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May 30, 2021

BRI and VM Collaboration Sheds Light on Early Predictors of Severe COVID-19

Aaron Rips started volunteering at a New York hospital right as the city became the epicenter of the pandemic in spring 2020.

“My experience there motivated me to get involved in COVID-19 research as soon as I could,” says Aaron, a medical student at New York Medical College.

Featured Bio Aaron Rips
Aaron Rips

Aaron is from Seattle and he reached out to BRI to see if he could get involved with COVID-19 research during his visit home over summer 2020. He then connected with Uma Malhotra, MD, Infectious Disease physician at Virginia Mason (VM) and BRI investigator, who was already engaged with COVID-19 research. Together they worked on a study that yielded answers to a pressing question about COVID-19: Which patients presenting with mild COVID-19 will go on to develop severe disease?

“Findings from this study can guide doctors on which patients with initially mild illness are most likely to progress to severe disease so they can treat those patients with appropriate caution, care and monitoring,” Dr. Malhotra says. “The collaboration between BRI and VM made this work possible.”

Key Questions at the Start of the Pandemic

In the early weeks of the pandemic, researchers at BRI and around the world launched countless COVID-19 studies. Most of them were looking at patients who were hospitalized with severe illness. But Dr. Malhotra wanted to learn more about which early symptoms and other indicators might predict severe illness down the road.

“No one was really looking at this and I wanted Aaron to work on something completely new,” Dr. Malhotra says.

The partnership between BRI and VM made it possible to gather and analyze key COVID-19 data quickly. Once the study was approved by the internal review board, BRI researchers had access to data from 180 people who came to VM with COVID-19 between March and May 2020. Of the 180:

  • 153 recovered at home with no complications
  • 27 had complications that brought them back to the emergency room or urgent care
  • 14 of the 27 were hospitalized and ultimately two among them died from the disease

BRI Biostatistician Alyssa Ylescupidez led data analysis. She used advanced tools to look for patterns among the patients who had mild versus severe illness.

“We used a statistical modeling approach to determine how well we could predict who was at the highest risk for future complications or would need hospitalization,” she says.

What Shortness of Breath Says About COVID-19

This analysis highlighted that a patient’s early symptoms could help predict their outcome: Flu-like symptoms — fevers (even high fevers), chills, cough, body aches — were not indicators of severe disease. But patients who experienced shortness of breath were much more likely to subsequently develop serious complications.

Levels of lymphocytes, a type of white blood cells, were also a key indicator. Not every patient had a blood test. But for those who did, there was a correlation between low levels of lymphocytes and subsequent severe disease and need for hospitalization.

“This simple test is another parameter that could inform physicians if a patient’s condition is likely to get worse,” Dr. Malhotra says. “They could do the blood test to help predict the prognosis.”

Other Predictors of Severe Illness

Age and gender also helped predict outcomes: Patients who were younger and female had a better prognosis than those who were older and male. Comorbidities (having another condition like heart failure or diabetes) were also predictors of severe disease.

Uma Malhotra
Uma Malhotra, MD

“Most people — about 96 percent — who did not have comorbidities did not develop complications,” Dr. Malhotra says. “Whereas all patients who had over three co-morbidities ended up having some subsequent complications that brought them back to the emergency room or required hospitalization.”

While we have highly effective COVID-19 vaccines, Dr. Malhotra said knowing who will have severe complications from the virus is still important.

“People who don’t take the vaccine or those who cannot mount a strong immune response to the vaccine will still be vulnerable,” Dr. Malhotra says.

This research can help doctors know who among patients that initially present with relatively mild illness are at risk for developing serious disease. Then, they can monitor those patients more closely and consider use of emerging therapies to keep their illness from escalating.

As an aspiring physician, Aaron was excited to be part of a study that could have a big impact on patient care.

“The BRI-Virginia Mason team has been one of the most collaborative partnerships I have been fortunate to be a part of,” Aaron says. “There is still so much more work to be done, but it is equally incredible how much has been accomplished in just the past year. I am thankful to have contributed to the global effort against COVID-19 and am proud of the work this team put in to further understand the wide manifestations of the virus and to recognize at-risk patients.”

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