risk management

COVID-19 Roundup: Antidepressants and Mortality Risk, Updated Travel Recommendations, Myocarditis

SSRIs and Mortality Risk1

Individuals with COVID-19 who are taking selective serotonin reuptake inhibitors (SSRIs) may have a lower risk of death. Fluoxetine and fluvoxamine may provide the most significant reduction in mortality in these patients.

The researchers utilized data from the electronic health records of 83,584 patients with COVID-19. All included individuals had presented to 1 of 87 US-based health care centers from January 2020 to September 2020.

Among those taking this class of antidepressants, the risk of mortality was lower compared with their matched, untreated control groups:

  • 14.6% (497 of 3401 participants) for any SSRI vs 16.6% (1130 of 6802) for the control
  • 9.8% (46 of 470) for fluoxetine only vs 13.3% (937 of 7050) for control
  • 10.0% (48 of 481) for fluoxetine or fluvoxamine vs 13.3% (956 of 7215) for control

The risk of death in individuals prescribed any SSRI other than fluoxetine or fluvoxamine was 15.4% (447 of 2898) and was not statistically significant compared with the control of 17.0% (1474 of 8694).

Updated Travel Recommendations2

The Centers for Disease Control and Prevention has updated its international travel recommendations for those intending to enter the United States.

Individuals who are US citizens, nationals, lawful permanent residents, and immigrants do not need to be fully vaccinated before entry to the United States. Individuals who are a non-US citizen or a non-US immigrant must be fully vaccinated before entering the country.

Prior to entrance, individuals who are fully vaccinated must provide proof of vaccination and a negative COVID-19 test taken no more than 3 days before travel. Individuals who are not fully vaccinated must provide a negative COVID-19 test no more than 1 day before travel. Alternatively, individuals may provide documentation of recovery from a COVID-19 infection within the last 90 days and documentation of travel clearance from a health care provider.

Upon arrival to the United States, all travelers are recommended to get a COVID-19 test within 3 to 5 days following travel. In addition, unvaccinated individuals are recommended to self-quarantine for 7 full days following travel.

Masks are still required for all individuals in any indoor spaces for US public transportation. Individuals are urged to be fully vaccinated before travel. Additional COVID-19 requirements may be necessary because of travel companies’ policies or other countries exit requirements.

Myocarditis and mRNA COVID-19 Vaccination3

Individuals who have been fully vaccinated against COVID-19 with the Pfizer-BioNTech mRNA vaccine may be at an increased risk of myocarditis.

Researchers from the Israeli Ministry of Health reviewed 283 cases of myocarditis from December 2020 to May 2021. Of these cases, 142 had occurred after receiving the Pfizer-BioNTech COVID-19 vaccine.

Men aged 16 to 19 years had the largest risk difference between the first and second doses of 13.73 per 100,000 persons, compared with the overall risk difference of 1.76 per 100,000 persons. This patient population also had the highest standardized incidence ratio (13.60), compared with the overall ratio (5.34). This ratio was compared with the expected incidence based on historical data. Men aged 16 to 19 years also had the highest rate ratio 30 days after the second vaccine dose in fully vaccinated individuals compared with unvaccinated individuals (8.96) and compared with the overall ratio (2.35).

“The incidence of myocarditis, although low, increased after the receipt of the BNT162b2 vaccine, particularly after the second dose among young male recipients,” the researchers concluded. “The clinical presentation of myocarditis after vaccination was usually mild.”


—Leigh Precopio


  1. Oskotsky T, Marić I, Tang A, et al. Mortality risk among patients with COVID-19 prescribed selective serotonin reuptake inhibitor antidepressants. JAMA Netw Open. 2021;4(11):e2133090. doi:10.1001/jamanetworkopen.2021.33090
  2. International travel requirements and recommendations. Centers for Disease Control and Prevention; Updated November 5, 2021. Accessed November 19, 2021. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel/index.html
  3. Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA vaccine against COVID-19 in Israel. New Engl J Med. Published online October 6, 2021. Accessed November 19, 2021. doi:10.1056/NEJMoa2109730