IntroductionSmoking causes inflammation of the lung epithelium by releasing cytokines and impairing mucociliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association.MethodsThis was a retrospective analysis of all adults hospitalised with COVID-19 from 9 March to 18 May 2020.Results1173 patients met the study criteria. 837 patients never smoked whereas 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male and had higher incidence of underlying chronic obstructive pulmonary disease (19% vs 6%, p<0.001), HIV infection (11% vs 5%,p<0.001), cancer (11% vs 6%, p=0.005), congestive heart failure (15% vs 8%, p<0.001), coronary artery disease (15% vs 9%, p=0.3), chronic kidney disease (11% vs 8%, p=0.037) and end-stage renal disease (10% vs 6%, p=0.009) compared with non-smokers. Outcome analysis showed that smokers were more likely to develop critical illness requiring mechanical ventilation (47% vs 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that among smokers only current smokers had higher risk of death compared with never smokers (HR 1.61, 95% CI 1.22 to 2.12, p<0.001). In the multivariate approach, Cox model for the survival, female sex, young age, low serum lactate dehydrogenase and systemic steroid use were associated with overall improved survival.ConclusionIn our large single-centre retrospective database of patients hospitalised with COVID-19, smoking was associated with development of critical illness and higher likelihood of death.

Vaccines will play a key role in ending the COVID-19 pandemic. Vaccination against infections remains an important part of the management of patients with multiple sclerosis. However, there are limited data about the safety and efficacy of the currently available COVID-19 mRNA vaccines in patients with multiple sclerosis receiving concurrent immunosuppressive therapies. Patients on B cell depleting therapy such as ocrelizumab have an attenuated vaccine response. We report the first case of COVID-19 vaccine failure in a patient with relapsing-remitting multiple sclerosis on B cell depleting therapy, ocrelizumab. We offer suggestions to improve vaccine efficacy in these patients.

Background: Since the start of coronavirus disease 2019 (COVID-19) pandemic, several studies have linked obesity with severity of illness as well as mortality in patients with COVID-19. Outcomes of patients with overweight or obesity, who develop critical illness, have been studied extensively over the past decade where the studies have shown conflicting results. In this study, we aimed to assess the association between the body mass index (BMI) classes and outcomes among hospitalized patients with COVID-19.Methods: This was a retrospective chart review of all adults admitted to our hospital with COVID-19 illness between 1 March 2020 and 30 June 2020. Patients were divided into four groups based on their BMI range as follows: patients with underweight (BMI < 18.5 kg/m 2 ), patients with normal weight (BMI 18.5-24.9 kg/m 2 ), patients with overweight (BMI 25-29.9 kg/m 2 ), and patients with obesity (BMI ≥ 30 kg/m 2 ).Results: 1274 patients were admitted during the study period. There were 24(1.9%) patients with underweight, 268 (21%) patients with normal weight, 445 (34.9%) patients with overweight, and 537 (42.2%) patients with obesity. Patients with obesity were younger (p < 0.001) and there were more females among patients with underweight and patients with obesity (54% and 48% respectively, p < 0.001).There were no differences in subgroup with regards to presence of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, and dyslipidemia. In a multivariate logistic regression model, patients with overweight and patients with obesity had higher odds of requiring mechanical ventilation. BMI class was not associated with difference in survival time in a multivariate analysis. Conclusions:In our large single-center study of hospitalized patients with COVID-19, patients with overweight and obesity had higher need for mechanical ventilation but had similar mortality when compared to patients with normal weight and underweight.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Background Monoclonal antibody therapy (MAT) is recommended in mild to moderate Coronavirus disease 2019 (COVID-19) patients who are at risk of progressing to severe disease. Due to limited data on its outcomes and the logistic challenges in administering the drug, MAT has not been widely used in the United States (US) despite of emergency use authorization (EUA) approval by the Food and Drug Administration (FDA). Aim We aim to study the outcomes of MAT in patients predominantly from ethnic minority groups and the challenges we experienced in implementing the infusion therapy protocol in an inner-city safety-net-hospital in the South Bronx. Methods and results We conducted a retrospective observational study of 49 patients who were offered MAT as per EUA protocol of FDA. Patient who met the criteria for MAT and received therapy were included in treatment group ( n = 38) and the remaining ( n = 11) who declined treatment were included in the control group. A majority of patients (76%) in the study group reported symptomatic improvement, the day after infusion. There was statistically significant reduction in COVID-19 related hospitalizations (7.8 vs 54.5%, P = < 0.001) mortality (0 vs 18.1%, P value = 0.008) in the treatment group. Conclusion MAT reduced both hospitalization and mortality in this predominantly Hispanic patient population with mild to moderate COVID-19 with high risk factors for disease progression.