Madhury (Didi) Ray, MD, MPH COVID-19 19 Critical Care Planning Lead NYC Department of Health and Mental Hygiene HEALTHCARE Corinne Thompson, PhD PROVIDER Co-Lead, Epi Data Unit, COVID-19 Response NYC Department of Health and Mental Hygiene UPDATE Aaron J. Miller, MD, MPA Community Partner Liaison, Test & Trace Corps Assistant Vice President, Office of Ambulatory Care JUNE 12, 2020 NYC Health + Hospitals Our understanding of COVID-19 is evolving rapidly. This presentation is based on our knowledge as of June 11, 2020, 5 PM.
WHERE WE ARE NOW SURVEILLANCE AND EPIDEMIOLOGY UPDATE OUTLINE CLINICAL UPDATE: OBESITY AND COVID-19 HOTELING RESOURCES FOR PATIENTS AND CONTACTS QUESTIONS AND DISCUSSION
• More than 7.2 million cases and 410,000 deaths due to COVID-19 have been confirmed worldwide • New daily case count records are being set • World Health Organization warns nations that have seen WHERE improvement not to let their guard down WE ARE • Large-scale protests against racism and police violence NOW are occurring across the United States (U.S.) • 100 days after its first recognized case, New York City (NYC) began initial stages of re-opening • Prevention measures must be maintained as we gauge the impact of these changes
CUMULATIVE CASES AND DEATHS REPORTED TO WORLD HEALTH ORGANIZATION 6/11/20 >7,273,000 cases >413,000 deaths World Health Organization. COVID-19 dashboard: cumulative confirmed cases. https://covid19.who.int
CHANGE IN THE NUMBER OF NEW CASES WORLDWIDE IN THE LAST TWO WEEKS 6/11/20 New York Times. Coronavirus Map: Tracking the Global Outbreak https://www.nytimes.com/interactive/2020/world/coronavirus-maps.html
CUMULATIVE CASES AND DEATHS, U.S. 6/11/20 >2,000,000 cases (~28% of confirmed global cases) >113,000 deaths (~27% of reported global deaths) New York Times. Coronavirus in the U.S.: latest map and case count. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
CHANGE IN NUMBER OF NEW CASES IN THE U.S. IN THE PAST TWO WEEKS 6/11/20 New York Times. Coronavirus in the U.S.: latest map and case count. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
EPID IDEMIOLOGY Cor orin inne Thompson, PhD OF COVID ID-19 19 Co-Lead, Epi Data Unit, COVID-19 Response NYC Department of Health and Mental Hygiene IN IN NYC
CLINICAL Mad adhury ry (Di Didi) Ra Ray, MD, MPH UPDATE: Critical Care Planning Lead NYC Department of Health and Mental Hygiene OBESITY AND COVID ID-19 19
“It was very obvious and noticeable, even in those few first days… what stood out among the group OBESITY AND of younger patients was their [BMI.]” COVID ID-19: • Retrospective analysis of 3,615 COVID-19 patients YOUNG who presented to the ED, stratified by body mass index (BMI) and age PATIENTS • Likelihood of admission to hospital and admission to ICU were increased in young patients with BMI ≥ 30 Lighter J, Phillips M, Hochman S, et al. Obesity in patients younger than 60 years is a risk factor for COVID-19 hospital admission. Clin Infec Dis. Published online April 9, 2020. https://doi.org/10.1093/cid/ciaa415
• Obesity is the second most common comorbidity of hospitalized COVID-19 patients in NYC series 1-2 • ~ 35% of all hospitalized COVID-19 patients have body mass OBESITY AND index (BMI) ≥ 30 COVID ID-19: • ~ 40% of all ventilated COVID- 19 patients have BMI ≥ 30 SEVERITY OF • Palaiodimos et al. found a statistically significant increase in mortality in patients with BMI ≥ 35 3 IL ILLNESS • Retrospective cohort study of 200 patients followed for 3 weeks • 24% mortality of total cohort 1. Goyal P, Choi JJ, Pinheiro LC, et al. Clinical characteristics of COVID-19 in New York City. N Engl J Med. June 11, 2020. https://doi.org/10.1056/nejmc2010419 2. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5,700 patients hospitalized with COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-2059. https://doi.org/10.1001/jama.2020.6775 3. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism . 2020;108:154262. https://doi.org/10.1016/j.metabol.2020.154262
• Obesity is an independent risk factor for severe disease in other pandemic respiratory viruses, POSSIBLE like H1N1 1,2 MECHANISMS • Possible mechanisms: OF OBESITY IN IN • Obese adipose tissue effect on immunity SEVERE • Hypercoagulability COVID ID-19 19 • Respiratory dysfunction • Comorbidities 1. Dietz W, Santos-Burgoa C. Obesity and its implications for COVID-19 mortality. Obesity . 2020;28(6):1005-1005. https://doi.org/10.1002/oby.22818 2. Luzi L, Radaelli MG. Influenza and obesity: its odd relationship and the lessons for COVID-19 pandemic. Acta Diabetol . 2020;57(6):759-764. https://doi.org/10.1007/s00592-020-01522-8
• Obesity impacts both POSSIBLE innate and adaptive MECHANISMS: immunity OBESITY, , • “Obese” adipocytes may IMMUNITY AND IM act as a reservoir for virus HYPER- • Obesity increases COAGULABILITY propensity for thrombosis 1. Ryan PM, Caplice NM. Is adipose tissue a reservoir for viral spread, immune activation and cytokine amplification in coronavirus disease 2019. Obesity . April 21, 2020. https://doi.org/10.1002/oby.22843 2. Sattar N, McInnes IB, McMurray JJV, et al. Obesity a risk factor for severe COVID-19 infection: multiple potential mechanisms. Circulation. April 22, 2020. https://doi.org/10.1161/circulationaha.120.047659
POSS SSIBLE MECHANIS ISMS: RESPIRATORY DYSFUNCT CTION, COMORBIDITIES, AND METABOLIC RIS ISK Stefan N, Birkenfeld AL, Schulze MB, Ludwiget DS. Obesity and impaired metabolic health in patients with COVID- 19. Nat Rev Endocrinol. April 23, 2020. https://doi.org/10.1038/s41574-020-0364-6
• Respiratory dysfunction and comorbidities POSSIBLE may impact the course of COVID-19 MECHANISMS: • What about the “obesity paradox”? RESPIRATORY • Obesity is a risk factor for non-COVID acute DYSFUNCTION respiratory distress syndrome (ARDS) AND • Obese patients with non-COVID ARDS have better COMORBIDITY outcomes 1. Stefan N, Birkenfeld AL, Schulze MB, Ludwiget DS. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. April 23, 2020. https://doi.org/10.1038/s41574-020-0364-6 2. Jose RJ, Manuel A. Does coronavirus disease 2019 disprove the obesity paradox in acute respiratory distress syndrome? Obesity . April 15, 2020. https://doi.org/10.1002/oby.22835
• Pietrobelli et al. reported on a longitudinal study of 41 obese schoolchildren under IM IMPACT OF quarantine in Verona. After quarantine: 1 COVID ID-19 ON • More sugary drinks and potato chips • Less physical activity, more sleep OBESITY • Stress, immunity, and obesity 2 1. Pietrobelli A, Pecoraro L, Ferruzzi A, et al. Effects of COVID‐19 lockdown on lifestyle behaviors in children with obesity living in Verona, Italy: a longitudinal study. Obesity. April 30, 2020. https://doi.org/10.1002/oby.22861 2. Obesity Medicine Association. Guidance on Obesity and Coronavirus (COVID-19). March 30, 2020.https://obesitymedicine.org/covid-19-guidance/
• People with severe obesity (BMI ≥ 40) are at risk of severe COVID - 19 infection 1 • Cautiously observe patients with less severe obesity (BMI ≥ 30) 2 • Cardiopulmonary fitness may have a beneficial impact in COVID-19 3 GUID IDANCE • Promote physical activity while physically distancing 4 ON OBESITY • Balanced nutrition 4 AND • Regular physician “contact” COVID ID-19 • Combat stigma 4 • Use of telemedicine 4 • Stress management 4 1. CDC. People Who Are at Higher Risk for Severe Illness. https://www.cdc.gov/coronavirus/2019-ncov/need-extra- precautions/people-at-higher-risk.html 2. Flint SW, Tahrani AA. COVID-19 and obesity — lack of clarity, guidance, and implications for care. Lancet Diabetes Endocrinol. 2020;8(6):474-475. https://doi.org/10.1016/s2213-8587(20)30156-x 3. Zbinden‐Foncea H, Francaux M, Deldicque L, Hawley JA. Does high cardiorespiratory fitness confer some protection against pro‐inflammatory responses after infection by SARS‐CoV‐2? Obesity. April 23, 2020 https://doi.org/10.1002/oby.22849 4. Obesity Medicine Association. Guidance on Obesity and Coronavirus (COVID-19). March 30, 2020.https://obesitymedicine.org/covid-19-guidance/
How to Access Hotels for COVID- 19 Cases & Contacts How to support your patients and social service clients to access all components of testing, tracing, and getting the support they need to separate safely June 12, 2020 Aaron J. Miller, MD, MPA Community Partner Liaison, Test & Trace Corps Assistant Vice President, Office of Ambulatory Care, NYC Health + Hospitals
Today’s Webinar ▪ Objective: To inform healthcare and social service providers on the details of the Test & Trace Corps programs so that you can educate and support your clients to access all of these services. ▪ Outline for today: ▪ Overview of the City’s Test and Trace Corps ▪ Take Care at Hotels ▪ Services ▪ Maintaining continuity of care ▪ Issues unique to youth ▪ Referral process
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