Demographics and disparities subsection #460

dziakj1 · 2020-06-30T20:42:24Z

This is an attempt to answer @rando2 's concern that a lot of studies don't say enough about demographics and risk factors. It goes very far outside my expertise, so please edit ruthlessly. @rando2 , please feel free to remove anything that goes too far afield.

Description of the proposed additions or changes

Expanded the paragraph about pediatric symptoms into a subsection about different subgroups of patients and at-risk people.

Related issues

#325, #420, #421, #433, #434, #435, #436, #437,
#438, #439, #440, #441, #442, #443, #444, #445,
#446, #447, #448, #449, #450, #451, #452, #453,
#454, #455, #456, #457, #458, #459

Suggested reviewers (optional)

@rando2 @scapone01 @RLordan

Checklist

Text is formatted so that each sentence is on its own line.

Pre-prints cited in this pull request have a GitHub issue opened so that they can be reviewed.

@rando2

This is an attempt to answer @rando2 's concern that a lot of studies don't say enough about demographics and risk factors. It goes very far outside my expertise, so please edit ruthlessly. @rando2 , please feel free to remove anything that goes too far afield.

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RLordan

Hi @dziakj1, I really enjoyed reading that. I only had minor suggestions. Your last point is so important about future studies reporting the demographic and medical characteristics of the cohorts being studied. .

RLordan · 2020-07-01T03:40:36Z

content/02.introduction.md

-Though older populations are generally considered the most vulnerable, pediatric infections are also a concern.
+#### Subpopulations of Special Concern  
+
+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of preexisting risk factors [@doi:10.1007/s00592-020-01546-0].


Should it be pre-existing? or does it matter? same below on another line.

Hmm maybe we also want some medical people in here! @esell17 @anskelly @rishirajgoel
Also @yemarshall in case you're interested!

content/02.introduction.md

RLordan · 2020-07-01T03:52:15Z

content/02.introduction.md

+Less health care access could cause infections to be less likely to be diagnosed unless or until they are very severe. 
+However, more research is needed into studying and and remediating these disparities. 
+Long-term damage caused by chronic stress related to aversive social experiences [@doi:10.1101/2020.05.10.20097253] leading to cardiovascular risk [@doi:10.1007/s12170-013-0338-5] might be relevant but have not yet been researched in the specific case of COVID-19 disparities.
+Disproportionate harm from COVID-19 has also been noted in other minorities, namely Latino/Hispanic communities and Native American / Alaskan Native tribal communities [@doi:10.1001/jama.2020.8598; @doi:10.1136/bmj.m1483; @doi:10.1111/jrh.12451]. 


Would it be good to give the Navajo Nation a specific mention here?

Yes, it definitely would! I will do so!

RLordan · 2020-07-01T04:01:40Z

content/02.introduction.md

+Obesity also appears to be associated with higher risk of severe outcomes from SARS-CoV-2, [@doi:10.1016/j.metabol.2020.154262; @doi:10.1101/2020.04.23.20076042] although 
+further research is needed regarding the exact mechanisms [@doi:10.1016/j.medj.2020.06.005].
+
+Because different subpopulations may have somewhat different vulnerabilities, needs, and resources, we recommend that researchers publishing studies on diagnostics and therapeutics take extra care to be clear about the demographic and medical characteristics of their sample, in order to facilitate discussions of the degree to which results may generalize or differ in other settings.


That last sentence might be useful for a conclusion section if we have one @rando2

Talked to Casey -- we will add a conclusion but probably not for a week or two since anything could change by then!

Co-authored-by: RLordan <62627112+RLordan@users.noreply.github.com>

dziakj1 · 2020-07-01T16:05:50Z

Hi @dziakj1, I really enjoyed reading that. I only had minor suggestions. Your last point is so important about future studies reporting the demographic and medical characteristics of the cohorts being studied. .

Thanks! The last point was really @rando2's point but I just saved @rando2 the trouble of writing it.

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rando2

Just formatting feedback here. Thank you SO much for doing this, @dziakj1. This is really important to talk about. I believe @shiktadas is an expert in this area -- would you be interested in giving some feedback?

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Co-authored-by: HM Rando <halie.rando@pennmedicine.upenn.edu>

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yemarshall · 2020-07-01T21:37:36Z

content/02.introduction.md

+#### Subpopulations of Special Concern  
+
+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].
+In the context of the United States, persons infected with COVID-19 are more likely to require hospitalization if they are of male sex, older age, and/or of Black/African American background [@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].


I would need to think about this more & you have read more about this than me (I read just a tiny bit), but for now just noting: The wording here might be changed here to make more rigid what's more confirmed or ~rigid and more flexible what should be more flexible. Here's what I mean. It could start instead with the main risk factors that are put by the CDC (age, co-morbidities / disease conditions that could lead to higher risk -- see whatever is the most up to date). Then separately start with a sentence that also describes other possible patterns (I'm guessing maybe not really risk factors, just patterns) seen in the data "so far" -- I say "patterns" because I'm guessing there's still analysis being done and because it's might be more complicated or different to figure out why a pattern related to ~ethnic background or ~race may be seen versus a pattern related to a co-morbidity (although this is also complicated) or age (again although this is also complicated) & I say "so far" is because these patterns might be partially changed if some of the reasons for the patterns are adjustable (e.g. if there's a lack of access --> increase access) and actually all the patterns might be changed because public health sometimes adds targeting (or improves coverage) to populations identified through data as more vulnerable (or more generally fills in coverage gaps).

Thank you, @yemarshall ! One thing we could do is include a few sentences to say that in theory there may be different ways in which a group could have higher risk for COVID-19 deaths or other severe outcomes. They could:

be more likely to contact the virus (e.g., essential workers, people living in big cities?)

be more likely to get infected once exposed (e.g., depressed immune system?)

be more likely to get seriously sick once infected (e.g., comorbidities, older age?)

be less likely to get adequate help once seriously sick (e.g., poor, minorities, far from health care).
These can all get lumped together because some of the steps aren't easy to empirically study (e.g., it seems hard to study Keep example formatting #2 directly without doing some really horrible human challenge study, and by definition of Switch rootstock branding in readme #4 the people aren't around to be studied by the scientists). So in practice they add up to the same thing, but in terms of mechanisms they are completely different. In a few cases the distinction might be especially important (e.g., is a group less resistant to the virus for genetic reasons, or are they living in more crowded places, or are they not getting enough information, or not enough care -- if we knew for sure which one, it would in principle be easier to design an intervention). Of course we could never resolve this in one subsection in a literature review, but maybe it would be a good contribution to list the questions? What do you think, @yemarshall and @rando2?

@dziakj1 I like that breakdown! Probably outside the scope of this section, but there is also a loop from 4 to 2 due to allostatic load, i.e. the long-term burden of chronic stress -- assuming that reduced to access to health resources is correlated with other life stressors such as experiencing racism or poverty.

Potentially framing it as something along the lines of:
There are some factors that are associated with greater risk from COVID-19. There are several possible etiologies through which a factor could influence COVID-19 outcomes, which could (your list of 4).

(I am not really sure if this is the best way to phrase this because I am not a public health person!)

yemarshall · 2020-07-01T21:41:26Z

content/02.introduction.md

-Though older populations are generally considered the most vulnerable, pediatric infections are also a concern.
+#### Subpopulations of Special Concern  
+
+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].


I'm guessing "pre-existing" might be more of an insurance term, maybe you could just say "risk factors"; but I may be wrong (if that's what you read in the research, then you know better); another word I heard is "co-morbidity" or chronic conditions or simultaneous conditions, but you need a medical person to answer this (I'm science/math)

I would write ..... "varying levels of pre-exitisting co-morbidities, such as hypertension, diabetes and lung diseases".

also to check at some point: how big effect age structure / age distribution may have ... this is also more complicated b/c depends on other possible age-related differences (and for infection rates also differences in age contact structure / interactions between different age groups).

I hadn't thought about age as a confounder -- I will check the reference you suggested. Thanks!

yemarshall · 2020-07-01T21:49:37Z

content/02.introduction.md

+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].
+In the context of the United States, persons infected with COVID-19 are more likely to require hospitalization if they are of male sex, older age, and/or of Black/African American background [@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].
+African Americans have also been reported to have disproportionate risk for kidney complications for COVID-19 [@doi:10.1016/j.kint.2020.05.006].
+The racial disparity may be due to a number of factors, including different vulnerability due to higher levels of a pre-existing conditions such as diabetes, to greater economic difficulties or more hazardous work, or to less access to or trust in the health care system [@doi:10.1377/hlthaff.2020.00598; @doi:10.1016/j.kint.2020.05.006].


putting "trust" in there without a specific description like what's in the article cited doesn't work as well / is too general (and is too rigid b/c it can be changed); maybe something like "different pattern of use (e.g. for just severe conditions or for both mild and severe conditions)" or "different pattern of use" (note this may leave room for flexibility for improvement which is actually mentioned in the article cited)?? but that's not a good alternative either. There's a point somewhere in there but it's a bit difficult to figure out how to write it in a short way without being too general or rigid.

The racial disparity may be due to a number of factors, including greater economic difficulties or more hazardous work and due to higher levels of pre-existing conditions such as hypertension or diabetes. These groups also have less access to the health care system which may cause this disproportionate higher burden of coronavirus [@doi:10.1377/hlthaff.2020.00598; @doi:10.1016/j.kint.2020.05.006].

yemarshall · 2020-07-01T22:06:50Z

content/02.introduction.md

+The racial disparity may be due to a number of factors, including different vulnerability due to higher levels of a pre-existing conditions such as diabetes, to greater economic difficulties or more hazardous work, or to less access to or trust in the health care system [@doi:10.1377/hlthaff.2020.00598; @doi:10.1016/j.kint.2020.05.006].
+Less health care access could cause infections to be less likely to be diagnosed unless or until they are very severe. 
+However, more research is needed into studying and and remediating these disparities. 
+Long-term damage caused by chronic stress related to aversive social experiences [@doi:10.1101/2020.05.10.20097253] leading to cardiovascular risk [@doi:10.1007/s12170-013-0338-5] might be relevant but has not yet been researched in the specific case of COVID-19 disparities.


the first reference you cite here should be placed elsewhere in the sentence because it doesn't really discuss what is immediately preceding it

content/02.introduction.md

shiktadas · 2020-07-01T23:12:34Z

content/02.introduction.md

-Though older populations are generally considered the most vulnerable, pediatric infections are also a concern.
+#### Subpopulations of Special Concern  
+
+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].


I would write ..... "varying levels of pre-exitisting co-morbidities, such as hypertension, diabetes and lung diseases".

shiktadas · 2020-07-01T23:14:40Z

content/02.introduction.md

+#### Subpopulations of Special Concern  
+
+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].
+In the context of the United States, persons infected with COVID-19 are more likely to require hospitalization if they are of male sex, older age, and/or of Black/African American background [@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].


In the context of the United States, persons infected with COVID-19 are more likely to require hospitalization if they are of male, older age, and/or have pre-existing conditiosn. Black/African American backgrounds have a higher risks than White Americans and are younger[@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].

(Blacks/African American are younger than Whites!!!!)

shiktadas · 2020-07-01T23:16:46Z

content/02.introduction.md

+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].
+In the context of the United States, persons infected with COVID-19 are more likely to require hospitalization if they are of male sex, older age, and/or of Black/African American background [@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].
+African Americans have also been reported to have disproportionate risk for kidney complications for COVID-19 [@doi:10.1016/j.kint.2020.05.006].
+The racial disparity may be due to a number of factors, including different vulnerability due to higher levels of a pre-existing conditions such as diabetes, to greater economic difficulties or more hazardous work, or to less access to or trust in the health care system [@doi:10.1377/hlthaff.2020.00598; @doi:10.1016/j.kint.2020.05.006].


The racial disparity may be due to a number of factors, including greater economic difficulties or more hazardous work and due to higher levels of pre-existing conditions such as hypertension or diabetes. These groups also have less access to the health care system which may cause this disproportionate higher burden of coronavirus [@doi:10.1377/hlthaff.2020.00598; @doi:10.1016/j.kint.2020.05.006].

shiktadas · 2020-07-01T23:18:13Z

content/02.introduction.md

@@ -130,6 +147,16 @@ The results of COVID-19 infection can vary greatly among pediatric patients as w
 In particular, some children have experienced a severe inflammatory syndrome after COVID-19 infection, similar in some respects to Kawasaki disease or to Kawasaki disease shock syndrome [@doi:10.1093/jpids/piaa069;@doi:10.1001/jama.2020.10369; @doi:10.1016/j.ajem.2020.05.117].
 Heart failure can also occur [@doi:10.1161/CIRCULATIONAHA.120.048360].

+Genetic factors may also play a role in risk of respiratory failure for COVID-19 [@doi:10.1056/NEJMoa2020283; @doi:10.1093/gerona/glaa131; @doi:10.1101/2020.06.16.155101], including possibly higher risk to individuals of blood group A and possibly lower risk to individuals of type O [@doi:10.1056/NEJMoa2020283].


The blood group has not been able to replicate in a larger study. I would leave it out.

shiktadas · 2020-07-01T23:19:48Z

content/02.introduction.md

@@ -130,6 +147,16 @@ The results of COVID-19 infection can vary greatly among pediatric patients as w
 In particular, some children have experienced a severe inflammatory syndrome after COVID-19 infection, similar in some respects to Kawasaki disease or to Kawasaki disease shock syndrome [@doi:10.1093/jpids/piaa069;@doi:10.1001/jama.2020.10369; @doi:10.1016/j.ajem.2020.05.117].


"A very small proportion of children"..... (kawaski was a rare occurrence)

shiktadas · 2020-07-01T23:20:03Z

content/02.introduction.md

@@ -130,6 +147,16 @@ The results of COVID-19 infection can vary greatly among pediatric patients as w
 In particular, some children have experienced a severe inflammatory syndrome after COVID-19 infection, similar in some respects to Kawasaki disease or to Kawasaki disease shock syndrome [@doi:10.1093/jpids/piaa069;@doi:10.1001/jama.2020.10369; @doi:10.1016/j.ajem.2020.05.117].
 Heart failure can also occur [@doi:10.1161/CIRCULATIONAHA.120.048360].


this sentence is a bit out of place.

shiktadas · 2020-07-01T23:22:53Z

content/02.introduction.md

+[@doi:10.1111/dom.14057] and [@doi:10.1152/ajpendo.00124.2020] discuss possible ways in which COVID-19 and diabetes may interact.  
+On a speculative basis, the mechanisms described in a report by [@doi:10.1007/s00592-009-0109-4] involving effects on the pancreas by the related SARS-CoV-1 virus, which could reportedly cause short-term diabetic symptoms, might perhaps be relevant here as well.
+
+Obesity also appears to be associated with higher risk of severe outcomes from SARS-CoV-2 [@doi:10.1016/j.metabol.2020.154262; @doi:10.1101/2020.04.23.20076042], although further research is needed regarding the exact mechanisms [@doi:10.1016/j.medj.2020.06.005].


Obesity also appears to be associated with a higher risk of severe outcomes from SARS-CoV-2...... Obesity is considered an underlying risk factor for most of the pre-existing conditions and therefore its causal routes are still under investigation. Further research might be required to know the exact mechanisms.

shiktadas · 2020-07-01T23:23:52Z

content/02.introduction.md

+Obesity also appears to be associated with higher risk of severe outcomes from SARS-CoV-2 [@doi:10.1016/j.metabol.2020.154262; @doi:10.1101/2020.04.23.20076042], although further research is needed regarding the exact mechanisms [@doi:10.1016/j.medj.2020.06.005].
+
+Because different subpopulations may have somewhat different vulnerabilities, needs, and resources, we recommend that researchers publishing studies on diagnostics and therapeutics take extra care to be clear about the demographic and medical characteristics of their sample, in order to facilitate discussions of the degree to which results may generalize or differ in other settings.
+
 #### Molecular Mechanisms of COVID-19

 - How can we evaluate the human response to SARS-CoV-2 on a molecular level?


There are some studies in cases/controls of hospitalized Covid patients. They can see a cluster of six genes that are mostly related to respiratory inflammation.

yemarshall · 2020-07-02T11:45:07Z

Interesting material. Suggest to double-check (/make sure) throughout & especially at beginning that you distinguish clearly between the different types of numbers, e.g. (i) numbers like incidence of SARS-CoV-2 infection (# new infections per unit time) or incidence of severe COVID-19 cases (# new severe cases per unit time) or incidence of COVID-19 deaths (# COVID-19 attributed deaths per unit time) or relatedly cumulative infections or cumulated severe cases or cumulated COVID-19 deaths, & (ii) numbers like fraction of SARS-CoV-2 infections which are severe or, with the confounding factor of level of reporting(/testing) the fraction of reported cases which are severe. [the split is not exact, I'm just giving examples; e.g. # severe cases per unit time = # infections per unit time x fraction of infections which are severe] Even if the data doesn't allow easy distinguishing between (i) and (ii), they are still mathematical features of the system which are important in different ways with respect to biology/medicine/epidemiology/possibilities-to-improve-through-public-health-measures/etc & each/either/both of them might have associations with different demographic factors. (Also double-check your use of term "prevalence" at beginning and any other terms like "incidence" or "cumulative cases" / make sure the mathematical intention clear as needed) I'm not sure if I wrote this clearly, so input on this comment to extract the important points would be useful e.g. from @dziakj1 @RLordan @scapone01 @rando2 @shiktadas or anyone else.

@yemarshall

I rewrote the demographics and disparities subsection to add some more references and address the concerns of @yemarshall and @shiktadas. I propose moving the pediatrics paragraph out of this subsection entirely, into the clinical presentation section.

dziakj1 · 2020-07-06T18:39:45Z

Hello, @rando2 , @shiktadas and @yemarshall ! I made some changes after thinking about your comments. Could you take a look?

rando2

@dziakj1 I saw we were working on this simultaneously, so these changes may no longer be applicable! But just posting them in case they are!

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rando2 · 2020-07-06T18:39:48Z

content/02.introduction.md

+#### Subpopulations of Special Concern  
+
+The prevalence of different clinical features of COVID-19 infection differ in different areas of the world, presumably due to differential reporting and/or different levels of pre-existing risk factors [@doi:10.1007/s00592-020-01546-0].
+In the context of the United States, persons infected with COVID-19 are more likely to require hospitalization if they are of male sex, older age, and/or of Black/African American background [@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].


@dziakj1 I like that breakdown! Probably outside the scope of this section, but there is also a loop from 4 to 2 due to allostatic load, i.e. the long-term burden of chronic stress -- assuming that reduced to access to health resources is correlated with other life stressors such as experiencing racism or poverty.

Potentially framing it as something along the lines of:
There are some factors that are associated with greater risk from COVID-19. There are several possible etiologies through which a factor could influence COVID-19 outcomes, which could (your list of 4).

(I am not really sure if this is the best way to phrase this because I am not a public health person!)

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rando2 · 2020-07-06T19:09:04Z

@dziakj1 I would say maybe wait for final approval from @shiktadas and @yemarshall and then we can go ahead and add it?

Implemented changes based on comments yesterday and this morning

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agitter · 2020-07-13T21:57:42Z

Welcome @tlukan. I saw your intro in #17 and thought you may be interested in commenting on this work-in-progress update on demographics and disparities.

yemarshall · 2020-07-17T17:47:27Z

content/02.introduction.md

-Heart failure can also occur [@doi:10.1161/CIRCULATIONAHA.120.048360].
+#### Subpopulations of Special Concern  
+
+In the context of the United States, persons diagnosed with COVID-19 are more likely to require hospitalization if they are of male sex, of older age, and/or of Black/African American background [@doi:10.1377/hlthaff.2020.00598; @doi:10.15585/mmwr.mm6925e1].


I don't see our earlier comments/conversation about this. When I browsed the articles you cited & the 14 state CDC article cited in the second article, then I also saw it written something like:
"Hospitalized COVID-19 patients are more commonly older, male, of black race, and have underlying conditions."
or similarly
"Reports of U.S. patients hospitalized with SARS-CoV-2 infection (the virus that causes COVID-19) describe high proportions of older, male, and black persons (2-4)." followed by another sentence about underlying conditions
[quotations from summary & intro from second reference]
I think it makes sense from the beginning to cover both types of major observations seen so far -- things having to do with probability of getting infected and things having to do with probability that infection is severe. You do this later on, but I think your opening sentence should also include both in order to get readers to see both key interesting points from the beginning. If you want just one sentence then I think something closer to the quotation above is better because it covers both aspects and then it can be broken up into components later on; the other option is putting both your current sentence & something like quotation above to suggest multiple components from beginning. (Though everyone has worked on this, still going back to this discussion b/c it's at beginning of section)

Thank you, @tlukan and @yemarshall! I guess the ideal thing to do would be to tell which demographic, lifestyle, or medical variables contribute to each stage of the process, like:

Risk factors for infection:...

Risk factors for hospitalization given infection:...

Risk factors for death given hospitalization:...

Then we could talk about, for example, are the elderly more likely to get infected than the young, or do they just get sicker if and when they do get infected?
But I'm not sure whether we can really do that with the literature we have now, which is preliminary and doesn't have prospective longitudinal data on the general population. Studies on hospitalized samples can provide information about 3 but only 3. Studies using vital statistics can probably provide information on a muddled mixture of 1, 2, and 3, but probably only under assumptions that aren't safe to make (equal and honest reporting by the authorities in all localities).
We certainly could talk about these general issues first, and then mention the specific disparities and risk factors. But it might be kind of embarrassing for us in a way, because we will have to say "Here are some important questions! And the answers are ... we don't know." So I thought of putting the theoretical issues at the end of the subsection instead, like the limitations section at the end of a paper. I guess that doesn't really solve the problem either -- we can only say "Here's a bunch of findings! By the way, it would be nice if we could explain them." @rando2, what do you think?

@dziakj1 would these perhaps be questions worth raising in the discussion? #514
This is a huge area of research and definitely we are not going to be able to answer these questions. I made the discussion file specifically to support brainstorming on this topic because it seems like there are far more questions than answers and a lot of these concerns may be easier to address as outstanding concerns in the discussion!

You're right, @rando2. I know that the deadline is looming ever closer! Would you like to just reorganize this section however you see fit? I will approve whatever changes you make.

Hi @dziakj1 I'm happy to! I'm a lot sharper in the morning so I'll work on this first thing tomorrow.

Co-authored-by: HM Rando <halie.rando@pennmedicine.upenn.edu>

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Move to discussion so we can emphasize the injustice without having to prove it since it's not *totally* related to the point of the paper (except that it's related to everything)

rando2

I propose we merge this in, and then turn it over to @tlukan to create a new PR breaking things up between the intro and discussion, since that seems like potentially a good project for him to take the lead on (and I will help him with this!)

I know @shiktadas wants to give feedback on this section before it is finalized, but if she's open to it, I know @tlukan (an undergrad student at Penn) has expressed that he would love to work with her and learn from her!

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rando2 · 2020-07-22T15:26:56Z

Hearing no objections, I'm merging this in so that @tlukan can start incorporating his research! There will be plenty of additional chances to review this topic as @tlukan expands it :)

[ci skip] This build is based on d7e35e4. This commit was created by the following CI build and job: https://github.com/greenelab/covid19-review/commit/d7e35e4e49b5a0f10e40e6bad63703f49d046afc/checks https://github.com/greenelab/covid19-review/runs/178652428

yemarshall · 2020-07-26T14:19:28Z

content/50.discussion.md

@@ -16,5 +16,6 @@ Some concerns include:
 1. Who is being included in clinical trials?
 2. While biotechnological developments are exciting, how likely are they to be available to people broadly?
 3. Even this review is likely biased (e.g., we look at traditional western medicine in the nutraceuticals section and mainly report statistics from US and other data collection services)
-



@tlukan @shiktadas Since I think you guys may be working on rewriting this, please refer to #532 for what I think may be some important considerations/suggestions for this part of the Discussion.

dziakj1 added 2 commits June 30, 2020 16:41

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I rewrote the demographics and disparities subsection to add some more references and address the concerns of @yemarshall and @shiktadas. I propose moving the pediatrics paragraph out of this subsection entirely, into the clinical presentation section.

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Implemented changes based on comments yesterday and this morning

rando2 mentioned this pull request Jul 17, 2020

Add a discussion section with a vague outline #514

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Move to discussion so we can emphasize the injustice without having to prove it since it's not *totally* related to the point of the paper (except that it's related to everything)

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yemarshall mentioned this pull request Jul 26, 2020

Discussion Fixes & Discussion manuscript edits not showing up on obvious Discussion PR's #532

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rando2 mentioned this pull request Jul 30, 2020

Discussion: inital draft of equity concerns (work in progress) #552

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		@@ -130,6 +147,16 @@ The results of COVID-19 infection can vary greatly among pediatric patients as w
		In particular, some children have experienced a severe inflammatory syndrome after COVID-19 infection, similar in some respects to Kawasaki disease or to Kawasaki disease shock syndrome [@doi:10.1093/jpids/piaa069;@doi:10.1001/jama.2020.10369; @doi:10.1016/j.ajem.2020.05.117].

		@@ -130,6 +147,16 @@ The results of COVID-19 infection can vary greatly among pediatric patients as w
		In particular, some children have experienced a severe inflammatory syndrome after COVID-19 infection, similar in some respects to Kawasaki disease or to Kawasaki disease shock syndrome [@doi:10.1093/jpids/piaa069;@doi:10.1001/jama.2020.10369; @doi:10.1016/j.ajem.2020.05.117].
		Heart failure can also occur [@doi:10.1161/CIRCULATIONAHA.120.048360].

Demographics and disparities subsection #460

Demographics and disparities subsection #460

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