Interesting figures on less asthmatics being hospitalised than expected in New York

[CallyBx]

I’ve read about this in China too - forgive me if someone has flagged this already but this is something that cheered me up a little this week, after feeling in the beginning of the outbreak that we were so vulnerable. Obviously it doesn’t mean we can’t get seriously ill with Covid, and I know many of us will have the cardiovascular conditions that raise our risks as well - but I just think it’s great to have a little bit of good news in the sea of everything else out there ATM! This came up in my news feed (from the Independent):

From the Feinstein Institutes for Medical Research at Northwell, New York.

“The analysis is the largest and most comprehensive look at outcomes in the United States to be published so far. Researchers looked at the electronic medical records of 5,700 patients infected with Covid-19 between 1 March and 4 April who were treated at Northwell Health's 12 hospitals located in New York City, Long Island, and Westchester County - all epicentres of the outbreak. Sixty per cent were male, 40 per cent female and the average age was 63.

"It's important to look to American data as we have different resources in our health care system and different demographics in our populations," Davidson said.

The paper also found that of those who died, (figures for those with cardiovascular disease & diabetes here) which is consistent with risk factors listed by the Centres for Disease for Control and Prevention. Noticeably absent from the top of the list was asthma. As doctors and researchers have learned more about Covid-19, the less it seems that asthma plays a dominant role in outcomes. In fact there are only nine patients with asthma hospitalised at Northwell for the virus.”

(My bold letters not theirs!)

I hope this cheers someone up this morning!

[Wheezycat]

Yes, it has been mentioned before, and one person flagged up that though it wasn’t among the top 5, say, it was not far behind. For me it as much about how seriously affected people with asthma could be, as sheer numbers. And what proportion in society has reasonably significant asthma compared with the proportion who ended up in hospital? Maybe cardiovascular is more common. I could look this up, but so far it is too early in the morning! As yet I have just not heard enough about this to feel properly reassured.

[CallyBx in reply to Wheezycat]

Yes, Wheezycat, I think it’s definitely good not to be complacent about potential serious effects on asthmatics - and hospital admissions don’t reflect the total effect on asthmatics for sure, but I do think there has been a lot of fear that has been based on lack of information and assumptions rather than on science. In terms of sheer numbers, 9 hospital admissions of asthmatics in a total of 5,700 people treated to me is almost unbelievable. Almost as unbelievable as my personal experience of Covid having no apparent effect on my severe, hard to treat asthma! And yes, that’s a personal experience and I completely accept it won’t be backed up by everyone’s experience of Covid - but I’d love to hear if anyone else who is usually triggered by viruses have had symptoms without a severe exacerbation.... I guess it’s all just another contribution towards an overall picture that we won’t be able to see properly for a while...

And yes, very early....I guess the higher dose of steroids my dr put me on for breathlessness is wreaking even more havoc than usual - I’m barely sleeping and buzzing rather!!!

[Wheezycat in reply to CallyBx]

Sure! And, sorry, I didn’t properly take aboard you have been through it! And yes it is good to know it is potentially not so bad for asthmatics as was feared. I like Maverick2’s answer as well. And of course this whole pandemic is a steep learning curve for scientists as well as others.

The other day I saw a series of rather amusing drawings by a woman who suffered it, in Sweden, managed at home. She also had asthma, though mild /moderate from the sound of it. She made a drawing illustrating each symptom she suffered. And, I must admit, many sounded familiar, like my experiences getting a cold-leading to chest infection-and-asthma-flare, one of those hat take weeks or months to get over. I must say I really wouldn’t want that whole bundle! She did not claim that this was how it would be for everybody.

[CRP386 in reply to Wheezycat]

The article in JAMA reports 9% not 9 patients, so the number of asthmatics hospitalised is actually 479 patients. I've emailed the Independent to point this out.

[Maverick2]

A piece of good news for the asthma community. More bad news for the scientific community.

Any infection consists of both morbidity and mortality. Thus complete analysis requires morbidity as well as mortality. if both morbidity and mortality are low, we can be happy as it confers protection to us as well as family members. if morbidity is high whereas mortality is low then the COVID-19 infection in asthma patient are asymptomatic thus a threat to the family. So, we have to be cautious of the result as it is a hospital study that ignores asymptomatic carriers.

Till now the COVID-19 mortality is attributed just to the presence of more comorbidities. if some of the comorbidities are protective, a new understanding is a need for explaining as well as reducing mortality.

Lung COVID-19 infection threat to lung disease like asthma and COPD are expected. Increased COVID-19 mortality of COPD is along the expected line, but increased severity in non-lung disease like diabetes and decreased severity in asthma is even more puzzling.

COVID-19 is throwing hopes and new challenges every day to the people and the scientific community.

[CallyBx in reply to Maverick2]

Good points....food for thought

[Poobah]

Some media reports are suggesting that the medications that treat the high risk conditions may be a larger factor than the conditions themselves. For instance, yesterday I read that some treatments for high blood pressure may make it easier for the virus to access cells and damage them. Checking more scientific sources put my mind at ease as it appears that the MSM have misunderstood the research. the-scientist.com/news-opin...

The whole issue of Covid-19 is an enormous area of investigation and experts are challenged with learning as much as possible in as shortest time as possible. Ideas will be grasped by the media and we'll be reading and hearing conflicting information.

But it is heartening that NYC data is providing good news for the asthma community at least. In the meantime we still need to practice isolation or social distancing.

Keep safe everyone. Stay well. 🤗

[Hidden]

Some of the best athletes in the world have asthma. I was told once that asthmatics develop a higher level of stamina than those who don't have it because we have to fight harder. Be safe and be strong!

[CallyBx in reply to Hidden]

Love that!!!! ❤️

[Wheezycat in reply to Hidden]

Good! But I wish it felt, or played out like that for me, but it certainly doesn’t!

[Polzovatel]

I also read that 'the research team found that 81.2 per cent of those who died from Covid-19 in the study “had very low eosinophil counts on admission to the hospital."'

I wonder what that means for people with eosinophilic( high count) asthma

[CallyBx in reply to Polzovatel]

Also food for thought - so much we don’t know!

[Maverick2 in reply to Polzovatel]

The inflammation during the COVID-19 is Neutrophilic in nature. Large number of Neutrophils are generated in an attempt to contain the virus. As a result, there is a decrease in the percentage of eosinophils in COVID-19. Thus we got to be extra careful in interpreting the result as a cause or consequence. Higher neutrophil may be an indicator of severity of COVID-19 infection

[CRP386]

Hi , I am curious about this. So I looked up the research article that has been published in JAMA (Journal of American Medical Association). Unfortunately, the report copied above is incorrect. The research article is from those at Feinstein Institutes for Medical Research at Northwell, New York. The baseline characteristics of those hospitalised shows that 9% were hospitalised, not 9 people (as per the report above). 9% of the patient population here is 479 patients! There has obviously been a mistake in the report, so its always good to check the primary source. To put this into context, the top 10 list of comorbidities were hypertension 56.6% (n=3026), obesity 41.7% (n=1737), diabetes 33.8% (n=1808), morbid obesity (BMI greater or equal to 35) 19% (n=791), coronary heart disease 11.1% (n=595), asthma 9% (n=479), cancer 6% (n=320), chronic kidney disease 5% (n=268), COPD 5.4% (n=287), end stage kidney disease 3.5% (n=186).

There has obviously been a mistake in the report, and journalists dont always check their sources. The link to the research publication is here jamanetwork.com/journals/ja...

[CallyBx in reply to CRP386]

Shame on the Telegraph! When I feel slightly better I should write to them....and you’re right in the source material has been misquoted. But I don’t think it changes the discussion around this article and others coming out of China. The point remains that in a respiratory virus that causes breathlessness & pneumonia, you would expect that asthmatics would make up far more than (even) 9% of patients hospitalised. That’s still an extremely low rate given the virus attacks the very parts of our bodies that are considered the weakest. And yes, 9 patients out of 5,700 hospitalised being asthmatics did sound unbelievable - but 479 patients out of 5,700 hospitalised being asthmatics is also not what would be projected given the level of risk we would expect to face. Sloppy journalism yes, but the point remains the same.

[CRP386 in reply to CallyBx]

Sorry, its not a low rate - its still high on the list! An 'extremely low rate' in medical terms would be much less than 9%. The authors of the article do not make any comments suggesting that the 9% is a low rate.

We can see that the virus effects those with cardio or metabolic disorders in higher rates, and then after that in the list are respiratory disorders. This is consistent with other data on risk factors for serious outcomes of flu viruses.

To note the news report in the original post is quoted from the Independent, was originally published by the Washington Post. They have since corrected the article, washingtonpost.com/health/2..., but the Independent has not made that correction yet (emailed to flag that).

[Maverick2 in reply to CRP386]

yes, 9% in hospital admission in asthma is high. A clear breakup analysis of the mortality would have given the clearer picture but unfortunately, the analysis skips it. Much lower hospital admission COPD (4.5 %) has a mortality ratio higher than the morbidity (higher Odds ratio).

medium.com/microbial-instin...

More analysis has to be carried out by including atopic disease to get clear picture.

[CallyBx]

I really don’t want to get into a debate about what is a low rate and what the Telegraph journalist meant!! As I was drawing attention to references I’d seen, including this one, to the lower than expected rates of asthma patients seriously affected by Covid 19 perhaps a better article would be this New York Times one (“Asthma Is Absent Among Top Covid-19 Risk Factors, Early Data Shows”) that references the research coming out of China as well as New York. However the journalists have written the articles, all the research referenced is showing a different picture than was expected regarding the effect of Covid 19 on asthmatics. As I’m still fighting the virus myself & am not feeling great today, I haven’t source checked this article in detail. But I do think it’s important that research is heard that balances some of the extreme fear-mongering that comes out of some news outlets regarding how vulnerable people with comorbidities are - and given this is an asthma forum particularly those of us with asthma. A little bit of good news is sometimes just that!

See: nytimes.com/2020/04/16/heal...

Also see:

thelancet.com/journals/lanr...

onlinelibrary.wiley.com/doi...

and this Lancet article positing whether the inhaled corticosteroids we already take could be having a protective effect against the virus (maybe why my ‘severe’ asthma has been almost normal throughout my Covid 19 symptoms...?!)

thelancet.com/action/showPd...

It’s all extremely early days yet, it may be months before we have a better understanding of the risks of having asthma with Covid 19 but there is a chance that its not all bad!

[CRP386 in reply to CallyBx]

The Lancet article cited, is a commentary piece, and evidence around this still lacking to draw robust conclusions. The only conclusion that can be drawn from this early data is that asthma plays a less dominant role in C-19 outcomes.

Regarding the additional NYT article and Lancet publication you state (but not linked) on theories why admission rates for those with asthma and C-19 are much lower than to be expected. Please read those responses too. Thanks.

[Maverick2 in reply to CallyBx]

Another factor to consider is the epidemiology of asthma and COVID-19 disease. Children have the highest rate of asthma and predominantly considered as a childhood disease. The lowest rate of death in COVID-19 is also in children. At least we can guess that the effect of COVID-19 in asthma patients is not as severe as in Diabetes patients.

[erifder]

Thanks ...it really has..

[CallyBx in reply to erifder]

Very happy it did ...😁

[AsthmaSufferer]

I've been wondering - does our daily use of inhalers protect us from the virus?

[CallyBx]

Interestingly that’s one of the theories suggested as a possible reason that patients with asthma seem “to be under-represented in the comorbidities reported for patients with COVID-19” - and it’s discussed in the Lancet article linked to above...

It seems it’s way too early to know until more research has been carried out but I for one find it reassuring as I battle through another day of Covid-induced breathlessness that perhaps not all the odds are stacked against us!!! 😁

[Jollygood]

Hope you feel better soon, callyb, & that you continue to recover. Also, I'm glad you got your food slot sorted X

[CallyBx in reply to Jollygood]

Thank you Jollygood....finished my prednisolone yesterday so think it was just a bit of a rebound - I’ll be ok v soon 🤞... and yes, thank you, I finally got my Sainsbury’s email too so you were right, it came in the end!!! 😁x