Northwestern researchers study COVID-19 mechanisms, infection patterns and impact on gender minorities

Children's Health

Northwestern Medicine investigators continue to study the COVID-19 pandemic, from the biological mechanisms of disease and infection patterns to the pandemic’s impact on women and sexual and gender minorities.

Outcomes of COVID-positive youths at emergency departments

Among 3,221 youths who tested positive for SARS-CoV-2, the virus that causes COVID-19, in emergency departments (EDs), 3.3 percent had severe outcomes within 14 days, according to a study published in JAMA Network Open.

The findings add to the growing body of knowledge about differential COVID-19 outcomes in children compared to adults, according to Todd Florin, MD, associate professor of Pediatrics in the Division of Emergency Medicine and a co-principal investigator of the study.

Children with COVID-19 can present with very different symptoms than adults and respond to infection in different ways, therefore it is important that we evaluate outcomes in children rather than relying on adult data.”

Todd Florin, MD, Associate Professor of Pediatrics, Division of Emergency Medicine, Northwestern Medicine

While COVID-19 is generally mild in children, severe outcomes and death do occur, though risk of those outcomes is poorly understood. Current studies examining large administrative databases or hospitalized youths have produced a wide range of risk estimates, Florin said.

The investigators found severe outcomes, defined as complications or interventions suggesting severe organ impairment or death, occurred in 3.3 percent of patients. For children well enough to be discharged from the emergency department, risk of developing severe outcomes was low: just 0.5 percent.

“This study provides clinicians with evidence to assist in risk stratifying children who present with COVID-19, supporting them to provide focused care on those at higher risk, while also providing reassurance for those without risk factors for severe disease,” Florin said.

This study was supported by grants from the Canadian Institutes of Health Research (Operating Grant: COVID-19 – Clinical management; Alberta Innovates; the Alberta Health Services – University of Calgary – Clinical Research Fund; the Alberta Children’s Hospital Research Institute; the COVID-19 Research Accelerator Funding Track (CRAFT) Program at the University of California, Davis; and the Cincinnati Children’s Hospital Medical Center Division of Emergency Medicine Small Grants Program.

Sex and gender bias in COVID-19 case reports

Case reports of patients with COVID-19 exhibited similar sex and gender bias seen in previous studies, including an overrepresentation of male patients, according to a study published in Frontiers in Global Women’s Health.

As sex and gender are increasingly recognized as important biological variables, recognition of theses biases is an important step towards changing them, according to Nicole Woitowich, PhD, research assistant professor of Medical Social Sciences and senior author of the study.

“It’s imperative that we strive to present sex- and gender-balanced information in both educational and research settings,” said Woitowich.

Woitowich and her collaborators analyzed nearly 500 clinical case reports of patients with COVID-19: 45 percent were male and 30 percent were female, and only 25 percent of case reports included patients of both sexes.

Case reports with male senior authors were more likely to include male-only patients, compared to case reports with female last authors. Female authors were also more likely to include patients of both sexes.

Unbalanced genders in biomedical science are not a new phenomenon, Woitowich said, but the novelty of COVID-19 means it’s especially important to understand any gender differences in illness — an understanding that’s made difficult by gender bias in case reports.

“I think the biomedical community has made forward strides in acknowledging how conscious and unconscious biases may inform decision-making and clinical care,” Woitowich said. “Yet, this work indicates that there is much more work to do — and this may fall upon journal editors to ensure that the reports which do get published are representative and balanced.”

This work was supported by a Women’s Health Access Matters Grant.

Impact of COVID-19 and substance misuse in sexual and gender minority young adults

Sexual and gender minority (SGM) young adults who reported employing fewer social distancing behaviors were also more likely to engage in risky sexual behaviors and use methamphetamines, according to results of a study published in the journal Drug and Alcohol Dependence.

These findings illustrate the intersecting vulnerabilities in which many SGM people lie, according to Casey Xavier Hall, PhD, MPH, research assistant professor of Medical Social Sciences and lead author of the study.

“Sexual and gender minority young adults can experience discrimination and stigma. They often rely on the LGBT community for support,” Xavier Hall said. “It’s possible that some prevention measures for COVID-19 such as social distancing could disrupt this support, increase mental health concerns and increase risk for intimate partner violence.”

Further, the use of fewer social distancing behaviors was associated with higher odds of intimate partner violence — contrary to what some in the field had speculated, according to Xavier Hall.

“There are several possible explanations, but it may be related to how younger people are less likely to live with their romantic or sexual partners. If this is the case, logically those who were physically near their partners — and possibly exposed to risk of violence — were not strictly following isolation behaviors,” Xavier Hall said.

Brian Mustanski, PhD, professor of Medical Social Sciences and director of the Institute for Sexual and Gender Minority Health and Wellbeing (ISGMH), was senior author of the study. Michael Newcomb, PhD, associate professor of Medical Social Sciences, was a co-author of the study.

Omicron: Evolution of the pandemic

A study of several South African countries confirmed the Omicron variant of COVID-19 spreads more rapidly compared to previous variants.

The findings, published in the journal JMIR Public Health and Surveillance, demonstrate the need to curb future variants to prevent new waves like this one, according to Lori Post, PhD, the Buehler Professor of Geriatric Medicine, director of the Buehler Center for Health Policy and Economics at the Institute for Public Health and Medicine (IPHAM) and senior author of the study

“We are playing with fire by allowing this variant to plow through our populations because it increases the risk of a novel variant of concern that is even more transmissible or more lethal,” said Post, who is also a professor of Emergency Medicine and of Medical Social Sciences.

Using surveillance metrics in several southern African countries, the authors compared the Omicron infection wave to previous outbreaks.

“If a country has almost zero cases of SARS-CoV-2 infections, we only get seven to nine days of advanced warning that a country is going into an outbreak whereas with other variants, we had up to 35 days advanced warning,” Post said. “The magnitude of an Omicron outbreak is two times that of Delta in half the duration.”

This has implications for public health measures, said Ramon Lorenzo-Redondo, PhD, assistant professor of Medicine in the Division of Infectious Diseases and a co-author of the study.

“The biological properties and transmission dynamics of the virus have shifted, suggesting the need for re-assessing the prevention strategies needed to avert future viral outbreaks,” said Lorenzo-Redondo, who is also bioinformatics director of the Center for Pathogen Genomics and Microbial Evolution (CPGME).

As the wave continues and eventually subsides, more investigation is required to better understand how mutations in Omicron affect therapeutics and vaccine efficacy, said Judd Hultquist, PhD, assistant professor of Medicine in the Division of Infectious Diseases and co-author of the study.

“A lot more research still needs to be done to understand how these changes influence disease severity, risk of re-infection and potential vaccine breakthrough,” said Hultquist, who is also associate director of the CPGME.

This study was supported by the Robert J. Havey, MD Institute for Global Health.

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