The role of non-invasive ventilation

Patients with severe COVID-19 usually develop acute respiratory distress syndrome (ARDS) characterised by acute hypoxemic respiratory failure (HRF) and bilateral pulmonary infiltrates [1, 2]. The common reason for HRF occurring in the course of ARDS is the ventilation-perfusion mismatch or the intrapulmonary shunt [3]. Generally, HRF is defined as an acute condition where the arterial oxygen tension is below 60 mmHg on room air or oxygen is required to maintain measurements of pulse oximetry above 90% with low or normal partial carbon dioxide pressure [4]. Therapeutic options are limited to target the ongoing pathological processes of ARDS, and hence mechanical ventilation continues to be the mainstay for patient management [5]. Non-invasive ventilation (NIV) and high flow nasal cannula oxygen therapy (HFNC) can play a role in providing respiratory support to COVID-19 patients before developing severe HRF or in circumstances where there is limited access to more invasive techniques [1]. © Springer Nature Switzerland AG 2020.

The problem of aerosolization

Transmission of COVID-19 is primarily through droplets (only short distances) and fomite spread (e.g., clothing, equipment, furniture) that can become contaminated by the virus [1]. In contrast, aerosols are composed of much smaller fluid particles that can remain suspended in the air for prolonged periods [2]. Current evidence suggests that coronaviruses can survive in the aerosol within fluid particles under certain conditions [3, 4]. Some events can potentially lead to aerosolization of virally contaminated body fluid (aerosol-generating procedures "AGPs"), including coughing/sneezing/expectorating, NIV, HFNC, jet ventilation, delivery of nebulized medications via simple face mask, cardiopulmonary resuscitation (before tracheal intubation) and tracheal extubation [5, 6]. A higher risk of viral aerosolization was reported with tracheal suction (without a closed system), tracheal intubation, laryngoscopy, bronchoscopy/gastroscopy and tracheostomy/cricothyroidotomy [6]. Thus, these procedures carry a potential increased risk of nosocomial infection to healthcare workers (HCWs) and COVID-19 has now been classified as a high consequence infectious disease (HCID), emphasizing the significant risk to HCWs and the healthcare system [1]. © Springer Nature Switzerland AG 2020.

The psychological impact of COVID-19 on seeking medical care for patients with chronic diseases

Introduction: Patients with many comorbidities and chronic conditions have been severely affected by the outbreak, as their outcomes are the worst. Their routine of seeking medical care during Covid-19 is thought to be changed, in addition to the psychological impact of the pandemic. Research Question or Hypothesis: Patients with chronic conditions may suffered from anxiety, depression, and stress during covid-19, which their pattern of seeking medical care was changed Study Design: cross-secttional study Methods: In March 2021, a cross-sectional, web-based survey of patients with chronic diseases was conducted. 1037 eligible patients were assessed for psychological disorders, primarily depression, stress, and anxiety, using the DASS-21 scale, as well as their pattern of receiving medical care during Covid-19. Results: Diabetes and hypertension accounted for 62.5 percent of patients with chronic diseases, 17.8 percent for hypertension alone, 8.6 percent for diabetes, and 11.6 percent for other chronic diseases. During the pandemic, 52.5 percent of patients with chronic diseases were depressed, 57.9 percent were anxious, and 35.6 percent were stressed. Patients with chronic disease who had moderate to severe depression, moderate to severe anxiety, or moderate to severe stress were significantly more likely to have no follow-up for their chronic conditions (34.9 percent vs. 45.1 percent p=0.001), (43.6 percent vs. 53.8 percent p=0.001), and (14.9 percent vs. 34.8 percent p=0.001), respectively Conclusion: Patients with chronic conditions experienced significant anxiety, depression, and stress during covid-19, which changed their pattern of seeking medical care, and the majority of them receiving no follow-up for their chronic condition.