Topline
Global life expectancy rose by 6.2 years between 1990 and 2021, driven by reductions in deaths from diarrhea, lower respiratory infections, stroke and ischemic heart diseasebut the world faced significant setbacks due to the Covid-19 pandemic, according to a new study by the Lancet.
FILE - Travelers pass a sign near a COVID-19 testing site in Terminal E at Logan Airport, on Dec. ... [+] 21, 2021, in Boston. (AP Photo/Charles Krupa, File)
The leading causes of death worldwide remained consistent from 1990 to 2019with ischemic heart disease, stroke, chronic obstructive pulmonary disease and lower respiratory infections topping the listwith global life expectancy improving in that time period thanks in part to annual reductions in deaths from all causes ranging from .9% to 2.4%.
The Covid-19 pandemic hampered progress, with pandemic-related mortality causing a net reduction in life expectancy of 1.6 years between 2019 and 2021 and Covid-19 becoming the second-leading cause of deaththe first major shakeup of the rankings in decades.
Changes in life expectancy varied significantly by region, the study foundthe so-called super-region consisting of Southeast Asia, East Asia and Oceania saw the greatest net gain in life expectancy from 1990 and 2021, rising by 8.3 years due to big drops in mortality from chronic respiratory diseases, stroke, lower respiratory infections and cancer, with strong management of the pandemic curbing life expectancy losses due to Covid-19 to just .4 years between 2019 and 2021.
Reductions in deaths from enteric diseaseswhich include diarrhea and typhoidsignificantly contributed to improvements in life expectancy, estimated to contribute an overall increase of 1.1 years globally.
Control of mortality due to diarrheal disease contributed to significant gains in life expectancy in the super region of South Asia, which had the second-highest increase among super regions in life expectancy with 7.8 years, and in Eastern sub-Saharan Africa, which had the highest increase in life expectancy of any local region with 10.7 years.
On one hand, we see countries monumental achievements in preventing deaths from diarrhea and stroke, said Dr. Liane Ong of the Institute for Health Metrics and Evaluations, one of the authors of the study, in a statement. At the same time, we see how much the Covid-19 pandemic has set us back.
31.5%. Thats how much the age-standardized mortality rate for ischemic heart disease, the leading cause of death worldwide, dropped between 1990 and 2021. The rate in 2021 was 108.7, with Covid-19 the second-leading cause of death at 94.0.
The largest decline in life expectancy due to Covid-19 was in Latin America and the Caribbean, where it caused a 3.6-year reduction.
The study is the first of its kind to compare deaths from Covid-19 to other leading causes of death, according to the authors. It notes Covid-19 may have had indirect effects on mortality rates as well, with physical distancing measures affecting mortality for other diseases, and deferred care-seeking leading to pandemic-related deaths not attributable directly to Covid-19. Another study published by the Lancet earlier this month previously found the global life expectancy dropped by 1.6 years due to the pandemic, with the United States seeing the highest excess mortality rate when compared to similar high-wealth nations.
Health and medicine | Population Health | Public Health | Research | UW News blog
April 3, 2024
Tabea Schendekehl, then a UW undergraduate, attends class from home in the fall of 2020.
As unprecedented as the outbreak of COVID-19 felt, it was far from the first time a deadly disease has swept the globe. Historians have identified epidemics and pandemics dating as far back as 430 B.C. Records tell us how these diseases spread and how many people died, but not peoples personal experiences of the crises.
COVID-19 presented a rare opportunity to document in real-time how people processed the tumult of a pandemic, and how necessary public health measures affected their lives. Starting in the earliest days of the 2020 outbreak, a team of researchers at the University of Washington conducted real-time surveys of King County residents, asking what measures people had taken to protect themselves, how their daily lives had been affected and what worried them most.
The results, published in February in the journal PLOS One, provide a glimpse into the subtle effects that public health measures like social distancing and stay-at-home orders had on the community.
UW News spoke with Kathleen Moloney, research scientist at the UW Collaborative on Extreme Event Resilience, and Nicole Errett, a UW assistant professor of environmental and occupational health sciences and director of the new Center for Disaster Resilient Communities, to discuss the study, how people experienced those early months and what public health practitioners can learn for future pandemics.
Its been four years since COVID-19 changed all our lives, and more than two years since we started to emerge into this new normal. Why is it important to share this research now, to understand peoples experiences of the pandemic and collective efforts to limit COVIDs spread?
Kathleen Moloney: Unfortunately, COVID-19 is unlikely to be the last pandemic we face. To fully understand this pandemics impacts and better prepare for the next, we need research studies like ours where data was collected in real time, from March to May of 2020 that document the lived experiences of communities during the pandemic. For example, by documenting how people in King County experienced the social distancing measures in real-time, our study provides valuable insights into which negative impacts were most acute during the early stages of the pandemic. Our results, combined with evidence from other research studies, can provide direction for researchers and policymakers to explore effective interventions for future pandemics.
Nicole Errett: It is really important to start collecting data in the immediate aftermath of a disaster to understand effects on health and well-being, but researchers face a variety of administrative, logistical and ethical challenges when designing rapid-response research studies. By sharing our approach in this paper, we can provide ideas and guidance for other investigators while designing studies for future disasters, whether those are caused by an infectious disease or natural hazard.
The COVID-19 pandemic has been unprecedented in a lot of ways, and was for most Americans the most significant disruption to our daily lives ever. How unusual are events like this in human history? What do we know about how past pandemics and epidemics have affected the people who lived through them?
KM: During the height of the COVID-19 pandemic, we often heard comparisons to the 1918 influenza pandemic, as closures of schools, businesses and other community gathering spaces were implemented in response to both. However, it isnt really possible to compare the experiences of those who lived through COVID-19 with those who lived through the 1918 Flu and other pandemics throughout history, because there werent any research studies conducted at the time to document those experiences. Thats why rapid-response disaster research, like our study, is so important.
In the paper you evaluate the unintended impacts of efforts to slow the pandemic, like people losing their jobs and students falling behind in school. How do you think about that delicate balance between public health and individual well-being?
KM: I dont think of protecting public health and individual well-being as opposing priorities that need to be balanced. Public health, as a field, is dedicated to protecting and improving the health and well-being of the individuals that make up communities. Disruptions to employment and schooling can negatively impact long-term health outcomes, and ideally, these potential consequences should be considered when thinking through the type and duration of social distancing measures. Unfortunately, all the empirical research needed to inform those decisions was limited prior to this pandemic.
You asked participants about steps they took to protect themselves at the height of the pandemic. Some steps had pretty low rates of participation for example, only 63% of people said they stopped going to the gym, and 82% of people avoided large gatherings. What does that say about the effectiveness of our collective response to the pandemic?
KM: I want to give the caveat that our survey only captured participants self-reported behavior at a single point in time. For example, someone who responded to the survey on March 19th, 2020, that they had not stopped going to the gym might have stopped the next week, when the statewide Stay Home, Stay Safe order was issued. Our survey was also a convenience sample, and therefore shouldnt be considered representative of the compliance of King County residents as a whole with various social distancing recommendations.
With that said, those numbers were still slightly surprising. The narrative we often hear of public acceptance of COVID-19 social distancing measures is that compliance was initially high, and then decreased over time due to factors such as message fatigue theres research documenting this phenomenon. We need additional research to confirm this, but our results might indicate that there was also an initial lag in compliance with the social distancing recommendations implemented in response to COVID-19.
Overall, these measures still appear to have been effective, despite imperfect or slightly delayed compliance among certain residents.
NE: At the time of our survey, our understanding of disease transmission was still evolving. Its possible that people took measures they thought were protective (like hand washing) while attending these gatherings, based on their understanding of transmission at the time. It would have been interesting to re-survey folks at various time points throughout the pandemic to see how their behavior evolved as the pandemic, and our understanding of the disease, progressed.
You evaluated participants well-being as described in their written stories about their experience. What trends appeared there, and were they what you expected to find?
KM: Two findings surprised me in particular. First, less than half of our participants described impacts to their social life I expected the percentage to be much higher. It would be interesting to know how that result might change if we surveyed the same participants at a later point in the pandemic, when social distancing measures had been in place for longer. I was also surprised to see the poorest average well-being reported by those over the age 65, and the highest average well-being reported by 18-to-34 year olds. This is in contrast to several other national-scale studies in the US and Europe, which found worse mental health impacts in young adults.
Given that older adults are more likely to reside alone in the U.S. than in most other countries and report high rates of social isolation and loneliness even during non-pandemic times, interventions to mitigate the mental health impacts of future pandemics on older adults probably deserve special attention.
In their written responses, participants most frequently described a negative financial or employment-related impact, even more than social impacts. How might that change how we prepare to help people through future crises?
KM: Knowing which negative impacts are most prevalent at various points in the pandemic, and how these impacts differ between groups, can help us develop more specific, more effective interventions to prevent these unintended consequences in the future. We saw that employment and financial impacts were the top concern for every age group except those 65 and older this group expressed higher concern about physical health and social impacts. So while an early intervention to mitigate the financial impacts of a future crisis on younger adults could be effective, we would likely want to prioritize different resources for older adults.
Whats also interesting is that many of the concerns our participants reported, both in written narratives and the close-ended survey questions, were about impacts to others, rather than themselves. Concern and empathy for fellow community members well-being is something that we should want to cultivate for many reasons, but specifically in a pandemic context, theres evidence that decreased concern for others well-being is correlated with decreased compliance with non-pharmaceutical interventions. Something we should also think about while preparing for future crises is how we can foster the concern for others and the sense of community that were clearly present during the early stages of the pandemic to make sure they endure.
NE: The pandemic influenced the development or at least accelerated the uptake of systems that allowed many folks to work safely from the comfort of their own home without financial or employment impacts. However, folks with jobs in essential services and sectors often had to physically report to work, and often interface with the public. My colleague, Marissa Baker, found that folks that couldnt work from home are lower paid. Accordingly, Id suspect that employment and financial concerns would be disproportionately borne among lower wage workers, who would have to choose between their health and safety and their income. In advance of the next pandemic, we need to figure out ways to keep these folks safe and at work.
For more information, contact Errett at nerrett@uw.edu or Moloney at kmoloney@uw.edu.
INDIANAPOLIS A large multi-state electronic health record-based study from the Centers for Disease Control and Preventions (CDCs) VISION Network has found that COVID-19 vaccines are as effective for adults with anxiety or depression or mood disorders as for individuals without these common diagnoses. This is one of the first studies to evaluate COVID-19 mRNA vaccine effectiveness for those living with mental illness.
While vaccination provided similar protection regardless of psychiatric diagnosis (none, one or multiple conditions), in contrast, unvaccinated adults with any of these conditions had a higher rate of hospitalization for COVID-19 a marker for severe disease than did those without a psychiatric diagnosis.
Both these findings held true whether two, three or four vaccinations were received and for ages 18-49, 50-64 and 65 and older.
Although mental health conditions can tax the immune system, putting stress on the body, we saw similar COVID-19 vaccine effectiveness in people with psychiatric diagnoses compared with those without. Thats encouraging, said study co-author Shaun Grannis, M.D., M.S., Regenstrief Institute vice president for data and analytics.
But we also found that the risk of COVID-19 associated hospitalization is higher among unvaccinated patients with a psychiatric diagnosis, added Dr. Grannis. For patients with a diagnosis of depression, anxiety, or mood disorders who are wondering if the COVID vaccine would be valuable, this paper gives us evidence that the vaccine maintains its effectiveness even in the face of mental illness. So, I would encourage vaccination because it reduces the risk of hospitalization significantly.
Psychiatric disorders have been associated with lower antibody positivity and reduced immune response to other vaccines. Prior to this study, it was not known whether anxiety, depression, or mood disorders influence COVID-19 vaccine effectiveness.
While the evidence on vaccine effectiveness for the overall population is well-established, many people still have questions about whether someone like them should get the vaccine or whether people like them benefit from the vaccine, said study co-author Brian Dixon, PhD, MPA, interim director of Regenstrief Institutes Clem McDonald Center for Bioinformatics. Studies like this one help answer those questions for large segments of society. Our network will continue to pursue rigorous studies on important, vulnerable populations. That is, after all, the work we do in public health.
Risk of COVID-19 hospitalization and protection associated with mRNA vaccination among US adults with psychiatric disorders is published in the peer-reviewed journal Influenza and Other Respiratory Viruses. The study was funded by the CDC.
All authors and affiliations:
Matthew E. Levy1,2 | Duck-Hye Yang1 | Margaret M. Dunne1 | Kathleen Miley3 | Stephanie A. Irving4 | Shaun J. Grannis5,6 | Zachary A. Weber1 | Eric P. Griggs7 | Talia L. Spark1 | Elizabeth Bassett1 | Peter J. Embi5,8 | Manjusha Gaglani9,10 | Karthik Natarajan11,12 | Nimish R. Valvi5 | Toan C. Ong13 | Allison L. Naleway4 | Edward Stenehjem14 | Nicola P. Klein15 | Ruth Link-Gelles7 | Malini B. DeSilva3 | Anupam B. Kharbanda16 | Chandni Raiyani9 | Maura A. Beaton11 | Brian E. Dixon5,17 | Suchitra Rao13 | Kristin Dascomb14 | Palak Patel18 | Mufaddal Mamawala9 | Jungmi Han11 | William F. Fadel5,17 | Michelle A. Barron13 | Nancy Grisel14 | Monica Dickerson18 | I-Chia Liao9 | Julie Arndorfer14 | Morgan Najdowski7 | Kempapura Murthy9 | Caitlin Ray18 | Mark W. Tenforde18 | Sarah W. Ball1
1Westat, Rockville, Maryland, USA | 2Helix, San Mateo, California, USA | 3HealthPartners Institute, Minneapolis, Minnesota, USA | 4Kaiser Permanente Center for Health Research, Portland, Oregon, USA | 5Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA | 6School of Medicine, Indiana University, Indianapolis, Indiana, USA | 7Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA | 8Vanderbilt University Medical Center, Nashville, Tennessee, USA | 9Baylor Scott & White Health, Temple, Texas, USA | 10Texas A&M University College of Medicine, Temple, Texas, USA | 11Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York, USA | 12New York Presbyterian Hospital, New York, New York, USA | 13School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA | 14Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah, USA | 15Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California, USA | 16Childrens Minnesota, Minneapolis, Minnesota, USA | 17Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA | 18Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Shaun Grannis, M.D., M.S. In addition to his role as vice president for data and analytics and research scientist with the Clem McDonald Center for Biomedical Informatics, at Regenstrief Institute, Shaun Grannis, M.D., M.S., is the Regenstrief Professor of Medical Informatics and a professor of family medicine at Indiana University School of Medicine. He is also an adjunct professor with Indiana University Richard M. Fairbanks School of Public Health and at Indiana University School of Informatics and Computing, both at Indiana University-Indianapolis.
Brian E. Dixon, PhD, MPA In addition to his role as the director of public health informatics at the Regenstrief Institute and Indiana University Richard M. Fairbanks School of Public Health at Indiana University-Indianapolis, Brian E. Dixon, PhD, MPA, is the interim director and a research scientist with the Clem McDonald Center for Biomedical Informatics at Regenstrief Institute and a professor of epidemiology at the Fairbanks School of Public Health. He is also an affiliate scientist at the U.S. Department of Veterans Affairs Health Services Research and Development Center for Health Information and Communication, Richard L. Roudebush VA Medical Center.
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Testing waterways, such as this one, located near unsheltered encampments could help monitor COVID-19 infections in a community that is often underrepresented in current surveillance methods.
Credit: Edwin Oh
To better understand COVID-19s spread during the pandemic, public health officials expanded wastewater surveillance. These efforts track SARS-CoV-2 levels and health risks among most people, but they miss people who live without shelter, a population particularly vulnerable to severe infection. To fill this information gap, researchers reporting in ACS Environmental Science & Technology Letters tested flood-control waterways near unsheltered encampments, finding similar transmission patterns as in the broader community and identifying previously unseen viral mutations.
In recent years, testing untreated wastewater for SARS-CoV-2 incidence and dominant viral variants, as well as other pathogens, has been vital to helping public health officials determine infectious disease transmission in local communities. Yet, this monitoring only captures information on viruses shed from human feces and urine in buildings that are connected to local sewage infrastructure. Beyond the pandemics impact on human health, it also exacerbated socioeconomic difficulties and increased the number of people experiencing homelessness and living in open-air encampments without access to indoor bathrooms. To understand the prevalence of COVID-19 among people who live unsheltered, Edwin Oh and colleagues tested for SARS-CoV-2 in waterways near encampments outside Las Vegas from December 2021 through July 2022.
Using quantitative polymerase chain reaction, the researchers identified SARS-CoV-2 RNA in more than 25% of the samples tested from two flood-control channels. The highest detection frequency over the study period aligned with Las Vegas first wave of omicron variant infections, as confirmed through parallel testing at a local wastewater treatment plant. The researchers say these results suggest a similar level of transmission was occurring within the unsheltered community as it was among the general population. Then the researchers conducted whole genome sequencing to identify the SARS-CoV-2 variants in the waterways. These samples largely contained the same variants identified in the broader community. Deeper computational analysis of the viral sequences identified three novel viral spike protein mutations in some waterway samples, but the researchers have not yet examined what impact these mutations might have on viral function or clinical outcomes. Regardless, the ability to detect and identify SARS-CoV-2 in environmental water samples could help improve public health measures for a community that is often underrepresented in current surveillance methods. The researchers also say monitoring waterways could warn health officials of unexpected variants circulating in the community.
The authors acknowledge funding from the National Institutes of Health, the Nevada Governors Office of Economic Development, the Centers for Disease Control and Prevention, and the Water Resources Research Institute of the United States Geological Survey.
The papers abstract will be available on April 3 at 8 a.m. Eastern time here:http://pubs.acs.org/doi/abs/10.1021/acs.estlett.3c00938
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Environmental Science & Technology Letters
Environmental Surveillance of Flood Control Infrastructure Impacted by Unsheltered Individuals Leads to the Detection of SARS-CoV2 and Novel Mutations in the Spike Gene
3-Apr-2024
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MADISON Researchers at the University of Wisconsin have found 19 viruses in wild fish, most of them never before discovered, including one coronavirus in walleyes that was previously found only in birds.
The new study, published in the journal Pathogens, found the different viruses in 103 fish sampled from Wisconsin lakes and rivers, including walleyes, bluegills, brown trout, sturgeon and northern pike.
So far, the viruses dont seem to be hurting the fish or impacting overall fish populations, the scientists note, and there's no indication the viruses can be passed to humans.
Contributed / Bryce Richter / UW-Madison
We have no evidence that these viruses are making fish sick. The fish we tested were all healthy, Tony Goldberg, a professor in UW's Department of Pathobiological Sciences, told the News Tribune. It's possible some of the viruses could make fish sick under particular conditions when the fish are stressed out for some other reason.
"But all the viruses are new, so we really don't know anything else about them yet, except that they exist.
The effort, funded by Wisconsin Sea Grant, is the first of its kind in North America.
The study found the first fish-associated coronavirus, from the Gammacrononavirus genus, which differs from the type of virus that causes COVID-19. It was found in 11 of 15 walleyes collected by the Wisconsin Department of Natural Resources.
Goldberg stressed that anglers should not be worried.
None of these viruses can infect people, he said. Its not a risk for people to catch, handle and eat fish because of these viruses. Theres no evidence that these viruses are causing any problems. They may just be part of the natural ecosystem of these fish.
Tony Goldberg, University of Wisconsin professor
Of the different species of fish sampled, lake sturgeon blood contained the most viruses, 97% of samples, with brown trout samples showing the least prevalence at 6%.
This virus survey builds on previous Sea Grant-funded research in which Goldberg studied viral hemorrhagic septicemia, or VHS, an often fatal fish disease. The DNR took blood samples from healthy-looking fish across Wisconsin to test for VHS antibodies. They saved the blood and used it for this current study on viruses.
Contributed / Bryce Richter / UW-Madison
The new findings should help fishery managers when they routinely test the health of fish about to be released into state lakes from hatcheries or fish that are being shipped out of state. Sometimes, those releases are halted over concerns that the fish may carry a disease, and the studys findings will help managers decide what is normal and what is concerning in terms of fish viruses.
This is a huge problem for fisheries managers that happens all the time, Goldberg said. We recently had a case where there were thousands of muskies that were ready to be released and they came back with an unknown virus. So, do you release them? Do you just keep them there? Do you kill them all?
"Maybe there are viruses out there that are a normal part of the ecosystem, and they just infect a lot of fish, but they dont cause disease," Goldberg said.
While anglers shouldnt be too concerned about the new fish viruses, they can help prevent any potential problems by not moving fish, including baitfish, from one lake to another.
If you move a fish from one water body to another, youre moving everything that lives on and in that fish and potentially causing problems, he said.
The U.S. Fish and Wildlife Service recently designed specific tests for the various viruses and expects to test a larger set of fish blood samples from around Wisconsin. They will map the viruses found so that fisheries managers can tell whats normal for a particular watershed and whether stocking should proceed or not.
Editor note: This story was updated at 2:50 p.m. Friday, March 29, to correct the type of fish in the cutline of the first photo. It was originally published at 7 a.m. Friday, March 29, 2024. The News Tribune regrets the error.
John Myers reports on the outdoors, natural resources and the environment for the Duluth News Tribune. You can reach him at jmyers@duluthnews.com.
April 3, 2024 Photo: Depositphotos.com
People who live in areas with poor air quality such as busy roads and factory farms are more likely to become infected with coronavirus and their symptoms are often more severe, leading to more hospitalisations and deaths, according to new Dutch research.
The results, the researchers say highlight the the importance of having cleaner air in the Netherlands, and offer insights for dealing with future pandemics.
The study, carried out by public health institute RIVM, Utrecht and Wagening universities and regional health boards, shows air pollution does not play a direct role in the process of spreading coronavirus.
But it does confirm other research that air pollution makes respiratory diseases worse.
The researchers looked at the first year of the epidemic, before people had been vaccinated, and found people who live in areas with relatively poorer air quality were more likely to become infected, end up in hospital or die.
Air quality can vary due to high volumes of traffic, industry and intensive livestock farming, the researchers said. In terms of coronavirus, livestock showed the most detrimental health effect.
In the period to 1 February 2021, around 22,500 people died from COVID-19, the report says. In the regions where the air quality was worse than the Dutch average, a total of 400 to 800 deaths could have been prevented if the air had been as clean as average. The cleaner the air, the greater the preventive effect.
Cleaner air would also have prevented 1,100 hospitalisations, the researchers said.
The outcomes of this study stress the importance of improving air quality in Europe, the report concluded. Moving toward the WHO air quality guidelines would improve health generally and reduce the impact of severe acute respiratory infections.
We could not provide the Dutch News service, and keep it free of charge, without the generous support of our readers. Your donations allow us to report on issues you tell us matter, and provide you with a summary of the most important Dutch news each day.
NEW BRUNSWICK, N.J. - As of Monday, Rutgers University in New Jersey no longer requires students, faculty, staff, and university affiliates to get the COVID-19 vaccine.
Now reporting positive COVID-19 test results is not required at Rutgers.
In March 2021, Rutgers became the first in the nation to require COVID vaccination, and many higher-ed institutions followed.
RELATED: Rutgers University students, faculty, staff must get COVID vaccine booster
However, face masks are welcomed on campus, but aren't required.
Based on a recent survey conducted by the American College Health Association across 311 institutions, it was found that merely 7.4% persist in enforcing universal vaccination mandates for all students. Additionally, 10.7% of institutions mandate vaccination for specific subgroups, such as residential students, against coronavirus.
The following is a summary of Cardiac Adverse Events and Remdesivir in Hospitalized Patients with Coronavirus Disease 2019 (COVID-19): A Post Hoc Safety Analysis of the Randomized DisCoVeRy Trial, published in the March 2024 issue of Infectious Disease by Terzi et al.
Researchers started a retrospective study to assess the association between remdesivir and cardiac adverse events (AEs) in hospitalized COVID-19 patients receiving standard of care (SoC).
They utilized data from the DisCoVeRy trial involving hospitalized COVID-19 patients. They considered any initial AE within 29 days post-randomization in the modified intention-to-treat (mITT) group assigned to either remdesivir or control. They utilized Kaplan-Meier survival curves for analysis, calculating event rates using Kaplan-Meier estimates.
The results showed that cardiac AEs occurred in 11.2% of patients (46/410) in the remdesivir group and 11.3% of patients (48 /423) in the control group among the mITT population (n=833). No significant difference between the groups (HR 1.0, 95% CI 0.7-1.5, P=0.98), even when considering serious and non-serious cardiac AEs separately. Most reported events in both groups were arrhythmic (remdesivir: 84.8%, control: 83.3%) and had favorable outcomes. Occurrence of different cardiac AE subclasses, including arrhythmic events, did not significantly differ between the remdesivir and control groups (HR 1.1, 95% CI: 0.7-1.7, P=0.68).
Investigators concluded that remdesivir treatment did not increase the risk of cardiac adverse events in hospitalized moderate or severe COVID-19 patients compared to standard care, which aligns with other controlled trials and meta-analyses.
Source: academic.oup.com/cid/advance-article/doi/10.1093/cid/ciae170/7637630
A study finds that SARS-CoV-2 can cause heart damage indirectly through systemic inflammation, revealing a new understanding of cardiovascular complications from COVID-19 and suggesting potential anti-inflammatory treatments. Credit: SciTechDaily.com
NIH-supported research shows that the virus that causes COVID-19 can damage the heart without directly infecting heart tissue.
SARS-CoV-2, the virus that causes COVID-19, can damage the heart even without directly infecting the heart tissue, a National Institutes of Health-supported study has found. The research, published in the journal Circulation, specifically looked at damage to the hearts of people with SARS-CoV2-associated acute respiratory distress syndrome (ARDS), a serious lung condition that can be fatal. However, researchers said the findings could have relevance to organs beyond the heart and also to viruses other than SARS-CoV-2.
Scientists have long known that COVID-19 increases the risk of heart attack, stroke, and Long COVID, and prior imaging research has shown that over 50% of people who get COVID-19 experience some inflammation or damage to the heart. What scientists did not know is whether the damage occurs because the virus infects the heart tissue itself, or because of systemic inflammation triggered by the bodys well-known immune response to the virus.
This was a critical question and finding the answer opens up a whole new understanding of the link between this serious lung injury and the kind of inflammation that can lead to cardiovascular complications, said Michelle Olive, Ph.D., associate director of the Basic and Early Translational Research Program at the National Heart, Lung, and Blood Institute (NHLBI), part of NIH. The research also suggests that suppressing the inflammation through treatments might help minimize these complications.
To reach their findings, the researchers focused on immune cells known as cardiac macrophages, which normally perform a critical role in keeping the tissue healthy but can turn inflammatory in response to injury such as heart attack or heart failure. The researchers analyzed heart tissue specimens from 21 patients who died from SARS-CoV-2-associated ARDS and compared them with specimens from 33 patients who died from non-COVID-19 causes. They also infected mice with SARS-CoV-2 to follow what happened to the macrophages after infection.
In both humans and mice, they found the SARS-CoV-2 infection increased the total number of cardiac macrophages and also caused them to shift from their normal routine and become inflammatory.
When macrophages are no longer doing their normal jobs, which includes sustaining the metabolism of the heart and clearing out harmful bacteria or other foreign agents, they weaken the heart and the rest of the body, said Matthias Nahrendorf, M.D., Ph.D., professor of Radiology at Harvard Medical School and senior author on the study.
The researchers then designed a study in mice to test whether the response they observed happened because SARS-CoV-2 was infecting the heart directly, or because the SARS-CoV-2 infection in the lungs was severe enough to render the heart macrophages more inflammatory. This study mimicked the lung inflammation signals, but without the presence of the actual virus. The result: even in the absence of a virus, the mice showed immune responses strong enough to produce the same heart macrophage shift the researchers observed both in the patients who died of COVID-19 and the mice infected with SARS-CoV-2 infection.
What this study shows is that after a COVID infection, the immune system can inflict remote damage on other organs by triggering serious inflammation throughout the body and this is in addition to damage the virus itself has directly inflicted on the lung tissue, said Nahrendorf. These findings can also be applied more generally, as our results suggest that any severe infection can send shockwaves through the whole body.
The research team also found that blocking the immune response with a neutralizing antibody in the mice stopped the flow of inflammatory cardiac macrophages and preserved cardiac function. While they have yet to test this in humans, Nahrendorf said a treatment like this could be used as a preventive measure to help COVID-19 patients with pre-existing conditions, or people who are likely to have more severe outcomes from SARS-CoV-2 associated ARDS.
Reference: Virus-Induced Acute Respiratory Distress Syndrome Causes Cardiomyopathy Through Eliciting Inflammatory Responses in the Heart by Jana Grune, Geetika Bajpai, Pervin Tlin Ocak, Eva Kaufmann, Kyle Mentkowksi, Steffen Pabel, Nina Kumowski, Fadi E. Pulous, Kim A. Tran, David Rohde, Shuang Zhang, Yoshiko Iwamoto, Gregory R. Wojtkiewicz, Claudio Vinegoni, Ursula Green, Filip K. Swirski, James R. Stone, Jochen K. Lennerz, Maziar Divangahi, Maarten Hulsmans and Matthias Nahrendorf, 20 March 2024, Circulation. DOI: 10.1161/CIRCULATIONAHA.123.066433
Funding: This study was supported by NHLBI grants: HL139598, HL142494, HL155097, and HL149647.
