Covid-19 Research 07.12.20

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Although COVID-19 is most well known for causing substantial respiratory pathology, it can also result in several extrapulmonary manifestations. These conditions include thrombotic complications, myocardial dysfunction and arrhythmia, acute coronary syndromes, acute kidney injury, gastrointestinal symptoms, hepatocellular injury, hyperglycemia and ketosis, neurologic illnesses, ocular symptoms, and dermatologic complications.

Gupta, A., Madhavan, M.V., Sehgal, K. et al. Extrapulmonary manifestations of COVID-19. Nat Med (2020). https://doi.org/10.1038/s41591-020-0968-3

Extrapulmonary manifestations of COVID-19

I do a fair amount of reading and research on this virus.  This review article is highly scientific and clinical.  If you choose to read this article I am not to blame if you never leave your house again for the next few years.

 

Saturday 07.11.20 – Covid-19 Research Project

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Black individuals at higher risk for contracting COVID-19

“Association of Black Race with Outcomes in COVID-19 Disease: A Retrospective Cohort Study” is not the first to examine race. However, it provides further evidence that, while anyone can get COVID-19, race is indeed a factor in the extent to which some populations are affected. Of the 4413 individuals tested, 17.8 percent tested positive. Of those who tested positive, 78.9 percent were Black while 9.6 percent were White.

The original study article is open access and can be downloaded here.

It’s kind of geeky but I downloaded and read the study.  And I uncovered the following problems with this study:

Our study was limited by unavailable datapoints such as socioeconomic status, health insurance, comorbidities, and medication history, which could have enabled us to test the independent association of these outcomes with Black race, and fully assess potential confounders.

These issues are significant limitations.

Also, while most subjects in our cohort were from the greater Chicago area, the proportion of Blacks in our cohort (57.6%) substantially exceeds that of Chicago (30.1%) and the US (13.4%)

Race-wise not exactly a representative study cohort of the general population.

as access to care is generally lower for Blacks, these subjects are likely to be sicker and undergo testing at a higher threshold than Whites.

You should expect a higher percentage of Blacks testing positive if you’re testing more Blacks.

So while there may be an association of Black race with higher rates of Covid-19 infection I am unable to infer from this study that an actual higher risk exists.

Take Home Message for Life Underwriters:

These data suggest that Blacks are more likely to test positive and be hospitalized with SARS-CoV-2; however, we found no difference in mortality for Blacks vs non-Blacks.

No difference in mortality for Blacks vs non-Blacks.

Covid-19 is an equal opportunity killer.

Wear a mask.  Avoid the C’s.  Wash your hands often.

Florida Cx3

Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018

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What is already known about this topic?

Falls are the leading cause of injury among adults aged ≥65 years, who in 2014 experienced an estimated 29 million falls, resulting in 7 million fall-related injuries.

What is added by this report?

In 2018, 27.5% of adults aged ≥65 years reported at least one fall in the past year (35.6 million falls) and 10.2% reported a fall-related injury (8.4 million fall-related injuries). From 2012 to 2016, the percentages of these adults reporting a fall increased, and from 2016 to 2018, the percentages decreased.

Citation for this article: Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018. MMWR Morb Mortal Wkly Rep 2020;69:875–881. DOI: http://dx.doi.org/10.15585/mmwr.mm6927a5external icon.

Trouble in Arizona

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There is no country in the world where confirmed coronavirus cases are growing as rapidly as they are in Arizona, Florida or South Carolina. The Sun Belt has become the global virus capital.

This chart ranks the countries with the most confirmed new cases over the past week, adjusted for population size, and treats each U.S. state as if it were a country. (Many states are larger in both landmass and population than some countries.)

The only countries with outbreaks as severe as those across the Sunbelt are Bahrain, Oman and Qatar — three Middle Eastern countries with large numbers of low-wage migrant workers who are not citizens. These workers often live in cramped quarters, with subpar social services, and many have contracted the virus.

Source: NYT Morning daily email briefing

 

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Remember to avoid the 3 C’s.  And wear a mask.

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The Bloody Mask — RadaJonesMD

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My honeymoon with Thailand ended yesterday. We live in a condo in Chiang Mai, Thailand. Signs on every door warn: No Mask, No Entry. Most people comply. Some don’t. I ignore them unless they try to join me in the elevator. If they do, I wave them away. “Not without a mask, please.” …

Unlike many adopters of national mask policies, who value discipline and conformity, Americans hate being told what to do and feel the mask is an assault on their freedom. Unfortunately, that contributed to our high COVID numbers. Thailand – who had the first COVID case outside China –  had a total of 3185 cases, 58 deaths, and no community transmission in weeks. Compare that to the US numbers.  2.9 mil cases, 130K deaths and 58K new cases on July 3rd. Yes, Thailand has 70Mil people, while USA has 328 mil. Still.

via The bloody mask — RadaJonesMD

This article by Dr. Jones is worth reading in its entirety.

Mask up people!

Know Your Risk – the Three C’s

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Know Your Risk – Texas Medical Association was a post that generated a lot of interest.  So today I’ve decided to stay on topic and add to this series to continue offering my insights as a mortality risk assessment professional.  I’ll share both personal strategies and other professional opinions for dealing with Covid-19. I’ve had a long career of researching, learning and understanding what kills people.  Maladaptive and malfunctional behaviors do an incredible amount of damage. A lot of people kill themselves doing stupid things.  Unfortunately with Covid-19 a lot of people might kill others doing stupid things.

We all must adapt different behaviors to deal with a highly infectious disease.  Estimates range between 40 and 45% of Covid-19 infected individuals may be asymptomatic spreaders.  Thus the combination of maladaptive and malfunctional behaviors by others is a huge problem. None of us can control nor influence the behaviors of everyone we come in contact with. We can only control and modify our own personal behaviors to minimize the risk of infection. Risk identification is the first step.

Stay safe.  Wear a mask.

COVID-19 is primarily a respiratory pathogen that spreads through droplets from infected people who talk, shout or sing. Closed spaces make it more likely you could inhale these droplets because the droplets are not diluted.

Mary-Claire Roghmann, MD, MS, is a Professor of Epidemiology and Public Health and Medicine and Associate Dean for Physician Scientist Training at the University of Maryland School of Medicine. She is also a Staff Physician and Epidemiologist for the VA Maryland Health Care System.

I tell family and friends that, as a general rule of thumb, they should avoid the three C’s: crowds, closed spaces with poor ventilation and close contact with anyone outside their household. Crowds bring you into contact with many people who could have COVID-19 even if they’re asymptomatic. The more people around you, the greater your chance of getting infected, particularly if you’re in a hot spot area with a rising number of cases.

Close contact through a hug or close conversation, for example, also enhances this risk. The risk of COVID-19 spread is greatest when the three C’s converge: chatting with a group in a crowded indoor bar is one of the highest risk activities.

Follow the Three C’s to Reduce COVID-19 Risk

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I’m on the right.  The other guy is my barber.

Everything is Bigger in Texas

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Today’s post is not intended to offend anyone or to plainly demonstrate how dumb some Texans are.  I married a Texan.  My two most successful projects are Texans.  I lived for over 20 years in Texas.  But you can’t make this stuff up:

As public health experts warn that ICUs in the city might soon be overwhelmed with coronavirus patients, shops and restaurants remain packed.

  What Pandemic? Houstonians Party, Shop, and Ice-skate as COVID-19 Surges.

Nearly 22 new cases per 100k people (7 day moving average) as of 07.02.20

In Galveston county less than an hour away by car:

54 new cases per 100k people (7 day moving average) as of 07.02.20

While down at the border:

EMERGENCY ALERT:  STARR COUNTY RESIDENTS:  Today it is with a heavy heart that we announce that we have had 18 deaths in Starr County due to COVID-19, and we had two (2) severely ill patients flown out of the valley for medical assistance, one was flown to San Antonio and one to Dallas. The local and valley hospitals are at full capacity and have no more beds available.

I urge all of our residents to please shelter-in-place, wear face coverings, practice social distancing and AVOID GATHERINGS.
– Your Judge Eloy Vera

Nearly 66 new cases per 100k people (7 day moving average) as of 07.02.20

Meanwhile in Oklahoma County:

No fireworks today.  We’ll have a quiet July 4th, burgers on the grill, potatoes, slaw and some beer.

13 new cases per 100k people (7 day moving average) as of 07.02.20

All statistics are from the Harvard Global Health Institute.  See my previous post Do You Live in a Covid-19 Hotspot?

And if you are offended by my comments on your intelligence I don’t care.