There is a growing body of research related to clinical characteristics and prognostic factors associated with COVID-19-related outcomes.
The risk of severe COVID-19 infection and mortality increases with advancing age, male sex and presence of comorbid conditions such as diabetes mellitus, hypertension and cardiovascular disease.
Information is limited about some risk factors such as smoking exposure, racial/ethnic identity that could contribute to better understanding of risk stratification and support early intervention.
Williams-Roberts, H; Groot, G; Dalidowicz, M; Young, C; Mueller, M. What are the risk factors for severity and death associated with COVID-19? 2020 May 17; Document no.: EPM050901 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 14 p. (CEST rapid review report)
Williams-Roberts, H; Groot, G; Dalidowicz, M; Young, C; Mueller, M. What are the risk factors for severity and death associated with COVID-19? 2020 May 17; Document no.: EPM050901 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. (CEST table)
· The significance of rhinorrhea as a presenting/predictive clinical feature of COVID-19 is unclear at this time with rates ranging from as low as 2% to as high as 60% in the published literature
· Rhinorrhea generally associated with less severe disease
· No reports of sneezing as a clinical symptom of COVID-19
Badea, A; Groot, G; Howell-Spooner, B; Young, C. What is the evidence that runny nose or sneezing are symptoms of COVID-19? 2020 Sep 29; Document no.: EOC092401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 16 p. (CEST rapid review report)
Generally speaking, data indicate that adult cancer patients and those who have recently received or are receiving anti-cancer therapy are at a higher risk of severe outcomes and death resulting from COVID-19 compared to those without cancer. However, more data are beginning to elucidate the nuances of these risks depending on patient specific factors.
Limited data indicate that pediatric cancer patients are not at a high level of risk of severe outcomes from COVID-19.
Limited evidence indicates some differences in the course and severity of SARS-CoV-2 infection depending on the type of immunosuppressive therapy a patient receives.
Key Findings
Generally speaking, data indicate that adult cancer patients and those who have recently received or are receiving anti-cancer therapy are at a higher risk of severe outcomes and death resulting from COVID-19 compared to those without cancer.
Pediatric cancer populations may not be at the same level of risk as adult populations.
There is not enough evidence at this time to determine if there are differences in the course of SARS-CoV-2 infection in patients receiving chemotherapy vs. those who are not aside from outcomes and severity.
Vanstone, J; Groot, G; Miller, L; Mueller, M. What are the differences in the clinical course of COVID-19 between patients undergoing chemotherapy and otherwise healthy individuals? 2021 Jan 22; Document no.: EOC062201v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 5 p. (CEST rapid review report)
Vanstone, J; Groot, G; Miller, L; Mueller, M. What are the differences in the clinical course of COVID-19 between patients undergoing chemotherapy and otherwise healthy individuals? 2021 Jan 22; Document no.: EOC062201v2 RR Table. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 5 p. (CEST table)
Badea, A; Reeder, B; Groot, G; Miller, L; Mueller, M. What are the harmful/adverse effects of multiple doses of COVID-19 mRNA vaccines? 2022 Feb 04, Document no.: EOC220103 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. (CEST table).
Evidence to date of adverse events associated with mRNA COVID-19 vaccines are largely local reactions such as pain and swelling of the injection site, and systemic reactions of an allergic nature
Increased incidences of myocarditis and pericarditis have been observed, most often occurring in men under 30 years of age, and most often after the second dose of mRNA vaccine, with more occurrences following the Moderna COVID-19 vaccine versus Pfizer, however all cases appear to resolve
To date, there is no evidence indicating a negative effect on the immune system from the administration of multiple doses of mRNA COVID-19 vaccines
Badea, A; Reeder, B; Groot, G; Miller, L; Mueller, M. What are the harmful/adverse effects of multiple doses of COVID-19 mRNA vaccines? 2022 Feb 04, Document no.: EOC220103 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 10 p. (CEST rapid review report).
Groot, G; Reeder, B; Muhajarine, N; Lee, S; Badea, A; Fox, L; Miller, L. What is known about hybrid immunity to COVID-19? 2022 Jun 06, Document no.: INF220501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. (CEST table).
There is substantial immunologic and increasing epidemiologic evidence that vaccination following infection further increases protection against subsequent illness among those who have been previously infected.
Laboratory studies indicate that hybrid immunity (i.e., immunity conferred by the combination of previous infection and vaccination) offers greater protection against COVID-19 infection.
A single dose of the AstraZeneca COVID-19 vaccine following SARS-CoV-2 infection induced a 2 to 3-fold increase in anti-Spike and -RBD IgG levels 30 days post-vaccination.
A study in Brazil found that hybrid immunity showed a modest increase in protection against symptomatic infection and waning over time.
Neutralising antibody titres against SARS-CoV-2 variants over 7 months following Pfizer vaccination in SARS-CoV-2-recovered and naïve healthcare workers resulted in substantially enhanced T-cell responses, anti-spike IgG responses and neutralising antibodies effective against SARS-CoV-2 variants in recovered participants.
Pfizer and Moderna vaccines were associated with greater IgG responses compared to Johnson & Johnson regardless of administration following infection.
Those with vaccine-after-infection or vaccine-breakthrough-infection had a more durable anti-spike-IgG response compared to infection-alone.
A study on healthcare workers from Oregon Health & Science University found enhanced immune responses after vaccination in COVID-19 recovered (hybrid immunity) compared with their naïve-vaccinated peers. However, the effects of post-vaccination breakthrough infections on humoral immune response remain to be determined.
Groot, G; Reeder, B; Muhajarine, N; Lee, S; Badea, A; Jagwani, M; Fox, L; Miller, L. What is known about hybrid immunity to COVID-19? 2022 Jun 06, Document no.: INF220501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 11 p. (CEST rapid review report).