Weekly Review: What’s new in the COVID-19 clinical world? – March 15,2021

Weekly Review: What’s new in the COVID-19 clinical world? – March 15,2021

Long-term complications from COVID-19

As patients have recovered from severe COVID-19, we are beginning to see some of the long term effects related to the infection. Most patients will recover fully after 2 to 6 weeks, but a small percentage may develop post-COVID-19 complications. Literature has published complications such as myocarditis, pericarditis, restrictive lung disease, thrombolytic events, anxiety, depression, PTSD, persistent fatigue, and myalgias. A new term coined “long-haulers” has been coined for these individuals.

In this article, long-term complications affecting the endocrine and cardiovascular systems are discussed. Myocarditis has been recognized as a well-known complication of infection, however, in this article a healthy young patient presents with diabetes insipidus as a late-onset sequela of COVID-19. Involvement of the hypothalamic-pituitary axis related to COVID-19 has been suggested, however, the symptoms were transient and resolved within a year. Research suggests inflammation-mediated reversible hypophysitis and direct immune-mediated damage could be explanations for the ongoing issues within the hypothalamic-pituitary axis.

Considering the effects of routine change and social distancing in older adults

During the pandemic social distancing has been recognized as key to preventing the spread of COVID-19 transmission. This cross-sectional study, participants were invited to join a self-perception study by answering questions on an interdisciplinary survey. The questions were divided into the following: sociodemographic data, financial conditions, routine-related perception, perception of health, physical, and emotional state, and eating habits. The adult group with a mean age of 43.15 years consisted of 139 participants while the older adult group consisted of 437 participants with a mean age of 67.59 years, both including males and females. The adult group reported greater income impairment and need for financial assistance while most older adults reported more than 15 days since they had visited a relative or friend, reported a higher time of remaining in home since the beginning of social distancing, and other factors. This study dives into the physical, emotional, and social consequences of isolation related to the pandemic. There is a great concern about the impact of social distancing on loneliness mainly among older adults which is associated with functionality decline, depression and anxiety symptoms, decreased social bonds and eating habits, as well as discouragement. It is suggested by the literature that older adults be followed up by health professionals in order to identify any conditions that require intervention.

COVID Stress Syndrome

In this psychiatry report, authors discuss the newly proposed “COVID Stress Syndrome.” Research has identified a pandemic-related adjustment disorder that consists of five inter-correlated elements: fear of infection and/or coming into contact with contaminated surfaces; fear of socio-economic impacts from the pandemic; fear of foreigners due to beliefs that those people may be infected; pandemic-related compulsive checking and reassurance seeking; and pandemic-related traumatic stress symptoms. A severe form of the syndrome characterized by clinically significant distress and impaired functioning is known as COVID Stress Disorder. The at-risk demographic is associated with younger age, female, unemployment status, low education, Asian and Hispanic ethnicities, and a diagnosis of COVID-19. During self-isolation people with high scores on the COVID Stress Scales, compared to people with lower scores, were more likely to engage in over eating, drug and alcohol abuse, and excessive online shopping. The research goes on to discuss the disorder as well as treatment implications, however, concludes that further research is warranted on this topic.

Drug repurposing during the pandemic

In this article, authors discuss the most commonly repurposed drugs over the course of the pandemic. The discussion includes: “old antivirals” and non-antiviral agents such as hydroxychloroquine, remdesivir, colchicine, etc.; drugs typically used for COPD or pulmonary fibrosis such as phosphodiesterase-4 inhibitors; dietary supplements, micronutrients and herbal medications; and finally gas mixtures such as nitric oxide, among others. The article discusses each medication in detail with a focus on the mechanisms of action and current trials that are investigating efficacy of various drugs. The article concludes that none of the agents show clinical efficacy against SARS-CoV-2 and it’s many complications, including remdesivir. The authors urge further pharmaceutical research to enhance drug repurposing and implementation of novel formulations for older medications to improve safety and offer efficacy against COVID-19.

Further support of corticosteroids in severe COVID-19 treatment

In a previous review, the use of corticosteroids for the treatment of COVID-19 was discussed. In this manuscript from The Journals of Gerontology, the use of corticosteroids is again discussed and supported. The aim of the study was to determine the safety and clinical efficacy of corticosteroid therapy in older adults with severe COVID-19 pneumonia. The authors reviewed clinical records of COVID-19 patients aged 75 years or older who were admitted over a three month period. In total, 88 patients (61.5%) were treated with corticosteroids, and 55 patients (38.4%) were not. Both groups had similar baseline characteristics with a median age of 85 years. In-hospital mortality was lower in the group treated with corticosteroids when compared to the non-corticosteroid group. The study concluded that in critically older adults with COVID-19 pneumonia, the use of corticosteroids resulted in lower mortality without significant adverse events.

Does Zinc help to prevent severe COVID-19 infection?

In this study, authors used a retrospective analysis to evaluate the correlation between the prevalence of zinc deficiency and COVID-19 cases/deaths per million in Asian and European countries. In the study, the prevalence of zinc deficiency was higher in the Asian population (mean 17.5%) than in the European population studied (mean 8.9%). Researchers discovered a positive correlation (p60 years of age, obesity, diabetes, extensive pulmonary involvement, and low SaO2 at admission.

|2021-03-15T09:37:36-04:00March 15th, 2021|COVID-19 Literature|Comments Off on Weekly Review: What’s new in the COVID-19 clinical world? – March 15,2021

About the Author: Casey Cummins

Casey Cummins
Casey Cummins, MSN, APRN, NP-C is a board-certified Family Nurse Practitioner who currently serves as the Chief Nurse Consultant for the Immunizations Division at the Indiana Department of Health. She is part of the ISDH COVID-19 Outbreak Response Team, and has assisted with coordinating testing efforts state-wide during the pandemic. She enjoys spending time with her husband and their children, being outdoors, gardening, and traveling whenever possible.

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