COVID-19 complications more likely in Black and Native American populations

Black people and Native Americans with health problems prior to contracting COVID-19 are more likely to have longer hospital stays, require treatment with a ventilator and have a higher risk of death than White people who have similar preexisting conditions, according to a new nationwide study led by University of Utah Health scientists.

The researchers say these results refute the notion that Black, Indigenous and People of Color are at greater risk of COVID-19 complications because they have one or more previous illnesses or diseases.

“Our findings contest arguments that Blacks and other racial and ethnic minorities are dying from COVID-19 at higher rates than their White counterparts because they have more comorbidities,” says Fares Qeadan, an assistant professor of biostatistics in the Division of Public Health and lead author of the study. “In fact, when we compared Blacks, Native Americans and Whites who had the same number of prior conditions, Blacks and Native Americans were still at higher risk of dying or being put on a ventilator.”

The study appears in Scientific Reports.

Preexisting conditions such as cancer, heart disease and obesity could be driving factors in higher risks for hospitalization, need for ventilation and death due to COVID-19, according to the Centers for Disease Control and Prevention. Blacks, Latinos and Native Americans all tend to also have more preexisting conditions than Whites. As a result, some researchers have suggested this could account for the higher rate—up to 3.7 times greater—of hospitalization and other COVID-19 complications among these racial and ethnic minority groups compared to Whites.

However, few studies have scrutinized whether populations with health disparities that have similar types of preexisting conditions as Whites have the same risk of COVID-19 complications. To address this concern, Qeadan and colleagues examined more than 52,000 medical records of patients who were diagnosed or who had tested positive for COVID-19.

Using a computerized analytical tool called the Elixhauser comorbidity index (ECI), they identified 31 common preexisting conditions that could contribute to COVID-19 complications. Each patient received a comorbidity score based on disease history and was then compared to patients with similar scores. This apples-to-apples approach, as well as multi-level regression models, allowed the researchers to more precisely identify differences in COVID comorbidities among racial and ethnic groups.

Specifically, compared with Whites, Blacks who had similar comorbidity scores had:

  • Longer hospital stays (1.22 days vs. 1.07 days)
  • Were more likely to be ventilator-dependent (85% more when the comorbidity score is low and 23% more when the score is high)
  • Were more likely to die (47% more when the comorbidity score is low and 13% more when the score is high)

Compared with Whites, Native Americans with similar comorbidity scores had:

  • Longer hospital stays (1.42 days vs. 1.07 days)
  • Higher odds of ventilator dependence across all comorbidity scores and
  • Higher odds of death (234% higher when the comorbidity score is low and 169% higher when the score is elevated)

The researchers note that their study only included patients who sought treatment for COVID-19. As a result, medically underserved and minority populations without health insurance may be underrepresented in this research. Differences in medical record coding within and between health care facilities also could have influenced these results.

“We hope the results of this study will help us better understand what’s going on in medical care that creates these disproportionalities,” says Elizabeth VanSant-Webb, a study co-author and project manager at the Sorenson Impact Center at University of Utah. “Hopefully, this will lead to better interventions to close the health care gap in this country.”

Moving forward, the researchers plan to potentially conduct a qualitative study to better explore patients’ experiences, provider behavior and hospital practices that may have contributed to these disparities.

“Our study did not explicitly examine the influence of social determinants of health such as structural racism, which could have contributed to the inequities we found,” says Charles R. Rogers, an assistant professor of Public Health and senior author of the study. “Decades before the pandemic, the value based on an individual simply because of the color of their skin has likely contributed to both poor health outcomes and health care access at alarmingly high rates for communities of color and warrants further investigation.”

The study, “Racial Disparities in COVID-19 Outcomes Exist Despite Comparable Elixhauser Comorbidity Indices between Blacks, Hispanics, Native Americans, and Whites,” appears in Scientific Reports. The V Foundation for Cancer Research, 5 for the Fight, Huntsman Cancer Institute and the National Cancer Institute partly supported the study financially. The content does not necessarily represent the official views of any of these entities and is solely the responsibility of the research team.

Evidence suggests COVID-19 isn’t sexually transmitted

COVID-19 is unlikely to be spread through semen, according to University of Utah Health scientists who participated in an international study of Chinese men who recently had the disease. The researchers found no evidence of the virus that causes COVID-19 in the semen or testes of the men.

The study was not comprehensive enough to fully rule out the possibility that the disease could be sexually transmitted. However, the chances of it occurring, based on this limited finding, appear to be remote.

“The fact that in this small, preliminary study that it appears the virus that causes COVID-19 doesn’t show up in the testes or semen could be an important finding,” says James M. Hotaling, M.D., a co-author of the study and a U of U Health associate professor of urology specializing in male fertility. “If a disease like COVID-19 were sexually transmittable that would have major implications for disease prevention and could have serious consequences for a man’s long-term reproductive health.”

The study appears in Fertility & Sterility, a peer-reviewed journal published by the American Society of Reproductive Medicine.

The international team of researchers from China and the United States launched the study in response to concerns that SARS-CoV-2, the virus that causes COVID-19, could be sexually transmitted like Ebola, Zika and other emerging viral pathogens. To find out, they collected semen samples from 34 Chinese men one month (on average) after they were diagnosed with mild to moderate cases of COVID-19. Laboratory tests did not detect SARS-CoV-2 in any of the semen samples.

But just because the virus wasn’t present in the existing semen didn’t necessary rule out that it hadn’t entered the testes where sperm cells are formed.

“If the virus is in the testes but not the sperm it can’t be sexually transmitted,” says Jingtao Guo, Ph.D., a postdoctoral scientist at the Huntsman Cancer Institute at the University of Utah who also co-authored the study. “But if it is in the testes, it can cause long-term damage to semen and sperm production.”

To sort this part of the puzzle out, the researchers analyzed a dataset generated from a single cell mRNA atlas from healthy young organ donors that was available from prior work. This atlas allows them to examine mRNA, the genetic material used to make proteins, in any single testicular cell. In this case, scientist used it to examine the expression of a pair of genes associated with SARS-CoV-2. These two genes, angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) act as receptors, allowing SARS-CoV2 to penetrate cells and replicate. In order for the virus to access cells effectively, both receptors must be present in the same cell.

When the scientists examined the dataset, they found that genes encoding these two proteins were only found in four of the 6,500 testicular cells, suggesting that SARS-CoV-2 is unlikely to invade human testicular cells, Guo says

Despite these findings, the researchers acknowledge that their study has several important limitations including a small sample size and the fact that none of the donors had been severely ill with COVID-19.

“It could be that a man who is critically ill with COVID-19 might have a higher viral load, which could lead to a greater likelihood of infecting the semen. We just don’t have the answer to that right now,” Hotaling says. “But knowing that we didn’t find that kind of activity among the patients in this study who were recovering from mild to moderate forms of the disease is reassuring.”

However, Hotaling warns that intimate contact can still increase the risk of spreading the disease through coughing, sneezing and kissing. In addition, some infected people are asymptomatic and can appear healthy, even as they pass the virus along to others.

In addition to Drs. Hotaling and Guo, other U of U Health researchers involved in this study titled, “No Evidence of SARS-CoV-2 in Semen of Males Recovering from COVID-19,” were Darshan  Patel, MD, and Adam Spivak, MD. The research was supported by the National Natural Science Foundation of China and the Huazhong University of Science & Technology.

See original press release here.

Amniotic fluid could reduce symptoms, long-term risks of COVID-19

Amniotic fluid, the clear liquid that helps nourish and protect fetuses before birth, isn’t just for babies. In fact, for nearly 100 years, doctors have used the mixture to help heal skin wounds, burns, and leg ulcers as well as provide protection for surgical adhesions.

Now, in a first-of-its-kind effort, University of Utah Health researchers are investigating whether human amniotic fluid (HAF) can reduce lung inflammation caused by COVID-19 and promote the recovery of patients who have contracted the disease.

“If successful, our research could shorten or mitigate the intensity of COVID-19 and have a lot of downstream effects including reducing the need for critical care, improving patient outcomes, and getting them home faster,” says Craig Selzman, MD, the study’s senior investigator and chief of U of U Health’s Division of Cardiothoracic Surgery.

Selzman and his colleagues first became interested in amniotic fluid as a possible treatment for COVID-19 after reading about a small study conducted in China. The study found that four pregnant women who were ill with the virus gave birth to healthy babies who didn’t have any covid-19 symptoms.

Intrigued, Selzman’s team, working in conjunction with the School of Medicine’s Cell Therapy and Regenerative Medicine program, treated 10 COVID-19 patients with HAF. Preliminary results in this small group suggest there was a 40% reduction of inflammation in some patients’ lungs. This reduction was measured by changes in C-reactive protein (CRP), a substance produced in the liver that is considered a biomarker of body’s inflammatory response.

“Theoretically, amniotic fluid is probably halting the progression of the disease by impeding its ability to cause inflammatory responses in the heart, lungs and other organs,” Selzman says.

But why HAF, which is composed of a mixture of electrolytes (salts), proteins, carbohydrates, lipids and urea, triggered this effect still isn’t clear and will required additional study.

In the meantime, Selzman and his colleagues are getting ready to conduct a phase 2 clinical trial involving 60 COVID-19 patients with varying severity of the illness. Half will receive HAF treatment; the other 30 will get standard care.

In addition to monitoring the patients for acute symptoms, the researchers hope HAF treatment will diminish the risk that these patients will develop pulmonary fibrosis (scarring and stiffening of the lungs) and other chronic respiratory conditions.

“If we can halt this inflammatory process early on, we could actually prevent the onset of advance lung disease in the months and years ahead,” Selzman says. “So, it’s not just trying to get people better right now. It’s also trying to stave off what could be long-term consequences of this viral infection.”

This research is supported, in part, by the University of Utah’s Immunology, Inflammation & Infectious Disease Initiative (3i) See original press release here. 

Vaping injuries more difficult to diagnose during time of COVID-19 pandemic

Diagnosing respiratory illness associated with vaping has always been challenging. But add the current COVID-19 pandemic to the mix and it becomes extremely difficult since both illnesses share many symptoms.

There are no tests for e-cigarette, or vaping, product use-associated lung injury, known by the acronym, EVALI, which has sickened 2,800 people and killed 68 Americans as of February. Physicians can only diagnose EVALI by first ruling out other conditions that it’s not, a task that is further complicated by patients not always disclosing that they vape.

While cases of EVALI have dropped since their peak in September 2019, they are now once again climbing, and the COVID-19 pandemic has made diagnosing the condition even more difficult since both illnesses share symptoms.

“EVALI is still happening, and on the rise again as people use vaping to cope with pandemic stress,” said Denitza Blagev, a pulmonary medicine physician at Intermountain Healthcare. “It’s important for clinicians to keep EVALI in mind as they are considering COVID. EVALI has a different prognosis and therapies that we can use to treat these patients, as long as we can diagnose them.”

This comes on the heels of a new study by researchers at Stanford University this week that found vaping is linked to a substantially increased risk of COVID-19 among teenagers and young adults, according to a new study led by researchers at the Stanford University School of Medicine.

The study, which published online Aug. 11 in the Journal of Adolescent Health, is the first to examine connections between youth vaping and COVID-19 using U.S. population-based data collected during the pandemic.

The study found that among young people who were tested for the virus that causes COVID-19, those who vaped were five to seven times more likely to be infected than those who did not use e-cigarettes.

“Patients who contract EVALI or COVID and suffer the same levels of respiratory failure tend to have divergent outcomes,” said Sean J. Callahan, assistant professor of pulmonary and critical care medicine at University of Utah Health. “Patients with EVALI require a high level of oxygen, but still tend to do well, whereas someone with COVID needing the same level of oxygen support may not do as well. Getting the diagnosis right is vital.”

In a new study published in the journal CHEST, researchers from Intermountain Healthcare and University of Utah Health looked at all patients diagnosed with EVALI at their institutions since March 2020, when COVID tests were readily available in Utah. They found a total of 12 people, who were diagnosed with EVALI who had a negative flu test and at least one negative COVID-19 test between March 1 and May 15.

They found that both illnesses showed similar symptoms: respiratory failure, gastrointestinal distress and/or ground glass opacities in the lungs.

Making accurate EVALI diagnoses even more difficult are patients who didn’t admit that they vaped, even after being asked repeatedly. In some cases, clinicians didn’t know someone’s true vaping history until well into the hospital course.

“This is a situation in which you’ve got to ask the patient repeatedly and hope they eventually volunteer the truth,” said Dr. Callahan. “It’s crucial for diagnosis.”

Researchers did, however, find two important differences that can help differentiate between EVALI and COVID-19.

First, COVID-19 often leads to normal or low white blood cell counts, while 11 of the 12 EVALI patients showed an increased white blood cell count. Second, patients with severe EVALI tended to be young, with a mean age of 30.8 years old. While COVID-19 can severely affect younger adults, it’s relatively uncommon.

While treatments for COVID-19 are being evaluated, EVALI patients typically respond well to established treatments, such as to corticosteroids. Drs. Blagev and Callahan said this is why physicians should consider EVALI when evaluating patients who test negative for COVID-19.

“The risk of missing other diseases that can present with similar and non-specific symptoms, such as a cough or shortness of breath, remains during this time,” said Dr. Blagev.

She said while it’s more challenging to diagnose in the time of COVID, EVALI remains an important diagnosis to consider in patients, particularly after an initial negative COVID test.

“First, and foremost, it’s important to keep EVALI in mind because that diagnosis has different treatment and prognosis than COVID. Equally important during a pandemic is ruling out COVID before making the diagnosis of EVALI,” she added.

See original post here.

Severity of COVID-19 determines likelihood of pregnancy complications

Pregnant women who contract SARS-CoV-2, the strain of the virus that causes COVID-19, are at greater risk of dying and experiencing serious complications compared to nonpregnant women who contract the disease, according to a recent report by the Centers for Disease Control and Prevention (CDC).

Now, in a new study, researchers unveil findings that suggest that pregnant women who become severely or critically ill due to COVID-19 are at greater risk of dying and experiencing serious pregnancy complications compared to pregnant women who have COVID-19 but were asymptomatic, or without symptoms. In contrast, pregnant women with mild or moderate illness were not at higher risk of pregnancy complications than those without symptoms. The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

The study examined medical records of 1,219 pregnant women from 33 hospitals in 14 states from March 1, 2020 to July 31, 2020. All patients tested positive for COVID-19; 47 percent were asymptomatic, 27 percent were mild, 14 percent were moderate, 8 percent were severe, and 4 percent were critical.

Findings showed that pregnant women who become severely or critically ill due to COVID-19 were older, had a higher body mass index, and were more likely to have underlying medical conditions, such as asthma/chronic obstructive pulmonary disease (COPD), diabetes, and high blood pressure. These women were more likely to die or have serious complications, such as cesarean delivery; heavy bleeding after giving birth, known as postpartum hemorrhage; high blood pressure during pregnancy; and preterm birth. High blood pressure and preterm birth also have the potential to cause long-term health problems in women or their infants.

A total of four women (0.3%) died due to COVID-19, a figure that is higher than the death rate for pregnant women without COVID-19. The death rate for pregnant women without COVID-19 is 17.4 deaths per 100,000 live births, according to the latest data from the CDC.

“Our research shows that serious pregnancy complications appear to occur in women who have severe or critical cases of COVID and not those who have mild or moderate cases,” said the study’s lead author, Torri D. Metz, a maternal-fetal medicine subspecialist and associate professor at the University of Utah Health.

“This information helps us to counsel our patients more effectively. For pregnant women who have contracted a mild or moderate case of COVID-19, these findings can help to alleviate their fears that they are at an increased risk of having serious pregnancy complications due to the disease.”

Find original post here.

Learn more about the study.

Learn more about the Society for Fetal Medicine here.

Utah HERO project announces phase one findings

The Utah Health and Economic Recovery (HERO) Project— a collaboration between the David Eccles School of Business at the University of Utah, University of Utah Health, Study Design and Biostatistics Core of the Center for Clinical and Translational Science, the Governor’s Office of Management and Budget, Utah Department of Health and the Hope Corps—has concluded phase one of a large-scale undertaking to test 10,000 Utahns from across four counties. In phase one, field workers collected data from 8,500 Utahns aged 12 and older from Davis, Salt Lake, Summit and Utah counties. The data gathered will inform decision-makers in the state as they work to help keep residents safe and get people back to work.

Phase One of the two-phase project aims to measure the proportion of people who have antibody to SARS-CoV-2, the virus that causes COVID-19 infection, in order to understand prevalence within the population (that is the total number of infections that have occurred over time) and other factors associated with the virus . Phase Two will extend the same work to Utah’s other counties, assess communities that may have high viral activity, focus on students/children to help guide best practices for returning to school, and monitor changes in antibody prevalence over time.

Phase One Main Findings:

Results were analyzed for blood samples and nasopharyngeal tests collected between May 4th and June 10th, 2020. This project used the best available tests to yield accurate estimates. A random sampling scheme called cluster sampling was used to get a representative sample. The estimated seroprevalence accounts for sampling design, non-response, and test error.

  • It is estimated that the overall 4-county seroprevalence (or the proportion of members of the population with detectable antibodies to SARS-CoV-2) is 0.96% (95% confidence interval: 0.42% – 1.81%). This means that about 1 in 100 residents of these counties showed evidence of prior infection.
  • For every case that was detected by some other means, there were approximately another 2.4 cases that were not detected.This is lower than case count ratios reported in community seroprevalence studies conducted in other states and suggests that testing was comparatively comprehensive during the early months of the pandemic In Utah.
  • Roughly 30% of participants who were seropositive (i.e., had COVID-19 antibodies) reported having a prior positive COVID test, which is consistent with the detected fraction estimated at the population level, as reported above. To re-emphasize, more people have had COVID-19 infection than what clinical diagnosis, contact tracing, and screening indicate.
  • We estimate the infection fatality rate (or ratio) in Utah to be approximately 0.29% (with an approximate 95% confidence interval of 0.16% to 0.67%). The case fatality rate, the proportion of fatalities among diagnosed cases, is approximately 0% in Utah. Note: the term “case fatality rate (ratio)” refers to COVID-19 related deaths among reported cases of COVID-19 infection while the term “infection fatality rate (ratio)” includes both detected and undetected COVID-19 infections. Hence, the case fatality rate can be expected to be larger than the infection fatality rate, proportional to the seroprevalence to case count ratio.
  • When one member of a household had antibody to SARS-CoV-2, the proportion of other members of the household that were seropositive was 12.4%. This figure is a rough estimate of the secondary attack rate of COVID-19 infection within households.
  • Overall, 0.2% of nasopharyngeal swabs were positive by viral PCR testing.

Implications: Phase One has two implications. First, the low seroprevalence and the relatively high detection fraction indicate that Utah’s early efforts to monitor and limit SARS-CoV-2 infections were successful. Second, the low seroprevalence indicates our population is highly susceptible to COVID-19. As efforts to restore economic and social activities are underway, it is imperative that recommended preventive measures are followed to retain the benefits achieved through substantial statewide efforts over the past few months. NOTE: the data in this report largely reflect infections that occurred up until the beginning of June, before current increases in detected cases.

Overview of project design: Utah HERO provides the first randomized, representative estimate of seroprevalence in Utah using two different systematic sampling designs. The project’s primary sampling design targeted 10,694 randomly selected households and used an intensive sampling process including both in-person visits and mailings to maximize the response rate across these households. Because of the need to conduct in-person visits and obtain laboratory testing, the primary design used a clustered sampling approach in which the targeted households were sampled from 23 of 229 compact geographic areas (defined by two or more adjacent Census tracts) which were themselves randomly selected across the four-county area. An additional 10,040 households across the same four counties were recruited by mailings, but did not receive in-person visits.

This “letter only” sampling design was able to broadly sample across all geographic areas within the four counties, but the less intensive sampling led to a higher rate of non-response. Both the primary and secondary designs utilized stratified random sampling based on 15 strata defined by combinations of  the COVID-19 cumulative case count at the start of the study, median age, and the proportion of individuals self-identifying as Hispanic to the Census. The stratified sampling plan assured adequate representation in the project across the different ethnicity, age, and COVID-19 case-count groups. By taking into account the relative proportions of individuals within each stratum, our data analyses are able to make inferences to the full population across these strata, as well as to important subgroups of individuals.

See original press release here.

U studying services for homeless populations during COVID-19

This is adapted from a release by the University of North Texas, available here, and is used with permission.

University of Utah political scientist Jesus Valero is embarking on a study of how the continuum of care for people experiencing homelessness, which includes the social, medical, public health and education sectors, has changed during the COVID-19 pandemic.

Valero and Hee Soun Jang, an associate professor and graduate coordinator for the Department of Public Administration at the University of North Texas, have been researching services for people experiencing homelessness that are run at a local level and often involve multiple agencies known as Continuum of Care.

“Understanding how organizations from the medical, social, and public health systems are working together to address the needs of individuals and families experiencing homelessness during COVID-19 is crucial to improving the effectiveness of community programs,” Valero said.

“Continuum of Care is a premise that is unique to improving a fragmented service system for homelessness,” Jang said. “There are innovative and interesting examples of individual agencies providing successful interventions for homeless populations. But, because agencies do not always coordinate services and information with one another, it is difficult to capture comprehensive knowledge of homeless populations.”

In their new research project, funded by a grant from Systems for Action, a national research program of the Robert Wood Johnson Foundation (RWJF), Valero and Jang are specifically looking at how Continuum of Care networks were affected by COVID-19. They will use previous national studies from 2018 conducted by IBM and RWJF to compare pre-COVID-19 levels of service with current offerings.

“The COVID-19 pandemic has disproportionately affected vulnerable populations and this RWJF-funded project seeks to identify best practices and the conditions that help communities achieve successful collaboration for those experiencing homelessness,” Valero said.

The two-year project will start with case studies in 20 U.S. cities that have both high levels of homelessness and high levels per capita of COVID-19 cases. The second year will consist of a national survey developed from the case studies. Valero and Jang will integrate factors such as racial equity into their research.

“The community has to develop its coordinated approach and aligned mechanism for a fuller, holistic, comprehensive service system that can help these homeless communities,” Jang said. “The people that experience homelessness are in very different stages of their lives. There is no single approach that can fix the problem.”

Findings will be used to understand the effects of the pandemic on Continuum of Care homeless service networks and the effectiveness of the networks in achieving health equity during COVID-19.

“We hope,” Valero said, “that the results of this study will help improve the coordination of cross sector actors in addressing the multidimensional needs of homeless individuals particularly during this public health pandemic.”

See original post here.

Systems for Action is a national research program of the Robert Wood Johnson Foundation that aims to discover and apply new evidence about ways of aligning delivery and financing systems across the medical, public health, and social services sectors that support a Culture of Health.

COVID-19 complication clues

An overactive defense response may lead to increased blood clotting, disease severity and death from COVID-19. A phenomenon called NETosis—in which infection-fighting cells emit a web-like substance to trap invading viruses—is part of an immune response that becomes increasingly hyperactive in people on ventilators and people who die from the disease.

A team led by University of Utah Health and PEEL Therapeutics, in collaboration with Cold Spring Harbor Laboratory and Weill Cornell Medicine, report the findings in a new study published in the journal Blood.

“This study tells us about a potential mechanism for lung injury in COVID-19 that had not previously been recognized as a possible target for treatment,” says Elizabeth Middleton, the study’s first author and a critical care specialist at U of U Health.

The investigation also reports that a naturally occurring protein—originally found in umbilical cord blood—quiets this NET immune response in laboratory experiments, potentially opening new avenues for treatment.

A microscopic image of immune cells emitting a web-like substance in hot pink, with small specks of hot green specks.

Image of infection-fighting cells emitting a web-like substance (hot pink) to trap invading viruses.

It is estimated that up to 10% of people with COVID-19 become critically ill with respiratory distress. Causes of lung damage are a subject of intense investigation, and increasing evidence demonstrates that increased blood clotting may lead to complications caused by the disease.

A research team led by Elizabeth Middleton (pictured), Christian Con Yost and Joshua Schiffman at University of Utah Health has found that a phenomenon called NETosis—in which infection-fighting cells emit a web-like substance to trap invading viruses—is part of an immune response that becomes increasingly hyperactive in people on ventilators and people who die from the disease.

As part of an immune response, white blood cells release web-like Neutrophil Extracellular Traps (NETs) to capture and kill pathogens. While typically beneficial, Yost had previously shown that overactive NETs exacerbate certain illnesses. In conditions such as overwhelming infection, NETs can clog blood vessels and lead to inflammatory tissue damage.

To determine whether NETs could be responsible for complications seen in COVID-19, the team examined plasma from 33 patients, along with tracheal aspirates from the lungs. They found that NET activity correlated with disease severity.

Patients on life support and those who died from COVID-19 had significantly more signs of NET activation than patients who were not as sick or who went on to recover. The NET immune response was lower still in healthy people. NET levels also tracked with a marker for blood-oxygen levels, an independent indicator of disease severity.

Similarly, plasma from sick patients was primed to launch the NET response. When examined in laboratory experiments, plasma from COVID-19 patients triggered white blood cells from healthy patients to shoot out 50 times as many NETs as cells exposed to plasma from otherwise healthy adults.

“This study may tell us that NET levels in the blood could potentially help predict disease severity and mortality in COVID-19,” says Yost. “Additional information is urgently needed in this pandemic regarding how to know which patient will fare better or worse.” Larger studies will need to be done to determine whether NETs could become a biomarker for COVID-19 severity. “Importantly, we think exaggerated NETs could be a cause of morbidity and mortality in COVID-19,” Yost says.

In support of the idea, collaborators at Cold Spring Harbor Laboratory showed that blood vessels in the lungs of deceased COVID-19 patients were dotted with clumps of NET-producing cells and a critical type of blood cell for clotting, the platelets. Another recent study from U of U Health showed that platelets become hyperactive during the disease. Investigations are now underway to determine whether NETs and platelets increase the risk for blood clotting and other clinical manifestations of COVID-19.

Two scientists wearing face visors, blue hospital gowns, and thick blue rubber gloves working in a lab.

A research team led by Elizabeth Middleton (pictured), Christian Con Yost and Joshua Schiffman at University of Utah Health has found that a phenomenon called NETosis—in which infection-fighting cells emit a web-like substance to trap invading viruses—is part of an immune response that becomes increasingly hyperactive in people on ventilators and people who die from the disease.

“In COVID-19, thrombosis is a major cause of death. So, our findings tell us that we should focus on understanding more about NETs’ role in clotting in COVID-19,” Mikala Egeblad, a cancer researcher from Cold Spring Harbor Laboratory, says. “Thrombosis is also a major cause of death in late-stage cancer, where there also can be elevated NETs in the blood. Therefore, I think that what we learn from COVID-19 will help us with other diseases, including cancer.”

Additionally, laboratory experiments showed that a small protein found in the umbilical cord blood of newborn babies, called neonatal NET Inhibitory Factor (nNIF), quiets the hyperactive NET response in white blood cells treated with COVID-19 patient plasma. This peptide is thought to protect babies from harmful inflammation early in life, explains Schiffman, CEO of PEEL Therapeutics. His company is now evaluating whether the protein could become the basis for clinical treatment.

“Newborns babies have a natural therapeutic in their blood to protect against these same inflammatory events that we think could be killing COVID-19 patients,” Schiffman says. “This targeted approach to stopping NETs may be more effective with fewer side effects than some other drugs being tested now in COVID-19 patients that block the entire immune system­­­­.”

Find original post here.

The research was carried out in collaboration with PEEL Therapeutics, Cold Spring Harbor Laboratory, New York Presbyterian Hospital, and Weill Cornell Medicine and published as “Neutrophil Extracellular Traps (NETs) Contribute to Immunothrombosis in COVID-19 Acute Respiratory Distress Syndrome” on June 29, 2020, in Blood.

Support for the work came from the National Institutes of Health, University of Utah Health’s 3i Initiative, Fonds voor Wetenschappelijk Onderzoek Vlaanderen FWO, Animal Cancer Foundation, Soccer for Hope Foundation, Closer to Cure Foundation, PEEL Therapeutics, Inc., William C. and Joyce C. O’Neill Charitable Trust, the Linartz-Meier Family Foundation and the U.S. Department of Veterans Affairs.

Utah’s young population contributes to relatively low COVID-19 death rate

Research from the Kem C. Gardner Policy Institute shows Utah’s relatively young population is contributing to a lower COVID-19 death rate than the nation as a whole. As of July 14, 2020, the CDC COVID Data Tracker reported the Utah and U.S. per-capita death rates as 7.0 and 41.3 per 100,000, respectively, a difference of 34.3. Using various decomposition methods, demographers at the Gardner Institute estimate that about 8 of those deaths per capita are attributable to Utah’s younger population, with the remaining difference being a result of other factors.

“In many ways, this analysis is more exploratory than definitive, since the provisional data are still so fresh,” said Mike Hollingshaus, senior demographer at the Gardner Institute and lead author of the brief. “But, it provides an alternative outlook on the data. This different way of thinking changes how policymakers view per-capita rates and recommends a nuanced approach to the decision-making process.”

The analysis provided instructive, but still preliminary answers to three questions:

1. What would Utah’s COVID-19 death rate be if its population had the same age structure as the U.S. population? 

If Utah had the same age structure as the U.S., its death rate would rise by nearly 50% to 10.1 per 100,000.

2. What would the U.S. rate be if its age structure were identical to Utah’s?

If the U.S.’s age structure were similar to Utah’s, its death rate would drop by nearly one-third to 28.3 per 100,000, and deaths would have numbered under 100,000 instead of over 130,000 as of July 14.

3. How much of Utah’s lower death rate is the result of the state’s younger population?

About one-quarter of Utah’s lower death rate is attributable to its younger population. The majority (three-fourths) is due to other factors.

In addition to Utah’s young population, other socioeconomic, environmental and demographic characteristics likely play a role in explaining some of the remaining differences in the state’s death rate. The state could also have a lower per-capita rate due to better prevention, response, and treatment; but that conclusion is not justified until these other factors have been accounted for in statistical models.

“Utahns should continue to proceed with caution and remember that demographics matter when combating the profound impacts of COVID-19 on our society,” said Pamela Perlich, director of demographic research at the Gardner Institute. “We hope our research can help decision-makers wisely interpret and act upon population-level metrics as they develop effective policies to combat the pandemic.”

The full research brief and methodology are now available online.

The U leads national study of COVID-19 effects on pregnancy

A University of Utah Health researcher is leading a nationwide study of the effects of the COVID-19 pandemic on women during and after pregnancy.

Torri D. Metz, an associate professor of obstetrics and gynecology, is the principal investigator of a multipronged study that will analyze the medical records of up to 21,000 pregnant women. The study, supported by the National Institutes of Health (NIH), seeks to determine if changes to health care delivery implemented in response to the pandemic have resulted in higher rates of pregnancy-related complications and cesarean delivery.

The study, conducted by researchers in the Maternal-Fetal Medicine Units (MFMU) Network, a group of 12 U.S. clinical centers including the University of Utah Hospital, will also try to establish the risk of pregnant women with COVID-19 transmitting the virus to their fetuses. Newborns will be monitored and assessed until they are discharged from the hospital.

In addition, the scientists will track the health of more than 1,500 pregnant women with confirmed cases of COVID-19 for six weeks after childbirth.

“There have been so many changes in maternal health care in the past few months, both for practitioners and expectant women themselves,” Metz says. “Their relative willingness to come in for care during this time is declining. We’re seeing more and more data nationally that women are delaying presentation for care or not coming in for care at all because they fear contracting COVID-19. That decision actually puts them at higher risk of maternal morbidity and mortality.”

Telehealth can replace much of the necessary care provided by physicians, says Metz, who is also vice chair for research at U of U Health. However, there is the potential that some complications could be missed.

Among the risk factors the researchers will track are increased incidence of high blood pressure, postpartum hemorrhage and infections. The team will analyze medical records of women who delivered children on the same randomly chosen days (April 19, for instance) in 2019 and 2020 to determine if new moms in 2020 had an increased risk of adverse outcomes. The study will run through the end of the year.

“The questions we will be addressing in this study are ones that a lot of practitioners and women who are pregnant or are considering getting pregnant are asking themselves,” Metz says. “Hopefully, this study will illuminate some of the answers so that we can better counsel women on what to expect.”

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The study is funded by the Eunice Kennedy Shiver National Institute of Child Health and Human Development (NICHD).