- COVID-19 Selected Studies of Note
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COVID-19 Selected Studies of Note

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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)

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)

Review: Most adults develop antibodies after virus infection
A review by VA Portland researchers summarized the available evidence of the body’s antibody response to SARS-CoV-2 infection. Studies show that most adults who contract the virus develop detectable levels of antibodies. Antibody levels peak around 20 to 25 days after infection, and may remain detectable for at least 120 days. Some evidence suggests that older age, greater disease severity, and presence of symptoms are linked to higher antibody levels. The review showed that some adults do not develop antibodies after SARS-CoV-2 infection, and the reasons for this are unclear. While the evidence available will help scientists understand how the body reacts to the virus, most studies available were small, highlighting the need for more research. (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)

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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