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COVID-19 Scan for May 24, 2021

Age, health conditions are linked with COVID severity in pregnant women

Increased age and underlying medical conditions were associated with a greater likelihood for more severe COVID-19 infections in pregnant women, according to a study late last week in Clinical Infectious Diseases.

The researchers used the Surveillance for Emerging Threats to Mothers and Babies Network to identify 7,950 pregnant women, 20.9% of whom had moderate-to-severe or critical illness. Mothers were identified from Mar 29, 2020, to Mar 5, 2021. Most were 20 to 39 years old (91.2%) and had Medicaid (54.5%). About one in three (36.4%) had at least one underlying condition, with the most common being pre-pregnancy obesity (28.2%). 

Crude odds showed increased risk associations of moderate or worse COVID-19 infections with increasing age among pregnant women with COVID-19. Risk ratios (RRs) went from 1.32 for those 25 to 29 up to 1.66 for those 40 and older, compared with those under 20. Other independent associations included healthcare occupation (RR, 1.25), pre-pregnancy obesity (RR, 1.36), chronic lung disease (RR, 1.37), chronic hypertension (RR, 1.45), and pregestational diabetes mellitus (RR, 1.66). Any one health condition, whether pre-pregnancy or pregnancy-related, increased risk of moderate-to-severe or critical COVID-19 infection 1.39 times, and three or more health conditions increased the risk 2.31 times.

While non-private health insurance was associated with a 0.62 RR in crude analysis among pregnant women with COVID-19, the adjusted RR did not show any association—the only factor to have different results after adjustment. Cardiovascular disease, immunosuppression, gestational diabetes, and gestational hypertension did not have increased risk. Additionally, although the researchers noted that 42.0% of pregnant women with COVID-19 were Hispanic, the data did not show associations for any race or ethnicity.

“In this analysis, approximately half of pregnant women with moderate-to-severe or critical illness had no reported underlying medical conditions, which reinforces the importance of preventive measures, including vaccination, for pregnant women,” the researchers write.
May 22 Clin Infect Dis study


Medication patterns changed for hospitalized COVID-19 patients

Since the start of the COVID-19 pandemic, medication use patterns for hospitalized COVID-19 patterns have changed. To help quantify these trends, a JAMA Network Open study published late last week looks at the changes across the University of California (UC) Health medical centers for 10 medications or medication classes: dexamethasone, remdesivir, enoxaparin, heparin, colchicine, hydrocortisone, tocilizumab, azithromycin, hydroxychloroquine, angiotensin-2 converting ace inhibitors, and angiotensin receptor blockers.

Using the UC COVID Research Data Set, the researchers looked at daily use and overall use percentages for medication treatments that 3,546 hospitalized COVID-19 patients received from Mar 10 to Dec 31, 2020. Some of the most notable changes were in hydroxychloroquine, azithromycin, dexamethasone, and remdesivir. The drug enoxaparin saw steady use throughout 2020, most likely because its use as thrombosis prevention and treatment also appeared to help with COVID-related blood clots.

Hydroxychloroquine and azithromycin were two antimicrobials that were each used in more than 40% of hospitalized patients at the beginning of the pandemic, but by June, use declined to below 5% and below 40%, respectively, as new studies came out.

Dexamethasone and remdesivir, on the other hand, saw increases as the pandemic continued, with the former going from 1.4% patient use on Mar 31 to 67.5% by the end of the year, in part, the researchers said in a UC-Irvine press release, due to large trial results in the United Kingdom. Remdesivir grew 12-fold from June to December, which the researchers may say be because early on, the medication was only available for patients enrolled in UC trials.

“You can clearly see how usage of certain medicines grew or declined over the course of the pandemic and how those movements were tied to evidence-based decisions being made by UC healthcare providers in real time,” said lead author Jonathan Watanabe, PharmD, PhD, UC professor, in the press release. “You can monitor the evolution in how we treat our sickest patients.”
May 21 JAMA Netw Open study
May 21 UC-Irvine
press release

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