COVID-19 ROUNDUP

Elevated Risks for Patients Hospitalized With COVID-19 at 3 Years, Worldwide Overuse of Antibiotics, Perinatal Health Among Birth Mothers With SARS-CoV-2 Infection, and More

Anthony Calabro, MA

For Patients Hospitalized With COVID-19, Increased Risk of Health Issues, Death at 3-Year Follow-Up1

Patients with COVID-19 who were hospitalized within the first 30 days after infection have a 29% higher risk of death in the third year following infection compared with people who have not had the virus, a recent study found.

For their study, researchers enrolled a cohort of people with SARS-CoV-2 infection (n = 135,161) and controls (n = 5,206,835) from the US Department of Veterans Affairs between March and December 2020. They were followed for 3 years to estimate risks of death and post-acute sequelae of COVID-19.

In the third year after infection, patients who had been hospitalized with COVID-19 experienced a 34% elevated health risk across all organ systems compared with people who did not have COVID-19, the study results showed.

Among non-hospitalized individuals, the increased risk of death was no longer present after the first year of infection and risks for post-acute sequelae significantly declined. Among hospitalized patients, however, the risk of death declined over the 3 years but remained significantly elevated in the third year after infection (29% increased risk and excess burden of death of 8.16 per 1000 persons). Further, the risks for post-acute sequelae declined over the years, but substantial residual risk remained in the third year, leading to 252.8 sequelae per 1000 persons.

“Altogether, our findings show reduction of risks over time, but the burden of mortality and health loss remains in the third year among hospitalized individuals,” the authors concluded.

Worldwide Overuse of Antibiotics Among Patients Hospitalized With COVID-192

Although only 8% of hospitalized patients with COVID-19 had bacterial co-infections requiring antibiotics, nearly 75% of patients have been treated with antibiotics nonetheless, according to a recent WHO news release.

The widespread, worldwide overuse of antibiotics during the pandemic may have exacerbated the "silent" spread of antimicrobial resistance (AMR), the release notes. Further, the release indicated that antibiotic use did not improve clinical outcomes for patients with COVID-19. Instead, its use potentially created adverse events for those without bacterial infection compared with those not receiving antibiotics.

These findings, which were presented at the ESCMID Global Congress in Barcelona, Spain, were based on data from the WHO Global Clinical Platform for COVID-19, a repository of clinical data collected from nearly 450,000 patients hospitalized with COVID-19 in 65 countries between January 2020 to March 2023.

“When a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance,” Silvia Bertagnolio, MD, WHO Unit Head for Surveillance, Evidence and Laboratory Strengthening, Division for AMR, said in the news release. “However, when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance.”

SARS-CoV-2 Infection Linked to Increased Pre-Term Birth, Hypertensive Disorders, Severe Maternal Morbidity3

Among birth mothers during the pandemic period (the year, 2020), SARS-CoV-2 infection was associated with increased risk of pre-term birth (PTB), hypertensive disorders of pregnancy (HDP), and severe maternal morbidity (SMM) compared to birth mothers without infection during that same timeframe.

The researchers took these results, which have been found in previous studies, one step further by separating SARS-CoV-2 infection from the broader societal changes during the pandemic period including unemployment, vehicle ownership, vacancy rates, and more.

In the study, the researchers used statewide California data to quantify population-level associations of COVID-19 with birth parent and infant health. They did this by comparing perinatal health among 2020 birth parents with SARS-CoV-2 infection, 2020 birth parents without SARS-CoV-2 infection, and 2019 prepandemic birth parents.

The results showed higher burdens of PTB, HDP, and SMM among birth parents with SARS-CoV-2 infection compared with 2020 birth mothers without infection. Among 2020 birth parents without SARS-CoV-2 infection, there was a lower risk of PTB and spontaneous PTB and a higher risk of HDP and gestational diabetes (GD) compared with 2019 birth mothers. While SARS-CoV-2 infection was associated with increased PTB, HDP, and SMM, overall, the pandemic period was associated with decreased risk of PTB, but increased risk of HDP and GD.

“The pandemic period association with decreased risk of PTB was largest for spontaneous PTB, suggesting that it may be explained by socioenvironmental and behavioral modifications, such as commute changes and reduced non-SARS-CoV-2 infections,” the authors wrote. “Increased risk of HDP and GD may be due to stress and reduced and/or remote prenatal care due to the pandemic.”

Greater Mortality Risk Among Patients Hospitalized for COVID-19 vs Patients With Seasonal Influenza4

According to a recently published research letter, the risk of death among patients hospitalized for COVID-19 in the fall/winter 2023-2024 was greater than the risk of death among those hospitalized for seasonal influenza.

The authors evaluated the risk for death in a cohort of people hospitalized for COVID-19 (n = 8625) or seasonal influenza (n = 2647) in fall/winter 2023-2024. They also compared the risk of death between people hospitalized for COVID-19 before and during the JN.1-predominant era, which the authors describe as “before vs on or after December 24, 2023.” Participants were identified based on U.S. Department of Veterans Affairs electronic health records from all 50 states.

The researchers found that patients hospitalized for COVID-19 between October 1, 2023 and March 27, 2024 had a higher risk for death compared with those hospitalized for seasonal influenza at 30 days (adjusted hazard ratio [HR] = 1.35; [95% CI, 1.10 to 1.66]). They found no significant differences in mortality risk among people hospitalized for COVID-19 before and during the JN.1-predominant era at 30 days (adjusted HR = 1.07; [95% CI, 0.89 to 1.28]).

“The findings should be interpreted in the context of nearly twice as many hospitalizations for COVID-19 compared with seasonal influenza during 2023-2024,” the authors wrote.

References:

  1. Cai M, Xie Y, Topol EJ, Ziyad AA. Three-year outcomes of post-acute sequelae of COVID-19. Nat Med. Published online May 30, 2024. Accessed May 30, 2024. doi: 10.1038/s41591-024-02987-8.
  2. WHO reports widespread overuse of antibiotics in patients hospitalized with COVID-19. News release. World Health Organization; April 24, 2024. Accessed May 30, 2024. https://www.who.int/news/item/26-04-2024-who-reports-widespread-overuse-of-antibiotics-in-patients--hospitalized-with-covid-19
  3. Jung S, Liu EF, Goin DE, et al. The COVID-19 pandemic period, SARS-CoV-2 infection, and perinatal health. JAMA Netw Open. 2024;7(5):e2410696. doi:10.1001/jamanetworkopen.2024.10696
  4. Xie Y, Choi T, Al-Aly Z. Mortality in patients hospitalized for covid-19 vs influenza in fall-winter 2023-2024. JAMA. Published May 15, 2024. Accessed May 30, 2024. doi:10.1001/jama.2024.7395