Asthma Has a Greater Impact on Outcomes in Younger COVID-19 Patients

Doug Winesett, MD • Kieran Gallagher, MPH
Original Article: Data Analysis
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Asthma and COVID-19 outcomes by age group for COVID-19 admitted patients
Figure 2: The light blue bars show the risk of hospitalization, ICU admission, and death for an asthmatic patient with COVID-19 when compared to a non-asthmatic patient in the same age group. The dark blue lines indicate the 95% confidence intervals, or the range that contains the true value with 95% certainty. The risk was calculated using a hazard ratio, a statistical method used to assess the probability of an event in one group (asthmatic patients with COVID-19) compared to a control group (non-asthmatic patients with COVID-19 in the same age group). A hazard ratio of 1 means an asthmatic patient has the same risk of the event as a non-asthmatic patient. A hazard ratio of 2 means an asthmatic patient is twice as likely to experience the event, while a hazard ratio of 0.5 means an asthmatic patient is half as likely to experience the event.

The effect of asthma on outcomes in COVID-19 patients remains unclear. Studies have shown conflicting results. Our data show asthma has a greater impact on outcomes in younger COVID-19 patients…

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Asthma and COVID-19 outcomes by age group for COVID-19 admitted patients
Figure 2: The light blue bars show the risk of hospitalization, ICU admission, and death for an asthmatic patient with COVID-19 when compared to a non-asthmatic patient in the same age group. The dark blue lines indicate the 95% confidence intervals, or the range that contains the true value with 95% certainty. The risk was calculated using a hazard ratio, a statistical method used to assess the probability of an event in one group (asthmatic patients with COVID-19) compared to a control group (non-asthmatic patients with COVID-19 in the same age group). A hazard ratio of 1 means an asthmatic patient has the same risk of the event as a non-asthmatic patient. A hazard ratio of 2 means an asthmatic patient is twice as likely to experience the event, while a hazard ratio of 0.5 means an asthmatic patient is half as likely to experience the event.
Innovators
PerspectivesCHOP
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Silver Linings Pandemic

Zachary McClain, MD
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Dr. Zachary McClain of The Children's Hospital of Philadelphia
Dr. Zachary McClain of The Children's Hospital of Philadelphia.
Zachary McClain, MD

Life was so normal a few weeks ago. For me, and I imagine for many other health care workers, before the novel coronavirus etched its…

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Dr. Zachary McClain of The Children's Hospital of Philadelphia
Dr. Zachary McClain of The Children's Hospital of Philadelphia.
InnovatorsNYU Langone Health
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NYU Langone Health: Telemedicine Growth at An Epicenter of COVID-19

Tiffany Martinez, and Others
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Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
Tiffany Martinez, and Others

Evidence from one large health system—NYU Langone Health—at an epicenter of the coronavirus disease 2019 outbreak in the United States shows possibility of sharp and…

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Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
Figure 1. Visit volumes increase in telemedicine urgent care (VUC) and non-urgent care (non-VUC) and decrease in in-person care. Each bar represents 1 day. Key dates are annotated above corresponding bars. COVID-19: coronavirus disease 2019; ED: emergency department.
InnovatorsMount Sinai
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Mount Sinai Studies COVID-19 and Blood Clots

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A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19
A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19.

Physicians at Mount Sinai are exploring new avenues of clinical investigation, based on the beneficial response of patients to tPA in a small, preliminary case…

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A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19
A preliminary case series at Mt. Sinai studies the use of anticoagulation therapies for COVID-19.
Collaborations
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COVID-19 Hospitalization and Death Rates Among Active Epic Patients by Race Ethnicity as of July 2020

Despite being at increased risk of exposure to the virus, people of color did not have markedly higher testing rates compared to White patients and were more likely to be positive when tested and to require a higher level of care at the time they tested positive. Moreover, it builds on previous research showing people of color have higher rates of hospitalization and death due to COVID-19 by finding that these disparities persist after controlling for sociodemographic characteristics and underlying health conditions…

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COVID-19 Hospitalization and Death Rates Among Active Epic Patients by Race Ethnicity as of July 2020
Original Article: Data Analysis
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COVID-19 positive patients by age
Figure 1: Relative contribution of various age groups to total COVID-19 population over time. The population counts represent the total number of COVID-19 patients in each age group over the entire included timespan.

Interest in the demographic characteristics of people with COVID-19 has been high since the start of the pandemic. Initially, when testing resources were scarce and often limited to the sickest patients, older adults represented a higher proportion of patients than young people. Beginning in June, demographics shifted and young people now represent the largest subgroup of COVID-19 cases…

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COVID-19 positive patients by age
Figure 1: Relative contribution of various age groups to total COVID-19 population over time. The population counts represent the total number of COVID-19 patients in each age group over the entire included timespan.

COVID-19 Healthcare Coalition: Independent Investigations Show Famotidine Does Not Lower Risk of Death in COVID-19 Patients

Andrea Noel, MD, David B. Berry, PhD
Collaborations
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IV drip

The first collaborative study with the COVID-19 Healthcare Coalition looked at the impact of famotidine treatment on the risk of death in admitted COVID-19 positive patients. Each data partner performed an identical independent analysis on their own aggregated dataset. The final conclusion from each data source was the same: rapid famotidine treatment does not reduce the risk of death among admitted COVID-19 patients, even when adjusting for age, sex, and comorbidities…

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IV drip

Effect of COVID-19 Pandemic on Visit Patterns for Anxiety and Depression

Jeff Trinkl, MD, Alejandro Muñoz del Río, PhD
Original Article: Data Analysis
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Visit patterns for patients with anxiety and depression. Weekly volume by type of visit and type of patient, January 5-July 12, 2020.
Figure 1. Weekly visit volume for anxiety and depression over time across different visit and patient types. The green line indicates actual observed weekly volumes, while the dark purple one shows estimates from a generalized additive model (GAM) combining long term trend, yearly seasonal, and holiday effects. The light purple lines indicate the lower and upper 80% uncertainty bounds of the estimates. The GAM was fitted to observations up to and including the week of January 19, which is the date the first COVID-19 case in the U.S. was reported.

The CDC has raised concerns about increased isolation, fear, and anxiety during the pandemic. This brief examines how COVID-19 changed care delivery patterns for patients with anxiety or depression, in both established and newly diagnosed patients. Additionally, our analysis shows the initial steep drop-off in total visits has returned to pre-pandemic levels, with telehealth compensating for the reduction in office visits…

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Visit patterns for patients with anxiety and depression. Weekly volume by type of visit and type of patient, January 5-July 12, 2020.
Figure 1. Weekly visit volume for anxiety and depression over time across different visit and patient types. The green line indicates actual observed weekly volumes, while the dark purple one shows estimates from a generalized additive model (GAM) combining long term trend, yearly seasonal, and holiday effects. The light purple lines indicate the lower and upper 80% uncertainty bounds of the estimates. The GAM was fitted to observations up to and including the week of January 19, which is the date the first COVID-19 case in the U.S. was reported.

Telehealth: Fad or the Future

Bradley Fox, MD, J. Owen Sizemore, PhD
Original Article: Data Analysis
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Ambulatory visits by type and US region (#)
Figure 1. Number of ambulatory visits broken down by visit type and United States region. Regions were grouped according to the Census Regions and Divisions of the United States guidelines. (3)

Earlier this year, we published data demonstrating a 300-fold increase in telehealth, broken down by encounter reason and specialty. Many speculated that telehealth volumes would remain high throughout (and perhaps beyond) the pandemic; however, recent EHR data show that volumes peaked in mid-April. Since then, levels have dropped to make up only 21% of total visits, though this is still much higher than the rates seen before the pandemic…

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Ambulatory visits by type and US region (#)
Figure 1. Number of ambulatory visits broken down by visit type and United States region. Regions were grouped according to the Census Regions and Divisions of the United States guidelines. (3)

Inpatient Lengths of Stay, Number of ICU Days Among COVID-19 Patients Differ from Common Model Assumptions

Howard Bregman, MD, MS, Kieran Gallagher, MPH
Original Article: Data Analysis
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COVID-19 median inpatient and ICU length of stay

Public policy decisions in the United States have relied on epidemiologic models that predict the course of the COVID-19 pandemic. We compared the assumptions in the IHME model to a sample of admissions across 21 states, and found the median estimates differ from the assumptions…

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COVID-19 median inpatient and ICU length of stay

Uncontrolled Blood Sugar Contributes to COVID-19 Mortality in Type 2 Diabetics

Jeff Trinkl, MD, Kieran Gallagher, MPH
Original Article: Data Analysis
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Risk of COVID-19 mortality graph shows type 2 diabetics experience a higher COVID-19 mortality rate.
Figure 1. Type 2 diabetics experience a higher COVID-19 mortality rate compared to the general population. Our analysis found that 75% of this increased risk is explained by high blood sugar, while the remaining 25% is the result of other factors.

COVID-19-positive, diabetic patients were 86% more likely to die after controlling for age, sex, and race/ethnicity. Focusing on high blood sugar, we found that high blood sugar explained 75% of the increased risk of mortality in type 2 diabetics…

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Risk of COVID-19 mortality graph shows type 2 diabetics experience a higher COVID-19 mortality rate.
Figure 1. Type 2 diabetics experience a higher COVID-19 mortality rate compared to the general population. Our analysis found that 75% of this increased risk is explained by high blood sugar, while the remaining 25% is the result of other factors.

Non-Emergency Procedure Volumes in the Wake of COVID-19

Brad Fox, MD, Justin Lo, PhD, MT(ASCP)
Original Article: Data Analysis
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Relative weekly non-elective surgery volumes in 2020

Our analysis found a dramatic–but temporary–decrease in procedures for cardiac arrhythmia and coronary artery disease, as well as procedures for all of the major organ cancers we examined. At their lowest point, these procedure volumes were 49-88% below their historical weekly averages…

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Relative weekly non-elective surgery volumes in 2020

COVID-19 Patients with Elevated Liver Enzymes Show Higher Mortality Rates

David R. Little, MD, MS, Elliot First
Original Article: Data Analysis
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Liver AST and ALT association with COVID-19 mortality among admitted patients diagnosed with COVID-19
Figure 1. Percentage of patients grouped by Normal, Elevated, or Severely Elevated peak AST or ALT enzyme levels.

Patients with severely elevated liver enzymes during admission for COVID-19 showed 2.5 times higher mortality rates when compared to patients with normal or moderately elevated levels…

Hypertensive Patients Treated with Medication Show Better COVID-19 Outcomes than Untreated Patients

Steven R. Allen, MD, David B. Berry, PhD
Original Article: Data Analysis
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Worst outcome by hypertension medication
Figure 1. Distribution of worst COVID-19 outcomes by treatment.

Early in the COVID-19 pandemic, experts expressed concerns that hypertensive patients taking RAAS inhibitors to control blood pressure might be at a higher risk of increased COVID-19 disease severity and mortality. However, analysis of EHR data suggests…

Delayed Cancer Screenings—A Second Look

Christopher Mast, MD, Alejandro Munoz del Rio, PhD
Original Article: Data Analysis
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Figure 1. Weekly cancer screening volume vs. week number in year for each type of cancer screening. Colored capsules show the last observed volume.
Figure 1. Weekly cancer screening volume vs. week number in year for each type of cancer screening. Colored capsules show the last observed volume.

The number of cancer screenings has recently begun to rise, but has not yet reached previously expected levels: June 16 weekly volumes remained 29%, 36%, and 35% lower than their pre-COVID-19 levels for breast, colon, and cervical cancer screenings. The gap between the expected screenings and the actual screenings created a sizable deficit of “missed” screenings…

Geographic Variation in Use of Oxygen Support

Justin Lo, PhD, MT (ASCP), Sam Butler, MD
Original Article: Data Analysis
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Most intensive respiratory therapy by geographic region

Using data from nearly 50,000 hospitalized COVID-19 positive patients across the United States, statistically significant geographic variations in supportive oxygen treatment were demonstrated and not explained by differences in age, sex, or severity…

follow-upReturn to Near Average Number of ED Visits for Acute MI and Strokes 12 Weeks Post COVID-19 Emergency Declaration

Jeff Trinkl, MD, J. Owen Sizemore, PhD
Original Article: Data Analysis
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Weekly Trend in AMI Presentation April 7-June 6

EHR data from ED visits occurring between the weeks of April 7, 2020 and May 31, 2020 show the weekly incidence of acute myocardial infarctions has returned to approximately 92% of the historical trend prior to March 13, 2020…

Acute Kidney Injury in Admitted COVID-19 Patients

Sam Butler, MD, Tyler Heist, PhD
Original Article: Data Analysis
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Figure 1. Percent of patients who developed AKI during a COVID-19 admission, broken down by age and sex. Note: Two patients with a documented sex of “Other” were excluded from analysis.
Figure 1. Percent of patients who developed AKI during a COVID-19 admission, broken down by age and sex. Note: Two patients with a documented sex of “Other” were excluded from analysis.

COVID-19 is primarily a respiratory infection; however, there are multiple examples of multi-organ and systemic dysfunction associated with this infection. In addition to lung damage, it appears that the virus affects the lining of blood vessels, potentially leading to clotting, embolization, and organ damage…

Fewer Patients Started on Medications for Opioid Use Disorder During COVID-19

David R. Little, MD, Melissa Gaisser, MS
Original Article: Data Analysis
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Patients on OUD Medications for the First Time All
Figure 1. First-time MOUD, buprenorphine, and naltrexone patients over time. Solid colored capsules show the last observed value. Dashed outline capsules show the predicted value for May 2020.

The number of patients receiving first-time prescriptions for Medications for Opioid Use Disorder (MOUD) decreased by over 30% in the spring of 2020 when compared to trends observed in EHR data from January 2017 to May 2020. This finding suggests that patients at risk for opioid use disorder (OUD) and overdose are increasingly vulnerable during…

Mortality of COVID-19 Admitted Patients on Mechanical Ventilators

Original Article: Data Analysis
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Ventilator survival by age and sex

This brief was updated on June 26, 2020, with data as of June 18, 2020. Overall findings remain consistent, but the percentage of patients with an unknown outcome has decreased from 34% to 6%. Here we examine the mortality of patients who received invasive mechanical ventilation as treatment for acute respiratory failure due to COVID-19…

Patients with Multiple Positive COVID-19 Tests

Jeff Trinkl, MD, Melissa Gaisser, MS
Original Article: Data Analysis
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Figure 1. COVID-19 tested patients, by test result. Callout graph shows subsequent testing information for patients who tested positive for COVID-19.
Figure 1. COVID-19 tested patients, by test result. Callout graph shows subsequent testing information for patients who tested positive for COVID-19.

For numerous reasons, some patients are tested for SARS-CoV-2 virus multiple times, and a small percentage of patients test positive more than once. We were interested in better understanding how often patients undergo multiple tests, and what the time frame is between the first and last positive results. We speculate that fewer days between repeat…

As Office Visits Fall, Telehealth Takes Hold

Bradley Fox, MD, J. Owen Sizemore, PhD
Original Article: Data Analysis
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Telehealth by condition – v2

Recent data show that, while overall visit volumes have decreased dramatically since the beginning of the COVID-19 pandemic in the United States, telehealth visits overall have increased 300-fold.1 This brief describes the diagnoses and specialties that saw the largest visit volumes of telehealth, with the goal of informing future strategy around telehealth…

Famotidine and COVID-19 Severity During Hospitalization

Sam Butler, MD, David B. Berry, PhD
Original Article: Data Analysis
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Famotidine administration and worst COVID-19 severity by age

There has been recent speculation surrounding whether famotidine, the active ingredient in a common heartburn medicine, Pepcid, could serve as an antiviral that may inhibit coronavirus replication. Our examination of EHR data did not show an obvious difference between the worst severity level of COVID-19 patients who were administered famotidine and those who were not…

Effect of Comorbidities on Hospitalization and Death in COVID-19 Patients

Kieran Gallagher, MPH, Alejandro Munoz del Rio, PhD, and Others
Report
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Effect of COVID-19 on hospitalization and death by comorbidity
Figure 1: The light blue bars show higher or lower risk of hospitalization and death (using hazard ratios) for each comorbidity, controlling for age group, sex, and other comorbidities. For example, diabetics have a hazard ratio of 1.6 for hospitalization, which means that patients with diabetes are 60 percent more likely to be hospitalized compared to patients with the same age group, sex, and combination of comorbidities who don’t have diabetes. The dark blue lines indicate 95% confidence intervals, or the range that contains the true value with 95% certainty.

Using data from 190,194 COVID-19 patients, the following conditions were found to be most strongly associated with a higher risk of hospitalization and death: Heart failure, diabetes, a weakened immune system, COPD, and a BMI of 40 or higher…

Pediatric Immunizations Drop in the Wake of COVID-19

Original Article: Data Analysis
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Estimated missed or delayed immunizations during COVID-19 pandemic by patient age group

Recent EHR data show that immunization administrations for pediatric patients have decreased by 42% in the spring of 2020 compared to prior years. It is estimated that 260,000 immunizations expected for March 8-May 9 were missed or delayed across all age groups at sampled organizations. Patients under 6 months of age showed the smallest reduction…

Trends in Acute MI and Stroke in the ED During COVID-19

Original Article: Data Analysis
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Weekly Trend in AMI Presentation

Update: On July 7, we published an update to this article that found the weekly incidence of acute myocardial infarctions and stroke have returned to their near average historical trends. As the COVID-19 pandemic continues, there are growing concerns that patients with urgent conditions are not seeking the care they need for fear of exposure…

Race, Comorbidities, and COVID-19

Original Article: Data Analysis
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Comorbidities in COVID-19 hospitalizations and deaths: Aged 19-64 years, by race, compared to studied population
Table 1: Distribution of comorbidities by race for all sampled patients, COVID-19 positive hospitalized patients, and COVID-19 related deaths for patients aged 19-64 years. The “other” category contains the following groups: patients with a race documented as “other” in the EHR; patients without a documented race; and patients with a documented race that is not white or black, which have low sample sizes.

As coronavirus cases mount, racial minorities appear to be disproportionately affected by the pandemic. Across a sample population of 23 million patients across 16 states, 12% were black and 65% were white, but among the 108,000 of those patients who are documented COVID-19 positive, 22% were black and 46% were white. The root causes of…

Obesity and COVID-19 Severity

Original Article: Data Analysis
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Worst severity in COVID-19 patients by obesity class and age group

Severe obesity, defined as having a body mass index (BMI) of 40 kg/m2 or higher, has been identified by the CDC as a risk factor for more severe COVID-19 illness. This brief examines the relationship between obesity and severity of illness for adult COVID-19 positive patients. In this sample of 119,582 COVID-19 positive patients, 79% have a BMI documented in their electronic medical record…

COVID-19 Severity by Smoking Status

Original Article: Data Analysis
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COVID-19 outcomes by smoking status and age
Figure 1. COVID-19 worst severity by smoking status and age group. Some rows may not add to 100% due to rounding.

There has been recent conversation about the role that smoking status may play in severity of COVID-19 disease. To investigate this role, we examined the relationship between smoking status, as documented in the electronic health record, and general outcome severity of COVID-19 in a large national cohort of adult COVID-19 positive patients…

Prevalence of Comorbidities in COVID-19 Related Hospitalizations and Deaths

Original Article: Data Analysis
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Condition prevalence in adults in active patient population compared to adult national baselines
Table 1. Prevalence of examined conditions in adults in the active patient population as compared to national baselines.

COVID-19 hospitalization and mortality information were assessed in a sample of 36 million active patients.1 Nearly 10 million of those patients have documented hypertension, diabetes, chronic obstructive pulmonary disease (COPD), or moderate/severe asthma as of April 30, 2020. The summarized data were contributed by 31 health systems (300 hospitals) across 18 states. Table 1 shows…

Delayed Cancer Screenings

Original Article: Data Analysis
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Cancer screenings in the U.S. - Mean weekly screening volume for breast, colon, and cervical cancer
Figure 1. Weekly cancer screening volume vs. time for each type of cancer screening. Colored capsules show the last observed volume.

EHR data show a recent abrupt drop – between 86% and 94% – in preventive cancer screenings performed across the United States, presumably due to access disruptions caused by COVID-19. The data set includes 2.7 million patient records from 39 organizations that represent 190 hospitals spanning 23 states. If the trend continues, the data suggest that many cancer cases could go undiagnosed or be diagnosed at a later stage with a poorer prognosis…

Learning from New Orleans’ COVID-19 Gene Sequence

InnovatorsOchsner Health System
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Ochsner in Louisiana
An Ochsner team is using gene sequencing to investigate interactions between COVID-19 and underlying conditions.

Researchers from Ochsner and local lab BioInfoExperts have sequenced the genetic code of samples from their COVID-19 patients to learn more about the virus’s spread in Louisiana and how it continues to evolve. New Orleans has not only some of the highest per-capita rates of COVID-19 infection, but also a high rate of underlying health illness in the population…

Prior Outpatient Medications and Subsequent COVID-19 Positive Status

Original Article: Data Analysis
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Prior Outpatient Medications and Subsequent COVID-19 Positive Status
Figure 1: COVID-19 Positive Rate by Medication. See footnote for details.

As the COVID-19 pandemic sweeps the globe, there is a rush to find medications that, if taken before COVID-19 is acquired, may be protective against infection. Clinical trials are currently examining drugs in many different classes. Figure 1 shows the percentage of patients who acquire COVID-19 after taking each medication chronically…

COVID-19 Home Monitoring: The Role of Technology

Eric Boose, MD, Christopher Babiuch, MD, and Others
InnovatorsCleveland Clinic
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Cleveland Clinic Miller Family Pavillion
Cleveland Clinic Miller Family Pavillion

Story contributed by Cleveland Clinic. Never before has the need to leverage technology for population health management been more apparent. With the outbreak of COVID-19, consistent outreach and prompt intervention are necessary to prevent negative outcomes. Although patients with COVID-19 often experience mild symptoms, deterioration can be rapid, even in patients considered low risk. That’s…

NYU Langone Scientists Track Evolution of Virus

InnovatorsNYU Langone Health
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Genome sequencing holds clues about the progression of COVID-19 in New York City and offers hints about where to look next.
NYU Langone researchers are using the gene codes from COVID-19 samples to track the pandemic’s spread. This map uses color to represent countries, circle size to show the number of infections, and lines to illustrate transmission. (Photo courtesy of nextstrain.org)

Researchers at NYU Langone have sequenced the genetic code of samples from 91 COVID-19 patients in New York City, seeking clues to its origin and evolution in this region. Early data suggest that the virus has been spreading in the city for two months, before testing started. The findings also indicate the New York City…

COVID-19 Population Characteristics: Age and Sex

Original Article: Data Analysis
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COVID-19 testing rates by age and sex, compared to the overall population
Figure 1. COVID-19 testing rates by age group and sex

Investigators examined which patient populations are most likely to be tested for COVID-19, test positive for COVID-19, and have the most severe outcomes. The analysis below includes 165,359 patients tested for COVID-19 and 66,017 COVID-19 positive patients as of April 17, 2020. Data are pooled from 22 health systems that represent 140 hospitals, spanning 11…

Ibuprofen and COVID-19 Severity

Original Article: Data Analysis
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Worst severity probability by prior ibuprofen prescription by age and sex

Investigators examined whether patients who were prescribed ibuprofen before they were infected with COVID-19 showed a difference in disease severity. Patients who were prescribed ibuprofen before infection had less severe outcomes. This appeared to be the case regardless of sex or age group. We include patients in the “prescribed ibuprofen” group if they had a…