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Contributor ○○○

Some interesting info on COVID-19 Hospitalization risk factors

hello all

The following is taken from the data provided on the CDC COVID-NET web site. The downloadable data table includes all admissions to the COVID-NET hospital network in 14 states, organized by the group (by gender, race and age ranges), clinical symptoms when admitted and also listing all diagnosed pre-existing conditions. The value of the COVID-NET hospitals is they use standardized reporting for a geographic area and must use laboratory rather than clinical indicators to diagnose the admission as due to the COVID-19 virus. This combination of data to about 11,500 cells of data.

The data table shows 31,572  total admissions at the 250 COVID-NET Hospitals beginning with the first COVID-19 admission.. The actual data for each admission is for the week ending June 20, so does not have the past week's data, and so it is not cumulative.

I sorted by group primary strata, which are by gender, race/ethnicity and age group of 18-49, 50-64 and 65+. The secondary strata have a mix of PECs and presenting symptoms. I excluded clinical symptoms as I'm really interested most in what kind of conditions creates the highest risk for a COVID-19 infection serious enough to be admitted to the hospital. PECs include hypertension, obesity, smoking and a variety of medical diagnoses. I then sorted the primary strata group by the per-cent of all of the COVID-19 admissions that shared the PEC.

Here is the total admissions by race/ethnicity

ethnicity.jpg

And then by age group

admissions by age.jpg

This graph shows the highest PEC risk factors for the week's admissions

group by PEC.jpg

This suggest factors such as hypertension and obesity are primary PEC risk factors. However, what's really needed in addition to this is the prevelance of these risk factors in the population at large, information I don't have.

I left pneumonia as a PEC even though it may be a condition actually caused by the COVID-19 virus.

Here is the caption at the bottom of the downloaded .cvs data sheets that clarify what I said above about this data.

COVID-NET conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations

in children (less than 18 years of age) and adults. COVID-NET covers nearly 100 counties in the 10 Emerging Infections

Program (EIP) states (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) and four Influenza Hospitalization Surveillance Project

(IHSP) states (IA, MI, OH, and UT). 

 

A final point. Please, let's not politicize this and get Ryan all upset. It took me a long time to download and organize this data. Let's keep the discussion on the data and what it means.

BruceM

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Contributor ○○○

Re: Some interesting info on COVID-19 Hospitalization risk factors

Thanks for the data and implications.

In addition to interesting PEC indicators (Figure 3), it is well-known that ethnic culture/situations may play a role as well.  Figure 1 shows some of that, but of course, it needs to be examined in terms of percentage in each category.  

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Re: Some interesting info on COVID-19 Hospitalization risk factors

Thanks for the great post Bruce. Good data, my response is simply those at age 80, even in fairly good health need to try to manage staying at home, as it is hard not to have some systemic physical weakness like hypertension when one is of advanced age.

I wish everyone the best and hope y'all are able to find a way to avoid extreme boredom. 

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Re: Some interesting info on COVID-19 Hospitalization risk factors

I read a study that indicated part of the problem with hypertension and covid is due to the use of ACE inhibitors which somehow enhance the excessive immune response.

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Re: Some interesting info on COVID-19 Hospitalization risk factors


@FatKat wrote:

Thanks for the great post Bruce. Good data, my response is simply those at age 80, even in fairly good health need to try to manage staying at home, as it is hard not to have some systemic physical weakness like hypertension when one is of advanced age.

I wish everyone the best and hope y'all are able to find a way to avoid extreme boredom. 


My understanding is that there's a low risk of virus transmission outdoors. The big risk is having contact with virus carriers in poorly ventilated spaces, such as indoor restaurants, subways, buses, and maybe shopping malls. Air conditioning systems may or may not contribute to spreading the virus. The virus hates exposure to sunlight and prefers cool spaces.

Looking at the PECs published below, I conclude that it might be smart to get outdoors frequently for regular exercise in the park. But, don't stop at McDonald's for a Big Mac in the way home.

N.

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Explorer ○

Re: Some interesting info on COVID-19 Hospitalization risk factors

The only one of the factors over which we have any near-term control is our blood pressure, which evidently is important. Obvious measures: take any prescribed med and try not to get upset. As my home BP monitor shows, caffeine boosts my blood pressure a lot more than it used to. Guess I better cut way back on one of my few remaining pleasures. Ugh!

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Re: Some interesting info on COVID-19 Hospitalization risk factors

Other than age, I don't have other risks.  Heck, I still don't take blood pressure medicine.  Still, my written and verbal instructions are clear to my family, my medical POA and my physician.  I am not to go on a ventilator, my DNR is carried with me.  I've had a good life and have been lucky to live when and where I have.  The last piece of the puzzle is done: the establishment of an endowed scholarship for kids not as lucky as myself. 

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Re: Some interesting info on COVID-19 Hospitalization risk factors

Archer wrote:

"I read a study that indicated part of the problem with hypertension and covid is due to the use of ACE inhibitors which somehow enhance the excessive immune response."

Archer: that was an early hypothesis and it has been dismissed.  I get my info from two of our kids who have endowed chairs in medical research at a major medical center.

By the way, this center (thousands of employees) just concluded its own on-site examination of most effective measures to limit covid-19, and by far masks were the most effective preventive measure--followed by physical distance and hand washing.  Among thousands of employees. covid-19 cases are in single digits.

Stay well.

Bob

Reported research results from New England Journal of Medicine

"Use of ARBs or ACE inhibitors did not show any association with Covid-19 among case patients overall (adjusted odds ratio, 0.95 [95% confidence interval {CI}, 0.86 to 1.05] for ARBs and 0.96 [95% CI, 0.87 to 1.07] for ACE inhibitors) or among patients who had a severe or fatal course of the disease (adjusted odds ratio, 0.83 [95% CI, 0.63 to 1.10] for ARBs and 0.91 [95% CI, 0.69 to 1.21] for ACE inhibitors), and no association between these variables was found according to sex."

 

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Frequent Contributor

Re: Some interesting info on COVID-19 Hospitalization risk factors

Agree with Bob’s statements about ACE inhibitors (and ARB’s). The use of Angiotensin converting enzyme inhibitors (ACE inhibitors) and Angiotensin Receptor Blockers (ARB’s) has NOT been shown to worsen outcomes, hospitalizations, or deaths with Covid 19 infection. So stay on your ACE inhibitors or ARB’s!

Win
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Re: Some interesting info on COVID-19 Hospitalization risk factors

Hopefully drug companies did not sponsor (pay for) the research, there's big money (profits) at stake.

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Re: Some interesting info on COVID-19 Hospitalization risk factors

There's a couple of things that struck me about the PECS....there are only 3 in this group outside of pneumonia....which as I mentioned I think you could call it caused by the virus rather than pre-existing .....although I really can't conclude that as it may have been contracted prior to exposure to the virus.

But the big 3 are hypertension, obesity (particularly in those under age 50) and Cardiovascular Disease (CVD). Notice Asthma, BIPAP/CPAP, Tobacco use, HIV/AIDS, Chronic Renal Disease, Chronic Liver Disease, Bronchitis, Autoimmune Disorders, and on and on, as PECs are below this group, although COPD/Emphasema and Diabetes were in the mid 40% range. Again, this is most likely due to the prevalence of hypertension and obesity over the other PECs, but they show themselves as major risks.

If you're decent in Excel, you should go to the CDC web site I highlited above and download the data table. There are all manner of interesting sorts you can wile away your time doing

BruceM

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Re: Some interesting info on COVID-19 Hospitalization risk factors

@Tibbles 

"The only one of the factors over which we have any near-term control is our blood pressure, which evidently is important."

I looked all over this web site, but could not find how they defined Hypertension. Does it include all who are diagnosed with it regardless of whether their BP is held in a normal range....or does it include only those whose BP exceeds normal range?

I have the same question with obesity. The convention I've always seen is anything over a Body Mass Index of 30 is obese, but I can't see their definition anywhere.

Hospitals must have professional data gatherers whose full time job is to get all this info on each COVID-19 admission, cause its a lot of info.

BruceM

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Explorer ○

Re: Some interesting info on COVID-19 Hospitalization risk factors

@BruceM 

I too would like answers to those questions, as I think Fauci would. (Maybe by now he has them.) When the worries first emerged about ACE inhibitors and ARBs (which I was taking), I did some Googling and found a long online interview in which Fauci said that he too was concerned about those drugs because (1) there’s a “basic science” reason for concern and (2) “hypertension” had been reported as a major risk factor. Fauci said he ordinarily wouldn’t think of *controlled* hypertension as a risk factor for much of anything. So if there is one (and he wasn’t sure that that was the claim), he conjectured that it could be due to the popularity of the ACE inhibitors and ARBs as a method of controlling hypertension. My doctor texted me a statement by some professional association saying that there was no proof that the meds are harmful vis-a-vis Covid. I didn’t find it sufficiently reassuring that there was “no proof” that my med would put my life at risk. I insisted on a switch, but the concerns about those meds evidently have subsided.

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Re: Some interesting info on COVID-19 Hospitalization risk factors

Good work, Bruce.  And thankfully I don’t have to go off Lisinopril.   

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Re: Some interesting info on COVID-19 Hospitalization risk factors


@norbertc wrote:
My understanding is that there's a low risk of virus transmission outdoors. The big risk is having contact with virus carriers in poorly ventilated spaces, such as indoor restaurants, subways, buses, and maybe shopping malls. Air conditioning systems may or may not contribute to spreading the virus. The virus hates exposure to sunlight and prefers cool spaces.
Looking at the PECs published below, I conclude that it might be smart to get outdoors frequently for regular exercise in the park. But, don't stop at McDonald's for a Big Mac in the way home.

N.

 

Well-said, Norbert, both in principle and practice. 

On talking a walk outside, that has been my daily exercise (45-minutes) for a long while (before COVID-19).  Now I found crowds of people all doing the same on our used-to-be quiet street; I mean family by family and dogs after dogs... Unbelievable.  Thus I choose to take such a walk in my own large backyard, maybe twenty times a day; private and safe. 

On the extreme boredom (and loneliness) @FatKat referred to, to be honest, they are still somewhat there even after the walk, with the family/kids/grandkids, zooming, WFH, etc.  It may come with the COVID-19 era and we can never go back to the same old social life we enjoy any more.


 

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Re: Some interesting info on COVID-19 Hospitalization risk factors


@norbertc wrote:

@FatKat wrote:

Thanks for the great post Bruce. Good data, my response is simply those at age 80, even in fairly good health need to try to manage staying at home, as it is hard not to have some systemicphysicalweakness like hypertension when one is of advanced age.

I wish everyone the best and hope y'all are able to find a way to avoid extreme boredom. 


My understanding is that there's a low risk of virus transmission outdoors. The big risk is having contact with virus carriers in poorly ventilated spaces, such as indoor restaurants, subways, buses, and maybe shopping malls. Air conditioning systems may or may not contribute to spreading the virus. The virus hates exposure to sunlight and prefers cool spaces.

Looking at the PECs published below, I conclude that it might be smart to get outdoors frequently for regular exercise in the park. But, don't stop at McDonald's for a Big Mac in the way home.

N.


This may be one silver lining to a dismal situation. Getting more exercise and being outdoors.  Your point is well taken being outdoors and getting more exercise might be an excellent coping method for an otherwise depressing situation. 

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