Trends in ER visits during the COVID-19 pandemic related to mental health and violence

In this Journal of the American Medical Association Psychiatry publication, the authors discuss a cross-sectional study of nearly 190 million emergency department visits and found that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March through October 2020 when compared to the same time period in 2019. In the study, we see a decrease in emergency department visit volume in the specified outcome areas once mitigation measures were implemented across the U.S. However, beginning in March 2020, rates began to increase (when compared to the same timeframe in 2019) in areas of suicide attempts, and all drug/opioid overdoses. Visits were significantly lower for intimate partner violence visits and although suspected child abuse and neglect cases were lower when compared with overall emergency department visits, they did increase during this time frame. These findings suggest that ED care seeking shifts during a pandemic, which highlights the need to integrate mental health, substance abuse, and violence screening and prevention strategies into the COVID-19 response efforts during the public health crisis. These findings underline the changes in national-level ED visits and rates for these specified outcomes which may often be associated with societal, community, and individual level stressors associated with the pandemic.

Impacts of COVID-19 survival on quality of life and neuropsychological outcomes

In this study, the impact of surviving COVID-19 infection on neurocognition, psychiatric health, and quality of life are evaluated. Researchers used a cross-sectional analysis of patients who had been hospitalized and followed them for 2 months post-discharge. A battery of standardized instruments were utilized to evaluate neurocognitive function, psychiatric morbidity, and Qol (mental and physical components) and administered via telephone. Of the 229 patients who were screened, 179 were included in the final analysis. Among the survivors, the prevalence of moderately impaired immediate verbal memory and learning was 38%, delayed verbal memory 11.8%, verbal fluency 34.6%, and working memory/executive function 6.1%. In addition, 58.7% of patients report neurocognitive impairment in at least one area. Anxiety was reported among 29.6% of patients, depression in 26.8%, and post-traumatic stress disorder reported in 25.1%, and 39.1% of patients screened had psychiatric morbidity with females being greatly associated with this statistic. Delirium and psychiatric morbidity were associated with neurocognitive impairment. In conclusion, hospitalized COVID-19 survivors have shown a considerable prevalence of short-term neurocognitive impairment, psychiatric morbidity, and poor mental and physical components. It is unknown if these issues will persist over the long term, further studies are encouraged to gain insight into this subject.

Distinguishing COVID-19 from other etiologies using chest CT scans

In this publication, authors discuss the diagnostic and high sensitivity of chest CT when diagnosing COVID-19. The primary diagnostic test for the virus is the reverse transcriptase-polymerase chain reaction (RT-PCR) assay, however, chest CT has been proven to be a diagnostic tool when investigating this viral infection. The article highlights a variety of conditions that demonstrate similar presentations or “mimic” findings that may make it difficult to differentiate these diagnoses from COVID-19. As we know now, patients with COVID-19 typically present with fever, cough, dyspnea and may report headache, fatigue, hemoptysis conjunctival congestion, loss of smell, abdominal symptoms, etc. The disease may progress rapidly into an acute respiratory distress syndrome, metabolic acidosis, septic shock, coagulation dysfunction, and multi-organ failure. Lab findings show decreased lymphocytes, increased CRP, and high CRP levels. In regards to radiologic findings, ground-glass opacities with or without consolidation is the most common feature of COVID-19. Typically, they are bilateral, multifocal, and peripheral with posterior or lower lung distribution. The article presents CT findings of COVID-19 patients in comparison of those with mimicking signs on chest CT scans. The conditions discussed include viral pneumonias, organizing pneumonias, connective tissue associated pneumonias, drug induced acute lung injuries, diffuse alveolar damage and acute interstitial pneumonia, ARDS and more. There is a broad spectrum of pulmonary conditions discussed with a wealth of information to assist in differentiating COVID-19 from some other conditions when using chest CT for diagnostics.

Probiotic lactobacilli as a supplement during the pandemic

In this article, authors discuss the prophylactic and therapeutic benefits of microorganisms on gut function and immunity with a brief but thorough history on the current acceptance and wide-usage of probiotics in today’s culture. These “good” bacteria are used to improve intestinal tract health, to enhance the immune system, enhance the bioavailability of nutrients, reduce lactose intolerance, decrease allergy prevalence in individuals, and boost immunity. The article aims to investigate the use of probiotics in the prevention, management, and control in association with the SARS-CoV-2 virus. The authors conclude that nutritional and immunity enhancing probiotics operating homeostasis in the gut must be paid research attention as exercise, healthy lifestyle and probiotic supplementation are likely to induce stronger immunity. The authors encourage further investigation into the role of probiotics to enhance natural killer cell function, stimulation of IgA antibodies, and to reduce inflammation in the mucosal barrier and how a new generation of probiotics could be key in strengthening immunity against COVID-19.

COVID-19 Vaccine Advice from the Centers for Disease Control and Prevention

In this CDC publication, many frequently asked questions are answered in a straight-forward manner which can prove to be helpful to patients with similar concerns. It is important to educate patients on the facts related to the vaccines and arm ourselves with research to support the education we provide as healthcare professionals. This publication has multiple resources that may serve as beneficial to providers and patients. Please familiarize yourself with the information here to assist in giving the best, most up-to-date information available to your patients.