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🦘Cacatman's Personal Coronavirus COVID-19 Update Thread

cacatman

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Long Haulers/Long Covid

Definition
- “signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are
not explained by an alternative diagnosis.”

Almost a third of recovered COVID-19 patients in a UK study ended up back in the hospital within five months — and up to one in eight died of complications from the illness.

Researchers at the UK’s Leicester University and the Office for National Statistics found that out of 47,780 people discharged from the hospital, 29.4 percent were readmitted within 140 days.

Of the total, 12.3 percent ended up dying.

Respiratory disease was diagnosed in 14,140 of the COVID cases after discharge, with 6,085 of the diagnoses in patients who had no history of respiratory conditions.

The mean age of study participants was 65 years.

Weeks and months later, some people who have had COVID-19 continue to have problems. Came out of Italy. published in JAMA. 179 sample size. 143 overall. Mean age 56 yo. 63% men. 73% had pneumonia. Average length of stay 2 weeks. BMI average 26. Most had symptoms 2 months later.13% had no symptoms at 2 months. 32% had 1-2 symptoms. 55% had 3+ symptoms as at the beginning. 44% said their quality of life got worse!!! Fatigue, dyspnoea, joint pain and chest pain, cough could all still remain. Seems to be worse in the morning. Telogen Effluvium (temporary hair loss) also seems to occur.


Info about the so called "Long haulers"

Overall, the chance of being impacted by long covid increased with age. Long COVID was found to affect around 10% of 18-49 year olds who become unwell with coronavirus, rising to 22% of over 70s.
The team found that while most people with COVID-19 reported being back to normal in 11 days or less, around one in seven (13.3%) had COVID-19 symptoms lasting for at least four weeks, with around 1 in 20 (4.5%) staying ill for eight weeks and 1 in 50 (2.3%) suffering for longer than 12 weeks.

Mental Health is an issue also. See here.

In this cohort of individuals with COVID-19 who were followed up for as long as 9 months after illness, approximately 30% reported persistent symptoms. A unique aspect of our cohort is the high proportion of outpatients with mild disease. Persistent symptoms were reported by one-third of outpatients in our study, consistent with a previously reported study,4 in which 36% of outpatients had not returned to baseline health by 14 to 21 days following infection. However, this has not been previously described 9 months after infection.

Consistent with existing literature, fatigue was the most commonly reported symptom.2-4This occurred in 14% of individuals in this study, lower than the 53% to 71%2-4 reported in cohorts of hospitalized patients, likely reflecting the lower acuity of illness in our cohort. Furthermore, impairment in HRQoL has previously been reported among hospitalized patients who have recovered from COVID-19; we found 29% of outpatients reported worsened HRQoL.

About a third of patients with coronavirus disease 2019 (COVID-19) reported persistent symptoms in a survey completed an average of 6 months after the onset of their illness, a small study from the University of Washington found.

Most of those surveyed—150 (84.7%)—were outpatients who reported mild symptoms, 11 (6.2%) were asymptomatic and 16 (9%) were hospitalized with moderate or severe illness.

The most common persistent symptoms reported in the follow-up survey were fatigue and loss of taste or smell, both of which were reported among 24 patients (13.6%). Other symptoms included brain fog (2.3%). Health-related quality of life (HRQoL) was worse for 51 (30.7%) outpatients and hospitalized patients, and 14 patients (7.9%) reported negative impacts on at least 1 activity of daily living such as household chores.

Via the telephone interview, the researchers found that 244 patients (51 percent) declared at least one symptom that did not exist before COVID-19, including fatigue, cognitive symptoms, and new-onset dyspnea in 31, 21, and 16 percent, respectively. One hundred seventy-seven patients (37 percent) underwent further examination. The median 20-item Multidimensional Fatigue Inventory score was 4.5 and 3.7 for reduced motivation and mental fatigue, respectively. Sixty-three percent of the patients had computed tomographic lung-scan abnormalities, mainly subtle ground-glass opacities. Nineteen percent of the patients had fibrotic lesions; in all but one patient, the lesions involved less than 25 percent of parenchyma. Thirty-nine percent of survivors with acute respiratory distress syndrome had fibrotic lesions. Anxiety, depression, and posttraumatic symptoms were seen in 23, 18, and 7 percent, respectively, of 94 former intensive care unit patients.

New Symptoms Common Four Months After COVID-19

244 patients (51 percent) declared at least one symptom that did not exist before COVID-19, including fatigue, cognitive symptoms, and new-onset dyspnea in 31, 21, and 16 percent, respectively. One hundred seventy-seven patients (37 percent) underwent further examination. The median 20-item Multidimensional Fatigue Inventory score was 4.5 and 3.7 for reduced motivation and mental fatigue, respectively. Sixty-three percent of the patients had computed tomographic lung-scan abnormalities, mainly subtle ground-glass opacities. Nineteen percent of the patients had fibrotic lesions; in all but one patient, the lesions involved less than 25 percent of parenchyma. Thirty-nine percent of survivors with acute respiratory distress syndrome had fibrotic lesions. Anxiety, depression, and posttraumatic symptoms were seen in 23, 18, and 7 percent, respectively, of 94 former intensive care unit patients.

The researchers found that depression/anxiety and autoimmune disease were the most frequent comorbidities (42 and 16 percent, respectively). Brain fog, headache, numbness/tingling, dysgeusia, anosmia, and myalgias were the main neurologic manifestations (81, 68, 60, 59, 55, and 55 percent, respectively); only anosmia was more frequent in SARS-CoV-2-positive versus SARS-CoV-2-negative patients (74 versus 36 percent). Fatigue was experienced by 85 percent of patients. Both groups had impaired quality of life in the cognitive and fatigue domains. Compared with a demographic-matched U.S. population, SARS-CoV-2-positive patients performed worse in attention and working-memory cognitive tasks.

Post Acute COVID-19 Syndrome
41591_2021_1283_Fig1_HTML.png

 

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cacatman

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Current evidence for COVID-19 therapies: a systematic literature review

Mortality​

In total, 39 randomised and one non-randomised trial reported on mortality, either as the number of deaths that occurred during the study or as a pre-specified study end-point, with or without a statistical comparison between groups [2834, 3654, 5668, 70]. One study included [69] was a re-analysis of data from another trial (Wang et al. [44]) included in the qualitative synthesis. The outcomes for individual trials are shown in figure 2.

Antivirals​

Among trials of antivirals (figure 2a), four trials (n=48–66) reported trends towards decreased mortality with interferons (IFNs), sofosbuvir+daclatasvir, and triazavirin, compared with standard care or placebo in patients with COVID-19 of varying severity [59, 60, 67, 68]. Another trial (n=81) reported a significant reduction in 28-day mortality with IFN-β-1a plus standard care compared with standard care alone (19.0% versus 43.6%; p=0.015) in patients with severe COVID-19 [64]. The analysis also showed that administration of IFN β-1a early in the disease significantly reduced mortality (OR 13.5 (95% CI) 1.5–118) whereas late administration did not [64].
Of four trials that assessed lopinavir/ritonavir, three trials of patients with COVID-19 of varying severity (n=86–127) reported no deaths in either treatment group [37, 39, 62]. One trial (n=199) reported a numerical but nonsignificant reduction in 28-day mortality with lopinavir/ritonavir versusstandard care in patients with severe COVID-19 [31]. Of four trials that investigated remdesivir in patients with moderate or severe COVID-19, two trials (n=1062 and n=236) and the re-analysis of Wang et al. [44] by Shih et al. [69] showed no significant mortality benefit of remdesivir compared with placebo [28, 44], although one study showed a trend towards reduced mortality in patients who received treatment earlier in their disease course (within 10 days of symptom onset) [44]. The other two trials (n=397 and n=596) reported comparable mortality with 5- and 10-day remdesivir treatment [61, 70].

Antimalarial and mucolytic drugs​

Among eight trials of hydroxychloroquine or its derivatives (figure 2b), one trial (n=81) reported significantly greater lethality with high doses of chloroquine diphosphate compared with low doses (log-rank: −2.183; p=0.03) in patients with severe COVID-19 [29]. Six trials (n=150–821) reported similar mortality with hydroxychloroquine, with or without azithromycin, compared with standard care or placebo in hospitalised [33, 45, 63] or non-hospitalised [30, 40, 42] patients with mild, mild-to-moderate or severe COVID-19. Another trial (n=447) reported no mortality benefit of adding azithromycin to hydroxychloroquine compared with hydroxychloroquine alone in patients with severe COVID-19 [53]. In a trial of the mucolytic drug, bromhexine (n=78), there was a significant reduction in mortality with bromhexine plus standard care versus standard care alone (0% versus12.8%; p=0.027) in patients with COVID-19 of unspecified severity [47].

Anti-inflammatory drugs​

Among trials of corticosteroids conducted in patients with severe COVID-19, three trials (n=149–403) showed numerical but nonsignificant trends towards reduced mortality with hydrocortisone or methylprednisolone compared with placebo or standard care (figure 2c) [46, 50, 66]. One trial (n=62) reported significantly reduced mortality (5.9% versus 42.9%; p<0.001) with methylprednisolone plus standard care versus standard care alone [52] (figure 2c). In a large trial (n=6425) of patients with COVID-19 of unspecified severity, 28-day mortality was significantly decreased with dexamethasone plus standard care versus standard care alone, both overall (22.9% versus 25.7%; p<0.001) and in patients receiving oxygen (23.3% versus 26.2%) or mechanical ventilation (29.3% versus 41.4%) at randomisation (figure 2c) [43]. The mortality benefit was greatest in patients with a longer duration of symptoms (>7 days versus ≤7 days; 12.3 by Chi-squared test for trend) [43]. Another trial (n=105), also conducted in patients with COVID-19 of unspecified severity, showed significantly increased event-free survival with the anti-inflammatory drug colchicine in combination with standard care versus standard care alone (97% versus 83% of patients after 10 days; p=0.03; data not shown graphically) [36].

Other therapies​

Trials (n=20–135) investigating the kinase inhibitor, ruxolitinib [32], the calcium release-activated calcium channel inhibitor, auxora [56], the anticoagulant, enoxaparin [54], and N-acetylcysteine, a mucolytic drug with anti-oxidant properties [49], in patients with severe COVID-19 reported no significant difference in mortality versus the comparator groups (figure 2c). One trial (n=200) reported a reduced 21-day mortality with recombinant human granulocyte colony-stimulating factor (rhG-CSF) added to standard care versus standard care alone (HR 0.19 (95% CI 0.04–0.88)) in patients with severe COVID-19 [48].
Two studies reported on immunomodulatory therapies in patients with moderate and/or severe COVID-19 (figure 2c): one single-arm trial (n=46) reported a mortality of 6.5% with hyperimmune plasma [41], and another trial (n=103) reported numerical but nonsignificant trends towards decreased mortality with convalescent plasma versus standard care [38].

Hospitalisation

Antivirals​

Three trials of IFNs (IFN-β-1a, IFN-β-1b or IFN-κ+trefoil factor 2) (n=66–81) added to standard care in patients with moderate or severe COVID-19 reported improvements in hospitalisation outcomes, including reduced hospitalisation duration [65, 67] (figure 3a), a greater proportion of patients discharged [64, 67] (table 1) and reduced incidence of ICU admittance [64, 67] (table 1) versusstandard care alone. Other trials (n=66 and n=88) reported reduced hospitalisation duration with sofosbuvir+daclatasvir+standard care (6 versus 8 days; p=0.029) and early versus late administration of favipiravir (14.5 versus 20 days; HR 1.963 (95% CI 1.331–2.894)) in patients with moderate or severe COVID-19 [68] or asymptomatic to mild COVID-19 [51], respectively (figure 3a). Patients treated with sofosbuvir+daclatasvir+standard care also had a significantly higher probability of hospital discharge by day 14 (p=0.041) versus standard care alone (table 1).
Another trial (n=127), conducted in patients with COVID-19 of unspecified severity, reported a significant reduction in median hospitalisation duration with lopinavir/ritonavir+ribavirin+IFN-β-1b versus lopinavir/ritonavir alone [37]. When patients were stratified according to the timing of treatment administration, median hospitalisation was significantly reduced in patients who received treatment within 7 days of symptom onset, but not in those who received treatment later than this [37].
Among trials of remdesivir and the re-analysis of Wang et al. [44], one trial (n=1062) reported a reduced initial length of hospital stay with remdesivir versus placebo in patients with severe COVID-19 (median 12 versus 17 days) [28] (figure 3a). There were trends towards more patients discharged with remdesivir versus placebo/standard care, as well as with earlier remdesivir treatment in the remaining trials [44, 61, 69, 70] (table 1), but between-group differences were either not significant or not tested. A small pilot study (n=20) also reported a reduced mean duration of hospitalisation (7 versus 13 days; p=0.02) with the antiretroviral azvudine plus standard care versus standard care alone in patients with mild COVID-19 [57].

Antimalarial and mucolytic drugs​

Among six trials assessing hydroxychloroquine (n=194–821) [30, 33, 40, 42, 45, 53], with or without azithromycin, no benefit was seen relative to the comparator groups in terms of hospitalisation duration (figure 3a), incidence of ICU admittance (table 1) or incidence of hospitalisation (supplementary figure 3). In a trial conducted in patients with COVID-19 of unspecified severity (n=78), ICU admittance was significantly reduced with bromhexine plus standard care versusstandard care alone (5.1% versus 28.2%; p=0.006) [47] (table 1).

Anti-inflammatory drugs​

One trial (n=6425) reported a numerically shorter median duration of hospitalisation (12 versus 13 days) and a greater probability of discharge alive within 28 days with dexamethasone plus standard care versus standard care alone (rate ratio 1.10 (95% CI 1.03–1.17)) in patients with COVID-19 of unspecified severity [43] (figure 3b and table 1). In another trial of patients with severe COVID-19 (n=403), treatment with a 7-day fixed-dose course or shock-dependent dosing of hydrocortisone were associated with reduced hazard ratios for length of hospital and ICU stay; however, neither treatment strategy met pre-specified criteria for statistical superiority [46]. A further trial (n=62) reported a significantly reduced time to the composite outcome of hospital discharge or death with methylprednisolone plus standard care versus standard care alone in patients with severe COVID-19 (median 11.6 versus 17.6 days; p=0.006) [52] (table 1). Other trials of anti-inflammatory agents (n=54–416) reported no differences in hospitalisation outcomes versus comparators (figure 3b, table 1 and supplementary figure 3) [35, 36, 50, 66].

Other therapies​

Among trials of other therapies, one trial (n=103) reported numerical but nonsignificant trends towards reduced hospitalisation duration and increased numbers of patients discharged with convalescent plasma versus standard care [38] (figure 3b and table 1). Trials of rhG-CSF (n=200), N-acetylcysteine (n=135), enoxaparin (n=20) and ruxolitinib (n=43) reported no significant impact of these interventions on hospitalisation outcomes versus standard care or placebo [32, 48, 49, 54] (figure 3b and table 1).

Need for ventilation

Antivirals​

Most trials of antivirals did not report a significant impact of the interventions assessed on the number of patients requiring ventilation, or on related outcomes including duration of respiratory support (figure 4a and supplementary table 4). However, there were trends towards decreased use of ventilation with IFN therapies, sofosbuvir+daclatasvir and triazavirin (figure 4a) [59, 60, 64, 68]. Additionally, one trial (n=81) of patients with severe COVID-19 reported an increased number of patients extubated following treatment with IFN-β-1a plus standard care than with standard care alone (53.5% versus 11.8%; p=0.019) [64] (supplementary table 4). Another trial (n=1062), also conducted in patients with severe COVID-19, reported fewer patients requiring new use of oxygen (36% versus 44%), noninvasive ventilation (17% versus 24%) or intensive mechanical ventilation (13% versus 23%) with remdesivir versus placebo (figure 4a) [28].

Antimalarial and mucolytic drugs​

Four trials (n=194–665) reported no significant impact of hydroxychloroquine, with or without azithromycin, on reducing the need for ventilation or improving other respiratory outcomes compared with standard care, in patients with COVID-19 of a range of severities [33, 40, 45, 53] (figure 4b and supplementary table 4). Among two trials (n=78 and n=18) of bromhexine plus standard versus standard care alone, one reported significantly reduced numbers of patients with COVID-19 of unspecified severity requiring intensive mechanical ventilation with bromhexine (2.6% versus 23.1%; p=0.007) [47] (figure 4b). The other trial showed a numerical but nonsignificant trend towards reduced need for oxygen therapy with bromhexine (16.7% versus 33.3%; p=0.11) versus standard care, in patients with mild or moderate COVID-19 [55] (figure 4b).

Anti-inflammatory drugs​

Among studies of anti-inflammatory drugs (figure 4b and supplementary table 4), one randomised trial (n=6425) reported a statistically significantly decreased need for invasive mechanical ventilation with dexamethasone plus standard care versus standard care alone in patients with COVID-19 of unspecified severity [43] (figure 4b). The risk of progression to invasive mechanical ventilation was also significantly lower with dexamethasone than with standard care (risk ratio 0.77 (95% CI 0.62–0.95)) [43]. Another trial (n=62) of patients with severe COVID-19 reported a significant reduction in the proportion of patients receiving oxygen after 3 days of treatment with methylprednisolone, compared with before treatment (82.4% versus 100%; p=0.025) [52] (figure 4b).

Other therapies​

In a small trial (n=30), fewer patients with severe COVID-19 required invasive mechanical ventilation; and the composite end-point of death or invasive mechanical ventilation occurred significantly less frequently in patients receiving auxora than in those receiving standard care (HR 0.23 (95% CI 0.05–0.96); p<0.05) (figure 4b and supplementary table 4) [56]. In another small trial (n=20), administration of enoxaparin significantly reduced the median number of ventilator-free days compared with low molecular weight/unfractionated heparin (0 versus 15 days; p=0.028) and resulted in a higher ratio of successful liberation from mechanical ventilation after respiratory failure (HR 4.0 (95% CI 1.035–15.053); p=0.031) in patients with severe COVID-19 (supplementary table 4) [54]. Trials of ruxolitinib, N-acetylcysteine and rhG-CSF (n=43–200) showed no significant efficacy in reducing need for ventilation in patients with severe COVID-19 [32, 48, 49] (figure 4b and supplementary table 4).

 

cacatman

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Erectile Dysfunction
The study found that surviving COVID-19 may be associated with erectile dysfunction (ED). The research points to three factors that can lead to the potential onset of ED in men who have had the virus:

  • Vascular effects. Erectile function is a predictor of heart disease, so we know that the vascular system and reproductive system are connected. We also know that COVID-19 can cause hyperinflammation throughout the body, especially in the heart and surrounding muscles. Blood supply to the penis can become blocked or narrowed as a result of a new or worsened vascular condition caused by the virus.
  • Psychological impact. Sexual activity is closely associated with mental health. The stress, anxiety and depression caused by the virus and pandemic can be linked to sexual dysfunction and poor mood.
  • Overall health deterioration. ED is typically a symptom of an underlying problem. Men with poor health are at greater risk for developing ED and also for having a severe reaction to COVID-19. Since the virus can cause a plethora of health issues, general poor health is cause for concern both for ED and other complications.
 

JackGabriel

Oakley Beginner
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Most COVID-19 is Spread by 18-24 yo (USA)

57 percent of those new cases occurred in people 18 to 24 yo.

“It has been reported that mitigation behaviors, such as social distancing, wearing masks, and avoiding crowded spaces, is lowest among people between the ages of 18 and 29,” he told Healthline.

“They’re more likely to be asymptomatic and can easily unknowingly transmit the virus to others,” Russell said. “Many young adults also know that their risk of lethal infection or developing long-term health problems as a result of the virus is very low, which decreases their anxiety about getting sick and lends them less reason to adhere to COVID-19 recommended practices.”

Recent hospitalizations among children for COVID-19 were nearly 9 times higher than last spring.
Hi I'm a psychiatrist and I want to help people fighting depression and I have a medicine named Rivotril 2mg that helps a person to be better again.
 

cacatman

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Mental Illness & COVID-19
The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6–18·6), including 5·8% (5·2–6·4) that were a first diagnosis.

Overall, the estimated incidence of being diagnosed with a neurological or mental health disorder following COVID-19 infection was 34%. For 13% of these people it was their first recorded neurological or psychiatric diagnosis.

The most common diagnoses after COVID-19 were anxiety disorders (occurring in 17% of patients), mood disorders (14%), substance misuse disorders (7%), and insomnia (5%). The incidence of neurological outcomes was lower, including 0.6% for brain haemorrhage, 2.1% for ischaemic stroke, and 0.7% for dementia

This latest study analysed data from the electronic health records of 236,379 COVID-19 patients from the US-based TriNetX network, which includes more than 81 million people.

Prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms.
 

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cacatman

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CO2 Levels in Rooms is a proxy for viral load
Wherever you are sharing air, the lower the CO2, the lower risk of infection.

Tracking carbon dioxide levels indoors is an inexpensive and powerful way to monitor the risk of people getting COVID-19, according to new research from the Cooperative Institute for Research in Environmental Sciences (CIRES) and the University of Colorado Boulder.
 

cacatman

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Excess Mortality and Potential Life Years Lost
During the pandemic, the U.S. lost an additional 3.6 million potential years of life in 2020. Among excess deaths in 2020, the average person lost 14 years in the U.S. compared to an average of 8 years in peer countries before the age of 75. Excess mortality rates were higher among younger people of color, in part, leading to higher premature excess deaths among people of color in the U.S. Of the potential years of life lost in the U.S., 30% were among Black people and another 31% were among Hispanic people, compared to their share of the U.S. population at 12.2% and 18.5%, respectively. Although discussions in the U.S. of how to mitigate the continued impact of COVID-19 have often pegged the economy against deaths among the elderly, the pandemic has also led to high excess mortality rates among younger people, including working age adults.
 

cacatman

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Blood Type Risk - Not Found to Have an Association
Type 0 blood types have a reduced risk of developing COVID-19 - Now debunked - see below.

Blood type was linked with severity of illness

Meta-analysis of 10 eligible studies consisting of 54,218 subjects suggested that blood groups A and B are associated with an estimated increase in the probability of COVID-19 infection compared with non-A and non-B blood groups, which was statistically significant. However, compared with the non-O blood groups, individuals with blood group O had a significantly lower predisposition to COVID-19, which was highly statistically significant. No statistical evidence was found for an association between blood group AB and COVID-19 infection. In terms of Rh, patients who were Rh positive were more vulnerable to COVID-19 than those who were Rh negative. Furthermore, we found a contribution of ABO blood groups to the clinical outcome of patients with COVID-19. Compared with non-A blood groups, higher mortality was observed in patients with blood group A, suggesting that blood group A may be related to unfavourable outcomes.

Latest - Not Found to Be Associated
A total of 107,796 persons across 24 hospitals and 215 clinics were included in the study. Overall, 11,468 of these patients tested positive for COVID-19.1 Researchers noted that while other demographic determinants played a role in hospitalization, intensive care unit (ICU) admission, and viral positivity, blood type was not associated with susceptibility to or severity of COVID-19.
 

cacatman

No one knows 'cacat' like cacatman!!
Staff member
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Blood Type Risk - Not Found to Have an Association
Type 0 blood types have a reduced risk of developing COVID-19 - Now debunked - see below.

Blood type was linked with severity of illness

Meta-analysis of 10 eligible studies consisting of 54,218 subjects suggested that blood groups A and B are associated with an estimated increase in the probability of COVID-19 infection compared with non-A and non-B blood groups, which was statistically significant. However, compared with the non-O blood groups, individuals with blood group O had a significantly lower predisposition to COVID-19, which was highly statistically significant. No statistical evidence was found for an association between blood group AB and COVID-19 infection. In terms of Rh, patients who were Rh positive were more vulnerable to COVID-19 than those who were Rh negative. Furthermore, we found a contribution of ABO blood groups to the clinical outcome of patients with COVID-19. Compared with non-A blood groups, higher mortality was observed in patients with blood group A, suggesting that blood group A may be related to unfavourable outcomes.

Latest - Not Found to Be Associated
A total of 107,796 persons across 24 hospitals and 215 clinics were included in the study. Overall, 11,468 of these patients tested positive for COVID-19.1 Researchers noted that while other demographic determinants played a role in hospitalization, intensive care unit (ICU) admission, and viral positivity, blood type was not associated with susceptibility to or severity of COVID-19.

 

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