Thirty-Day Mortality and Morbidity in COVID-19 Positive vs. COVID-19 Negative Individuals and vs. Individuals Tested for Influenza A/B: A Population-Based Study

Abstract

Background: As of October 2020, COVID-19 has caused 1,000,000 deaths worldwide. However, large-scale studies of COVID-19 mortality and new-onset comorbidity compared to individuals tested negative for COVID-19 and individuals tested for influenza A/B are lacking. We investigated COVID-19 30-day mortality and new-onset comorbidity compared to individuals with negative COVID-19 test results and individuals tested for influenza A/B.Methods and findings: This population-based cohort study utilized electronic health records covering roughly half (n = 2,647,229) of Denmark's population, with nationwide linkage of microbiology test results and death records. All individuals ≥18 years tested for COVID-19 and individuals tested for influenza A/B were followed from 11/2017 to 06/2020. Main outcome was 30-day mortality after a test for either COVID-19 or influenza. Secondary outcomes were major comorbidity diagnoses 30-days after the test for either COVID-19 or influenza A/B. In total, 224,639 individuals were tested for COVID-19. To enhance comparability, we stratified the population for in- and outpatient status at the time of testing. Among inpatients positive for COVID-19, 356 of 1,657 (21%) died within 30 days, which was a 3.0 to 3.1-fold increased 30-day mortality rate, when compared to influenza and COVID-19-negative inpatients (all p < 0.001). For outpatients, 128 of 6,263 (2%) COVID-19-positive patients died within 30 days, which was a 5.5 to 6.9-fold increased mortality rate compared to individuals tested negative for COVID-19 or individuals tested positive or negative for influenza, respectively (all p < 0.001). Compared to hospitalized patients with influenza A/B, new-onset ischemic stroke, diabetes and nephropathy occurred more frequently in inpatients with COVID-19 (all p < 0.05).Conclusions: In this population-based study comparing COVID-19 positive with COVID-19 negative individuals and individuals tested for influenza, COVID-19 was associated with increased rates of major systemic and vascular comorbidity and substantially higher mortality. Results should be interpreted with caution because of differences in test strategies for COVID-19 and influenza, use of aggregated data, the limited 30-day follow-up and the possibility for changing mortality rates as the pandemic unfolds. However, the true COVID-19 mortality may even be higher than the stated 3.0 to 5.5-fold increase, owing to more extensive testing for COVID-19.

Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea

“… 12 In another observational study investigating the initial symptoms of COVID-19, neurological symptoms were found in 9.7% of the patients. 48 In another study, the onset of anosmia was noted early in 73% of the patients prior to the diagnosis of COVID-19. 49 In addition, severe neurological manifestations, including altered mental status, stroke, and Guillain-Barré syndrome, could be the first symptom of COVID-19.…”

COVID-19 Vaccine Acceptance and Its Associated Factors Among Pregnant Women Attending Antenatal Care Clinic in Southwest Ethiopia: Institutional-Based Cross-Sectional Study

“…Globally, the Corona Virus Diseases 2019 (COVID-19) has imposed enormous burdens of morbidity and mortality among the general population. 1 Evidence shows that COVID-19 caused more than 2.5 million deaths globally. 2 The risk of dying were higher among older adults and people who had chronic medical related disease such as lung cancer, asthma, type 2 diabetes mellitus, heart diseases, and immune compromised patients.…”

Acute Brain Ischemia, Infarction and Hemorrhage in Subjects Dying with or Without Autopsy-Proven Acute Pneumonia

“…In comparison, in reviews of Covid-19 publications, reported clinically and autopsy-determined rates of acute brain infarction range from 0.5% to 20% while rates of acute brain hemorrhage range from 0.13% to 9.5% 45-78 . A small number of clinical studies have also compared rates of stroke in hospitalized patients with Covid-19 versus influenza, with two studies finding increased rates with Covid-19 74,75 (1.6% vs 0.2% and 0.9% vs 0.3%) and one finding equivalent rates 45 T(1.2% for both). As these rates are all much smaller than what we have found here and as clinical detection of both stroke and pneumonia is poorly sensitive compared to autopsy 79-83,95 , the overall likelihood is that Covid-19 pneumonia and non-Covid-19 pneumonia may have similar risks tor concurrent acute brain infarction and acute brain hemorrhage when pneumonia is severe enough to cause death, and stroke overall may not be differentially prevalent in subjects dying with either type of pneumonia or non-Covid-19 pneumonia as compared to subjects dying from other causes.…”