Risk of death from COVID-19 more than twice as high for people living with HIV
A recent study explored whether HIV is associated with an increased rate of mortality from COVID-19 given the level of risk was unclear. Researchers, including Dr Roz Eggo, a HDR UK Research Fellow, used OpenSAFELY to explore this in a large-scale population study based in England.
Results from the study showed that people living with HIV had nearly three-fold higher risk of COVID-19 death and the risk remained high after accounting for deprivation and ethnicity. Initial evidence suggests that this association was higher for people of Black ethnicity. This may mean people living with HIV could be considered a high-risk group for COVID-19.
Factors affecting the risk of COVID-19 in ethnic minority populations
Using data from the 2011 Census and NHS patient registers in England, researchers added to the evidence that there is a higher risk of COVID-19 in ethnic minority populations. However, the research team, including Dr Ami Banerjee of HDR UK London, found it was largely, but not completely, reduced by geographical and socioeconomic factors such as living circumstances, socio-economic factors, occupational exposure, and health status. Lockdown was also associated with a reduced risk of excess mortality in ethnic minority populations. This evidence could prove useful in the event of any future waves or local spikes of the virus.
Healthcare workers have higher risk of COVID-19 related hospitalisation
Whilst a high number of healthcare professionals work in patient-facing and high-risk settings for contracting and transmitting COVID-19, there is limited evidence that explores their risk of hospitalisation. A research team have recently published a pre-print which shows healthcare workers in patient-facing roles and their households were at 3- and 2-fold respectively higher risk of COVID-19 related hospitalisation and there was a particular notable higher risk for older men with comorbidity. Given these findings, the authors suggest it is important to also include the households of healthcare workers when assessing occupational risk.
High risk of infection may explain higher risk of COVID-19 related hospitalisation and mortality
The REal-time Assessment of Community Transmission-2 (REACT-2) study used data from antibody testing which provides a long-lasting measure of the virus infection. The study indicated that the overall proportion of people who had COVID-19 by the end of June 2020 was 6.0% in England. Whilst London had the highest proportion (13 per cent), the South West had the lowest (3 per cent).
Additionally, whilst exploring the prevalence of COVID-19 by ethnicity and social deprivation, results of the study suggest that the higher risk of infection seen in ethnic minority populations and healthcare workers may be a key factor in the higher rate of hospitalisation and mortality in BAME patients.
Protective association between physical activity and COVID-19 outcomes
Given physical activity has shown to be protective against communicable diseases such as cancer or cardiovascular disease, researchers explored its association with COVID-19 outcomes.
Using data from the UK Biobank, the results of the study indicate there is a protective effect associated with physical activity and COVID-19 independent of age, sex, measures of obesity, and smoking status.
Whilst this particular study did not find a causal association between physical activity and COVID-19 outcomes, the authors do suggest that policies should encourage physical activity at a population level during the pandemic.
Individuals with pre-pandemic psychiatric disorders at higher risk of COVID-19
Linking data from the UK Biobank with national routine data, researchers found that those diagnosed with psychiatric disorders before the pandemic were associated with a higher risk of COVID-19, particularly more severe and fatal COVID-19 outcomes. Whilst the excess risk was seen across different sub-types of psychiatric disorders, the risk did increase in individuals who had a greater number of pre-pandemic psychiatric disorders.
Further research is needed to better understand the reasons behind this association, particularly given the authors note that there is a similar level of association between psychiatric disorders and other infections too.
Association between long term exposure to air pollution and COVID-19 related mortality
There has been limited research that has explored effects or association between long term exposure to air pollution and COVID-19 outcomes, including mortality. A recent study that used high geographical precision has shown the role of PM2.5 (fine particulate matter particles that have diameter less than 2.5 micrometres) remains uncertain. However, there is some evidence of an association between exposure to NO2 air pollution (nitrogen dioxide specific air pollutants) and COVID-19 mortality. This is lower than observed in previous studies, and the authors suggest that further research could explore pre-existing conditions within this area of work.
More than one test may be needed to rule out false positives for COVID-19
Given the impact of false positive results, including unnecessary quarantines or local lockdowns, and concerns within families and local community, researchers recently studied six serological assays (tests that looks for antibodies in the blood).
Whilst the tests had high levels of specificity, this research study suggests that more than one test may be needed to rule out false positives from initial tests. A similar approach is already in place for HIV and hepatitis testing. This is an important finding, and the authors suggest the need to better understand the cause of false positive test results so that serological testing can be improved.
Higher predisposition of COVID-19 towards super-spreading events unlikely due to viral shedding
A recent study used mathematical modelling to try and explore what levels of viral shedding would lead to transmission of COVID-19. Viral shedding refers to the point in which the virus replicates in the body and is then released into the environment and could therefore be contagious. With COVID-19, it is not yet known for certain when this occurs after an individual becomes infected.
The modelling has suggested that the higher predisposition of COVID-19 towards super-spreading events (when one person infects a large number of other individuals) is not due to additional viral shedding. Instead, it suggests that a person infected by COVID-19 may expose more people within close physical contact due to the aerosolization of the virus, which supports policies to limit crowd size in indoor spaces.
ALSPAC study explores parents’ concerns as schools begin to re-open
With restrictions from the pandemic in the UK easing and schools beginning to re-open, the Avon Longitudinal Study of Parents and Children (ALSPAC / ‘Children of the 90s’) explored parents’ and children’s COVID-19 related concerns through a questionnaire of its participants, in addition to exploring children’s behaviour since lockdown.
It found that 77% of parents of children over 3 years are worried about their child returning to school, 87% of parents with children aged under 3 years are concerned about the impact of their child missing social experiences and 73% are worried about when/if their child would return to nursery or school. It also found that the pandemic may be associated with increased emotional and behavioural difficulties in boys compared to girls aged 2 years and over.
Tweet of the Week
It’s time to highlight the ‘Tweet of the Week’. This week we look at one of our latest patient stories as research explores whether people with Cystic Fibrosis are at higher risk of COVID-19.
More information and tools
1. Submit your research question or project – we are calling on anyone with a research question for COVID-19 that requires health data to share your ideas via our online form.
Questions will be shared in our HDR UK COVID-19 Knowledge + Skills Matchmaker. We prioritise all of the questions using a transparent and objective process to identify the questions that most urgently need to access to data. Progress of the prioritised questions is reported weekly to the government’s Scientific Advisory Group for Emergencies (SAGE).
2. HDR UK GitHub repository – The HDR UK community is developing computer-based tools and methodologies to analyse and handle health data, including those that can help overcome the COVID-19 challenge. These are all shared in a central repository, which is open to the public, so that we can all learn from each other and build on each other’s work. They are shared in HDR UK’s area of GitHub
3. COVID-19 Slack channels – researchers and innovators looking to collaborate to use health data to address the pandemic can apply to join our dedicated Slack channels. Complete the form to register your interest in joining here.
4. Take a look at our Skills + Knowledge Matchmaker to see a full list of COVID-19 ongoing projects, or visit COVID-19 page to see the latest version of HDR UK’s strategy to support efforts to tackle the pandemic.