Post-COVID syndrome in non-hospitalized patients
In this longitudinal prospective cohort study, authors observed patients over four and seven months after COVID-19 symptom onset to determine symptom presence. The researchers observed 442 and 353 patients over four and seven months, respectively. In the group of 442 patients, 8.6% reported shortness of breath, 12.4% with anosmia, 11.1% with ageusia, and 9.7% with fatigue at month four. In the group of 353 patients, at least one of these symptoms were present at month four (27.8%) and month seven (34.8%). A lower baseline level of SARS-CoV-2 IgG, anosmia, diarrhea during acute COVID-19 were associated with higher risk of developing long-term symptoms. The continued assessment of patients with Post COVID syndrome will become a major task. Providers should aim to define and mitigate the socioeconomic and medical long-term effects of COVID-19 on those who have experienced infection.
Pericardial disease in COVID-19
This article discusses the effect of COVID-19 on the heart including pericardium and reviews the possible pathophysiological mechanisms involved in cardiac manifestations during COVID-19 infection. In addition, the article summarizes patient cases with pericarditis secondary to COVID and outlines treatment strategies. It is believed that an underlying hyperinflammatory reaction in those infected with COVID-19 may lead to pericardial inflammation. While most patients are managed medically, some may develop a life-threatening pericardial tamponade requiring pericardial drainage. Acute pericarditis may be diagnosed with or without myocardial involvement with clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram, as well as multimodality imaging when required. Authors suggest pericardial involvement is a possible clinical manifestation of COVID-19 and should lead a provider to consider a timely workup. Diagnosis and management based on presentation and organ involvement may help patients to completely recover.
Management of cardio-pulmonary-renal dysfunction in severe COVID-19
In this review article from Cardiorenal Medicine, authors discuss the effect of COVID-19 on the pulmonary system, as well as the profound effects on the cardiovascular and renal systems. Research studies have shown that direct heart and kidney injury is frequently observed in cadavers who were diagnosed with severe COVID-19 infection. The dysfunction of the heart may lead to deterioration of the kidneys, or vice versa, known as the cardiorenal syndrome. Authors urge proactive monitoring of micro-and macrohemodynamics to allow prompt correction of circulatory dysfunction which can be a crucial factor in prevention of acute kidney injury during COVID-19. The review goes into a brief but thorough outline to manage patients with or without mechanical ventilation and provides evidence regarding COVID-19 related renal and cardiorenal complications and discusses management strategies for these patients.
Altered mental status in COVID-19
In this article from the Journal of Neurology, the authors discuss the manifestation of altered mental status (AMS) as a common neurological issue affecting hospitalized COVID-19 patients and aimed to determine the primary cause for this manifestation. The authors conducted a retrospective observational study of patients presenting to three New York hospitals from March 1 to April 16, 2020. They categorized the underlying cause of AMS into three categories: neurological, metabolic encephalopathy, and indeterminate. Overall, 166 patients were involved in the study. Metabolic encephalopathy was diagnosed as the cause in 92.8% of patients, with 71.1% of those categorized as multifactorial and 21.7% as single-cause metabolic encephalopathy. Neurological causes (stroke, seizure, encephalitis) were found in 12%, and as the sole factor in 3.0% of patients. 6.0% were related to seizure, and 6.0% were cerebrovascular events. Of the patients with indeterminate causes (7 total), one was suspicious for encephalitis. Age, pre-existing dementia and cerebrovascular disease, and impaired renal function were considered as independent predictors of altered mental status. In conclusion, it appears that AMS on presentation to the emergency department is most frequently caused by delirium while seizures and cerebrovascular events contribute to a lesser degree.
Possible prevention for COVID-19
In this editorial, the author discusses a recent randomized, double-blind, placebo-controlled trial which evaluated the safety and efficacy of a single intravenous 4200-mg dose of bamlanivimab for prevention of SARS-CoV-2 infection among residents and staff of 74 skilled nursing and assisted living facilities in the U.S. Participants were eligible if they were 18 or older and had no known history of COVID-19 and were within a facility where at least one positive case had been confirmed within the preceding seven days. Swabs were obtained at study entry along with blood for SARS-CoV-2 serology. Participants were randomized and dosed prior to availability of baseline results. Those who tested negative for infection at entry represented the prevention population (966 total participants), and those who tested positive were followed as the treatment population. The primary outcome was incidence of COVID-19 as defined as detection of SARS-CoV-2 by nasal swab accompanied by mild or worsening disease within 21 days of detection and within 8 weeks of randomization. In the prevention population, bamlanivimab significantly reduced the incidence of mild or worsening COVID-19 symptoms when compared to placebo. The protective effect was greater in prespecified analyses when limited to the resident prevention population. A significant reduction in mild or worsening COVID-19 symptoms among staff members was not observed. At the time of the study, the FDA had authorized bamlanivimab for emergency use, however, after the emergence of variants carrying spike protein mutations that reduce susceptibility to bamlanivimab, the FDA withdrew the EUA for this drug. However, the EUA of bamlanivimab plus etesevimab remains available. Further studies are needed to determine the effectiveness and future use of this combination in the context of resistance.