Authors’ reply: Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis

We thank Richard Armitage for his interest in our work. We agree that whilst our systematic review and meta-analysis shows the effect sizes for infection, intensive care admission and death amongst Black and Asian compared to White ethnicities were reduced in studies adjusting for confounders, our study also underscores that there are still not enough studies that disaggregate data on COVID-19 outcomes by ethnicity or adjust for key risk factors. Of the 227 studies we examined, only eight (4%) presented adjusted analyses for infection, four (2%) for ITU admission, and 18 (8%) for death. At least 147 (65%) studies could have disaggregated outcome data by ethnicity or presented adjusted analyses, but did not do so, significantly reducing our ability to interpret the driving factors for the higher risk in ethnic minority populations. [Opening paragraph

High non-adherence rates to secondary prevention by chemical adherence testing in patients with TIA

Introduction: Transient ischaemic attack (TIA) clinics are important for secondary prevention of fatal or disabling stroke. Non-adherence to prescribed medications is an important reason for treatment failure but difficult to diagnose. This study ascertained the utility of a novel biochemical tool in the objective biochemical diagnosis of non-adherence. Methods: One-hundred consecutive urine samples collected from patients attending the TIA clinic, at a tertiary centre, were analysed for presence or absence of prescribed cardiovascular medications using liquid chromatography-mass spectrometry (LC-MS/MS). Patients were classified as adherent or non-adherent, respectively. Demographic and clinical characteristics were compared between the two cohorts. Univariate regression analyses were performed for individual variables and model fitting was undertaken for significant variables. Results: The mean duration of follow-up from the index event was 31 days [standard deviation (SD): 18.9]. The overall rate of non-adherence for at least one medication was 24%. In univariate analysis, the number of comorbidities [3.4 (SD: 1.9) vs. 2.5 (1.9), P = 0.032] and total number of all prescribed medications [6.0 (3.3) vs 4.4 (2.1), P = 0.032] were higher in the non-adherent group. On multivariate analysis, the total number of medications prescribed correlated with increased non-adherence (odds ratio: 1.27, 95% Confidence Intervals: 1.1-1.5, P = 0.01). Conclusions: LC-MS/MS is a clinically useful tool for the diagnosis of non-adherence. Nearly a quarter of TIA patients were non-adherent to their cardiovascular medications Addressing non-adherence early may reduce the risk of future disabling cardiovascular events

Exhaled SARS-CoV-2 RNA viral load kinetics measured by facemask sampling associates with household transmission

Objectives: No studies have examined longitudinal patterns of naturally exhaled SARS-CoV-2 RNA viral load (VL) during acute infection. We report this using facemask sampling (FMS) and assessed the relationship between emitted RNA VL and household transmission. Methods: Between December 2020 and February 2021, we recruited participants within 24 hours of a positive RT-qPCR on upper respiratory tract sampling (URTS) (day 0). Participants gave FMS (for 1 hour) and URTS (self-taken) on seven occasions up to day 21. Samples were analysed by RT-qPCR (from sampling matrix strips within the mask) and symptom diaries were recorded. Household transmission was assessed through reporting of positive URTS RT-qPCR in household contacts. Results: Analysis of 203 FMS and 190 URTS from 34 participants showed that RNA VL peaked within the first 5 days following sampling. Concomitant URTS, FMS RNA VL, and symptom scores, however, were poorly correlated, but a higher severity of reported symptoms was associated with FMS positivity up to day 5. Of 28 participants who had household contacts, 12 (43%) reported transmission. Frequency of household transmission was associated with the highest (peak) FMS RNA VL obtained (negative genome copies/strip: 0% household transmission; 1 to 1000 copies/strip: 20%; 1001 to 10 000 copies/strip: 57%; >10 000 copies/strip: 75%; p = 0.048; age adjusted OR of household transmission per log increase in copies/strip: 4.97; 95% CI, 1.20–20.55; p = 0.02) but not observed with peak URTS RNA VL. Discussion: Exhaled RNA VL measured by FMS is highest in early infection, can be positive in symptomatic patients with concomitantly negative URTS, and is strongly associated with household transmission

COVID-19 and the new variant strain in England – What are the implications for those from ethnic minority groups?

Two new variants of Severe Acute Respiratory Distress Syndrome-Coronavirus-2 (SARS-CoV-2) have been reported over a matter of days in the United Kingdom (UK). The first variant, named VUI-202,012/01, originally detected in Kent and London, has an unusually large number of mutations that increase the virus’ affinity for human hosts [1]. The second, named 501Y.V2 was first detected in Nelson Mandela Bay in South Africa [2]. Epidemiological evidence of a sharp rise in Coronavirus disease-2019 (COVID-19) admissions to both UK and South African hospitals along with a rising attributable proportion of cases due to these two variants, suggests that both are significantly more transmissible than previous variants. [Opening paragraph