Research on long COVID in Utah

While most people who have had COVID-19 recover within a few weeks, as many as 1 in 3 people experience long term side effects of the disease. This is called “Long COVID.” Researchers are grappling with the unknowns of Long COVID: Why does it happen? Who does it happen to? How can we help those who have it?

Learn how researchers at University of Utah Health leverage a global crisis to make a tangible impact on lives in Utah and beyond.

U of U Health leads national studies of “long covid” in adults and during pregnancy

University of Utah Health scientists are on the leading edge of a pair of large studies investigating the long-term effects of COVID-19. The nationwide studies, supported by the National Institutes of Health, will attempt to answer key questions about the lingering effects of the viral disorder on pregnant individuals and their infants, as well as why some people develop post-acute sequelae of SARS-CoV-2 (PASC), including “long COVID,” and others don’t.

PASC affects up to 30% of COVID-19 patients, causing a host of lingering and potentially serious symptoms. These include fatigue, breathing difficulties, memory problems, chest pain, and fast or pounding heart. The two groups are part of a larger NIH initiative, “Researching COVID to Enhance Recovery” (RECOVER) Initiative, which seeks to understand, prevent, and treat PASC.

Torri D. Metz, M.D., a University of Utah maternal-fetal medicine specialist. Photo credit: Charlie Ehlert

Assessing COVID-19’s impact on pregnancy, newborns

Among the vital but still unanswered questions about COVID-19 and PASC is what influence the disease may have on pregnant individuals and their infants.

“We really don’t understand right now what the long-term consequences are of getting COVID-19 in pregnancy,” says Torri D. Metz, MD, MS, a maternal-fetal medicine subspecialist and associate professor at U of U Health who is leading a multi-center effort seeking answers to this question.

Headshot of

Rachel Hess, M.D., co-director of the Utah Clinical and Translational Science Institute (CTSI). Photo credit: Charlie Ehlert

Previous research suggests that pregnant individuals who have severe COVID-19 are three times more likely to receive intensive care and twice as likely to die of the disease than those who aren’t pregnant. While transmission of the virus from mother to child during pregnancy is rare, up to 3% of babies born to women with COVID-19 test positive for the virus after birth.

“It’s possible that the disease may be different in pregnant women because their immune systems function a bit differently than in non-pregnant women,” Metz says. “In terms of offspring, we know how important the in-utero environment is for babies, and we’re concerned that the inflammatory process that occurs when patients who are pregnant get COVID-19 may affect the babies in utero and after they are born.”

Over the next four years, Metz and her colleagues from 12 other medical institutions nationwide involved in the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units (MFMU) Network will track the health of about 1,500 women who had COVID-19 during pregnancy and their children who were born in the following days, weeks, or months. They will also track the health of about 250 women who did not get COVID-19 during pregnancy and their offspring.

In particular, the researchers will be looking for any impairments in cognitive development or cardiovascular complications among the children as they grow. They will also compare the long-term effects of PASC on the mothers who had COVID-19 during pregnancy versus pregnant individuals who were uninfected.

Sorting out why some people get ‘Long COVID’

Rachel Hess, M.D., co-director of the Utah Clinical and Translational Science Institute (CTSI), leads an effort by the Mountain States PASC Consortium (MSPC), a coalition of five health care systems in Utah, Colorado, and New Mexico. The group will compare COVID-19 patients who have or have had PASC with those who had COVID-19 but did not develop long-term symptoms.

“My biggest hope for the MSPC study is that we can develop a better understanding of why some people are experiencing really debilitating PASC symptoms and eventually help them get back to normal—or as close to it as possible,” Hess says.

The consortium plans to recruit more than 900 adults, 18 and older, for the study, including a diverse set of volunteers from Hispanic, Native American, and rural populations within the Mountain West region.

“Because this is such a new syndrome, determining what is different about people who develop PASC as a result of having COVID-19 is an important task,” Hess says. “This study could help us better define what this syndrome is and improve our understanding of its biological basis.”

The MSPC study includes patients who have been newly diagnosed with COVID-19, as well as those who had COVID-19 throughout the pandemic. Others who have not been infected with SARS CoV-2, the virus that causes COVID-19, will be recruited as a control group.

“Tracking individuals who currently have COVID-19 could help us determine if there are any patterns early in the disease that lead some patients to develop PASC later on,” Hess says.

Rachel Hess, M.D., co-director of the Utah Clinical and Translational Science Institute (CTSI), leads an effort by the Mountain States PASC Consortium (MSPC), a coalition of five health care systems in Utah, Colorado, and New Mexico. The group will compare COVID-19 patients who have or have had PASC with those who had COVID-19 but did not develop long-term symptoms.

“My biggest hope for the MSPC study is that we can develop a better understanding of why some people are experiencing really debilitating PASC symptoms and eventually help them get back to normal—or as close to it as possible,” Hess says.

The consortium plans to recruit more than 900 adults, 18 and older, for the study, including a diverse set of volunteers from Hispanic, Native American, and rural populations within the Mountain West region.

“Because this is such a new syndrome, determining what is different about people who develop PASC as a result of having COVID-19 is an important task,” Hess says. “This study could help us better define what this syndrome is and improve our understanding of its biological basis.”

The MSPC study includes patients who have been newly diagnosed with COVID-19, as well as those who had COVID-19 throughout the pandemic. Others who have not been infected with SARS CoV-2, the virus that causes COVID-19, will be recruited as a control group.

“Tracking individuals who currently have COVID-19 could help us determine if there are any patterns early in the disease that lead some patients to develop PASC later on,” Hess says.

Young people recover quickly from rare myocarditis side effect of COVID-19 vaccine

Adapted with permission from the American Heart Association.

Most young people under the age of 21 who developed suspected COVID-19 vaccine-related heart muscle inflammation known as myocarditis had mild symptoms that improved quickly, according to new research published today in the American Heart Association’s flagship journal Circulation.

Myocarditis is a rare but serious condition that causes inflammation of the heart muscle. It can weaken the heart and affect the heart’s electrical system, which keeps the heart pumping regularly. It is most often the result of an infection and/or inflammation caused by a virus.

Using data from 26 pediatric medical centers across the United States and Canada, researchers reviewed the medical records of patients younger than 21 who showed symptoms, lab results or imaging findings indicating myocarditis within one month of receiving a COVID-19 vaccination, prior to July 4, 2021. Cases of suspected vaccine-associated myocarditis were categorized as “probable” or “confirmed” using CDC definitions.

Of the 139 teens and young adults, ranging from 12 to 20 years of age, researchers identified and evaluated:

  • Most patients were white (66.2%), nine out of 10 (90.6%) were male and median age was 15.8 years.
  • Nearly every case (97.8%) followed an mRNA vaccine, and 91.4% occurred after the second vaccine dose.
  • Onset of symptoms occurred at a median of 2 days following vaccine administration.
  • Chest pain was the most common symptom (99,3%); fever and shortness of breath each occurred in 30.9% and 27.3% of patients, respectively.
  • About one in five patients (18.7%) was admitted to intensive care, but there were no deaths. Most patients were hospitalized for two or three days.
  • More than three-fourths (77.3%) of patients who received a cardiac MRI showed evidence of inflammation of or injury to the heart muscle.
  • Nearly 18.7% had at least mildly decreased left ventricular function (squeeze of the heart) at presentation, but heart function had returned to normal in all who returned for follow-up.

“These data suggest that most cases of suspected COVID-19 vaccine-related myocarditis in people younger than 21 are mild and resolve quickly,” said the study’s first author, Dongngan T. Truong, M.D., an associate professor of pediatrics in the division of cardiology at University of Utah Health and a pediatric cardiologist at Intermountain Primary Children’s Hospital in Salt Lake City. “We were very happy to see that type of recovery. However, we are awaiting further studies to better understand the long-term outcomes of patients who have had COVID-19 vaccination-related myocarditis. We also need to study the risk factors and mechanisms for this rare complication.”

Researchers say future studies should follow patients who have suffered vaccine-associated myocarditis over a longer term, since this study examined only the immediate course of patients and lacks follow-up data. Additionally, there are several important limitations to consider. The study design did not allow scientists to estimate the percentage of those who received the vaccine and who developed this rare complication, nor did it allow for a risk/benefit ratio examination. The patients included in this study were also evaluated at academic medical centers and may have been more seriously ill than other cases found in a community.

“It is important for health care professionals and the public to have information about early signs, symptoms and the time course of recovery of myocarditis, particularly as these vaccines become more widely available to children,” Truong said. “Studies to determine long-term outcomes in those who have had myocarditis after COVID-19 vaccination are also planned.”

COVID-19 linked to serious health complications during pregnancy

Pregnant individuals infected with SARS-CoV-2, the virus that causes COVID-19, are about 40% more likely to develop serious complications or die during pregnancy than those who aren’t infected with the virus, according to a nationwide study led by a University of Utah Health obstetrician.

The researchers concluded that the severity of COVID-19 symptoms is a key indicator of heightened risk of pregnancy complications. This was particularly evident among the most severely ill people, who were three times more likely to develop pregnancy complications than those who tested negative or who were less affected by the disease.

“We already knew that pregnant people are at higher risk for the complications of COVID-19 itself,” says Torri D. Metz, MD, MS, a maternal-fetal medicine  specialist and associate professor of obstetrics and gynecology at U of U Health who led the multi-center effort. “Our research is among the first to find that infection with SARS-CoV-2 can elevate the risk of serious consequences related to progression of common pregnancy complications such as developing high blood pressure, having postpartum bleeding, or acquiring an infection other than SARS. This is why we need to make sure pregnant individuals are vaccinated.”

Torri D. Metz, M.D., a University of Utah maternal-fetal medicine specialist. Photo credit: Charlie Ehlert

The study appears in the February 7, 2022, issue of JAMA.

The researchers analyzed electronic medical records of 14,104 pregnant individuals treated at 17 medical centers nationwide that participate in the Eunice Kennedy Shriver NICHD Maternal-Fetal Medicine Units (MFMU) Network between March 1, 2020, and December 31, 2020.

About 2,350 of these individuals tested positive for SARS-CoV-2 during pregnancy or within six weeks of delivery. More than 13% of those who tested positive developed pregnancy complications during the study compared to 9% of those who tested negative. All five of the maternal deaths occurred in the SARS-CoV-2 positive group. In addition, the researchers found that:

Complications were more prevalent with moderate to severe COVID-19.

Compared to those who had mild (flu-like) symptoms or were asymptomatic, pregnant individuals who had moderate or severe symptoms, requiring treatment with supplemental oxygen or ICU care, were about three times (26.1% vs. 9.2%) more likely to have serious pregnancy complications.

These problems included eclampsia, severe high blood pressure, kidney failure and other end organ damage caused by high blood pressure, sepsis from infections other than SARS-CoV-2, and endometritis requiring prolonged administration of intravenous antibiotics.

Premature birth was more likely in infected individuals.

SARS-CoV-2 infection was significantly associated with premature birth and NICU admission. However, maternal SARS-CoV-2 was not associated with any other adverse outcomes among newborns. In fact, only 1.2% of newborns tested positive for the virus before discharge.

People with certain characteristics were more likely to have complications.

Individuals who tested positive and subsequently developed pregnancy complications were more likely to have a body mass index (BMI) of 30 or higher and identify as Hispanic or Black. These findings are consistent with other demographic findings among non-pregnant individuals infected with the virus, Metz says.

Pregnant individuals who had moderate or severe COVID-19 symptoms were also at significantly higher risk of cesarean birth (45.4% vs. 32.4%) than those without SARS-CoV-2. However, cesarean birth rates were similar among those who had mild symptoms or were asymptomatic compared with those without SARS-CoV-2.

“Some pregnant individuals who have COVID-19 are just too sick for us to attempt a vaginal birth,” Metz says. “In certain circumstances, such as the onset of preeclampsia, the fetus is also far less likely to tolerate it.”

Among the study’s limitations is that 80% of the SARS-CoV-2 infections were detected in the third trimester, hampering efforts to evaluate the effects of the virus on complications early in pregnancy.

The study was also conducted prior to the widespread availability of mRNA vaccines. However, Metz says, the new findings bolster the scientific rationale behind efforts to get individuals who are pregnant, or considering having a child, vaccinated.

“The complications of pregnancy we observed were mostly in people who had moderate to severe symptoms of COVID-19,” Metz says. “We know from other studies that vaccination prevents the most severe symptoms of the disease. So, this is just another piece of the puzzle that should encourage pregnant people to get vaccinated.”

The study, “Association of SARS-CoV-2 Infection with Serious Maternal Morbidity and Mortality from Obstetric Complications,” appears in the February 7, 2022 issue of JAMA. It was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Center for Advancing Translational Sciences.

In addition to U of U Health, institutions participating in this study include George Washington University, University of Alabama, Northwestern University, Brown University, University of Texas Medical Branch, University of Pittsburgh, Case Western University, University of North Carolina, The Ohio State University, Columbia University, University of Pennsylvania, the University of Texas Health Sciences Center-Houston, and the University of Texas-Austin.

Conflicts of Interest: Torri D. Metz received personal fees and grants from Pfizer as well as grants from Gestvision; Brenna L. Hughes received personal fees from Merck; Hyagriv N. Simihan is an LLC co-founder of Naima Health and received personal fees from UptoDate outside of the current study; Alan T. N. Tita received grants from Pfizer; Maged Costantine reported a relationship with Baxter International, Momenta Pharmaxeuticals, Progenity, AMAG Pharmaceuticals, and ObsEva. No other authors report any conflict of interest.

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.