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COVID-19 News Briefs

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COVID-19 reinfection increases risk of death and health problems
COVID-19 reinfection increases the risk of death and health problems, found a VA St. Louis study. Researchers used VA’s health care database to compare health outcomes of nearly 444,000 Veterans who had COVID-19 once, nearly 41,000 who had it two or more times, and over 5 million who never had it. They found that those who had multiple COVID-19 infections were at higher risk of death and hospitalization than those who only had COVID-19 once. They were also at higher risk for a variety of health problems, including lung and heart problems, diabetes, and mental health disorders. The risk was highest when people were first sick, but many still had elevated risk six months later. Risk of death and health problems increased with the number of infections. The results show that strategies are needed to prevent COVID-19 reinfection to protect against additional health risks, say the researchers. (Nature Medicine, Nov. 10, 2022)

Paxlovid lowers risk of Long COVID
The medication Paxlovid lowers the risk of Long COVID, according to a VA St. Louis study. The study included more than 56,000 Veterans with a positive COVID-19 test. Those given Paxlovid—an oral antiviral medication that has been shown to reduce the risk of severe COVID-19 and hospitalization—had a 25% decreased risk of developing 10 of 12 different Long COVID conditions studies. The decreased risk was found regardless of whether it was a participant’s first COVID-19 infection or a reinfection, and regardless of whether the participants were unvaccinated, vaccinated, or boosted. Paxlovid could be an important asset to address the serious issue of Long COVID, said the researchers. The study was released as a pre-print in the interest of public health. (medRxiv, Nov. 5, 2022)

COVID-19 increases risk of neurologic disorders
COVID-19 increases the risk of long-term neurologic disorders, according to a VA St. Louis study. Researchers compared data on over 150,000 VA patients who contracted COVID-19 with more than 11 million people who had not had COVID-19. A year after recovering, COVID-19 patients had higher risk of a wide array of neurologic conditions, including stroke, memory disorders, nervous system disorders, migraines and seizures, Guillain-Barré syndrome, and sensory disorders. COVID-19 patients had elevated risks and burdens even when they did not require hospitalization during their illness. The results highlight a need for health care system planning to address the potential long-term consequences of COVID-19, say the researchers. (Nature Medicine, Sept. 22, 2022)

New prediction model to estimate risk of COVID-19 death

VA researchers developed a new prediction model to estimate the probability of death from COVID-19. The mathematical model, called PDeathDx, uses diagnostic codes from medical records to survey all of a patients’ preexisting conditions to estimate the risk that COVID-19 poses. Starting with data from 1997, the researchers used diagnoses from the first time a patient sought care until 14 days before a positive COVID-19 test, then compared that to COVID outcomes for nearly 350,000 patients treated in VA. They found that the new model outperformed other conventional prediction models. The study also showed that certain underlying conditions—such as neurological diseases, dementia, and severe disability—are much more likely to result in severe COVID or death. The approach used here could be adapted to predict outcomes for other diseases and conditions, say the researchers. (Biological Methods & Protocols, Aug. 4, 2022)

COVID-19 boosters effective against Omicron and Delta variants
COVID-19 vaccine boosters were highly effective against recent virus variants, found a study by VA White River Junction researchers and colleagues. The study included data on more than 110,000 Veterans, mostly older and male, who had a COVID test between November 2021 and January 2022. Protection against both the Omicron and Delta COVID-19 variants was better in those who also had a booster dose of an mRNA vaccine, compared with those with only a two-dose vaccine. Boosters were 64% effective against Omicron infection, while initial vaccination was only 12% effective. For the Delta variant, booster vaccination was 90% effective, versus 54% for initial vaccination. Booster doses were 89% effective during the Omicron period and 94% effective during the Delta period at preventing hospitalization. Against hospitalization, two-dose vaccines were 63% effective against Omicron and 75% effective against Delta. With a booster dose, vaccines were 94% effective at preventing death during Omicron and 96% against Delta. The results show that vaccine boosters increase the effectiveness of COVID-19 vaccination against infection, hospitalization, and death, according to the researchers. (BMJ Open, Aug. 3, 2022)

Monoclonal antibody treatment could lower risk of death for hospitalized COVID-19 patient
A monoclonal antibody treatment improved survival in patients hospitalized with COVID-19, in an international clinical trial involving VA researchers. The study was part of ACTIV-3, a COVID-19 research program including many VA sites. Researchers randomly assigned more than 1,400 hospitalized patients to receive either the monoclonal antibody medication tixagevimab-cilgavimab (now called Evusheld) or placebo. Monoclonal antibodies are antibodies made in a laboratory. An infusion of the monoclonal antibodies resulted in 30% lower mortality, compared with standard care alone. The medication did not shorten recovery time. The drug was also shown to be safe, with the same percentage of adverse events occurring in both groups. The results suggest that this drug could be a useful treatment option for patients hospitalized with COVID-19, say the researchers. (Lancet Respiratory Medicine, July 8, 2022)

Sickle cell trait linked to increase risk of COVID-19 death
Sickle cell trait is linked to an increased risk of death from COVID-19, found a VA Million Veteran Program study. People with sickle cell trait have one sickle cell gene and one normal gene. Those with the trait usually do not have symptoms of sickle cell disease—a blood disorder primarily affecting people of African descent. Researchers studied MVP data of nearly 3,000 people with sickle cell trait, 13% of whom contracted COVID-19. They compared them to nearly 130,000 people without sickle cell trait, 10% of whom had COVID-19. Those with sickle cell trait had higher odds of death from COVID-19. The sickle cell group also had increased rates of acute kidney failure. About 21% of COVID-19 deaths were due to acute kidney failure for patients with sickle cell trait. The results strongly support including sickle cell trait as a risk factor for worse COVID-19 outcomes, say the researchers. (JAMA Internal Medicine, June 27, 2022)

Few differences in safety of Moderna, Pfizer COVID-19 vaccines
Both the Moderna and Pfizer COVID-19 vaccines have a low risk of adverse events, found a study by VA Boston researchers. The study looked at data on more than 400,000 Veterans who were vaccinated. Risks were low after 38 weeks for either vaccine. Veterans receiving the Moderna vaccine were slightly less likely to experience stroke, heart attack, blood clots, or kidney damage. However, the difference was less than two-tenths of one percent. The results show that either vaccine is safe and effective for individuals, say the researchers, but the differences may help inform future population-level vaccination efforts. (JAMA Internal Medicine, June 13, 2022)

Airborne virus linked to hospital COVID-19 spread
Hospital COVID-19 infection may result from airborne virus particles introduced by employees and patients in common hospital areas, according to a study by VA Boston researchers and colleagues. The researchers studied the genome sequence of viruses from infected nurses and patients during a hospital COVID-19 outbreak. They compared these to virus particles from air samples. They learned that viruses found in nurses and patients were genetically identical to virus particles in the air. The findings suggest that very small, aerosolized virus particles can lead to COVID-19 spread in hospitals, according to the researchers. Isolating infected health care providers and improving ventilation and masking could help decrease the spread, they say. (JAMA Network Open, June 8, 2022)

Vaccines only modestly reduce long COVID risk in breakthrough infection patients
Vaccines only modestly reduce the risk of long COVID in patients with breakthrough infection, according to a large study by VA St. Louis researchers. Long COVID refers to a wide range of ongoing health conditions that some people experience after recovering from COVID-19. Researchers studied data on nearly 34,000 people who had breakthrough COVID-19 infections after being vaccinated. They compared this group to more than 13 million controls. People with breakthrough infection had lower rates of death and long COVID symptoms six months after infection, compared to those who had never been vaccinated. However, breakthrough patients had a significantly higher risk of death and health problems compared to patients who never contracted COVID-19. These patients experienced many different symptoms, including cardiovascular, clotting, kidney, and mental health problems. The results show an urgent need to develop additional layers of protection beyond vaccines to protect against the long-term consequences of COVID-19, say the researchers. (Nature Medicine, May 25, 2022

Genetic links between severe COVID-19 and other diseases
A VA Million Veteran Program study identified genetic links between COVID-19 severity and certain serious medical conditions. Researchers analyzed genetic and health record data on more than 650,000 Veterans who volunteered for MVP. They compared gene variations previously found to be linked severe COVID-19 risk with gene variants connected to other conditions. The analysis showed that gene variants linked to severe COVID-19 are also linked to medical conditions known to be COVID-19 risk factors. The strongest links were found for venous embolism and thrombosis, as well as type 2 diabetes and ischemic heart disease. The study also showed genetic links between severe COVID-19 and neutropenia—low white blood cell count—in Veterans of African and Hispanic ancestry. This link was not seen in Veterans of European ancestry. Conversely, gene variants associated with severe COVID-19 were associated reduced risk of immune-related conditions such as lupus and rheumatoid arthritis. The findings shed light on genetic risk for COVID-19 and could lead to paths for new treatments, say the researchers. (PLOS Genetics, April 28, 2022)

Older and underweight Veterans at higher risk of death from COVID-19
Older and underweight Veterans had a higher risk of death from COVID-19, in a study by Salt Lake City VA researchers and colleagues. Researchers studied data on more than 400,000 Veterans who tested positive for COVID-19 in 2020 and 2021. Those 65 and older and those who were underweight were more likely to require mechanical ventilation and die in the hospital, compared with younger Veterans and those with normal weight. Veterans 85 and older had an almost five times greater rate of death. Asian and American Indian/Alaska Native Veterans also had higher risk of ventilation and death compared to white Veterans. Black Veterans had a 31% higher risk than white Veterans of hospitalization, but did not have a higher risk of death. Hospitalization, ventilation, and death rates decreased for all groups over time. The results show that age and weight are important variables to consider in COVID-19 risk, say the researchers. (Annals of Epidemiology, April 21, 2022)

Similar rates of moral injury in pandemic health care workers and combat Veterans
Potential for moral injury is as high for health care workers during the pandemic as it is for combat Veterans, according to a study by VA Durham researchers. Moral injury refers to feelings of guilt or shame when a person’s values or beliefs conflict with their actions or the way they see others acting. The researchers surveyed nearly 2,100 health care workers during the COVID-19 pandemic, along with more than 600 military Veterans who had deployed to combat zones. About 46% of Veterans and 51% of health care workers had potential moral injury related to the actions of others. Self-induced moral injury was seen in 24% of Veterans and 18% of health care workers. Moral injury was linked to higher depression symptoms and worse quality of life. Among health care workers, moral injury was tied to burnout. These feelings could stem from being unable to provide adequate care to dying patients and seeing others around them refuse to take steps to slow the spread of the virus, according to the researchers. Interventions related to moral injury in Veterans may be useful for health care workers in the aftermath of the COVID-19 pandemic, they say. (Journal of General Internal Medicine, April 5, 2022)

Video enabled tablets could decrease suicide in rural Veterans
Giving rural Veterans tablets for telehealth reduced suicidal behavior and increased mental health care use during the pandemic, found a VA Palo Alto study. Many fear that the COVID-19 pandemic has intensified suicide risk factors for people in rural areas. Researchers looked at mental health care use for more than 13,000 rural Veterans who were given video-enabled tablets. They compared this group to more than 458,000 Veterans who did not receive tablets. Those with tablets had an average increase of 1.8 in-person psychotherapy visits and 3.5 video visits per year. Tablets were linked to a 22% reduced likelihood of suicidal behavior. The tablet group had 20% lower odds an emergency department visit, and 36% lower odds of a suicide-related emergency room visit. The findings suggest that VA and other health systems should consider using tablets to increase access to mental health care via telehealth, say the researchers. (JAMA Network Open, April 1, 2022)

COVID-19 increases diabetes risk
COVID-19 increases the risk of developing diabetes, found a VA St. Louis study. Researchers studied data on more than 180,000 VA patients who had recovered from COVID-19. They compared these patients to over 4 million people who did not contract COVID-19 and over 4 million controls from before the pandemic. Those who had COVID-19 were at a 40% higher risk of being newly diagnosed with diabetes at least 30 days after infection, compared with controls. Odds of being prescribed medication for glycemic control were also increased. Diabetes risk was increased even in patients with mild COVID-19. More severe COVID-19 symptoms were linked to greater risk of developing diabetes. The results show that diabetes should be considered a facet of long COVID, and that strategies to address rising diabetes cases are needed, say the researcher. (Lancet Diabetes and Endocrinology, March 21, 2022)

COVID-19 increases mental health risks
COVID-19 increases the risk of multiple mental health conditions, according to a study by St. Louis VA researchers. The researchers examined data from more than 150,000 VA patients who had recovered from COVID-19. They compared the data to data on 5.8 million people who did not get COVID-19 during the pandemic era and 5.9 million controls from before the pandemic. Patients who contracted COVID-19 had a 60% higher risk of mental health disorders one year after recovering. This includes higher risk for anxiety, depression, stress disorders, opioid use, substance use disorders, and sleep conditions, as well as cognitive problems such as “brain fog.” Risk was increased ever in patients who had less severe COVID-19 and were not admitted to the hospital. But this risk was highest in patients with more severe COVID-19. The results show that tackling mental health disorders among COVID-19 survivors should be a priority, say the researchers. (BMJ, Feb. 16, 2022)

COVID-19 vaccines largely effective over long-term
COVID-19 vaccines are effective at preventing the disease long-term, according to a review by VA Iowa City researchers and colleagues. Most studies on vaccine effectiveness have looked at outcomes within three months after vaccination. The researchers conducted a literature search for studies of long-term vaccine efficacy. They found 16 studies including nearly 18 million patients who received either the Pfizer, Moderna, AstraZeneca, or Janssen vaccines. At least five months after vaccination, average vaccine effectiveness was 84%. Average protection against COVID-19 hospitalization was 89%. Vaccine effectiveness during the delta variant wave was 61%. The findings show that COVID-19 vaccines convey protection for months after vaccination, say the researchers. More studies are needed on the effectiveness of a third dose, mixing different vaccines, and against newly emerging variants, they say. (Antimicrobial Stewardship & Healthcare Epidemiology, Feb. 14, 2022)

COVID-19 increases cardiovascular risk
COVID-19 increases the risk of cardiovascular complications, found a study by VA St. Louis researchers. The study included data on more than 150,000 VA patients who contracted COVID-19, compared with more than 5 million controls who did not have COVID-19 and more than 5 million patients from before the pandemic. Patients who had recovered from COVID-19 were significantly more likely to have heart and vascular disease a year after infection. Overall, COVID-19 patients had a 4% higher rate of heart disease. Compared with controls, they had a 72% higher risk of coronary artery disease, 63% higher risk of heart attack, and 52% higher risk of stroke. The risk was evident regardless of age, race, sex, or other cardiovascular risk factors. Even those who had mild COVID-19 had higher cardiovascular risk, although the risk increased with disease severity. The findings show that post-COVD-19 care needs to take cardiovascular health into account, say the researchers. (Nature Medicine, Feb. 7, 2022)

Gene variants increase COVID-19 kidney risk in patients with African ancestry
Veterans of African ancestry who had gene variants linked to kidney injury were at heightened risk of acute kidney injury from COVID-19, found a VA Million Veteran Program study. COVID-19 can cause significant risk of acute kidney injury. Previous research has shown that people of African ancestry with two copies of specific variants of the APOL1 gene have increased rates of kidney disease. The researchers looked at genetic data on 990 MVP participants of African ancestry who were hospitalized with COVID-19. They found that patients with two copies of the high-risk APOL1 variants had higher odds of developing acute kidney disease, kidney disease severity, and death, compared with patients with one or none of the gene variants. This risk existed even in patients with prior normal kidney function. The findings suggest that genetic risk assessment could help predict kidney risk from COVID-19 in patients with African ancestry, say the researchers. (JAMA Internal Medicine, Jan. 28, 2022)

Veterans with and without mental illness equally likely to get COVID-19 vaccine
VA patients with and without serious mental illness were equally likely to get a COVID-19 vaccine, found a Greater Los Angeles VA study. Researchers looked at data from nearly 5 million VA patients. They compared vaccine rates during the period of December 2020 to June 2021. About 48% of Veterans with a serious mental health diagnosis received a COVID-19 vaccine during the time period. For Veterans without serious mental illness, the vaccination rate was 46%. The results show that VA outreach has led to equitable COVID-19 vaccine distribution, according to the researchers. (Psychiatric Services, Jan. 18, 2022)

Study identifies gene variant that may protect against severe COVID-19
An international study using VA Million Veteran Program data identified a specific gene variant that may protect against severe COVID-19 infection. The team, including a VA Boston researcher, studied the genome of nearly 3,000 patients of African ancestry with COVID-19 and more than 130,000 controls of African ancestry. They found that individuals with a specific variant of the gene OAS1 had a decreased chance of developing severe COVID-19. Previous studies of people of European ancestry identified the region on the genome containing OAS1 as related to COVID-19 risk. By examining this region in those with African ancestry, the researchers were able both to show that people of different ancestry shared this protection and to home in on the specific gene variant. People with this gene variant produce a longer form of a specific protein, which is more effective at breaking down the virus that causes COVID-19 than other forms of the protein. The finding could help develop new drugs against COVID-19, according to the researchers. The study also shows the importance of including ethnically diverse populations in genetic studies, they say. (Nature Genetics, Jan. 13, 2022)

Simple COVID-19 severity definition helps track pandemic
A simple definition of COVID-19 severity can help track pandemic severity and spread, according to a study by VA Boston researchers. COVID-19 hospitalization tracking often does not include disease severity. The researchers looked at data on COVID-19 admission to a VA hospital between March 2020 and November 2021. They defined moderate-to-severe COVID-19 as cases needing supplemental oxygen or a blood oxygen level of less than 94%. Among 67,000 patients, moderate-to-severe COVID-19 cases fell from 64% of total cases to 56%, driven by lower rates in vaccinated patients. Cases of more severe disease were highly correlated with dexamethasone medication receipt. They also increased after July 2021, corresponding to the emergence of the delta variant. The results show that this objective definition of COVID-19 severity can be used to detect trends in vaccine effectiveness and guide treatment and risk factor assessment, say the researchers. (Infection Control and Hospital Epidemiology, Jan. 11, 2022)

COVID-19 disparities narrowed as pandemic continued
Racial and ethnic disparities in testing positive for COVID-19 improved as the pandemic went on, according to a study of more than a million VA patients. The pandemic has disproportionally impacted racial and ethnic minority communities in the United States. Researchers looked at VA COVID-19 testing data from between February 2020 and August 2021. They found that racial and ethnic disparities for testing positive were more pronounced at the beginning of the pandemic. At the start of the pandemic, all racial and ethnic minority groups had higher positive rates than White patients. These disparities decreased over time. The disparity remained highest in Hispanic patients later into the pandemic, but the difference lowered with time. Disparities in Asian patients disappeared by March 2021, with fewer positive cases in Asian patients than White patients by the study’s end. While the findings suggest that tailored interventions to reach higher-risk groups were effective, say the researchers, the shrinking of disparities was also due to an increase in COVID-19 cases in White patients. (Scientific Reports, Jan. 7, 2022)

Vaccines effective in immunocompromised patients, but antibody levels lower
Vaccines are effective against symptomatic COVID-19 among immunocompromised patients, found a review by Iowa City VA researchers and colleagues. But vaccine effectiveness was lower than in non-compromised controls. The researchers reviewed 20 studies on COVID-19 vaccine response. They found that mRNA vaccines were about 70% effective for immunocompromised patients. Reasons for immunocompromised status included solid organ transplant, malignant diseases, and inflammatory rheumatic diseases. While vaccines were protective for these patients, healthy control groups had much higher antibody levels. More study is needed to understand this difference between antibody production and disease protection, say the researchers. (Journal of Infection, Jan. 1, 2022)

Blood pressure medications do not increase COVID-19 risk
Blood pressure and heart disease medications do not increase the risk of COVID-19 death, according to a VA study. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are medicines often used to treat high blood pressure, as well as heart disease and heart failure. Some have speculated that these drugs could increase the risk of COVID-19 because they increase ACE-2, the receptor through which the SARS-CoV-2 virus enters cells. Researchers examined data on more than 27,000 Veterans who tested positive for COVID-19. ACEI/ARB use was not associated with increased risk of death or worse outcomes in these patients. In fact, patients taking ACEIs/ARBs had a lower risk of intensive care admission and all-cause mortality compared with other patients. Those taking ACEIs did have higher odds of sepsis within 60 days of testing positive for COVID-19. The results suggest that these drugs are safe to take during the pandemic, according to the researchers, but more studies are needed on how specifically they interact with the virus. (Drugs, January 2022)

Blood pressure drugs safe, may improve COVID-19 survival
Blood pressure medication do not increase COVID-19 risk and may even be protective, found a San Francisco VA study. The SARS-CoV-2 virus enters cells by hooking on to a protein called angiotensin-converting enzyme 2 (ACE2). Drugs called ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)—used to treat high blood pressure—effect how this protein is expressed in the body. Because of this, some doctors worried that the medications could increase COVID-19 risk. Researchers studied the medical records of more than 9,000 patients hospitalized with COVID-19. They found that discontinuing ACEI treatment was linked to an increased risk of death. Beginning or continuing ACEI was associated with reduced risk of death. ARBs and metformin, a diabetes medicine, had similar effects on mortality risk. The findings confirm recent studies that have shown taking ACEI/ARB medication does not increase COVID-19 risk. To the contrary, the study suggests that these drugs could actually convey a COVID-19 survival benefit, say the researchers. (BMJ Open, Dec. 31, 2021)

Two monoclonal antibodies do not appear to improve COVID-19 outcomes
Two monoclonal antibody therapies were not shown to be effective for treating COVID-19, in an international study in which VA participated as part of the ACTIV-3 trial platform, an NIH initiative. Monoclonal antibodies are a type of drug created from human proteins designed to bind to the virus and neutralize it. Researchers tested two new monoclonal antibodies (sotrovimab or BRII-196 plus BRII-198) compared with placebo in more than 500 volunteers with COVID-19. Neither drug provided patients with higher odds of favorable pulmonary or complication outcomes, compared with those who received placebo. Some evidence suggested that BRII-196 plus BRII-198 could be beneficial to patients who did not naturally produce antibodies to the virus. The results do not support the use of monoclonal antibody treatment for patients hospitalized with COVID-19, conclude the researchers. (Lancet Infectious Diseases, Dec. 23, 2021)

Mixed results for monoclonal antibody treatment
The efficacy of the monoclonal antibody bamlanivimab for treating COVID-19 depends on whether a patient already has virus antibodies, found an ACTIV-3 study. Monoclonal antibodies are a type of drug created from human proteins designed to bind to the virus and neutralize it. Researchers studied the effectiveness of bamlanivimab in patients hospitalized with COVID-19, compared with controls who received placebo. In patients who already had detectable antibodies in their blood from the body’s immune response, bamlanivimab appeared to slow recovery time. For those without antibodies, the drug improved recovery time. The results suggest that bamlanivimab does not improve COVID-19 recovery for most patients but could have benefits for some. (Annals of Internal Medicine, Dec. 21, 2021)

Cancer screenings and diagnoses fall during pandemic
Cancer screening procedures and new cancer diagnoses in VA fell in 2020 due to the pandemic, found a VA Maryland Health Care System study. Researchers analyzed data from more than 9 million VA patients. Screenings and diagnoses were significantly lower than in the previous two years. This change was likely caused by disruptions in non-emergency care due to the pandemic. New cancer diagnoses dropped between 13% and 23%, depending on type of cancer. In 2020, colonoscopies in VA decreased by 45%, prostate biopsies dropped 29%, cystoscopies for bladder cancer fell by 21%, and chest scans for lung cancer fell by 10%.The researchers hope that the results will help physicians and health care organizations plan and allocate resources to re-engage with patients. (Cancer, Dec. 6, 2021)

Vaccine comparison shows slightly better protection from Moderna vaccine
In the first head-to-head comparison of the effectiveness of the Pfizer and Moderna COVID-19 vaccines, Moderna was shown to offer slightly better protection. Researchers looked at health data from more than 400,000 VA patients who received vaccines. Both vaccines were highly effective in prevention COVID-19 infection, hospitalization, and death. But patients who received the Moderna vaccine had a 21% lower risk of infection and a 41% lower risk of hospitalization. The study confirms that both vaccines are extremely effective, say the study authors, and either one in recommended to any individual offered a choice between the two. The differences may be meaningful for public-health officials setting policy or making decisions on a wide scale, they explain. (New England Journal of Medicine, Dec. 1, 2021)

COVID-19 antibodies decline after six months in nursing home residents
Antibodies from a COVID-19 vaccine declined significantly in nursing home residents six months after vaccination, found a Cleveland VA study. Researchers tested the blood of 130 nursing home residents and 95 health care workers two weeks and six months after they received the Pfizer mRNA vaccine. At two weeks, nursing home residents had only one-quarter of the antibodies as health care workers. The difference was likely due to age and health-related risk factors. All subjects who did not contract COVID-19 after vaccination had drastically lower antibody levels after six months. Of nursing home residents who never caught COVID-19, 69% had antibody levels below the limit of detection after six months. Residents with COVID-19 infection before vaccination had slightly higher antibody levels, but antibody levels still dropped by at least 81%. The results highlight the need for vaccine boosters, especially in older populations, say the researchers. (Clinical Infectious Diseases, Nov. 19, 2021)

COVID-19 vaccine effectiveness wanes, but remains high against death
Vaccine protection against COVID-19 declined during 2021, but protection against death after infection remained high, according to a study by VA San Francisco researchers. The study looked at COVID-19 infection rates and deaths for more than 780,000 VA patients between February and October 2021. Effectiveness against infection for the three vaccines being given in the United States—created by Pfizer, Moderna, and Janssen—fell from an average of 88% to 48% as the Delta variant of the virus emerged. Although breakthrough infections increased, the vaccines proved to be highly protective against death from COVID-19. Protection against death from COVID-19 remained above 73% for all three vaccines in patients younger than 65, and above 70% for older patients. The findings support efforts to increased vaccination, booster campaigns, and additional layers of protection against infection, say the researchers. (Science, Nov. 4, 2021)

In VA, COVID-19 vaccination rates higher in minority than white patients
COVID-19 vaccine receipt was higher among most racial/ethnic minority groups than in white patients in the VA health care system, found a study by VA Greater Los Angeles researchers and colleagues. Researchers looked at data of more than 3 million VA patients from between December 2020 and February 2021. They found that Black, Hispanic, and Asian patients were more likely than white patients to receive COVID-19 vaccines. In the general U.S. population, minority patients have lower vaccine rates than white patients. American Indian/Alaskan Native patients were less likely than whites to receive a vaccine from VA, but only in areas with Indian Health Service care delivery, suggesting that Veterans may have received vaccines through IHS rather than VA. The results suggest that VA has reduced barriers to minority vaccination to a greater extent than in non-VA care, say the researchers. (American Journal of Preventive Medicine, Oct. 20, 2021)

Vaccines protect against hospitalization from COVID-19 Delta variant
COVID-19 mRNA vaccines are highly effective at preventing infection against the Delta variant, according to a report by VA researchers and colleagues. Researchers looked at infection rates at five VA medical centers between February and August 2021. They found that mRNA vaccines were 87% effective, including during periods of widespread circulation of the COVID-19 Delta variant. Vaccines were 80% effective at preventing COVID-19-related hospitalization in people aged 65 or older. They were 95% effective at prevention hospitalization for patients 18 to 64. The results suggest that all eligible persons should receive COVID-19 vaccination to prevent hospitalization, according to the researchers. (CDC Morbidity and Mortality Weekly Report, Sept. 10, 2021)

Immunologic resilience grades could help predict COVID-19 severity
A team with the South Texas Veterans Health Care System and the University of Texas Health Science Center at San Antonio published findings on an idea they call “immunologic resilience” that can help predict which COVID-19 patients will advance to severe disease. The research team developed “immune health grades” for more than 500 VA patients with COVID-19, based on measures of infection-fighting T cells and the expression of certain genes. The team found the metric to be “highly prognostic.” Using biomarkers to track immunologic resilience could help predict resistance not only to COViD-19, but also to other diseases such as influenza or HIV, according to the researchers. The work is part of a broader partnership between VA and the National Institute of Allergy and Infectious Diseases (NIAID), the NIH agency led by Dr. Anthony Fauci. (Journal of Allergy and Clinical Immunology, Sept. 7, 2021)

COVID-19 pandemic has not increased suicide risk in Veterans
The COVID-19 pandemic has not increased suicidal behavior among Veterans, according to a VA National Center for PTSD study. Many scholars warned that hardships and isolation caused by the pandemic could create a “perfect storm” of suicide risk among vulnerable populations. Researchers surveyed more than 3,000 Veterans in November 2019, and again in November 2020. They found that rates of suicidal thoughts actually decreased by almost 3% during the pandemic. The number of suicide attempts did not increase during the study period. However, Veterans who contracted COVID-19 were more than twice as likely to report suicidal thoughts than they were before infection. The results suggest that the resiliency of Veterans and increased social support may be protective against suicide risk during a health crisis, according to the researchers. More research is needed into how the physical and social effects of COVID-19 infection may affect suicide, they say. (JAMA Psychiatry, Aug. 25, 2021)

Severe obesity a risk factor for death from COVID-19
Severe obesity increases the risk of death from COVID-19, according to a study of VA patients. Researchers looked at outcomes for more than 16,000 VA patients hospitalized with COVID-19 between March and November of 2020. Of those, 12% died in the hospital. Severe obesity, defined as a body mass index above 40, increased the risk of death by 43%. Obesity (BMI between 30 and 40) and sleep apnea did not increase the risk of death from COVID-19. Severe obesity should be considered an underlying medical condition when prioritizing treatment and predicting severe COVID-19 risk, conclude the researchers. (International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Aug. 23, 2021)

Smoking, alcohol use tied to lower mortality risk in COVID-19 patients
Risk factors for death differ in COVID-19 infected and uninfected patients, found a Durham VA and Duke University study. Researchers compared mortality rates between Veterans with and without COVID-19 who had similar risk factors. They looked at outcomes of more than 340,000 male Veterans tested for COVID-19 between March and September 2020. Of those, 7% tested positive. Older age and obesity both increased the chance of death in patients with COVID-19 beyond the risk in similar patients not infected. Surprisingly, COVID-19 patients who smoked or had alcohol use disorder had lower mortality risk than patients who did not smoke or had alcohol use disorder. Both smoking and alcohol use disorder increased mortality risk in patients without COVID-19. More study is needed on why normally harmful behaviors might be associated with better mortality outcomes in COVID-19 patients, say the researchers. (International Journal of Environmental Research and Public Health, Aug. 11, 2021)

Equal access to VA COVID-19 testing among racial groups
Minority Veterans have had equal or greater access than White Veterans to COVID-19 testing from VA during the pandemic, found a VA Greater Los Angeles study. Researchers looked at data on the nearly 1 million Veterans who sought care through VA for COVID-19 symptoms or exposure in 2020. Early in the pandemic, Hispanic, Black, and other non-White minorities were more likely than White patients to receive COVID-19 tests. As the pandemic continued, testing was similar in VA among all racial and ethnic groups. As periodic testing shortages continue, it is important to ensure that groups that may have increased COVID-19 exposure risk continue to have equal access to testing, say the researchers. (Preventive Medicine Reports, July 22, 2021)

COVID-19 vaccines highly effective
Vaccines are highly effective at preventing COVID-19 infection, found a VA Pittsburgh study. Researchers looked at data on more than 54,000 VA patients who tested positive for COVID-19 between December 2020 and March 2021, and over 54,000 controls who did not test positive. Results showed that either of the two mRNA vaccines available in the United States were 97% effective seven days after the second dose. Among patients who tested positive, 18% had been vaccinated. Vaccine effectiveness remained above 95% regardless of age, sex, race, or other health conditions. The results show that can prevent COVID-19 infection in high-risk populations in a real-world setting, say the researchers. (Annals of Internal Medicine, July 20, 2021)

Nasal swab COVID-19 test less sensitive, easier than sinus swab
Nasal swabs are less sensitive than deeper sinus swabs at detecting the virus that causes COVID-19 but are still highly accurate, found a study by a VA researcher. The “gold standard” for detecting SARS-CoV-2 is a nasopharyngeal swab, which takes a sample from the back of the sinuses through the nose. Researchers reviewed studies of how effective this type of COVID-19 test was compared with nasal swabs taken from the nostrils. They found that nasal swabs were 82% to 88% effective at detecting the virus, compared with 98% for nasopharyngeal swabs. However, nasal swabs are quicker to perform and require less protective equipment. The lower sensitivity of nasal swabs is balanced by the ability to screen more patients and the easier procedure, conclude the researchers. (PLoS One, July 20, 2021)

Remdesivir linked to longer hospital stays for COVID-19 patients
Remdesivir treatment was associated with longer hospital stays for COVID-19 patients, in a study by Iowa City VA researchers. Previous studies suggested that the drug remdesivir can reduce recovery time for COVID-19 patients. Researchers looked at data on nearly 6,000 Veterans treated for COVID-19 at VA medical centers. Of those, 40% received remdesivir. Patients given remdesivir had longer median hospital stays than patients not treated with the drug. Remdesivir did not appear to reduce patients’ 30-day risk of death. Because the treatment lasts several days, remdesivir may increase the need for hospital beds for COVID-19 patients while not improving survival, say the researchers. (JAMA Network Open, July 1, 2021

No benefit for COVID-19 patients from hydroxychloroquine
Hydroxychloroquine does not appear to offer any benefit to hospitalized COVID-19 patients, found a large VA study. Researchers looked at data on more than 64,000 VA patients tested for COVID-19. More than 7,000 positive cases were found, of which nearly 3,000 required hospitalization. Of those, 657 Veterans were prescribed hydroxychloroquine. The data show no apparent benefit for the patients given hydroxychloroquine, either alone or combined with azithromycin. Those given both hydroxychloroquine and azithromycin had an increased risk of intubation. The results show that hydroxychloroquine does not improve survival for COVID-19 patients, concluded the researchers. (American Journal of Epidemiology, June 24, 2021)

Convalescent plasma treatment did not affect COVID-19 mortality
Convalescent plasma treatment did not reduce mortality in patients with non-severe COVID-19, in a study of VA patients. Convalescent plasma is a treatment using the blood from a person who has recovered from COVID-19. Scientists hypothesized that transferring antibodies to the new patients could improve recovery. Out of nearly 5,000 VA patients admitted for non-severe COVID-19 between May and November of 2020, about 8% received convalescent plasma. Thirty-day mortality for the convalescent plasma patients was 6.5%, compared with 6.2% in other patients. The results show no meaningful differences between patients treated or not treated with convalescent plasma for non-severe COVID-19, according to the researchers. (Journal of Infectious Disease, June 21, 2021)

Social and behavioral risk factors did not increase COVID-19 mortality risk in Veterans
Social and behavioral risk factors were not associated with death from COVID-19 in VA patients, in a study of more than 27,000 Veterans. Researchers looked at data on Veterans with a positive COVID-19 test between March and September of 2020. They found that Veterans with risk factors traditionally associated with barriers to care had no higher risk of dying from COVID-19 than patients without those risk factors. Social risk factors including housing problems and financial hardship. Behavioral risk factors included tobacco, alcohol, and drug use. The results show that an integrated health system such as VA can transcend social vulnerabilities that often lead to health care disparities, according to the researchers. (JAMA Network Open, June 9, 2021)

Diabetes linked to worse COVID-19 outcomes
Diabetes is linked to worse outcomes from COVID-19 infection, according to a VA Puget Sound study. Researchers looked at outcomes form nearly 36,000 VA patients who tested positive for COVID-19. Patients with diabetes had greater odds of hospitalization, intensive care unit admission, and death than patients without diabetes. Prior use of the diabetes medication sulfonylurea was linked to increased odds of hospitalization. Prior insulin use was linked to increased odds of both hospitalization and death. Statin use was associated with lower chance of death, and angiotensin receptor blockers (ARBs) were associated with lower odds of hospitalization. The results show that diabetes increases the danger posed by COVID-19. (BMJ Open Diabetes Research and Care, June 2021)

COVID-19 vaccines largely effective in inflammatory bowel disease patients taking immunosuppressants
Vaccination against COVID-19 proved mostly effective in patients with inflammatory bowel disease, found a Michael J Crescenz VA Medical Center study. Clinical trials of COVID-19 vaccines mostly excluded patients taking immunosuppressive medication. The researchers studied outcomes for nearly 15,000 patients taking medication for inflammatory bowel disease. Full vaccination—meaning patients were at least a week past the second vaccine dose—showed 80% effectiveness against COVID-19. Unvaccinated patients in this population had a much higher rate of COVID-19 infection than vaccinated patients. Partial vaccination did not significantly reduce the hazard of infection. The results could help increase patient and provider willingness to vaccinate immunosuppressed patients, say the researchers. (Gastroenterology, May 25, 2021)

Lower job-person fit leads to more health care worker burnout during the pandemic
Health care workers with lower job-person fit were more likely to feel burnout during the COVID-19 pandemic, found a VA study. Job-person fit was defined as how well worker expectations met workplace realities. Researchers surveyed 147 health care workers in the summer of 2020. Of those, 43% reported burnout. Those who felt better about being recognized or appreciated for their work and who felt that their goals and values aligned with organization goals and values were less likely to feel burnout. Addressing job-person fit may be key to reducing burnout during health crises, according to the researchers. (Journal of Occupational and Environmental Medicine, May 14, 2021)

Potential replacement materials for N95 mask filters
Several commercially available materials could be potential replacements for filters used in N95 masks, found a study by VA Puget Sound researchers and colleagues, but downsides exist. Researchers tested 14 filter materials in a 3-D printed face mask. Several materials proved effective at blocking virus transmission. Disinfection by dry heat did not reduce the materials’ ability to block virus transmission. Ten cycles of vaporized hydrogen peroxide for disinfection significantly reduced filter efficiency. While multiple filter materials appeared to be effective potential replacements for N95 filters, they did show reduced efficiency and increased breathing resistance, compared with traditional N95 filters. (Journal of Occupational and Environmental Hygiene, May 14, 2021)

COVID-19 ‘long-haulers’ face increased risk of death and many other health problems
A large VA study showed that people who have had COVID-19 are at heightened risk of both death and many other health problems. In the largest post-acute COVID-19 study to date, VA Saint Louis Health Care System researchers characterized many potential long-term consequences of COVID-19. The researchers looked at outcomes on more than 73,000 VA patients who survived COVID-19 and close to 5 million who did not contract the disease. The COVID-19 group had a higher risk of dying six months after diagnosis. People who have recovered from COVID-19 also are at increased risk of health problems affecting virtually every organ system in the body, not just the lungs. About 8% to 10% of people affected by COVID-19 will likely have long-term effects, according to the researchers. (Nature, April 22, 2021)

Vaccines led to significantly lower COVID-19 infection in nursing homes
Positive COVID-19 tests declined in VA and community nursing homes following the start of vaccine availability, found two studies by VA researchers. Results showed that COVID-19 vaccines accelerated the rate of decline of infections and death in this population. As of January 2021, 82% of VA community living center residents had received at least the first vaccine shot. The number of positive tests dropped among all residents in the fourth week after vaccination, even though some residents refused the vaccine. One week after their first vaccine clinics, non-VA nursing homes had 2.5 fewer new COVID-19 infection per 100 at-risk residents, compared with facilities with later vaccinations. After seven weeks, early vaccination facilities had 5.2 fewer infections and five fewer hospitalizations or deaths per 100 residents. The results show that vaccines are an effective way to stop the spread of COVID-19 in nursing homes, say the researchers. (Journal of the American Geriatric Society, April 16, 2021; article 1, article 2)

Using genetics, researchers identify potential drugs for early treatment of COVID-19
A study using genetics suggests researchers should prioritize clinical trials of existing drugs that target two proteins to manage COVID-19 in its early stages. Researchers studied the genomes of more than 7,500 patients hospitalized with COVID-19 and more than a million controls. They found that two proteins, ACE2 and IFNAR2, are likely involved in COVID-19 hospitalization. IFNAR2 is the target for approved drugs used to treat multiple sclerosis. A drug developed prior to the pandemic to treat severe respiratory illness targets ACE2. The researchers suggest that clinical trials should examine existing drugs such as these known to act on these two proteins for possible new treatments for COVID-19. (Nature Medicine, April 9, 2021)

How COVID-19 guidance was translated into clinical practice
Medical facilities rapidly implemented treatment recommendations for clinical practice in the wake of the COVID-19 pandemic, according to a study by VA Boston researchers, but recommendations did not always agree with guideline-issuing organizations. After the initial pandemic peak, organizations such as the Centers for Disease Control and Prevention generally recommended COVID-19 patients be referred to clinical trials. Individual facilities favored offering specific treatments, most commonly hydroxychloroquine, remdesivir, and interleukin-6 inhibitors. Recommendation to clinical trials was mostly limited to academic medical centers with easier access to research studies. Understanding how and why evidence is translated into clinical care is critical to improve processes for emerging diseases, say the researcher. (Open Forum Infectious Disease, April 7, 2021)

COVIDVax risk model could save lives with vaccination prioritization
Researchers with the VA Puget Sound Healthcare System developed a model called COVIDVax to estimate COVID-19 risk and guide vaccine prioritization. To develop the model, the researchers used data from more than 7.5 million VA patients to predict COVID-19-related death. COVIDVax was highly accurate at predicting which patients were at greatest risk of dying from COVID-19. Using this model to prioritize vaccination was estimated to be able to prevent 64% of deaths that would occur by the time 50% of all VA enrollees are vaccinated. Prioritizing vaccination based on COVIDVax should prevent a large number of deaths, concluded the researchers. (JAMA Network Open, April 1, 2021)

Veteran suicide risk during the pandemic
Researchers from several VA offices studied the COVID-19-related factors that protected against and increased risk of suicidal thoughts of Veterans during the pandemic. They studied data on more than 3,000 Veterans with pre-existing psychiatric conditions before and after the pandemic began. Pre-pandemic purpose in life and higher income appeared to be protective against suicidal thoughts.COVID-19 infection, pre-pandemic psychosocial difficulties, and increased psychiatric symptoms increased risk of suicidal thoughts during the pandemic. Among Veterans infected with COVID-19, older Veterans and those with low feelings of purpose in life were at greatest risk of suicidal thoughts. Interventions to help enhance purpose in life may help lower suicide risk during the pandemic, according to the researchers. (Journal of Psychiatric Research, March 16, 2021)

Most adult COVID-19 patients develop antibodies
Most adults with COVID-19 develop antibodies that stay in the body after infection, according to a review by VA Portland researchers. The researchers surveyed studies published on COVID-19 in 2020. They found that most adults had detectable levels of antibodies after infection with the SARS-CoV-2 virus. Levels of IgM, short term antibodies that protect from initial infection, peak at about 20 days after infection and then decline. IgG—longer-term antibodies—levels peak about 25 days after symptom onset and remain detectable for at least 120 days. Some evidence suggests that older age, greater COVID-19 severity, and presence of symptoms may be linked to higher antibody levels. Some adults do not develop antibodies for unclear reasons. (Annals of Internal Medicine, March 16, 2021)

Increasing physical distance in schools not linked to fewer COVID-19 cases
Maintaining three feet versus six feet of physical distance between students did not affect COVID-19 cases, found a study by VA Boston researchers and colleagues. Researchers looked at COVID-19 infection data for nearly 540,000 students and more than 99,000 staff attending in-person school in the Massachusetts public school system. They found that infection rate was similar in districts with policies requiring three feet of physical distance, compared with districts requiring six feet. Increasing physical distance is not necessary to prevent COVID-19 cases in schools, concluded the researchers, provided that universal mask mandates and other precautions are implemented. (Clinical Infectious Diseases, March 10, 2021)

Anticoagulants could lower COVID-19 mortality risk
Anticoagulation medication could lower the risk of death from COVID-19, according to a study by VA researcher and colleagues. The study looked at data on more than 4,000 patients hospitalized with COVID-19. Most of the patients were given medication to prevent blood clots. Results show that patients given the medication had a 27% lower risk of dying from COVID-19 within 30 days of hospitalization, compared with patients not receiving anticoagulants. Anticoagulant use was not associated with serious bleeding events. The findings provide strong evidence for the use of anticoagulants as an initial treatment for COVID-19, say the researchers. (BMJ, Feb. 11, 2021)

Study: Smoking increases risk of death for Veterans with COVID-19
A VA study showed that smoking increases patients’ risk of dying from COVID-19. The research team led by a Southeast Louisiana VA researcher looked at risk factors for COVID-19 death among 440 Veterans. They found that lifetime tobacco use predicted death from COVID-19 above other risk factors. Although it was expected that smoking would exacerbate COVID-19—considering it is primarily a respiratory disease—the fact that smoking could predict death independent of other demographic and medical factors was surprising, according to the researchers. Nearly 90% of the Veterans in the study who died were smokers. The results highlight the importance of assessing lifetime tobacco use in COVID-19 patients, say the researchers. (Addictive Behaviors, February 2021)

Study: Smoking increases risk of death for Veterans with COVID-19
A VA study showed that smoking increases patients’ risk of dying from COVID-19. The research team led by a Southeast Louisiana VA researcher looked at risk factors for COVID-19 death among 440 Veterans. They found that lifetime tobacco use predicted death from COVID-19 above other risk factors. Although it was expected that smoking would exacerbate COVID-19—considering it is primarily a respiratory disease—the fact that smoking could predict death independent of other demographic and medical factors was surprising, according to the researchers. Nearly 90% of the Veterans in the study who died were smokers. The results highlight the importance of assessing lifetime tobacco use in COVID-19 patients, say the researchers. (Addictive Behaviors, February 2021)

Potential new medication for treating COVID-19
A team led by a Jesse Brown VA Medical Center researcher created a potential new medication to treat COVID-19. The virus behind COVID-19 binds with an enzyme in the body called ACE2, which allows it to enter human cells. The researchers designed a peptide (a chain of amino acids) that blocks ACE2 from binding with the spike proteins on the outside of the virus. They gave the new peptide to mice with symptoms that mimic COVID-19 as a nasal spray. The spray reduced fever, protected the lungs, and improved heart function and the mice’s movement. The results could lead to an important new treatment for COVID-19, according to the researchers. (Journal of Neuroimmune Pharmacology, Jan. 11, 2021)

COVID-19 protein can enter the brain
A study by VA Puget Sound and University of Washington researchers showed that the virus causing COVID-19 may be able to enter the brain. Researchers found that the spike proteins, protrusions on the surface of the virus, can cross the blood-brain barrier and enter the brains of mice. The blood-brain barrier is a border of cells that usually prevents harmful compounds from moving from the blood to the central nervous system. The fact that the spike proteins can cross this barrier on their own suggests that the full virus may be able enter the brain as well. The results add to the understanding of how COVID-19 can affect the central nervous system, and could help scientists develop treatments to counter its damaging effects. (Nature Neuroscience, Dec. 26, 2020)

COVID-19 patients at higher risk of death, health problems than those with flu
COVID-19 patients are at much higher risk of health problems and death than those with the flu, showed a study by St. Louis VA and Washington University researchers. Researchers looked at VA data on more than 3,000 COVID-19 patients and more than 12,000 flu patients. COVID-19 patients were five times more likely to die than flu patients. COVID-19 patients were also four times more likely to require breathing machines and almost 2.5 times more likely to be treated in the intensive care unit. COVID-19 patients were hospitalized for an average of three days longer than flu patients. Compared with flu patients, COVID-19 patients were also at higher risk of developing diabetes, acute kidney damage, and other medical conditions. (BMJ, Dec. 15, 2020)

First 10-days after hospitalization high-risk for COVID-19 patients
COVID-19 patients are at the highest risk of ending up back in the hospital or dying in the first 10 days after leaving the hospital, according to a VA Ann Arbor and University of Michigan study. In the first 10 days after leaving the hospital, COVID-19 patients had a 40% to 60% higher risk of returning to the hospital or dying, compared with patients with heart failure or pneumonia. Risk of readmission or death after 60 days was lower in COVID-19 patients than in patients with these two conditions. The results highlight a need for “special vigilance” in the first days after hospital discharge, say the researchers. (JAMA, Dec. 14, 2020)

Nurses at higher risk of COVID-19 than other health care workers
Nurses are more likely than other health care workers to test positive for the virus causing COVID-19, found a study including an Edward Hines, Jr. VA Hospital researcher. Researchers looked at COVID-19 test data for more than 6,500 health care workers. Nearly 2,000 of those were nurses. About 5% tested positive for the virus. Nurses had nearly twice the odds of testing positive, compared with other health care workers. Administrators who worked in hospitals but did not interact with patients were the least likely to test positive. Nurses who saw patients receiving high-flow oxygen therapy had a 45% higher risk of contracting the virus, and those treating patients receiving kidney dialysis had 57% higher odds, compared with other nurses. The results show that health care workers who spend more time around COVID-19 patients, such as nurses, are at increased risk from the virus, say the researchers. (Open Forum Infectious Disease, Dec. 9, 2020)

Race-based COVID-19 disparities
African American and Hispanic populations have higher rates of COVID-19 infection and death compared with other ethnic groups, according to a VA Portland review. Researchers reviewed 37 studies on COVID-19 data. They found that African American and Hispanic patients had disproportionately higher rates of virus infection, hospitalization, and death from COVID-19, compared with white patients. While these groups had a higher proportion of deaths from COVID-19, they did not show a higher risk of death in confirmed COVID-19 cases. Asian patients had similar COVID-19 rates as white patients. Not enough data exist on other racial groups to draw conclusions. The higher COVID-19 rates appear to be due to differences in health care access and exposure risk rather than any biological disposition, according to the researchers. (Annals of Internal Medicine, Dec. 1, 2020)

VACO Index can accurately predict COVID-19 mortality risk from health data
The VA COVID-19 (VACO) Index can accurately predict risk of COVID-19 mortality using demographic and health data, according to a VA study. Researchers used VA medical administrative data to develop a tool to assess who is at highest risk of dying from COVID-19 within 30 days of infection. The VACO Index takes into account demographics such as age, sex, and race/ethnicity, as well as pre-existing medical conditions. To validate this measure, the researchers assessed more than 13,000 people who tested positive for COVID-19. Older age, multiple health conditions, and a history of heart attack or peripheral vascular disease were all associated with increased risk of death from COVID-19. The Index accurately predicted higher likelihood of death. The VACO Index could provide a timely, quantifiable, and individualized risk estimate of COVID-19 mortality risk, say the researchers, which will aid in social distancing and treatment decisions. (PLoS One, Nov. 11, 2020

Face coverings negatively impact communication
Face coverings negatively impact communication, especially for people with hearing loss, according to a study by a researcher affiliated with the VA’s National Center for Rehabilitation Auditory Research, along with colleagues from the University of Manchester in the United Kingdom. The researchers surveyed 463 people in the U.K., including many with hearing loss. The study found that face coverings negatively impacted hearing and understanding, as well as engagement and feelings of connection. These effects were felt by both speakers and listeners. All respondents reported being affected, but people with hearing loss were significantly more impacted than those without, especially when communicating with doctors, pharmacists and nurses. Face coverings increased anxiety and stress, and made communication more fatiguing, frustrating, and embarrassing. The researchers say three main factors are involved: face coverings limit sound transmission, making speech harder to hear; they hide the mouth and lips, making it impossible to lip-read; and they cover the lower half of the face, making it much more difficult to read emotions and social cues. The researchers concluded that communication-friendly face coverings need to be developed as face coverings continue to be required for public health needs. Health care providers also need to ensure they are addressing the communication needs of their patients, say the researchers. (International Journal of Audiology, November 2020)

Elevated immune response leads to more severe COVID-19
Elevated immune response is associated with more severe COVID-19 and death, found a review led by a Michael E. DeBakey VA Medical Center researcher. The review analyzed 16 previous studies. Researchers found that COVID-19 patients with higher levels of interleukins, proteins secreted by the immune system, were more likely to have worse symptoms or die, compared with patients with lower levels. Conversely, high levels of a different type of immune proteins (CD4 and CD8) were linked to better prognosis in COVID-19 patients. The results suggest that medications that block interleukin production could be a useful treatment for COVID-19, say the researchers. A number of interleukin blockers are already being tested as possible treatments. (Diabetes and Metabolic Syndrome, November–December 2020)

COVID-19 has five times higher in-hospital death rate than flu
Patients with COVID-19 hospitalized in the Veterans Health Administration had a more than five times higher risk of death than patients hospitalized with the flu, found a CDC study including VA researchers. Researchers looked at electronic health records data from nearly 4,000 patients with COVID-19 and more than 5,000 with influenza. Those hospitalized for COVID-19 had a much higher death rate. COVID-19 also carries a significantly higher risk of both respiratory and non-respiratory complications, compared with flu. Risk of COVID-19 complications was higher in Black and Hispanic patients, compared with white patients. (Morbidity and Mortality Weekly Report, Oct. 23, 2020)

Testing for virus presence after COVID-19 infection
Researchers from the San Francisco VA and University of California San Francisco studied how long it took health care workers with COVID-19 to test negative after initial infection. They tested 12 employees with reverse transcriptase polymerase chain reaction (RT-PCR). RT-PCR measures the amount of a specific type of RNA (genetic material). It can be used to test for the presence of the virus that causes COVID-19. The time between initial COVID-19 infection and a negative test ranged from seven to 57 days. The average time was 34.5 days. Understanding this time range could help institutions make decisions on when it is safe for employees to return to work, say the researchers. (Journal of Occupational and Environmental Medicine, Aug. 13, 2020)

Blood pressure medications not linked to worse COVID-19
Common blood pressure drugs are not linked to worse COVID-19 outcomes, according to a review by VA Portland researchers. Researchers reviewed 17 studies on how angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) interact with the SARS-CoV-2 virus. Both types of drugs are used to treat high blood pressure and heart failure. Evidence suggests that taking ACE inhibitors or ARBS does not lead to more severe COVID-19. The drugs also were not linked to positive SARS-CoV-2 test results. The researchers found four studies looking at ACE inhibitors or as COVID-19 treatments, but results from these studies are not yet available. (Annals of Internal Medicine, Aug. 4, 2020)

COVID-19 fever screening criteria lack accuracy in older patients
A new approach to temperature screening for COVID-19 is needed in nursing homes, according to a Providence VA Medical Center study. Current guidance for COVID-19 screening in nursing homes includes checking for fever, defined as at least 38°C. However, many older patients may not reach this temperature threshold even when infected. Researchers studied SARS-CoV-2 screening data on more than 7,000 residents of VA community living centers. They found that, while SARS-CoV-2 positive patients did show rising temperatures, only 27% met the fever threshold of 38°C. Repeated temperature measurement with a patient-specific baseline could improve screening efforts in older patients, conclude the researchers. (Journal of the American Medical Directors Association, July 2020)

Universal COVID-19 testing needed in community living centers
VA Greater Los Angeles Healthcare System researchers discovered the benefit of universal COVID-19 testing and daily screening for all staff and residents in community living centers. After identifying two cases of COVID-19 testing, all staff members and residents were administered RT-PCR testing. They found 14 of 19 residents who tested positive showed no symptoms of infection. Half of the eight staff members who tested positive were also asymptomatic. The researchers concluded that universal and repeated lab-based testing for the virus was an effective strategy to curb the spread of COVID-19. (Morbidity and Mortality Weekly Report, May 29, 2020)

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