Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Lessons from COVID-19 plain chest radiographs on pathophysiology, early diagnosis and therapeutics

Introduction: There are multiple radiographic manifestations of COVID-19 described in recent literature on plain chest radiographs and lung CT scans. We discuss observations on apparent similarities and differences seen on plain chest radiographs of confirmed COVID-19 cases with clinically mild, moderate and severe form of disease.&nbsp;Material and method: We randomly selected 3 cases of COVID-19 with mild, moderate and severe disease, and compared the radiological findings on plain chest radiographs.Results: The radiographic observations suggest that poorly aerated regions of the lung are affected early during the disease course. The inference is that improving the degree of lung aeration may limit the spread of the disease on the remainder of the lung parenchyma. Therefore, early oxygen supplementation therapy may prevent progression of a clinically mild COVID-19 case to moderate or severe form of disease.Conclusion: Early plain chest radiographs may assist to increase the index of suspicion in a COVID-19 Patient Under Investigation (PUI) with pending RT-PCR results. The degree of lung aeration in COVID-19 correlates with the disease severity. Early oxygen therapy in mild cases may prevent progression of COVID-19. Larger studies are recommended to ascertain the statistical significance of these findings.</p