Interpretation of COVID-19 case fatality risk measures in England

Harman, Katie; Allen, Hester; Kall, Meaghan; Dabrera, Gavin

doi:10.1136/jech-2020-216140

Cited by 10 publications

(8 citation statements)

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“…The catastrophic zoonotic emergence of severe acute respiratory syndrome coronavirus 2 (SARS- in the human population in China at the end of 2019, and its subsequent pandemic spread has caused global devastation [1]. To date, only limited treatment regimens exist for COVID-19 patients [2][3][4], and their management is primarily supportive, with case-fatality rates remaining at 1% -2% in Western countries including the UK [5]. In the search of alternative methods to treat COVID-19, convalescent plasma therapy boosting levels of neutralising antibody has been considered as a potential means to reduce morbidity and mortality [6,7], particularly if given in early stages of infection [8].…”

Section: Introductionmentioning

confidence: 99%

Virological Characterization of Critically Ill Patients With COVID-19 in the United Kingdom: Interactions of Viral Load, Antibody Status, and B.1.1.7 Infection

Ratcliff

Nguyen

Fish

et al. 2021

The Journal of Infectious Diseases

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Background Convalescent plasma containing neutralising antibody to SARS-CoV-2 is under investigation for COVID-19 treatment. We report diverse virological characteristics of UK intensive care patients enrolled in the Immunoglobulin Domain of the REMAP-CAP randomised controlled trial that potentially influence treatment outcomes. Methods SARS-CoV-2 RNA in nasopharyngeal swabs collected pre-treatment was quantified by PCR. Antibody status was determined by spike-protein ELISA. B.1.1.7 was differentiated from other SARS-CoV-2 strains using allele-specific probes or restriction site polymorphism (SfcI) targeting D1118H. Results Of 1274 subjects, 90% were PCR-positive with viral loads 118-1.7x10 11 IU/ml. Median viral loads were 40-fold higher in those seronegative for IgG antibodies (n=354; 28%) compared to seropositives (n=939; 72%). Frequencies of B.1.1.7 increased from <1% in early November, 2020 to 82% of subjects in January 2021. Seronegative individuals with wild-type SARS-CoV-2 had significantly higher viral loads than seropositives (medians 5.8x10 6 and 2.0 x10 5 IU/ml respectively; p=2x10 -15). However, viral load distributions were elevated in both seronegative and seropositive subjects infected with B.1.1.7 (4.0x10 6 and 1.6x10 6 IU/ml respectively). Conclusions High viral loads in seropositive B.1.1.7-infected subjects and resistance to seroconversion indicate less effective clearance by innate and adaptive immune responses. SARS-CoV-2 strain, viral loads and antibody status define subgroups for analysis of treatment efficacy.

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Section: Introductionmentioning

confidence: 99%

Virological Characterization of Critically Ill Patients With COVID-19 in the United Kingdom: Interactions of Viral Load, Antibody Status, and B.1.1.7 Infection

Ratcliff

Nguyen

Fish

et al. 2021

The Journal of Infectious Diseases

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“…We are not yet able to calculate excess mortality as surveillance of deaths among people with HIV in 2020 is still under way. We cannot calculate case fatality or account for any differences in exposure to COVID‐19 comparing HIV and those without [ 37 ]. Despite HIV surveillance being comprehensive and of high quality, there were some missing data which may have affected our findings.…”

Section: Discussionmentioning

confidence: 99%

COVID‐19 mortality among people with diagnosed HIV compared to those without during the first wave of the COVID‐19 pandemic in England

et al. 2021

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Objectives We describe COVID‐19 mortality among people with and without HIV during the first wave of the pandemic in England. Methods National surveillance data on adults (aged ≥ 15 years) with diagnosed HIV resident in England were linked to national COVID‐19 mortality surveillance data (2 March 2020–16 June 2020); HIV clinicians verified linked cases and provided information on the circumstances of death. We present COVID‐19 mortality rates by HIV status, using negative binomial regression to assess the association between HIV and mortality, adjusting for gender, age and ethnicity. Results Overall, 99 people with HIV, including 61 of black ethnicity, died of/with COVID‐19 (107/100 000) compared with 49 483 people without HIV (109/100 000). Compared to people without HIV, higher COVID‐19 mortality rates were observed in people with HIV of black (188 vs. 122/100 000) and Asian (131 vs. 77.0/100 000) ethnicity, and in both younger (15–59 years: 58.3 vs. 10.2/100 000) and older (≥ 60 years: 434 vs. 355/100 000) people. After adjustment for demographic factors, people with HIV had a higher COVID‐19 mortality risk than those without (2.18; 95% CI: 1.76–2.70). Most people with HIV who died of/with COVID‐19 had suppressed HIV viraemia (91%) and at least one comorbidity reported to be associated with poor COVID‐19 outcomes (87%). Conclusions In the first wave of the pandemic in England, COVID‐19 mortality among people with HIV was low, but was higher than in those without HIV, after controlling for demographic factors. This supports the strategy of prioritizing COVID‐19 vaccination for people with HIV and strongly encouraging its uptake, especially in those of black and Asian ethnicity.

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“…An earlier smaller analysis of data over a 10-week period between June and September 2020 for England showed lower case fatality risk among LTCF residents compared with non-LTCF residents. 10 It should be noted that the odds of deaths and case fatality rates are highly influenced by access to testing. There are different arrangements for access to SARS-CoV-2 testing for those living and not living in LTCFs.…”

Section: Discussionmentioning

confidence: 99%

Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021

Paranthaman¹,

Allen²,

Chudasama³

et al. 2021

J Epidemiol Community Health

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BackgroundPersons living in long-term care facilities (LTCFs) are presumed to be at higher risk of adverse outcomes from SARS-CoV-2 infection due to increasing age and frailty, but the magnitude of increased risk is not well quantified.MethodsAfter linking demographic and mortality data for cases with confirmed SARS-CoV-2 infection between March 2020 and January 2021 in England, a random sample of 6000 persons who died and 36 000 who did not die within 28 days of a positive test was obtained from the dataset of 3 020 800 patients. Based on an address-matching process, the residence type of each case was categorised into one of private home and residential or nursing LTCF. Univariable and multivariable logistic regression analysis was conducted.ResultsMultivariable analysis showed that an interaction effect between age and residence type determined the outcome. Compared with a 60-year-old person not living in LTCF, the adjusted OR (aOR) for same-aged persons living in residential and nursing LTCFs was 1.77 (95% CI 1.21 to 2.6, p=0.0017) and 3.95 (95% CI 2.77 to 5.64, p<0.0001), respectively. At 90 years of age, aORs were 0.87 (95% CI 0.72 to 1.06, p=0.21) and 0.74 (95% CI 0.61 to 0.9, p=0.001), respectively. The model had an overall accuracy of 94.2% (94.2%) when applied to the full dataset of 2 978 800 patients.ConclusionThis study found that residents of LTCFs in England had higher odds of death up to 80 years of age. Beyond 80 years, there was no difference in the odds of death for LTCF residents compared with those in the wider community.

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Interpretation of COVID-19 case fatality risk measures in England

Abstract: Figure 1 Case fatality risk by age group and long-term care facility (LTCF) residency among those aged 80 years old and over, from week 27-37 (29 June 2020-13 September 2020). copyright.

Cited by 10 publications

References 1 publication

Virological Characterization of Critically Ill Patients With COVID-19 in the United Kingdom: Interactions of Viral Load, Antibody Status, and B.1.1.7 Infection

Virological Characterization of Critically Ill Patients With COVID-19 in the United Kingdom: Interactions of Viral Load, Antibody Status, and B.1.1.7 Infection

COVID‐19 mortality among people with diagnosed HIV compared to those without during the first wave of the COVID‐19 pandemic in England

Case–control study to estimate odds of death within 28 days of positive test for SARS-CoV-2 prior to vaccination for residents of long-term care facilities in England, 2020–2021

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