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COVID-19 News from Annals of Internal Medicine

All coronavirus-related content published in Annals is free

American College of Physicians

Research News

Below please find link(s) to new coronavirus-related content published today in Annals of Internal Medicine. All coronavirus-related content published in Annals of Internal Medicine is free to the public. A complete collection is available at https://annals.org/aim/pages/coronavirus-content.

1. Liver transplant recipient reinfected with SARS-CoV-2 infection 3 months after initial diagnosis

Viral genomic sequencing used to distinguish between relapse and reinfection

Free full text: https://www.acpjournals.org/doi/10.7326/L21-0108

A liver transplant recipient was reinfected with SARS-CoV-2 111 days after his initial diagnosis. Researchers from the University of Massachusetts Medical School and The Broad Institute of MIT and Harvard used viral genomic sequencing to distinguish whether the later positive samples were due to SARS-CoV-2 relapse or reinfection. The case report is published in Annals of Internal Medicine.

A 61-year-old man with a history of liver transplant reported to the emergency department (ED) complaining of fever, nausea, vomiting, and cough. The patient tested positive for SARS-CoV-2 infection with a RT-qPCR swab taken at the time of his visit. Swabs taken 48 and 53 days after his visit were negative for the virus. On day 111, the patient returned to the ED reporting several days of increasing confusion, hallucinations, unstable gait, and frequent falls. Once again, the patient tested positive for SARS-CoV-2 infection.

According to the study authors, the patient may have been susceptible to reinfection due to a lack of antibody response after the first infection. This case shows that genomic sequencing offers the ability to discern whether subsequent infections may be reinfection. In addition, genomic sequence data can also identify variants circulating in the population that are of high risk because of infectivity, disease severity, or resistance to treatment.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Stuart M. Levitz, MD, can be reached at Stuart.Levitz@umassmed.edu.

2. People of color have substantially higher risk for hospitalization, intensive-level care for COVID-19 than White persons

Authors say pandemic response must be adjusted to be culturally appropriate, address mistrust in health care system

Free full text: https://www.acpjournals.org/doi/10.7326/M20-8283

Even after adjustment for known COVID-19 risk factors, such as comorbidities and body mass index, persons of color continue to have a substantially higher risk for hospitalization and requiring intensive-level care than White persons. These results confirm findings from earlier in the pandemic suggesting that COVID-19 affects Hispanic, Black or African American, and Asian persons disproportionately. Further, they provide evidence of the disproportionate effect of COVID-19 on Pacific Islanders. A brief research report is published in Annals of Internal Medicine.

Researchers from Kaiser Permanente Southern California (KPSC) studied electronic health records from KPSC to compare age- and sex-adjusted relative risk (RR) of COVID-19 testing, cases, hospitalizations, and intensive-level care among Hispanic, Black or African American, Asian, and Pacific Islander populations versus White populations before and after adjusting for comorbidities and body weight status. The researchers observed disparities across race/ethnicity for all outcomes regardless of adjustment. Patients of color were slightly more likely to be tested than White patients but were substantially more likely to be hospitalized and to receive intensive-level care. Hispanic patients had the highest RRs of being tested and testing positive or being diagnosed with COVID-19 compared with White patients; however, Pacific Islander, Black or African American, and Asian patients had higher RRs for severe COVID-19 outcomes than White patients.

According to the authors, inequities in COVID-19 outcomes are a call to action for a culturally appropriate pandemic response and vaccination strategies that go beyond addressing comorbidities and account for factors like distrust in the medical system, resource constraints, language proficiency, and health literacy.

Media contacts: A PDF for this article is not yet available. Please click the link to read the full text. The corresponding author, Claudia Nau, PhD, can be reached through Maureen McInaney at Maureen.McInaney@kp.org or Kerry Sinclair at KSinclair@webershandwick.com.

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