Department of Research & Evaluation News

As the COVID-19 pandemic wears on, researchers and physicians at Kaiser Permanente Southern California are analyzing the data collected and lessons learned over the first year of the pandemic to find better ways to test, treat, and care for patients.

On January 26, a few of the researchers and scientists shared their latest projects at a Department of Research & Evaluation Research Seminar. Anny Xiang, PhD, MS, a senior research scientist and biostatistician and the director of Biostatistics Research for the department, kicked off the seminar by introducing the speakers.

Dr. Xiang noted: “These seminars are not inclusive of all Kaiser Permanente Southern California research on COVID-19. We have many studies ongoing and this is just a few samples of current research. I’m sure in the future you will hear more.”

Asthma, COPD, and COVID-19 hospitalization

Brian Huang, PhD, MPH, a biostatistician with Research & Evaluation, led research exploring the associations between asthma, COPD, and COVID-19 outcomes. Previous studies had inconsistent findings, he said. So, the research team set out to determine more conclusively how people with asthma and COPD fared after testing positive for COVID-19.

They analyzed the electronic health records for more than 70,000 Kaiser Permanente Southern California members diagnosed with COVID-19 between March 1 to August 31, 2020.

“We found that patients with both asthma and COPD had the highest risk of hospitalization,” Dr. Huang said. “Among patients with asthma and COPD, those who used both corticosteroids and bronchodilators were more likely to be hospitalized. This suggests that the severity of asthma or COPD could be a key risk factor for developing severe COVID-19.”

The manuscript for this research has been submitted for publication. This study was supported by the National Institute of Environmental Health Sciences and the National Cancer Institute at the National Institutes of Health, and the Keck School of Medicine Department of Preventive Medicine COVID-19 Pandemic Center at the University of Southern California.

COVID-19 and pregnancy outcomes

Darios Getahun, MD, PhD, MPH, a research scientist at Research & Evaluation, led a team of researchers who examined the association between prenatal COVID-19 diagnosis and adverse outcomes before and after birth. They also studied whether the timing of the infection, severity of illness, and race/ethnicity of the mother impacted the magnitude of those associations.

The study cohort included women who delivered in Kaiser Permanente Southern California hospitals from April 6 through December 31, 2020. Of the over 29,000 singleton baby deliveries (multiple births were not included in the study) about 4% of the mothers tested positive for COVID-19.

The study found that prenatal SARS-CoV-2 infection was associated with an increased risk of preeclampsia/eclampsia, slightly abnormal APGAR scores (a test that quickly summarizes the health of newborn children), COVID-19 infection for the child, and neonatal intensive care unit admission. The findings also suggested that women who tested positive during the first and second trimesters may be at increased risk for premature birth and stillbirth.

Dr. Getahun said the research shows a “very low vertical transmission rate,” which is the direct transmission of COVID-19 from the mother to the unborn baby.

The internally funded research is currently being written for submission to a peer-reviewed journal.

Antihypertensive medications and COVID-19

In the early days of the pandemic, there were serious concerns that certain types medications to treat high blood pressure — specifically angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) — might increase COVID-19 risk or worsen outcomes.

Jaejin An, PhD, a research scientist with R&E, and her research team analyzed data from 824,650 Kaiser Permanente Southern California members with high blood pressure to determine:

• whether the use of ACEIs and ARBs increase the risk of COVID-19 infection,
• whether use of ACEIs and ARBs are associated with more severe COVID-19 illness, and
• what are the benefits and harms of continuation of ACEIs or ARBs for patients hospitalized with COVID-19?

“Our study showed that neither ACE inhibitors nor ARB use was associated with increased likelihood of COVID-19 infection or severity of COVID-19 infection,” Dr. An said. “These results reassure us that patients with hypertension should continue their ACEIs or ARBs as prescribed during the pandemic.”

The findings appeared in the Journal of the American Heart Association. The research was supported by an American Heart Association grant and a grant from the Southern California Permanente Medical Group Regional Research Committee.

COVID-19 and patients with HIV

Although several studies have described COVID-19 hospitalization outcomes in people living with HIV/AIDS, few have examined how the incidence has differed between people infected with HIV/AIDS and those who are not infected.

Jennifer Chang, MD, an HIV/AIDS primary care specialist in the Kaiser Permanente Los Angeles Medical Center’s Department of Infectious Diseases, led a study to understand the incidence and severity of COVID-19 among people living with HIV/AIDS.

The study established that there were 3.7 million HIV-uninfected people and 10,700 people with HIV enrolled in the 3-month study period from March through May 2020. People with HIV were tested at a higher incidence for COVID-19 (551 per 10,000 patients) than HIV-uninfected people (268 per 10,000 patients).

“We found a higher incidence of testing, diagnosis, hospitalization, and ICU admission for COVID-19 among people living with HIV, than for HIV-uninfected adults,” Dr. Chang said.

People living with HIV/AIDS who tested positive for COVID-19 were more likely to be male, younger, and have a lower BMI than those who did not have HIV/AIDs.

The research was presented at the IDWeek2020 conference in fall 2020 and is currently being submitted for publication.

Heart attack trends during the pandemic

As a result of California’s stay-at-home orders during the pandemic and a fear of COVID-19, many people did not seek necessary medical care during the pandemic.

To determine how that affected patients who may have had heart attacks, Matthew Mefford, PhD, a post-doctoral research fellow with Research & Evaluation, led a research team with 2 objectives:

• To compare rates of active myocardial infarction (AMI) during the pre-pandemic and pandemic period of 2020 to the comparable period in 2019.
• To compare in-hospital and 30-day case fatality rates of AMI patients during the pre-pandemic and pandemic period of 2020 to the comparable period in 2019.

The research showed that AMI rates were lower during the COVID-19 pandemic compared to the same time during the prior year. Fatality rates were higher for both patients who died in the hospital and those who died within 30 days of their heart attack. Those who did seek care during the pandemic were more likely to have had heart attacks in the past, which may indicate that awareness from previous experience or prior education may influence patients’ actions.

“These findings may provide insights that could help develop public health campaigns aimed at improving patients’ willingness to seek care during stay-at-home orders,” Dr. Mefford said.

The research, which was supported by the Southern California Permanente Medical Group, is under review for publication.

More COVID-19 research summaries available

This research seminar was the second in the series of updates on COVID-19 research. The first was held on October 27, 2020. You can read about it here.