known to present severely in AML patients, with estimated mortality higher than 40% in this population before vaccines were available. However, there has been a lack of studies on large cohorts with long-term follow-ups, and there are no clinical guidelines for optimal management of COVID-19 and AML concurrently.

A total of 388 AML patients with a concurrent COVID-19 diagnosis were identified in the registry and included in the study. Of those patients, 196 patients (50.5%) had controlled AML, while 192 (49.5 %) had active AML. The majority of patients (64.6%) were either currently on intensive treatment or had received intensive chemotherapy or transplantation in the 3 months before COVID-19 diagnosis.

As far as treatment management, 174 patients had their chemotherapeutic schedules modified due to COVID-19 diagnosis, 106 patients permanently discontinued treatment, and 68 patients had delayed treatment due to COVID-19 that was resumed after a median of 1 month post-COVID-19 diagnosis.

A total of 82 patients (21.1%) had critical COVID-19, 160 (41.2%) were classified as severe, 69 (17.9%) had mild COVID-19, and the remaining 19.8% were asymptomatic. Overall, 293 patients (75.5%) were hospitalized and 82 (21.1%) were admitted to an intensive care unit. At a median 325-day follow-up, 180 patients (46.4%) had died, with 78 deaths (43.3%) attributed primarily to COVID-19. Forty-seven deaths (26.1%) were attributed to AML, and 48 deaths (26.7%) were attributed to a combination of COVID-19 and AML.

Patients whose chemotherapy was delayed had a lower overall mortality rate than patients whose chemotherapy was not delayed (18.4% and 37.5%, respectively). Treatment discontinuation was also associated with higher mortality rates, as was age and having active AML.

The data presented in our manuscript confirm that AML patients frequently have a severe clinical presentation of COVID-19, mainly with respiratory symptoms, and a high rate of ICU admission, even in patients with low-risk AML, study authors wrote.

Of the treatment approached for concurrent AML and COVID-19, delaying treatment was associated with the lowest mortality rate when compared with therapy discontinuation or no delay of AML treatment. This is in line with findings from a univariable analysis within another study.

Despite study limitations, including a lack of information on COVID-19 vaccinated patients and patient selection bias, considering patients with the ability to delay treatment may have less severe AML.

Our study shows that COVID-19 in AML patients poses a serious challenge, as it adds a layer of complication which can lead to modified therapeutic algorithms, the authors concluded. The mortality rate in this patient group was very high, even when the significant reduction over the pandemic course was considered. According to our results, the best approach to improve the survival of AML patients with COVID-19 seems to delay AML treatment, whenever possible.

Reference

Marchesi F, Salmanton-Garca J, Emarah Z, et al. COVID-19 in adult acute myeloid leukemia patients: a long-term follow-up study from the European Hematology Association survey (EPICOVIDEHA).Haematologica. Published online May 12, 2022. doi:10.3324/haematol.2022.280847

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AML and COVID-19: Chemotherapy Delay May Be the Best Approach - AJMC.com Managed Markets Network