Weekly Review: What’s new in the COVID-19 clinical world? – May 24, 2021

Weekly Review: What’s new in the COVID-19 clinical world? – May 24, 2021

Prevalence of post-acute sequelae of SARS-CoV-2 infection

In this article authors discuss the persistent symptoms after acute COVID-19 illness and attempt to estimate the prevalence and correlates of post-acute sequelae of SARS-CoV-2 infection (PASC). Research involved a population-based probability survey of adults with COVID-19 in Michigan. Among the 629 adults who completed the survey, the researchers estimated PASC prevalence defined as persistent symptoms at 30+ days and 60+ days post COVID-19 onset.

  • The analytic sample was predominately female (56.1%), aged 45 and older (68.2%), and Non-Hispanic White (46.3%) or Black (34.8%).
  • 30 and 60 day COVID-19 symptoms were highly prevalent (52.5% and 35.0% respectively), even among non-hospitalized respondents.
  • Respondents reporting very severe versus mild symptoms had 2.25 times higher prevalence of 30-day COVID-19 and 1.71 times higher prevalence of 60-day COVID-19 symptoms.
  • Hospitalized respondents had about 40% higher prevalence of both 30-day and 60-day COVID-19 symptoms.

In conclusion, PASC is highly prevalent among participants who reported severe initial symptoms, and in participants who reported mild to moderate symptoms, but to a lesser extent.

Long COVID, multicenter 6-month follow up study

In this retrospective observational 6-month study, the effects of long-term COVID-19 were explored among four hospitals in Spain. The authors estimate that 10% of patients experience long-term effects of COVID-19 with more severe cases (hospitalized patients) presenting with a higher frequency of sequalae. The objective of this study aimed to identify and quantify the frequency and outcomes associated with the present of sequalae or persistent symptoms in the six-month period after hospital discharge. Outcome measures included hospital readmission, return to emergency services, and post-discharge death. Of the 969 patients initially observed, 82.2% survived. The mean age of this group was 63.0 years, 53.7% male, and 509 (63.9%) reported some sequalae during the first six months after discharge. The most frequently reported sequalae were respiratory (42.0%), systemic (36.1%), neurological (20.8%), mental health (12.2%) and infections (7.9%). Women presented with higher frequencies of mental health and headache symptoms. The main factors independently associated with emergency service use include persistent fever, dermatological symptoms, arrhythmia or palpitations, thoracic pain and pneumonia. Authors provide a detailed list of symptoms and outcomes and encourage identification of possible factors associated with these long COVID symptoms to optimize preventive services and follow-up strategies in primary care settings.

Neuropsychological and psychiatric sequelae of COVID-19

In this systematic review the impact of COVID-19 on neuropsychological and psychiatric sequalae are reviewed. Thirty-three studies met inclusion/exclusion criteria for this review. Current findings link COVID-19 to cognitive deficits, particularly those related to attention, executive function, and memory. It appears that psychiatric symptoms occur at high rates in COVID-19 survivors which include anxiety, depression, fatigue, sleep disruption, and post traumatic stress. Severity of acute illness does not necessarily predict severity of cognitive or mental health outcomes. There is a lack of longitudinal data at this time, however, risk factors appear to include female sex, perceived stigma related to COVID-19, infection of a family member, social isolation, and prior psychiatric history. Authors encourage further studies as well as emphasis on delineating the unique contributions of premorbid functioning, viral infection, co-morbidities, treatments, and psychosocial factors to cognitive and psychiatric sequelae of COVID-19.

Cardiac involvement in patients with COVID-19

This study aimed to determine the frequency of cardiac involvement in patients with COVID-19, possible immune mechanisms of myocardial injury, and the place of cardiovascular pathology among other prognostic factors. The study included 86 patients (48 males, 60.2 ± 16.6 years), with COVID-19. Evaluation of troponin and anti-heart antibodies (AHA) were used. The average hospital stay was 14 days. Results indicate the incidence of cardiovascular disease and symptoms was 45.3%. Cardiac injury related to coronavirus include arrhythmias, heart failure, low-QRS voltage, repolarization disorders and pericardial effusions. The level of anti-heart antibodies were increased in 73.5% of patients, with significant correlations of AHA level with inflammatory activity, pneumonia, respiratory failure, cardiac symptoms, and death. D-dimer >0.5 μg/mL had a sensitivity of 79.2% and specificity of 60% in the prediction of cardiovascular manifestations. The most reliable prognostic model includes age, diabetes, oxygen therapy volume, maximum leukocyte level, C-reactive protein, and D-dimer. The study concludes that cardiovascular pathology is frequent in patients with COVID-19 and strongly correlates to the D-dimer. This indicates high significance of prothrombotic and ischemic outcomes and suggests cardiovascular pathology is associated with higher lethality.

Ensuring high and equitable COVID-19 Vaccine uptake in patients with IBD

In this article, COVID-19 vaccination among patients with inflammatory bowel disease (IBD) is discussed. Authors urge gastroenterology clinicians to become familiar with the safety and efficacy of the vaccines when concerns arise from patients who are diagnosed with IBD. Patients with IBD with pre-existing comorbidities, those of advanced age, and/or those taking corticosteroids are at increased risk for developing severe COVID-19 infection. At the time of this writing there are three COVID-19 vaccines which have been authorized for emergency use. To decrease the risk of COVID-19 in IBD patients, it is advised that these patients should be vaccinated. Hesitation persists among the public due to complex factors, therefore, it is urged by the authors that clinicians should be well-equipped to mitigate barriers which impede vaccine confidence. Recommendations to limit misconceptions include sharing educational tools such as the COVID-19 vaccination toolkit to build confidence among IBD patients who are hesitant. Authors suggest legitimizing concerns and normalizing hesitancy, presume patients are open to receiving a vaccination and discuss the risks and benefits and employing a positive framing technique when discussing the benefits of vaccination. Additionally, discussion of the risk of disease and benefits of immunization should be prioritized as well as clinicians strongly recommending vaccination. The article aims to encourage IBD clinicians to take on new professional roles and to be adaptable in the ways they provide care. Education and advocacy on behalf of the provider may help to bridge the gap between vaccine hesitancy and vaccine acceptance in high risk groups.

|2021-05-24T11:00:04-04:00May 24th, 2021|COVID-19 Literature|Comments Off on Weekly Review: What’s new in the COVID-19 clinical world? – May 24, 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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