Annals of Internal Medicine

ImportanceSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes coronavirus disease 2019 (Covid-19), an evolving pandemic. Limited data are available characterizing SARS-Cov-2 infection in the United States. ObjectiveTo determine associations between demographic and clinical factors and testing positive for coronavirus 2019 (Covid-19+), and among Covid-19+ subsequent hospitalization and intensive care. Design, Setting, and ParticipantsRetrospective cohort study includin...

BackgroundClass switching toward spike (S)-binding IgG4 antibodies after mRNA-based COVID-19 vaccination has been observed, an antibody subclass with strong neutralizing but limited effector activity. While this has been reported in healthy individuals, subclass dynamics in immunocompromised kidney patients are unclear. We assessed IgG subclass patterns and S-specific B-cell phenotypes up to 6 months after a two-dose mRNA-1273 vaccination schedule in kidney transplant recipients (KTRs), dialysis...

BackgroundRisk factors for poor outcomes from COVID-19 are emerging among US cohorts, but patient trajectories during hospitalization ranging from mild-moderate, severe, and death and the factors associated with these outcomes have been underexplored. MethodsWe performed a cohort analysis of consecutive COVID-19 hospital admissions at 5 Johns Hopkins hospitals in the Baltimore/DC area between March 4 and April 24, 2020. Disease severity and outcomes were classified using the WHO COVID-19 diseas...

PurposeRisk factors for coronavirus disease 2019 (COVID-19) mortality include older age, cardiovascular disease, diabetes, and other comorbidities. Latent class analysis (LCA) can identify unrecognized morbidity patterns for decedents with COVID-19. MethodsData were collected from 23 U.S. jurisdictions about decedents with COVID-19 early in the COVID-19 pandemic (February 12-May 12, 2020). LCA identified groups of individuals based upon pre-existing comorbidities: cardiovascular, renal, lung, n...

BackgroundThe COVID-19 pandemic continues to affect the United States and the world. Media reports have suggested that the wave of the alpha variant in the Spring of 2021 in the US caused more cases among younger patients and racial and ethnic subgroups. ApproachWe analyzed electronic health record data from a multihospital health system to test whether younger patients accounted for more cases and more severe disease, and whether racial disparities are widening. We compared demographics, patie...

BackgroundEffects of timing of Convalescent plasma (CP) administration on hospitalized COVID-19 patients are not established. MethodsWe used the National COVID Cohort Collaborative data to perform a retrospective cohort study of hospitalized COVID-19 patients in the United States between 07-01-2020 and 12-19-2020. We stratified patients based on day of CP administration (Day 0, 1, 2, 3 and 4) from COVID-19 diagnosis. We used 35 predictors to frame matched cohorts accounting for clinical and soc...

Background: Little is known about risk factors for COVID-19 outcomes, particularly across diverse racial and ethnic populations in the United States. Methods: In this prospective cohort study, we followed 3,086 COVID-19 patients hospitalized on or before April 13, 2020 within an academic health system in New York (The Mount Sinai Health System) until June 2, 2020. Multivariable logistic regression was used to evaluate demographic, clinical, and laboratory factors as independent predictors of in-...

ObjectivesThe aim of this analysis was to describe nirmatrelvir/ritonavir real-world effectiveness in preventing hospitalization among high-risk US COVID-19 patients during SARS-CoV-2 Omicron predominance. DesignAn ongoing population-based cohort study with retrospective and prospective collection of electronic healthcare data in the United States. MethodsData for this analysis were collected from the US Optum(R) de-identified COVID-19 Electronic Health Record (EHR) dataset during December 22,...

BackgroundData on effectiveness of sotrovimab preventing COVID-19-related hospitalization or mortality, particularly after the emergence of the Omicron variant, are limited. MethodDetermine the real-world clinical effectiveness of sotrovimab for prevention of 30-day COVID-19 related hospitalization or mortality using a retrospective cohort within the U.S. Department of Veterans Affairs (VA) healthcare system. Veterans aged [≥]18 years, diagnosed with COVID-19 between December 1, 2021, and A...

From 1999 to 2020, disparities in all-cause age-adjusted mortality rates between Black and White Non-Hispanic Americans decreased then stagnated and increased. Consistent improvement in racial disparities were made for cancer, HIV, and sepsis regardless of all-cause trends. In contrast, conditions like heart disease and external causes of death mirrored the overall trends.

BackgroundCOVID-19 test sensitivity and specificity have been widely examined and discussed yet optimal use of these tests will depend on the goals of testing, the population or setting, and the anticipated underlying disease prevalence. We model various combinations of key variables to identify and compare a range of effective and practical surveillance strategies for schools and businesses. MethodsWe coupled a simulated data set incorporating actual community prevalence and test performance c...

Long Covid - the disease encompassing the post-acute sequelae of SARS-CoV-2 (PASC) --affects millions of people around the world. Prevention of PASC is an urgent public health priority. In this work, we aimed to examine whether treatment with nirmatrelvir in the acute phase of COVID-19 is associated with reduced risk of post-acute sequelae. We used the healthcare databases of the US Department of Veterans Affairs to identify users of the health system who had a SARS-CoV-2 positive test between M...

BackgroundNational data from diverse institutions across the United States are critical for guiding policymakers as well as clinical and public health leaders. This study characterized a large national cohort of patients diagnosed with COVID-19 in the U.S., compared to patients diagnosed with viral pneumonia and influenza. Methods and FindingsWe captured cross-sectional information from 36 large healthcare systems in 29 U.S. states, participating in PCORnet(R), the National Patient-Centered Cli...

BackgroundMore than one-third of individuals experience post-acute sequelae of SARS-CoV-2 infection (PASC, which includes long-COVID). ObjectiveTo identify risk factors associated with PASC/long-COVID. DesignRetrospective case-control study. Setting31 health systems in the United States from the National COVID Cohort Collaborative (N3C). Patients8,325 individuals with PASC (defined by the presence of the International Classification of Diseases, version 10 code U09.9 or a long-COVID clinic v...

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is often comorbid with conditions subject to quality metrics (QM) used for hospital performance assessment and rate-setting. Although diagnostic coding change in response to financial incentives is well documented, no study has examined the association of QM with SARS-CoV-2 cause-of-death attribution (CODA). Calculations of excess all-cause deaths overlook the importance of accurate CODA and of distinguishing policy-related f...

BackgroundIn the EPIC-HR trial, nirmatrelvir plus ritonavir led to an 88% reduction in hospitalization or death among unvaccinated outpatients with early COVID-19. Clinical impact of nirmatrelvir plus ritonavir among vaccinated populations is uncertain. ObjectiveTo assess whether nirmatrelvir plus ritonavir reduces risk of hospitalization among outpatients with early COVID-19 in the setting of prevalent SARS-CoV-2 immunity and immune evasive SARS-CoV-2 lineages. DesignPopulation-based cohort s...

ObjectivesTo assess the association of specific comorbid conditions to COVID-19 deaths in Florida among decedents 16 to 64 years of age. MethodsThis report uses Florida vital statistics death data over the period of March 1, 2020 through January 16, 2021, to estimate the effects of comorbid conditions on COVID-19 mortality for decedents 16 to 64 years of age. All cases of COVID-19 death occurring in Florida, regardless of resident status, were evaluated. The comorbidities, or contributing cause...

ObjectiveTo evaluate differences by race/ethnicity in clinical characteristics and outcomes among hospitalized patients with Covid-19 at Massachusetts General Hospital (MGH). MethodsThe MGH Covid-19 Registry includes confirmed SARS-CoV-2-infected patients hospitalized at MGH and is based on manual chart reviews and data extraction from electronic health records (EHRs). We evaluated differences between White/Non-Hispanic and Hispanic patients in demographics, complications and 14-day outcomes am...

PurposeCOVID-19 disease continues to affect millions of individuals worldwide, both in the short and long term. The post-acute complications of SARS-CoV-2 infection, referred to as long COVID, result in diverse symptoms affecting multiple organ systems. Little is known regarding how the symptoms associated with long COVID progress and resolve over time. The Johns Hopkins COVID Long Study aims to prospectively examine the short- and long-term consequences of COVID-19 disease in individuals both w...

BackgroundWe present data on risk factors for severe outcomes among patients with coronavirus disease 2019 (COVID-19) in the southeast United States (U.S.). ObjectiveTo determine risk factors associated with hospitalization, intensive care unit (ICU) admission, and mortality among patients with confirmed COVID-19. DesignA retrospective cohort study. SettingFulton County in Atlanta Metropolitan Area, Georgia, U.S. PatientsCommunity-based individuals of all ages that tested positive for SARS-C...