Crowdsourcing COVID Data; The Pandemic’s Toll on Mental Health

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TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, president of the Texas Tech University Health Sciences Center in El Paso, look at the top medical stories of the week.

This week’s topics include crowdsourcing COVID data, COVID transmission among immune and non-immune household members, the impact of changed USPSTF guidelines for lung cancer screening, and mental health consequences of the COVID pandemic.

Program notes:

0:42 Crowdsourcing COVID data

1:42 Publicly available information

2:42 Transfer to other questions

3:00 Household transmission of COVID

4:01 Transmission to non-immune family members

5:01 Trying to reduce risk for the largest number of people

6:00 COVID and depression and anxiety

7:00 Increased in both by about 25%

8:01 Telehealth helping

9:02 Impact of changes in USPSTF guidelines for lung cancer

10:02 Included lower comorbidity burden

11:15 Early detection and decreasing disparity

12:29 End

Transcript:

Elizabeth Tracey: COVID transmission among those who are immune and not immune to COVID-19.

Rick Lange, MD: Depression and anxiety due to the COVID-19 pandemic.

Elizabeth: The upside of the new USPSTF lung cancer screening guidelines.

Rick: And can crowdsourcing help us to predict COVID-19 diagnosis and hospitalization?

Elizabeth: That’s what we’re talking about this week on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.

Rick: I’m Rick Lange, president of Texas Tech University Health Sciences Center in El Paso where I’m also dean of the Paul L. Foster School of Medicine.

Elizabeth: Rick, we have three COVIDs this week. Which of them would you like to start with?

Rick: Elizabeth, let’s talk about this crowdsourcing one. Here is what it centers around. If we’re going to try to predict who might be infected with COVID or who might be hospitalized, typically we collect a bunch of patient information that’s very sensitive and protected, we submit that to an institutional review board to get their approval to conduct a study, we conduct the study, and then get all the results, and those things take time. But as we have realized, this COVID pandemic can hit very quickly.

This is an interesting study conducted by the University of Washington. Rather than provide all this sensitive patient information that resides in the scientific community, can we use publicly available information to answer two questions? One is if someone gets tested, what’s the likelihood they are to be positive in a particular geographic region? Can we predict who of those positive patients will be hospitalized?

So they put out this request to any community “scientists.” These are computer nerds, essentially, who might be interested in having access to publicly available information from the public health department. You can go online. With that, knowing how many people were tested, how many were positive, where they were at, how many people were hospitalized, could they use models to predict that accurately?

They had data from over 108,000 patients who underwent testing; about 5,000 of them had a positive test. They actually had 482 registered participants from 90 different teams, 26 of whom submitted their analysis. In essence, the citizen scientists really achieved a pretty high performance for the prediction of COVID-19 testing and hospitalization using publicly available data.

Elizabeth: Clearly, in places that are low-resource settings — or even here in the U.S. where, honestly, I think a lot of our data gathering relative to the pandemic has been pretty lackluster — this is a powerful potential tool.

Rick: It protects the patient information. It allows for an unbiased model to be performed. You can actually transfer these to other questions as well. For example, this was about who was likely to be positive and who was likely to be hospitalized. So in limited resources, you can target resources toward a particular area. We could also use it for things like who is likely to get vaccinated.

Elizabeth: Let’s just mention that was in JAMA Network Open. Now, let’s turn to JAMA Internal Medicine. This is a gigantic study and those who have been listening to us for a long time know how fond I am of these really ginormous databases. I think that was one reason I found this one so compelling.

This is the association between the risk of COVID-19 infection in non-immune individuals and COVID-19 immunity in their family members. This is data from nationwide registries in Sweden. It encompasses all individuals who acquired immunity from either previous COVID-19 infection or a full vaccination until May 26th 2021.

Each person with immunity was matched 1:1 to an individual without immunity from a cohort of people with families comprising two to five members. They had a total of 1.7 million + individuals from over 800,000 families that were included in this analysis. They had a mean follow-up time of almost a month to see what happened with the non-immune family members.

What was so interesting was these non-immune families with one immune family member, even if you had one person in your household who was immune to COVID-19, saw a reduction of 45% to 61% with their risk of contracting COVID-19. This was an inverse relationship. The more people in your household who were immune to COVID-19, the less your risk if you were a non-immune person of actually developing the infection. In fact, when you had four immune family members, you virtually were assured that you weren’t going to get COVID-19. You had a 97% risk reduction and they also saw the same relationship with hospital stays.

The authors say that this may be a very informative study with regard to low-resource countries where there may be limited supplies of COVID-19 vaccinations with regard to the dispersal strategy and trying to reduce risk for the largest number of people.

Rick: As you mentioned, the results were similar whether the family member was immune because they had contracted COVID or because they received vaccination. By the way, it was effective even if someone only got one of the two vaccines.

Now, the caveat is this is not with the Delta variant. This is with the Alpha variant. The Delta variant is a little bit more transmissible and a little bit more serious as well. But it does speak to this issue of how important herd immunity is not only around the community, but within family units as well.

This is exciting; [what I’ve read] suggests that we may not get global herd immunity till 2025 or 2026, but we can certainly target family units to try to improve herd immunity.

Elizabeth: Exactly. I’m hopeful anyway that we are going to get some of these vaccines out there. If we can just get folks to get one, that’s going to help reduce transmission.

Rick: Elizabeth, let’s now talk about the effects of COVID-19 pandemic on the incidence of depression and anxiety.

Now, there are two reports. This one is from Lancet. There is one that centers primarily in the United States that’s in Morbidity and Mortality Weekly [Report]. It kind of overlaps, so I’ll kind of treat the two studies together.

The one from Lancet, again, looks at the global prevalence and it recognizes that determinants of mental health have been increasing. We’ve had more mental health disorders over the last decade, irrespective of the COVID pandemic. This really accelerated things.

They looked at over 5,600 unique data sources, 48 of which met their inclusion criteria. They discovered that there were two COVID impact indicators that were associated with the increased risk of anxiety and depression. They were both the daily COVID infection rate and also reductions in human mobility, a surrogate for social isolation.

They estimated there were an additional 53 million cases of major depressive disorder globally as a result of the COVID pandemic — that’s a 28% increase — and, unfortunately, a 76 million additional anxiety disorders reported; that’s an increase of 26%.

The hardest hit areas were obviously those that were hardest hit by the pandemic. The U.S. study shows a very similar thing. We saw an increase up until about December or January. We’ve seen a slight decrease, but it really parallels the number of daily infections in the United States as well.

Elizabeth: Clearly, an area of huge concern in view of the fact that we don’t have that many mental health professionals who are going to be out there available to treat all these folks. And although we have put many times about putting medications in the water so that more people could be treated, that also doesn’t seem like a strategy that’s going to help.

Rick: It’s really complicated because obviously this is worse when the pandemic is at its peak. That’s when people are most likely to be isolated and not going to see their physicians. Care is not available.

Elizabeth: With regard to the provision of mental health services, of course, telehealth has turned out to be a really big advance in the promulgation of those to people in far-flung areas.

Rick: Well, not only far flung, but even in high endemic areas where people can’t make it to the physician’s office. There is no transportation. The other thing that telehealth allows is group therapy.

Elizabeth: Would you suggest that this is a phenomenon that is going to ameliorate once the pandemic starts to slow down?

Rick: The U.S. data suggest that that’s the case. It increased from the summer until the fall and winter of 2020. Now it’s begun to decrease, but the levels have remained higher than they are at baseline. This is acute anxiety and depression, but it also has long-lasting health effects, one with regard to suicide and also other comorbid conditions. I think we’re going to have lingering effects even as the pandemic begins to die down.

Elizabeth: Then would your prescription be that we really need to bulk up our mental healthcare services?

Rick: We do. We need to look at groups that seem to be affected more. For example, females seem to be affected more than males, and the younger age group more than the older age group. These are the areas I would target the additional resources towards.

Elizabeth: OK. Finally, let’s turn back to JAMA Network Open. This is a “good news” study, as far as I’m concerned. What has been the outcome so far of the change in the USPSTF guidelines relative to lung cancer screening?

In 2021, they expanded those and this study takes a look at five community-based healthcare systems and says, “Well, all right. What was the impact of that?” They included individuals in those five systems who had a complete smoking history and were engaged with that healthcare system for 12 or more continuous months.

According to these expanded screening guidelines, they were able to include actually almost a 54% increase in the number of people who were eligible for screening. That also included 31%, almost 32%, of those aged 50 to 54 years, a larger proportion of women, more racial and ethnic minority groups, and included those with a lower comorbidity burden, which suggests to me that maybe their lung cancer would be able to be treated more effectively and wouldn’t impact on their lifespan. To me, this sounds like a really good news story.

Rick: It is. Elizabeth, for our listeners that may not be familiar with what happened, in 2021 the U.S. Preventive Services Task Force (USPSTF) updated their lung cancer screening recommendations and all they did was, they lowered the screening age from 55 to 50. Before the screening was recommended for people that had a smoking history of 30 pack-years and they lowered that to 20 pack-years. Those two simple changes increase the eligibility of more women, more minority individuals, and more people of lower socioeconomic status.

As you suggest, what has happened now is that’s decreased the disparity among who is getting screened. It’s also increased the incidence of lung cancer detection in these individuals that otherwise would not have been screened at all.

The whole reason to screen is the earlier you find cancer, the more likely you are to get it in an early stage and to completely cure it. There will be over 1.7 million deaths due to lung cancer globally, so early detection and decreasing disparities with regard to screening is incredibly important.

Elizabeth: The editorialist says that wider screening was associated with an estimated 30% increase in this lung cancer diagnosis. That’s a really good thing, also suggesting, though, that we’re going to need to expand all kinds of services, CTs specifically, and interpretation of the results.

Rick: Right. I mean, we need to get the people that are helping to screen individuals, to identify them, to contact them, capability of CT scans, radiology, and then follow-up including cardiothoracic surgeons. So it’s going to put an increased burden on the system. Nevertheless, the ability to detect cancer at an earlier stage, especially in these underserved populations, is incredibly important.

Elizabeth: Of course, we have to end with our recommendation that cigarettes and smoking ought to be abolished and that would largely eliminate this problem.

Rick: It is. But for those who qualify, those aged 50 that have 20 pack-year history of smoking, let’s make sure you’re involved with annual screening.

Elizabeth: That’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.

Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.

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