Comprehensive analysis of the key epidemiological parameters to evaluate the impact of BCG vaccination on COVID-19 pandemic
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Abstract
Globally, the heterogenous coronavirus disease 2019 (COVID-19) case fatality rate (CFR) could be influenced by various epidemiological parameters. Identifying these could help formulate effective public health strategies. Incidence and mortality of COVID-19 for each of the 220 countries as on July 30, 2020 were evaluated against key epidemiological variables, namely - BCG vaccination (ongoing vs. discontinued/never undertaken), %population aged ≥65 years, incidences of ischemic heart disease (IHD), hypertensive heart disease (HHD), cancer, malaria, and diabetes; human development index (HDI) and population density. These were retrieved from the public domains of WHO, UN, World Bank and published reports. The COVID-19 CFRs ranged between 0.0% and 28.3% (mean ± SD: 3.05% ± 3.48). The influence of the individual epidemiological parameters on CFR were evaluated through the event rate estimations. A significantly lower event rate was observed in countries with ongoing BCG vaccination program (ER: with vs without ongoing BCG vaccination: 0.020 vs 0.034, p<0.001). The type of BCG strains used also influenced the ER; this being 0.018, 0.031 and 0.019 for early, late and mixed strains respectively (p=0.008). The epidemiological variables significantly associated with higher COVID-19 event rate were countries with higher %population aged ≥65 years (p<0.001), greater incidence of IHD (p<0.001) and cancer (p=0.003) and better HDI (p=0.003). Incidences of malaria, HHD and diabetes along with population density had no significant impact on COVID-19 CFR. Further, BCG vaccination significantly lowered the COVID-19 ER in each of the high-risk population subgroups - countries with >7.1% population aged ≥65 years (p=0.008), >0.737 HDI (p=0.001), IHD >1171/10 5 population (p=0.004) and cancer incidence >15726 (p<0.001). The results supports BCG induced “trained immunity” leading to heterologous immunoprotection against COVID-19. Thus BCG vaccination with early strains could provide a cost-effective prophylaxis, especially in high-risk individuals and bridge the gap till an effective vaccine against SARS-CoV-2 is freely available globally.
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SciScore for 10.1101/2020.08.12.20173617: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Even with all the inherent limitations as discussed above, the present data should be construed as a reasonably adequate sample of more than 332.84 million test reports obtained globally reported as on July 30, 2020. Despite these constraints, the evidence of a likely protective effect of BCG vaccination on COVID-19 is apparent. It would …
SciScore for 10.1101/2020.08.12.20173617: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Even with all the inherent limitations as discussed above, the present data should be construed as a reasonably adequate sample of more than 332.84 million test reports obtained globally reported as on July 30, 2020. Despite these constraints, the evidence of a likely protective effect of BCG vaccination on COVID-19 is apparent. It would be imperative to examine the effects of BCG vaccinations through well designed randomized clinical trials. Presently, four phase III randomized clinical trials have been initiated, one each in Netherlands (NCT04328441), Australia (NCT04327206), USA (NCT04348370) and South Africa (NCT04379336) [32], These are being conducted in healthcare workers randomized between BCG and placebo injection of normal saline. The outcomes from these studies would confirm the observational findings of a potential benefit of BCG vaccination against COVID-19. The data from 220 countries and dependent territories represents 7.76 billion inhabitants globally [33]. Even though this is an observational study, the alleviating impact of BCG vaccination on COVID-19 cannot just be overlooked while we are still investigating to arrive at the optimum pharmacotherapy and racing against time towards developing a specific vaccine. However, the results of this analysis should not be construed as a gateway for advocating BCG vaccination for all. Nor should it deliver a false sense of security and complacency to those who have been previously vaccinated. It does not in any way di...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04328441 Active, not recruiting Reducing Health Care Workers Absenteeism in Covid-19 Pandemi… NCT04327206 Recruiting BCG Vaccination to Protect Healthcare Workers Against COVID-… NCT04348370 Recruiting BCG Vaccine for Health Care Workers as Defense Against COVID… NCT04379336 Recruiting BCG Vaccination for Healthcare Workers in COVID-19 Pandemic Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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