Introduction

The novel coronavirus disease 2019 (COVID-19) is an acute respiratory illness, which raises mortality rates in older people and those with underlying medical conditions such as cardiovascular disease, chronic respiratory disease, diabetes and cancer.

People with substance use disorders (SUD) are considered at increased risk of COVID-19 and its more serious complications for multiple physiological and social causes.

Comorbidities prevalent among people with SUD, such as cardiovascular diseases, chronic respiratory diseases, diabetes, obesity and cancer, increase vulnerability to COVID-19 and are associated with more severe COVID-19 symptoms, complications and fatalities.

Moreover, high-risk behaviors such as sharing drug-using paraphernalia, difficulties to maintain quarantines and living in close contact with others in crowded shelters may contribute to the spread of COVID-19 among people with SUD.

In addition, social and economic changes caused by the pandemic, along with the inconvenients regarding treatment access and adherence, can aggravate the SUD. Healthcare policies, including physical and social distancing isolation and restricted medical visits during the pandemic make it difficult for healthcare providers to address the needs of people with SUD with the availability of medications, harm reductions programs and mutual supports groups.

Despite this emerging health threat for people with SUD, data on COVID-19 and its intersection with SUD are scant. Therefore, this study aimed to describe the clinical characteristics, related factors and clinical outcomes of COVID-19 in people with SUD admitted to a reference hospital during the pandemic.

Methods

This observational study was conducted at the Hospital del Mar, which is located in one of the district in Barcelona (Spain) with the highest prevalence of people with SUD. This institution is an urban, tertiary, teaching hospital, which offers cost-free acute-care for the district reference population.

All individuals (aged ≥ 18 years) with SUD who were admitted for COVID-19 pneumonia from 12 March to 21 June 2020 (national state of alarm period) were included in the study.

Confirmed COVID-19 pneumonia was defined by clinical and radiological findings and a positive real time reverse-transcription polymerase chain reaction for SARS-CoV-2 in respiratory samples. CURB-65 scale was used to assess the severity of pneumonia. SUD were diagnosed according to the DSM-V-TR criteria.

The main variable of the study was the percentage of patients admitted for COVID-19 pneumonia with SUD. The secondary variables were the prevalence of subtypes of SUD, prevalence of comorbities associated to COVID-19 risk, incidence of acute respiratory distress syndrome and mortality among patients admitted for COVID-19 pneumonia with SUD.

For the purpose of the study, socio-demographic and clinical characteristics were extracted from the patients’ medical records. Recorded variables were age, gender, comorbidities, clinical characteristics of COVID-19 and outcomes.

Descriptive statistics were expressed as mean, standard deviation, median and range for quantitative variables and absolute frequencies and percentages for qualitative variables. The chi-square test was used to compare categorical variables and Mann–Whitney U test for variables that did not follow a normal distribution. A P value < 0.05 was considered significant.

Analysis was made using SPSS software, version 17.0.0 (Chicago, Illinois).

The study complied with the ethical statements in the Declaration of Helsinki (64th General Assembly, Fortaleza, Brazil, October 2013) and approved by the local Ethics Committee.

(Ethics Committee for Scientific Research IMIM, Barcelona, Spain, CEIm-2020/9355/I).

Results

During the study period, there was 2023 patients admitted for COVID-19 pneumonia in the hospital, of whom 27(1.3%) had SUD.

Clinical and social characteristics of 27 patients with SUD included in the study are showed in Table 1. The majority of patients were Spanish men, with mean age of 56 years and stable housing.

Table 1. Social and clinical characteristics of 27 individuals with SUD admitted for COVID-19 pneumonia

The main SUD was alcohol and a quarter of patients had psychiatric comorbidities. Ongoing SUD care previous to the admission was observed in 24(88.8%) patients.

About two third patients had one or more comorbidities associated to COVID-19 risk. The main observed were: hypertension in 8(29.6%) patients, chronic respiratory disease in 7(25.9%), liver cirrhosis in 5 (18.5%), chronic heart disease in 4(14.8%), chronic renal disease in 3 (11.1%), diabetes in 2(7.4%) and cancer in 2(7.4%). Patients with alcohol use disorder had more median COVID-19 risk factors than other patients (3 versus 1; P 0.02).

HIV infection was present in 2(7.4%) patients and chronic hepatitis C in 1(3.7%).

Fever and respiratory symptoms were present in all 27 patients, astenia and myalgia in 21(77.8%) and gastrointestinal in 4(14.8%).

During a median length of stay of 10 days (IQR: 7–19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died.

Discussion

Main finding of this study

In spite of the hypothetical risk for COVID-19, this study showed that a small number of people with SUD were admitted for COVID-19 pneumonia in a public referral hospital.

What is already known on this topic?

Several factors could explain the low percentage of patients with SUD admitted for COVID-19 pneumonia in this study.

First, despite Spain has been one of the European countries most affected by the COVID-19 pandemic so far, the findings from the recent nationwide seroprevalence study for SARS-CoV-2 have indicate that the prevalence of IgG antibodies against this coronavirus is ~5%, reflecting a low incidence of the disease in the general population.

Second, among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk and representing more than 80% of admitted patients with COVID-19 from the general population. By contrast, younger adults < 40 years represent only 10% of hospital admissions. In this sense, the median age of patients on SUD treatment in Barcelona is ~40 years and the main type of substance use is alcohol. According to these data, the majority of admitted patients with SUD had alcohol use disorder a median age of 56 years old in this study.

Finally, three quarters of patients scored low-moderate risk in the pneumonia severity index according to CURB-65 scale, so that the low severity of symptoms could have been confused by patients as withdrawal syndrome, or that patients could have decided not to go to overwhelmed hospital emergency department during the epidemic, In this sense, only 20% of symptomatic participants with antibodies against SARS-CoV-2 reported a previous PCR in the national prevalence survey, which was positive in ~75 of cases, suggesting that a substantial number of symptomatic patients with COVID-19 did not undergo medical assessment in the general population.

Moreover, asymptomatic infections, which are more frequent in young adults under 40 years of age of the general population, could have contributed to the low number of COVID-19 among people with SUD, given the same median age of people with SUD on ongoing SUD of the local area.

What this study adds

The group of patients with SUD admitted for COVID-19 was represented by patients over 50 years of age, diagnosed of alcohol use disorder and with a high prevalence of comorbidities associated to COVID-19 risk. This data should be taken into account when planning COVID-19 prevention measures, since the aging of populations with SUD and the progressive increase of older adults seeking treatment in drug addiction care centers.

Limitations of this study

Although this observational data collected from one hospital alone may limit the generalization of the findings, Hospital del Mar is the reference hospital for one of the district of the city with the highest prevalence of people with SUD and a large number of patients were admitted during the study period, thus the sample was representative. Otherwise, rates for inhabitant would have better indicated the COVID-19 risk among people with SUD, however, there was only local data about the population on ongoing SUD treatment which could exclude a considerable number of patients of the denominator.

Conclusion

The low number of people with SUD and COVID-19 admitted to the hospital in this study highlights the urgent need to carry out larger sample sizes and sero-epidemiological studies of SARS-Cov-2 infection in order to more completely understand the effects of COVID-19 among people with SUD. Meanwhile, it is mandatory to guarantee access to healthcare during the pandemic, including social and medical assistance for SUD and COVID-19.

Summary

This study investigated the clinical characteristics and outcomes of COVID-19 in individuals with substance use disorders (SUD) admitted to a Barcelona hospital during the 2020 pandemic. A low percentage (1.3%) of COVID-19 pneumonia patients admitted to the hospital had SUD. The study analyzed sociodemographic and clinical data, including comorbidities and COVID-19 severity, employing statistical methods to compare variables. Results indicated a higher prevalence of comorbidities associated with increased COVID-19 risk among patients with SUD, particularly those with alcohol use disorder. Despite the observed comorbidities, mortality among this group was zero. The study highlights the need for further research, including larger-scale studies and serological investigations to fully elucidate the impact of COVID-19 on individuals with SUD. Access to healthcare for this vulnerable population during pandemics remains crucial.

Methods

This observational study enrolled adult patients (≥18 years) with SUD admitted to Hospital del Mar in Barcelona, Spain, between March 12th and June 21st, 2020, for COVID-19 pneumonia. COVID-19 pneumonia was confirmed via clinical, radiological findings, and positive SARS-CoV-2 PCR tests. SUD diagnoses were based on DSM-V-TR criteria, and pneumonia severity was assessed using the CURB-65 scale. The primary outcome was the percentage of COVID-19 pneumonia patients with SUD. Secondary outcomes included SUD subtypes, comorbidity prevalence, acute respiratory distress syndrome (ARDS) incidence, and mortality. Data were analyzed using descriptive statistics and inferential tests (chi-square, Mann-Whitney U), with statistical significance set at P < 0.05. The study adhered to ethical guidelines outlined in the Declaration of Helsinki and received ethical committee approval.

Results

Of 2023 COVID-19 pneumonia admissions, 27 (1.3%) patients had SUD. The majority were Spanish men, with a mean age of 56 years. Alcohol use disorder was the most prevalent SUD, and a significant proportion (88.8%) received ongoing SUD care before admission. Approximately two-thirds exhibited comorbidities increasing COVID-19 risk, most frequently hypertension and chronic respiratory disease. Alcohol use disorder was associated with a higher median number of COVID-19 risk factors. All patients presented with fever and respiratory symptoms. Severe pneumonia developed in 25.9% of patients, ARDS in 18.5%, and there were no deaths.

Discussion

The low percentage of SUD patients admitted for COVID-19 pneumonia is discussed in the context of Spain's overall COVID-19 incidence, the age distribution of COVID-19 severity, and potential underreporting due to symptom overlap with SUD withdrawal or reluctance to seek care during the pandemic. The study's findings highlight that the population of SUD patients admitted for COVID-19 were older, primarily diagnosed with alcohol use disorder and had a high prevalence of comorbidities associated with increased COVID-19 risk.

Limitations

The study's limitations include its single-hospital setting, potentially limiting generalizability. While Hospital del Mar serves a high-SUD-prevalence area and enrolled a substantial number of patients, the absence of population-level data on SUD prevalence may affect the accurate calculation of incidence rates.

Conclusion

This study emphasizes the need for larger-scale epidemiological studies and serological investigations to comprehensively assess the impact of COVID-19 on individuals with SUD. Ensuring access to healthcare, including SUD treatment and COVID-19 care, during pandemics is vital.

Summary

This study investigated the clinical characteristics and outcomes of COVID-19 in individuals with substance use disorders (SUDs) admitted to a Barcelona hospital during the initial pandemic period. The researchers analyzed data from a cohort of patients to determine the prevalence of SUD among COVID-19 patients, the types of SUDs present, associated comorbidities, and clinical outcomes. The low number of SUD patients with COVID-19 pneumonia admitted to the hospital was discussed in relation to potential contributing factors and limitations of the study.

Methods

Researchers conducted an observational study at Hospital del Mar in Barcelona, a hospital serving an area with a high prevalence of SUDs. The study included all patients aged 18 and older admitted with COVID-19 pneumonia between March 12th and June 21st, 2020. COVID-19 pneumonia was confirmed through clinical, radiological findings, and positive SARS-CoV-2 PCR tests. SUD diagnoses were based on DSM-V-TR criteria, and the CURB-65 scale assessed pneumonia severity. The primary outcome was the percentage of COVID-19 patients with SUD. Secondary outcomes included SUD subtypes, prevalence of COVID-19 risk comorbidities, acute respiratory distress syndrome (ARDS) incidence, and mortality. Data were analyzed using descriptive statistics and appropriate statistical tests. The study adhered to ethical guidelines and received ethical committee approval.

Results

Of 2023 COVID-19 pneumonia admissions, 27 (1.3%) involved patients with SUD. The majority were Spanish men with a mean age of 56, and most had stable housing. Alcohol was the most common SUD, and a significant portion had psychiatric comorbidities. A majority (88.8%) had received prior SUD care. Two-thirds had comorbidities associated with increased COVID-19 risk, most frequently hypertension, chronic respiratory disease, and liver cirrhosis. Alcohol use disorder was associated with a higher median number of COVID-19 risk factors. All patients presented with fever and respiratory symptoms. Severe pneumonia developed in 25.9% of patients, ARDS in 18.5%, and there were no deaths.

Discussion

The low prevalence of SUD patients with COVID-19 pneumonia observed in this study is discussed in the context of several factors. The relatively low incidence of COVID-19 in the general population during the study period in Spain, the age distribution of COVID-19 severity (with older adults being at higher risk), and the age and SUD profiles of the study participants were considered. The possibility that patients with milder symptoms may not have sought hospital care, along with potential asymptomatic infections, are also suggested as possible explanations.

Limitations

The study's limitations include its observational design and single-hospital setting, which may limit the generalizability of findings. The researchers acknowledge that while Hospital del Mar serves a high-SUD-prevalence area and had a large number of admissions, rates per inhabitant would have provided a stronger epidemiological measure. However, data limitations regarding the precise population of individuals with ongoing SUD treatment hindered a more accurate calculation.

Conclusion

This study's findings suggest a low number of hospital admissions for COVID-19 pneumonia among individuals with SUDs. Further research, including larger-scale studies and seroprevalence surveys, are needed to better understand COVID-19's impact on this population. The study underscores the ongoing necessity of ensuring access to comprehensive healthcare, including SUD and COVID-19-related care, during pandemics.

Summary

This study investigated the impact of COVID-19 on individuals with substance use disorders (SUDs) in Barcelona, Spain. Researchers examined the characteristics and outcomes of COVID-19 in this population during a specific period of the pandemic. The study's findings offer insights into the relationship between SUDs and COVID-19 severity and highlight areas needing further research.

Methods

The study used data from Hospital del Mar, a Barcelona hospital serving an area with a high SUD prevalence. It included all patients aged 18+ with SUDs admitted for COVID-19 pneumonia between March 12th and June 21st, 2020. COVID-19 diagnosis relied on clinical findings, radiological results, and PCR testing. The severity of pneumonia was assessed using the CURB-65 scale, and SUD diagnoses followed DSM-V-TR criteria. The study collected socio-demographic and clinical data, using statistical methods (chi-square and Mann–Whitney U tests) to analyze the data. Ethical guidelines were followed, and the study was approved by the local ethics committee.

Results

Of 2023 COVID-19 pneumonia admissions, only 27 (1.3%) involved patients with SUDs. Most were Spanish men, averaging 56 years old, with stable housing. Alcohol was the most common SUD, and a quarter of patients had psychiatric comorbidities. Most (88.8%) received prior SUD care. About two-thirds had comorbidities increasing COVID-19 risk, mainly hypertension, chronic respiratory diseases, and liver cirrhosis. All patients displayed fever and respiratory symptoms. Severe pneumonia affected 25.9% of patients, acute respiratory distress syndrome impacted 18.5%, and there were no deaths.

Discussion

The low percentage of SUD patients hospitalized for COVID-19 pneumonia may be due to several factors: Spain's relatively low COVID-19 incidence, older adults being at higher risk for severe illness (while the SUD population studied was younger), and the possibility of mild symptoms being mistaken for withdrawal or patients avoiding overwhelmed hospitals. Asymptomatic infections may also have contributed. This study adds to current knowledge by characterizing the COVID-19 patients with SUDs as older adults, mostly with alcohol use disorder and existing comorbidities.

Limitations

The study's limitations include its single-hospital setting, which restricts generalizability. While Hospital del Mar serves a high-SUD-prevalence area, and a significant number of patients were included, data on the total SUD population wasn't available, impacting the accurate calculation of rates.

Conclusion

The low number of hospitalized SUD patients with COVID-19 underscores the need for larger studies and serological surveys to fully understand the disease's impact on this population. The study emphasizes the importance of ensuring continued healthcare access, including SUD treatment, during pandemics.

Summary

This study looked at how many people with substance use disorders (SUDs) got seriously sick with COVID-19. It focused on a hospital in Barcelona, Spain.

Methods

The study looked at everyone over 18 with an SUD who was admitted to the hospital with COVID-19 pneumonia between March 12th and June 21st, 2020. Doctors used tests and a special scale (CURB-65) to check how sick people were. They also looked at things like age, gender, other health problems, and what kind of SUDs people had.

Results

Out of 2023 people admitted with COVID-19 pneumonia, only 27 (a little over 1%) had SUDs. Most were men, around age 56, and lived in stable housing. Many had other health problems that made COVID-19 worse, like high blood pressure or lung disease. Most didn't die from COVID-19.

Discussion

The study found that surprisingly few people with SUDs were hospitalized with severe COVID-19. Several reasons are possible. COVID-19 wasn't as widespread in that area as in other places. Older people are more likely to get very sick, but most people with SUDs in this study were middle-aged or younger. Also, some people might have had mild COVID-19 symptoms and didn't go to the hospital.

Limitations

The study only looked at one hospital, so the results might not apply to everywhere. It also was hard to know the exact number of people with SUDs in the area.

Conclusion

This study showed that fewer people with SUDs got seriously ill with COVID-19 than expected. More research is needed to better understand COVID-19’s impact on people with SUDs. It’s also important to make sure people with SUDs can still get the healthcare they need during a pandemic.