Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19

Panagiotou, Orestis A.; Kosar, Cyrus M.; White, Elizabeth M.; Bantis, Leonidas E.; Yang, Xiaofei; Santostefano, Christopher M.; Feifer, Richard A.; Blackman, Carolyn; Rudolph, James L.; Gravenstein, Stefan; Mor, Vincent

doi:10.1001/jamainternmed.2020.7968

Cited by 172 publications

(190 citation statements)

References 37 publications

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“…Ein bis zwei Drittel aller an COVID-19-Verstorbenen sind BW von LPE; der überwiegende Teil ist dabei in der jeweiligen Einrichtung verstorben [ 1 ]. Die 30-Tage-Letalität von BW von LPE liegt bei etwa 21 % [ 2 ].…”

Section: Einleitung Und Hintergrundunclassified

Langzeitpflegeeinrichtungen in der COVID-19-Pandemie

et al. 2021

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Langzeitpflegeeinrichtungen (LPE) waren und sind von der COVID-19-Pandemie besonders betroffen. Die Dimension der Ausbrüche und die hohe Letalität unter den Bewohner(innen) (BW) führten zu massiven Einschränkungen, v. a. im Bereich der sozialen Kontakte und Aktivitäten, aber auch in Bereichen der medizinischen Versorgung. Mit dem Start der Impfungen und den verbesserten Testmöglichkeiten haben sich nun aber die Voraussetzungen geändert, und bestehende Beschränkungen müssen auf ihre Zweckmäßigkeit evaluiert werden. In einer interprofessionellen und interdisziplinären Expertengruppe wurden Überlegungen erstellt, wie ein Weg zurück in die Normalität für LPE ausehen kann.

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Section: Einleitung Und Hintergrundunclassified

Langzeitpflegeeinrichtungen in der COVID-19-Pandemie

et al. 2021

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“…Similarly, Panagiotou et al (2020) 20 sought to identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19. The study was conducted in 351 US nursing homes involving 5256 nursing home residents with COVID-19–related symptoms who had severe ARDS precipitated by SARS-CoV-2 infection that was confirmed by RT-PCR testing (March to September).…”

Section: Discussionmentioning

confidence: 99%

Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents

Alexander

Armstrong²,

Fareed

et al. 2021

Preprint

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The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found multidrug regimens relying on the use of hydroxychloroquine as well as other agents including doxycycline were associated with a statistically significant and >60% reductions in mortality. Going forward, we theorize and based on the evidence, that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients) has a genuine probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus that will prevent the development and/or worsening of problems associated with COVID-19, most particularly isolation, hospitalization, and death. In fact, with the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of patients with acute COVID-19 is possibly the most rational and importantly feasible strategy to reduce the risks of hospitalization and death. If the approach remains ‘wait-and-see’ and elderly high-risk patients in such congregated nursing room type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. We put forth the notion that the most important factor in this regard, is making available early therapeutic intervention as described here. These drugs include and under supervision by skilled doctors, combination/sequenced ivermectin, hydroxychloroquine, colchicine, azithromycin, doxycycline, bromhexine hydrochloride, and favipiravir (outside the US), along with inhaled steroids such as budesonide and oral steroids including dexamethasone and prednisone, and anti-thrombotic anti-clotting drugs such as heparin). As the clinical trials data on treatments for COVID-19 mature, this early treatment therapeutic option deserves serious, urgent, and sober consideration by the medical establishment and respective decision-makers.

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“…Consistent with CDC recommendations, early vaccination efforts (Phase 1a) in the United States have targeted healthcare workers, residents and staff at long term care facilities, who are at elevated risk for COVID-19 relative to the general public 8–11 . As the vaccines continue to be administered more broadly, it will be critical to continuously evaluate real world safety and efficacy data from all those who have received these vaccines.…”

Section: Introductionmentioning

confidence: 99%

Real-time analysis of a mass vaccination effort confirms the safety of FDA-authorized mRNA vaccines for COVID-19 from Moderna and Pfizer/BioNtech

McMurry

Lenehan

Awasthi

et al. 2021

Preprint

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As the COVID-19 vaccination campaign unfolds as one of the most rapid and widespread in history, it is important to continuously assess the real world safety of the FDA-authorized vaccines. Curation from large-scale electronic health records (EHRs) allows for near real-time safety evaluations that were not previously possible. Here, we advance context- and sentiment-aware deep neural networks over the multi-state Mayo Clinic enterprise (Minnesota, Arizona, Florida, Wisconsin) for automatically curating the adverse effects mentioned by physicians in over 108,000 EHR clinical notes between December 1st 2020 to February 8th 2021. We retrospectively compared the clinical notes of 31,069 individuals who received at least one dose of the Pfizer/BioNTech or Moderna vaccine to those of 31,069 unvaccinated individuals who were propensity matched by demographics, residential location, and history of prior SARS-CoV-2 testing. We find that vaccinated and unvaccinated individuals were seen in the the clinic at similar rates within 21 days of the first or second actual or assigned vaccination dose (first dose Odds Ratio = 1.13, 95% CI: 1.09-1.16; second dose Odds Ratio = 0.89, 95% CI: 0.84-0.93). Further, the incidence rates of all surveyed adverse effects were similar or lower in vaccinated individuals compared to unvaccinated individuals after either vaccine dose. Finally, the most frequently documented adverse effects within 7 days of each vaccine dose were fatigue (Dose 1: 1.77%, Dose 2: 1.2%),nausea (Dose 1: 1.05%, Dose 2: 0.84%), myalgia (Dose 1: 0.67%; Dose 2: 0.66%), diarrhea (Dose 1: 0.67%; Dose 2: 0.46%), arthralgia (Dose 1: 0.64%; Dose 2: 0.57%), erythema (Dose 1: 0.59%; Dose 2: 0.46%), vomiting (Dose 1: 0.45%, Dose 2: 0.29%) and fever (Dose 1: 0.29%; Dose 2: 0.23%). These remarkably low frequencies of adverse effects recorded in EHRs versus those derived from active solicitation during clinical trials (arthralgia: 24-46%; erythema: 9.5-14.7%; myalgia: 38-62%; fever: 14.2-15.5%) emphasize the rarity of vaccine-associated adverse effects requiring clinical attention. This rapid and timely analysis of vaccine-related adverse effects from contextually rich EHR notes of 62,138 individuals, which was enabled through a large scale Artificial Intelligence (AI)-powered platform, reaffirms the safety and tolerability of the FDA-authorized COVID-19 vaccines in practice.

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Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19

Cited by 172 publications

References 37 publications

Langzeitpflegeeinrichtungen in der COVID-19-Pandemie

Langzeitpflegeeinrichtungen in der COVID-19-Pandemie

Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents

Real-time analysis of a mass vaccination effort confirms the safety of FDA-authorized mRNA vaccines for COVID-19 from Moderna and Pfizer/BioNtech

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