Readmission and death after initial hospital discharge among patients with Covid-19 in a large multi-hospital system

‘Although more patients are surviving severe coronavirus disease 2019 (COVID-19), there are limited data on outcomes after initial hospitalization. We therefore measured the rate of readmission, reasons for readmission, and rate of death after hospital discharge among patients with COVID-19 in the nationwide Veterans Affairs (VA) health care system...

‘In this national cohort of VA patients, 27% of survivors of COVID-19 hospitalization were readmitted or died by 60 days after discharge, and this rate was lower than matched survivors of pneumonia or heart failure. However, rates of readmission or death were higher than pneumonia or heart failure during the first 10 days after discharge following COVID-19 hospitalization, suggesting a period of heightened risk of clinical deterioration. Study limitations include the inability to measure readmissions to non-VA hospitals and an older, male-predominant study population, who may be at higher risk of severe manifestations of COVID-19. Public health surveillance or clinical trials focused exclusively on inpatient mortality may substantially underestimate burdens of COVID-19.’

Read here (JAMA Network, Dec 14, 2020)

Coronavirus: How can we imagine the scale of Covid's death toll?

‘The suffering from the coronavirus pandemic has come to define 2020. But how do you grasp the immense scale of loss? Flowers - symbols of grief, peace, and love - serve as a tribute to those who have died.

‘Imagine the pandemic as a  flower. In the animation below, the stem grows as Covid-19 cases increase over time and the petals unfurl as more people die with the disease.’

View here (BBC, Dec 7, 2020)

Five things you need to know about living with a disability during Covid-19

1. Risk of contracting COVID-19 is higher for persons with disabilities
2. Risk of severe symptoms and death is higher
3. Living in institutions increases the risk of contracting and dying from COVID-19
4. Discrimination in accessibility of healthcare and life-saving procedures
5. The broader COVID-19 crisis affects persons with disabilities more

Read here (UN DESA Voice, December 2020)

NEJM paper on Iceland throws into question Imperial College team results: Antibodies stable after 4 months. Also death rate 0.3%, 44% not diagnosed

‘Our results indicate that antiviral antibodies against SARS-CoV-2 did not decline within 4 months after diagnosis. We estimate that the risk of death from infection was 0.3% and that 44% of persons infected with SARS-CoV-2 in Iceland were not diagnosed by qPCR.‘

Read here (NEJM, Oct 29, 2020)

Read here the BBC story on Imperial College study that says antibodies drop rapidly  

US Covid-19 cases are skyrocketing, but deaths are flat—so far. These 5 charts explain why

 ‘In just the last two weeks, the global daily tally for new COVID-19 cases has jumped more than 30%, according to TIME’s coronavirus tracker, which compiles data from Johns Hopkins University. The steep upward trend is driven by viral waves in Europe and the United States that started in August and mid-September, respectively. On Oct. 23, the daily case count in the U.S. reached a new record high, suggesting that this wave will be worse than the one that swept the country over the summer.

‘But despite this rapid uptick in cases, the daily death count in the U.S. is not yet rising at the same rate, and remains at lower levels than in April. At face value, a lower case-to-fatality rate suggests that fewer people who test positive for the virus are dying from it. But the virus hasn’t necessarily become less lethal; it isn’t mutating quickly enough for that to be the case.

‘What’s happening now is not a result of how the virus treats humans, but rather how humans are treating the virus—that is, how we test for it, how we avoid it and how we combat it. The following five charts explain how human-driven factors are, at least for the moment, keeping deaths from spiking as high as they did early in the pandemic, even as cases rise dramatically...’

Read here (Time, Oct 26, 2020)

What fans of ‘herd immunity’ don’t tell you

‘First, it makes no mention of harm to infected people in low-risk groups, yet many people recover very slowly. More serious, a significant number, including those with no symptoms, suffer damage to their heart and lungs. One recent study of 100 recovered adults found that 78 of them showed signs of heart damage. We have no idea whether this damage will cut years from their lives or affect their quality of life...

‘Second, it says little about how to protect the vulnerable. One can keep a child from visiting a grandparent in another city easily enough, but what happens when the child and grandparent live in the same household? And how do you protect a 25-year-old diabetic, or cancer survivor, or obese person, or anyone else with a comorbidity who needs to go to work every day?...

‘Third, the declaration omits mention of how many people the policy would kill. It’s a lot...If these restrictions are simply eased — as opposed to eliminating them entirely, which would occur if herd immunity were pursued — deaths could rise to as many as 571,527. That’s just by Feb. 1. The model predicts daily deaths will still be increasing then.

‘Will we have achieved herd immunity then? No.’

Read here (New York Times, Oct 19, 2020)

‘No longer groping in the dark’: NCID doctors share how Covid-19 is being treated in Singapore

‘So far, 28 people have died of COVID-19 in Singapore - one of the lowest mortality rates in the world. In the US, where there have been about 8 million cases, more than 200,000 people have died. As of Saturday (Oct 17), 37 COVID-19 patients remain hospitalised in Singapore, with none in intensive care. More than 99 per cent of those infected have been discharged, while there are 41 in community care facilities.

‘But it wasn't always like this. Three National Centre for Infectious Diseases (NCID) consultants told CNA how treatment of the novel coronavirus has evolved here and how NCID has kept the number of critical cases low.’

Read here (Channel News Asia, Oct 18, 2020)

WHO study says remdesivir did not cut hospital stay or mortality in Covid-19 patients. Same with hydroxychloroquine, anti-HIV drug combination lopinavir/ritonavir and interferon

‘Gilead Sciences Inc's GILD.O remdesivir had little or no effect on COVID-19 patients' length of hospital stay or chances of survival, a clinical trial by the World Health Organization (WHO) has found. The antiviral medication, among the first to be used as a treatment for COVID-19, was one of the drugs recently used to treat U.S. President Donald Trump’s coronavirus infection.

‘The results are from WHO’s “Solidarity” trial, which evaluated the effects of four potential drug regimens, including remdesivir, hydroxychloroquine, anti-HIV drug combination lopinavir/ritonavir and interferon, in 11,266 adult patients across more than 30 countries. The study found the regimens appeared to have little or no effect on 28-day mortality or the length of the in-hospital course among patients hospitalized with COVID-19, the WHO said on Thursday.’

Read here (Reuters, Oct 16, 2020)

NIH: 80% of Malaysia’s 157 coronavirus fatalities had at least one underlying medical condition; 72 per cent male; those aged 60-69 the largest group at 30.6 per cent

NIH: 80% of Malaysia’s 157 coronavirus fatalities had at least one underlying medical condition; 72 per cent male; those aged 60-69 the largest group at 30.6 per cent

‘More than 80 per cent of Covid-19 deaths in Malaysia reportedly had at least one underlying medical condition, said ICR. ICR also found that significantly more men in Malaysia succumbed to Covid-19 at 72 per cent, compared to women at 28 per cent.

‘More than 65 per cent of Malaysia’s coronavirus deaths were aged 60 years and above. Those aged 60 to 69 years formed the largest age group among Malaysia’s Covid-19 fatalities at 30.6 per cent, followed by people aged 70 to 79 years at 21 per cent, and those aged 50 to 59 years at 19.1 per cent. Adults aged 80 years and above comprised 14 per cent of coronavirus deaths in Malaysia.’

Read here (Code Blue, Oct 13, 2020)

Covid-19 death rates are lower worldwide, but no one is sure whether that’s a blip or a trend

‘The mortality rate of the coronavirus has been a moving target since the outbreak began. Early reports out of China put it as high as 7 percent. But that was based mostly on hospitalized patients, and by the time the wave hit the United States, epidemiologists believed it was closer to 2 to 3 percent. Now, factoring in asymptomatic infections, as well as mild cases that might not be part of official tallies, the Centers for Disease Control and Prevention puts the mortality rate at 0.65 percent.

‘Public health officials cite multiple reasons for the lower death rates: They note a shift in the demographics of who is being stricken with the virus, with younger people making up the bulk of new infections. More widespread testing is capturing a more diverse range of people and illness, and improved treatment strategies that include antivirals and steroids are saving more lives. But some researchers speculate there may be more to the story...’

This story is behind a paywall.

Read here (Washington Post, Oct 9, 2020)

Dying in a leadership vacuum: NEJM editorial

‘Covid-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy.

‘The magnitude of this failure is astonishing. According to the Johns Hopkins Center for Systems Science and Engineering,1 the United States leads the world in Covid-19 cases and in deaths due to the disease, far exceeding the numbers in much larger countries, such as China. The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000. Covid-19 is an overwhelming challenge, and many factors contribute to its severity. But the one we can control is how we behave. And in the United States we have consistently behaved poorly.’

Read here (New England Journal of Medicine, Oct 8, 2020)

What is the risk to Donald Trump's health?

‘Donald Trump has clear risk factors - including his age, weight and being male - that all raise the chances of a severe coronavirus infection. He is 74 and has a Body Mass Index (BMI) over 30, which is the clinical definition of obesity. So now he has tested positive for the virus, what does it mean?’

Read here (BBC, Oct 2, 2020)

The US excess mortality rate from COVID-19 is substantially worse than Europe’s

‘The US has 4% of the world’s population but 21% of the global COVID-19-attributed infections and deaths. This column shows that when comparing excess mortality rates, a more robust way of reporting on pandemic deaths, Europe’s cumulative excess mortality rate from March to July is 28% lower than the US rate, contradicting the Trump administration’s claim that Europe’s rate is 33% higher. The US Northeast – the region most comparable with individual European countries – has experienced substantially worse excess mortality than Europe’s worst-affected countries. Had the US kept its excess mortality rate down to the level in Europe, around 57,800 American lives would have been saved.’

Read here (Vox EU, Sept 29, 2020)

Coronavirus deaths pass one million worldwide

‘More than HIV. More than dysentery. More than malaria, influenza, cholera and measles — combined. In the 10 months since a mysterious pneumonia began striking residents of Wuhan, China, Covid-19 has killed more than one million people worldwide as of Monday — an agonizing toll compiled from official counts, yet one that far understates how many have really died. It may already have overtaken tuberculosis and hepatitis as the world’s deadliest infectious disease, and unlike all the other contenders, it is still growing fast.’

Read here (New York Times, Sept 28, 2020)

Covid-19: UK could face 50,000 cases a day by October without action - Vallance

‘The UK could see 50,000 new coronavirus cases a day by mid-October without further action, the government's chief scientific adviser has warned. Sir Patrick Vallance said that "would be expected to lead to about 200 deaths per day" a month after that. It comes as the PM prepares to chair a Cobra emergency committee meeting on Tuesday morning, then make a statement in the House of Commons.’

Read here (BBC, Sept 21, 2020)

Is herd immunity an option for India as it becomes second country after US to cross 5 million Covid-19 cases?

‘As coronavirus cases continue to spiral in India, only the second country after the US to cross the 5 million milestone, questions have been raised over whether herd immunity is an option for India now. Some epidemiologists believe it is already taking place in small areas where high infection levels have been followed by a weakening of the Covid-19 virus. Others believe that it is too soon to predict or holds little promise.

‘Dr Rajni Kant from the Indian Council of Medical Research: "Herd immunity right now is not a (government) strategy for coronavirus control. The current strategy is wearing a mask, following social distancing and good hygiene with regular washing of hands." Still, there are silver linings in India's Covid-19 fight. The country's mortality rate at 1.64 per cent is the lowest in the world and recovery is among the highest with a recovery rate of 78-79 per cent.’

Read here (Straits Times, Sept 17, 2020)

Demographic perspectives on the mortality of Covid-19 and other epidemics

‘With a hypothetical 1 million COVID-19 deaths [in the US], it is possible to portray the epidemic as unimaginably large—the biggest killer in American history—or small, reducing our remaining life [expectancy] by less than 1 part in 1,000. However, when the loss of life is put into comparative perspective, we see that the scale of an epidemic with 1 million deaths would be as large as that of the recent opioid and HIV crises but much smaller than that of the Spanish flu. The 1918 epidemic killed more people relative to population size, and it also caused a much greater loss of remaining life expectancy because those who died were so young.

‘As a society, we are and we should be making major and costly efforts to reduce mortality. The anticipated economic costs appear appropriate, or perhaps low, when compared to the statistical value of lives that may be saved.

‘The death toll of COVID-19 is a terrible thing, both for those who lose their lives and for their family, friends, colleagues, and all whom their lives touched. Those are real individuals, not the abstract statistics presented here. But the population perspective helps us to place this tragedy in a broader context. As we put our efforts into reducing the impact of the epidemic, it is important to know that we as a society have been through such mortality crises before.’

Read here (PNAS, Sept 8, 2020)

How many people has the coronavirus killed?

‘In times of upheaval — wars, natural disasters, outbreaks of disease — researchers need to tally deaths rapidly, and usually turn to a blunt but reliable metric: excess mortality. It’s a comparison of expected deaths with ones that actually happened, and, to many scientists, it’s the most robust way to gauge the impact of the pandemic. It can help epidemiologists to draw comparisons between countries, and, because it can be calculated quickly, it can identify COVID-19 hotspots that would otherwise have gone undetected. 

‘According to data from more than 30 countries for which estimates of excess deaths are available (see ‘Terrible toll’), there were nearly 600,000 more deaths than would normally be predicted in these nations for the period between the onset of the pandemic and the end of July (413,041 of those were officially attributed to COVID-19).’

Read here (Nature, Sept 1, 2020)

The coronavirus is most deadly if you are older and male — new data reveal the risks

‘For every 1,000 people infected with the coronavirus who are under the age of 50, almost none will die. For people in their fifties and early sixties, about five will die — more men than women. The risk then climbs steeply as the years accrue. For every 1,000 people in their mid-seventies or older who are infected, around 116 will die. These are the stark statistics obtained by some of the first detailed studies into the mortality risk for COVID-19.’

Read here (Nature, August 28, 2020)

Why do Covid fatalities remain low when infection numbers are rising?

‘Most statistics indicate that although cases of Covid-19 are rising in many parts of Europe and the United States, the number of deaths and cases of severe complications remain relatively low. For example, patients on ventilators have dropped from 3,000 at the epidemic’s peak in Britain to 70. At the same time, the number of cases in the UK have begun to rise in many areas.’

Questions: (1) What lies behind this trend? (2) Does that indicate that the worst may be over? (3) Is the Covid-19 virus becoming less deadly?

Read here (The Guardian, August 23, 2020)