Persistent Post-COVID Syndrome (PPCS)

In last week’s post, persistence of COVID symptoms in patients who had recovered from COVID were discussed. In this article, authors refer to persistent post-COVID syndrome or “long COVID” as a pathology in and of itself. This pathologic entity involves persistent physical, medical, and cognitive sequelae following infection with COVID-19. In addition, fibrosis of organs and vasculature leads to increased mortality and decreased quality of life in patients who suffer from this pathology. While many efforts have been focused on the manifestations and mechanisms of COVID-19 preclinically and during the prodromal period, this study focuses on the postdrome period occurring after infection which seems to have gained little attention. Potential long term effects from post-COVID syndrome are expected to surge with the release of patients from hospitals and clearing of initial critical presentations. The authors discuss the burden placed upon healthcare, families and primary care settings to follow up with the medically devastated survivors of COVID-19 who are still experiencing symptoms related to the virus long after it has passed. The article goes on to discuss underlying mechanisms and possible manifestations of persistent post-COVID syndrome, and offers a framework of strategies to diagnose and manage these patients. Providers who care for patients who have suffered from a COVID-19 infection could benefit from this article in it’s entirety.

Corticosteroids for CAP, Flu, and COVID-19: When, how, and benefits or harm?

In this article, authors discuss the use of corticosteroids as treatment in community acquired pneumonia, influenza, and COVID-19. In this particular review, we will focus on the results relating to COVID-19, please review the full publication to obtain information relating to CAP and influenza treatments using steroids. ARDS has been found to be the primary cause of death in patients with COVID-19, and 5-10% of the patients had a bacterial/fungal co-infection during hospital admission. At the beginning of the pandemic, the use of corticosteroid therapy in COVID was unclear and early studies suggest higher mortality in groups who were given corticosteroids during treatment when compared to non-corticoid treated groups. The RECOVERY (Randomised Evaluation of COVID-19 therapy) trial was first published in June 2020 as a preliminary report which assessed the use of dexamethasone in hospitalized patients with COVID-19. More than 6,000 patients were recruited, of which 2104 were assigned to receive dexamethasone. In this study, the use of dexamethasone resulted in lower 28-day mortality among those with a severe disease process requiring mechanical ventilation. This study had faults such as not including laboratory values, viral loads, etc. After this, other studies emerged which are discussed in detail within the publication. In conclusion, the use of corticosteroids has been considered as a potential co- adjuvant treatment in patients with pneumonia. Timing is crucial and corticosteroids, when indicated, should be implemented as soon as possible. The recently published guidelines do not recommend corticosteroids in the treatment of CAP, except when comorbidities such as COPD, asthma, or autoimmune disease are present. In patients with influenza, corticosteroids are not shown to have a benefit, however, evidence is mounting that there is a mixed benefit to the use of corticosteroids in patients presenting with severe pneumonia, however, there seems to be a recommendation for use in severe forms of COVID-19.

Ophthalmic manifestations related to COVID

In this study, researchers used a prospective observational study including patients with SARS-CoV-2 infection at a dedicated tertiary hospital in South India. Each participant was thoroughly reviewed to discuss onset, duration, progression, and nature of symptoms, medication history, etc. Ocular examinations were performed and were followed up by additional examinations every 72 hours, or when patients would complain of ocular symptoms, until discharge. The results indicate that a total of 2,742 patients were examined. Of them, none had ocular symptoms as a complaint at admission. Upon follow up, only 20 (0.72%) developed ocular manifestations. Nineteen of those twenty demonstrated features of bilateral viral conjunctivitis, with the remaining patients having orbital cellulitis secondary to pansinusitis. In conclusion, ophthalmic manifestations in the clinical spectrum of COVID-19 appear to be uncommon and are unlikely to be a presenting symptom.

Long term follow up in post COVID-19 patients with venous thromboembolism

We have discussed in previous articles how thrombolytic events have been noted in COVID patients. In this study, the follow up of 100 patients who were previously diagnosed with COVID-19 and hospitalized at the time of VTE diagnosis, is assessed at 90 days or more, after diagnosis. When diagnosed, 66% of the study participants were hospitalized, with 34.8% of them being in the ICU. Mean follow up was 97.9 days (+/- 23.3 days) During the study, 24% of patients expired with median time to death of 12 days; 11% had major bleeding with a median time of 12 days. Cause of death in those who passed were related to pulmonary embolism (5%), and bleeding (2%), with no evidence of VTE recurrence. In patients with COVID-19 and VTE, mortality and bleeding were high and approximately ⅓ of the deaths were associated with the VTE which mostly occurred during the first 30 days of diagnosis. The authors conclude that ICU admission, thrombocytopenia, and cancer are risk factors for poor prognosis.