The Observatory and Fast Facts

Sept. 24, 2020
Possible link between COVID-19 and chronic kidney disease

The results of a large-scale study of nearly 4,000 patients led by researchers at the Icahn School of Medicine at Mount Sinai suggest that nephrologists will need to prepare for a significant uptick in patients with chronic kidney disease, the result of exposure to the SARS-CoV-2 virus that causes COVID-19, according to a press release from Mount Sinai.

The study was published in the Journal of the American Society of Nephrology.

“We are grappling with a great deal of uncertainty as to how the virus will impact the kidneys in the long haul,” says Principal Investigator Girish Nadkarni, MD. “We may be facing an epidemic of post-COVID-19 kidney disease, and that, in turn, could mean much greater numbers of patients who require kidney dialysis and even transplants.”

In the study, Nadkarni and a team of Mount Sinai researchers describe consequences of COVID-19 on the kidneys, including acute kidney injury (AKI), which occurred in 46 percent of hospitalized patients, one-fifth of whom required dialysis. Most striking, in-hospital mortality was 50 percent among patients with AKI, versus 8 percent of patients hospitalized with COVID-19 who did not develop AKI. Only 30 percent of patients who were hospitalized with COVID-19 and developed AKI survived and experienced renal recovery.

The researchers conducted a retrospective observational study of 3,993 Mount Sinai Health System patients hospitalized from February 27 to May 30, 2020, reviewing data from electronic health records of patients older than 18 years with laboratory-confirmed COVID-19.

While describing how the Mount Sinai Health System’s patient population of racially and ethnically diverse New Yorkers fared during the peak of the pandemic, the authors also show a broader picture of a city unprepared. With New York City being the early epicenter of the COVID-19 pandemic not only in the United States but worldwide, the burden of severe AKI reached full tilt. The authors describe widespread shortages of dialysis nurses, machines, replacement fluids, and cartridges for continuous renal replacement therapy and dialysis.

SARS-CoV-2 infections among healthcare workers may go undetected

A high proportion of SARS-CoV-2 infections among healthcare personnel appear to go undetected, the Centers for Disease Control and Prevention (CDC) noted, based on the results of a study reported in Morbidity and Mortality Weekly Report (MMWR).

To conduct the study, researchers collected blood serum specimens between April 3–June 19, 2020, from frontline healthcare personnel who worked with COVID-19 patients at 13 geographically diverse academic medical centers in the United States, and specimens were tested for antibodies to SARS-CoV-2. Participants were asked about potential symptoms of COVID-19 they experienced since February 1, 2020, previous testing for acute SARS-CoV-2 infection, and their use of personal protective equipment (PPE) in the past week.

Among 3,248 personnel observed, 6 percent had antibody evidence of previous SARS-CoV-2 infection, 29 percent of personnel with SARS-CoV-2 antibodies were asymptomatic in the preceding months, and 69 percent had not previously received a diagnosis of SARS-CoV-2 infection. Seroprevalence by hospital ranged from 0.8 percent to 31.2 percent, with a median of 3.6 percent.

Prevalence of SARS-CoV-2 antibodies was lower among personnel who reported always wearing a face covering (defined in this study as a surgical mask, N95 respirator, or powered air purifying respirator [PAPR]) while caring for patients (6 percent), compared with those who did not (9 percent).

“These findings suggest that some SARS-CoV-2 infections among frontline HCP are undetected and unrecognized, possibly because of the minimally symptomatic or subclinical nature of some infections, underreporting of symptoms, or nonsystematic testing of some personnel with symptomatic infections,” the CDC said.

The study was conducted by the Influenza Vaccine Effectiveness in the Critically Ill (IVY) Network, which is a collaboration of academic medical centers in the United States conducting epidemiologic studies on influenza and COVID-19.

The CDC received serum specimens and completed testing for SARS-CoV-2 antibodies with an enzyme-linked immunosorbent assay against the extracellular domain of the SARS-CoV-2 spike protein. This assay uses anti-pan–immunoglobulin (Ig) secondary antibodies that detect any SARS-CoV-2 immunoglobulin isotype, including IgM, IgG, and IgA.

COVID-19 symptoms can persist for months after hospital stay

A research letter published in the Journal of Infection showed most patients requiring hospitalization for COVID-19 had symptoms – particularly fatigue and shortness of breath – for a mean of 111 days after returning home, according to a news report on the study from the Center for Infectious Disease Policy and Research (CIDRAP).

Researchers administered a phone questionnaire to 120 COVID-19 patients hospitalized from March 15 to April 14 at the University of Paris-affiliated Beaujon Hospital. Ninety-six patients had been treated in the general ward, while 24 required intensive care unit (ICU) care with artificial ventilation.

The most common persistent symptoms were fatigue (55 percent), shortness of breath (42 percent), memory loss (34 percent), lack of concentration (27 percent), and sleep disorders (31 percent). Twenty-four patients (20 percent) reported hair loss, 20 of whom were women. There was no statistically significant difference in symptoms between ward and ICU patients.

In both groups, slightly more ICU patients reported continued pain on health-related quality-of-life (HRQoL) self-assessment EQ-5D-5L subtests, but there were no other differences. Mean EQ-5D score was 0.86, indicating relatively good QoL.

Mean score on the EQ-VAS was 70.3 percent, indicating good health. “This clearly supports the interest of a full resuscitation for COVID-19 patients despite heaviness of cares,” the authors wrote. Thirty-five patients (29 percent) had a Modified Medical Research Council Dyspnea Scale grade of 2 or higher, indicating that they walked slower than their peers because of shortness of breath or had to stop to catch their breath when walking at their own pace.

Researchers show children spread virus that causes COVID-19

In a study of COVID-19 pediatric patients, Massachusetts General Hospital (MGH) and Mass General Hospital for Children (MGHfC) researchers provide data showing that children play a larger role in the community spread of COVID-19 than previously thought, according to a press release from MGH.

In a study of 192 children ages 0-22, 49 children tested positive for SARS-CoV-2, and an additional 18 children had late-onset, COVID-19-related illness. The infected children were shown to have a significantly higher level of virus in their airways than hospitalized adults in ICUs for COVID-19 treatment.

“I was surprised by the high levels of virus we found in children of all ages, especially in the first two days of infection,” says Lael Yonker, MD, director of the MGH Cystic Fibrosis Center and lead author of the study, “Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Reponses,” published in The Journal of Pediatrics. “I was not expecting the viral load to be so high. You think of a hospital, and of all of the precautions taken to treat severely ill adults, but the viral loads of these hospitalized patients are significantly lower than a ‘healthy child’ who is walking around with a high SARS-CoV-2 viral load.”

Along with viral load, researchers examined expression of the viral receptor and antibody response in healthy children, children with acute SARS-CoV-2 infection and a smaller number of children with Multisystem Inflammatory Syndrome in Children (MIS-C).

“Kids are not immune from this infection, and their symptoms don’t correlate with exposure and infection,” says Alessio Fasano, MD, director of the Mucosal Immunology and Biology Research Center at MGH and senior author of the manuscript. “During this COVID-19 pandemic, we have mainly screened symptomatic subjects, so we have reached the erroneous conclusion that the vast majority of people infected are adults. However, our results show that kids are not protected against this virus. We should not discount children as potential spreaders for this virus.”

The researchers also challenged the current hypothesis that because children have lower numbers of immune receptors for SARS-CoV-2, this makes them less likely to become infected or seriously ill. Data from the group show that although younger children have lower numbers of the virus receptor than older children and adults, this does not correlate with a decreased viral load. According to the authors, this finding suggests that children can carry a high viral load, meaning they are more contagious, regardless of their susceptibility to developing COVID-19 infection.

NIH establishes Centers for Research in Emerging Infectious Diseases

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), has announced that it has awarded 11 grants with a total first-year value of approximately $17 million to establish the Centers for Research in Emerging Infectious Diseases (CREID), according to a press release from the NIH. The global network will involve multidisciplinary investigations into how and where viruses and other pathogens emerge from wildlife and spillover to cause disease in people. NIAID intends to provide approximately $82 million over five years to support the network.

Each center in the network will involve collaborations with peer institutions in the United States and 28 other countries. Research projects will include surveillance studies to identify previously unknown causes of febrile illnesses in humans, find the animal sources of viral or other disease-causing pathogens, and determine what genetic or other changes make these pathogens capable of infecting humans. CREID investigators also will develop reagents and diagnostic assays to improve detection of emerging pathogens and study human immune responses to new or emerging infectious agents. Overall, the breadth of research projects in the CREID network will allow for the study of disease spillover in multiple phases of the process: where pathogens first emerge from an animal host; at the borders between wild and more populated areas, where human-to-human transmission occurs; and, finally, in urban areas, where epidemic spread can occur.

Each center will focus efforts on one or more regions of the world. In Central and South America, for example, studies will include investigations of several arthropod-borne viruses (“arboviruses”) including the ones that cause Zika virus disease, chikungunya and dengue. In East and Central Africa, focus pathogens will include Rift Valley fever virus and the coronavirus that causes Middle East respiratory syndrome. In West Africa, in addition to arboviruses, projects are slated on Ebola virus and Lassa virus. In Asia and Southeast Asia, investigators will conduct research on coronaviruses and arboviruses. In every region, investigators will be poised to study any newly emerging pathogen, dubbed “pathogen X.”

An award to RTI International in Research Triangle Park, NC, in collaboration with Duke University, Durham, NC, will fund a CREID Coordinating Center. This center will support network activities such as data management, outbreak research response and quality control for biospecimens, assays and reagents. It will also administer a pilot research program for early career investigators.