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COVID-19 Scan for Apr 27, 2021

Shift work may increase risk of COVID-19

People who work irregular or permanent shifts were associated with double the risk of COVID-19, according to findings from a Thorax study published yesterday. The study looked at 27,056 irregular and 21,836 permanent shift workers between ages 40 to 69, as well as 235,135 non-shift workers, all identified in the UK Biobank.

When compared with non-shift workers‚ÄĒthose who worked regular daytime hours‚ÄĒirregular shift workers were associated with a 2.42 odds ratio (OR; 95% confidence interval [CI], 1.92 to 3.05) of contracting COVID-19, while permanent shift workers had an OR of 2.50 (95% CI, 1.95 to 3.19), both after adjusting for age, sex, deprivation index, and ethnicity. After further compensation for body mass index (BMI), chronotype (eg, are they a morning person?), alcohol intake, smoking, and prior disease, ORs were 2.29 and 2.68 for irregular and permanent shift workers.

The researchers reported that shift workers experienced increased risk for COVID-19 diagnosis regardless of job type (nonessential, essential, healthcare) and physical proximity to coworkers and the public. Instead, they write, the disparity may be driven by the amount of people in the workspace within a 24-hour period, reduced cleaning time, fatigue leading to less mitigation adherence, and the possibility that shift work may alter immune response.

“The size of effect of shift work as a risk factor for COVID-19 is comparable with other reported risk factors for COVID-19, such as being non-white, being most socioeconomically deprived and having a BMI >40 kg/m2,” they conclude.

“We do believe it should be possible to substantially mitigate these risks through good handwashing, use of face protection, appropriate spacing, and vaccination,” said co-author Hannah J. Durrington, PhD, in a BMJ press release.

Most shift workers were younger, male, and of non-White ethnicity, and they were more likely to have a higher BMI, smoke more, drink less, and experience higher levels of sleep deprivation..
Apr 26 Thorax study
Apr 26 BMJ
press release

Study: Common irritable bowel drug blunts COVID-19 vaccine response

A UK study yesterday in the journal Gut found that the common inflammatory bowel disease (IBD) drug infliximab blunts COVID-19 vaccine response after one dose.

The findings come from the CLARITY study, which assessed COVID-19 infection and vaccination in 6,935 patients who have IBD, including Crohn’s disease and ulcerative colitis, from 92 hospitals from September to December 2020.

The study measured antibody response in patients who took infliximab, an anti-tumor necrosis factor (anti-TNF) biologic drug, and had one dose of either the Pfizer or AstraZeneca COVID-19 vaccine. Researchers found that only 31.4% of participants (103 of 328) treated exclusively with infliximab produced enough antibodies to offer adequate protection against COVID-19.

When a patient took infliximab with immunomodulator drugs, such as azathioprine or methotrexate, the levels of antibodies were even lower: Only 125 of 537 (23.3%) met the threshold of a positive antibody test after one dose.

Patients who had a previously documented COVID-19 infection, however, produced sufficiently protective antibodies after one dose. And of 20 infliximab-treated patients who received two doses of the Pfizer vaccine, 17 (85%) developed protective antibodies.

“Although we know that this has been an incredibly difficult time for people with IBD, our research indicates that people treated with infliximab should consider that they are not protected from COVID-19 until they have had both doses of a vaccine and should continue to practice enhanced physical distancing and shielding if appropriate,” said co-author Nick Powell, PhD, of Imperial College London, in a University of Exeter press release.
Apr 26 Gut
Apr 26 University of Exeter
press release


Pediatric diabetes complications rose during pandemic in LA hospital

Pediatric rates of diabetic ketoacidosis (DKA), a complication of type 2 diabetes that can lead to death, rose during the pandemic at Children’s Hospital Los Angeles (CHLA), according to a study published yesterday in Diabetes Care.

The researchers compared medical records from March to August in 2018, 2019, and 2020, and found that DKA in new-onset type 2 diabetes increased by 20% in 2020, compared with 9% in 2018 and 3% in 2019. Overall, 44, 66, and 82 children had new-onset type 2 diabetes in 2018, 2019, and 2020, respectively, and DKA was found in 4, 2, and 16, respectively. Age at diagnosis, sex, and high BMI were not significant variables.

In 2020, no patients with DKA had a positive COVID test on admittance, but two of six tested positive for antibodies and another was presumed to have an asymptomatic infection. The researchers believe that factors such as change in care-seeking behaviors, access to healthy foods, and physical activity may have affected the increase in DKA, as well as an undetermined, possibly bidirectional, relationship between COVID exposure and diabetes.

“It’s critical for pediatricians to recognize that when a child presents with symptoms of diabetes, the child needs to be evaluated right away,” said Lily C. Chao, MD, in a CHLA press release. “The sooner we see these kids, the better chance we have to prevent DKA.”
Apr 26 Diabetes Care
Apr 26 CHLA press release

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