Cognitive Profile of SARS-cov-2 Recovered Patients: A Comprehensive Analysis of Persistent Dysfunctions in Long COVID (preprint)

Long Covid is a term used for patients who have recovered from COVID-19 but exhibit persistent cognitive dysfunction, including mental confusion, difficulties in attention, impairment in executive functions and slow movements, among other common symptoms. A study was conducted with 65 patients who had a positive RT-PCR diagnosis and reported symptoms of cognitive impairment, such as memory loss and attention difficulties after recovery. The patients underwent neuropsychological evaluation and completed questionnaires on cognition, mood, and quality of life. During the cognitive screening, 71% of the patients showed alterations, with deficits in visual memory (69%), language (54%), visuospatial construction (49%), verbal episodic memory (37%), executive functions (36%), attentional abilities (34%), and premorbid intelligence (12%). It is important to highlight the need for treatments and further studies to understand the long-term side effects of this disease.

Psychiatric and Cognitive Morbidity Following Moderate and Severe SARS-CoV-2 Infection: A Cohort Study (preprint)

Background: Recent studies indicate that psychiatric and neurocognitive symptoms are frequent after Coronavirus Disease-2019 (COVID-19). The present study aims to investigate the occurrence of psychiatric and cognitive impairments in a cohort of survivors from moderate or severe forms of COVID-19.Methods: 425 adults (mean age 55.7 years) were assessed 6 to 9 months after hospital discharge with a structured psychiatric interview (Clinical Interview Schedule, CIS-R) and a combination of psychometric tests. Cognitive state was examined with a subjective memory complaint scale and screening tests. A large, multidisciplinary, set of clinical data depicting the acute phase of the disease, along with relevant psychosocial variables, were used to predict psychiatric and cognitive outcomes using the ‘Least Absolute Shrinkage and Selection Operator’ (LASSO) method.Outcomes: CIS-R diagnoses of ‘depression’, ‘generalized anxiety disorder’ and ‘post-traumatic stress disorder’ were established respectively in 8%, 15.5% and 13.6% of the sample. Memory decline was reported by 51.1% of the patients. Psychiatric or cognitive outcomes were not predicted by any clinical variables related to the severity of acute-phase disease, nor by disease-related psychosocial stressors. Rather, depression and anxiety were only predicted by current frailty and worse general health status.Interpretation: Using a structured psychiatric interview and an objective assessment of cognitive state, we found high rates of psychiatric and cognitive morbidity in the long-term outcome after moderate or severe COVID-19. The lack of associations of previous medical or psychosocial factors with these diagnoses suggests a direct, disease-related, mechanism in the pathophysiology of COVID-19 related psychiatric and cognitive impairments.Funding: This work was partially supported by donations from the general public under the HC-COMVIDA crowdfunding scheme (https://viralcure.org/c/hc) and the Fundação Faculdade de Medicina (ALA). ARB receives scholarships and support from FAPESP, the Brazilian National Council of Scientific Development (CNPq-1B), University of São Paulo Medical School (FMUSP), the UK Academy of Medical Sciences (Newton Advanced Fellowship), and the International Health Cohort Consortium (IHCC).Conflict of Interest: Authors Declare no Conflict of Interest.Ethical Approval: This research protocol has been approved by the Ethics Committee at HCFMUSP (CAPPesq HC), and registered at the Brazilian Registry of Clinical Trials (ReBEC) under the registration number 4.270.242 (RBR-8z7v5wc) and will be reported according to The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement.

Evaluating Burnout Among Health Workers Routinely Screened for SARS-CoV-2 (preprint)

Background: Healthcare workers (HW) are a vulnerable group to develop burnout during the COVID-19 pandemic. The aims of this study were to evaluate the perception of HW about the antibody test, and, secondarily, the prevalence of burnout and factors associated with burnout among HW who took the test.Methods: In this cross-sectional study, we evaluated burnout among HW in a 600-bed building entirely dedicated to COVID-19 inpatients care at Hospital das Clinicas (HC), located in São Paulo, Brazil. The HW answered an online questionnaire that included questions on burnout, a single-item scale based on the Maslach Burnout Inventory; demographic data, professional category, type of Protective Personal Equipment (PPE) used, distancing from social support; and emotional reactions to their serology result. Bivariate and multivariate analyses were done to evaluate the risk of burnout.Outcomes: Among 4,417 HW tested, 528 (12.0%) were positive for SARS-CoV-2 and 1,945 answered the questionnaire. Burnout was reported by 308 (15.8%); anxiety, tenseness, and depression associated with COVID-19 were reported by 344 (17.7%); 292 (15.1%); and 181(9.3%) of the participants, respectively. The risk factors for burnout were: being a physician [adjOR:1.604;(95%CI 1.604-1.080;p=0.019)]; a physiotherapist [adjOR:2.047;(95%CI:1.285–3.261;p=0.003)]; perceiving a decrease in public safety[adjOR:1.983;(95%CI:1.229–3.199;p=0.005)]; anxiety [adjOR:2.721;(95%CI:1.812–4.085;p=<0.001)], and depression associated with COVID-19[adjOR:2.071;(95%CI:1.308–3.279;p=0.002)]; and having negative feeling towards had a previously negative SARS-CoV-2 serology[adjOR:1,989;(95%CI:1.484-2.664; p<0.001)]. Interpretation: Routine serological testing was one of the strategies used in our hospital to promote the well-being of HW. We observed that those who had negative feeling regarding testing negative to COVID-19 in previous serologies were at higher risk of burnout, suggesting that the risk of contracting the disease is a major stressor for HW.Funding Statement: Internal funding from the Hospital das Clínicas of University of São Paulo, Brazil trough donation from Banco Pactual.Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: grant funding from the Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.Ethics Approval Statement: This study was approved by the Hospital das Clinicas da faculdade de Medicina da Universidade de Sao Paulo (protocol number 30701920200000068).

Evaluating burnout among health workers routinely screened for SARS-CoV-2. (preprint)

Background: Healthcare workers (HW) are a vulnerable group to develop burnout during the COVID-19 pandemic. The aims of this study were to evaluate the perception of HW about the antibody test, and, secondarily, the prevalence of burnout and factors associated with burnout among HW who took the test.Methods: In this cross-sectional study, we evaluated burnout among HW in a 600-bed building entirely dedicated to COVID-19 inpatients care at Hospital das Clinicas (HC), located in São Paulo, Brazil. The HW answered an online questionnaire that included questions on burnout, a single-item scale based on the Maslach Burnout Inventory; demographic data, professional category, type of Protective Personal Equipment (PPE) used, distancing from social support; and emotional reactions to their serology result. Bivariate and multivariate analyses were done to evaluate the risk of burnout.Outcomes: Among 4,417 HW tested, 528 (12.0%) were positive for SARS-CoV-2 and 1,945 answered the questionnaire. Burnout was reported by 308 (15.8%); anxiety, tenseness, and depression associated with COVID-19 were reported by 344 (17.7%); 292 (15.1%); and 181(9.3%) of the participants, respectively. The risk factors for burnout were: being a physician [adjOR:1.604;(95%CI 1.604-1.080;p=0.019)]; a physiotherapist [adjOR:2.047;(95%CI:1.285–3.261;p=0.003)]; perceiving a decrease in public safety[adjOR:1.983;(95%CI:1.229–3.199;p=0.005)]; anxiety [adjOR:2.721;(95%CI:1.812–4.085;p=<0.001)], and depression associated with COVID-19[adjOR:2.071;(95%CI:1.308–3.279;p=0.002)]; and having negative feeling towards had a previously negative SARS-CoV-2 serology[adjOR:1,989;(95%CI:1.484-2.664; p<0.001)].Interpretation: Routine serological testing was one of the strategies used in our hospital to promote the well-being of HW. We observed that those who had negative feeling regarding testing negative to COVID-19 in previous serologies were at higher risk of burnout, suggesting that the risk of contracting the disease is a major stressor for HW.

Neuromodulation and Inflammatory Reflex: Perspectives on the Use of Non-Invasive Neuromodulation in the Management of Disorders Related to COVID-19 (preprint)

Background: Novel coronavirus disease (COVID-19) is not restricted to the respiratory system, but also affects the peripheral (PNS) and central (CNS) nervous systems which appear to influence morbidity and mortality. It is urgent to approach all aspects of the disease in order to attenuate the impact of the pandemic. Noninvasive neuromodulation (NiN) might be useful in the management of the disorders related to the infection, considering its efficacy in modulation inflammation, neuroimmunity, musculoskeletal symptoms, and neuropsychiatric aspects associated with the disease. Objective: To describe the empirical basis and rationale for the use of NiN in the management of patients with COVID-19.Methods: Develop a comprehensive review of the SARS-CoV-2 pathophysiology with emphasis on neuroinvasiveness, neuroimmune response, autonomic balance, musculoskeletal and neuropsychiatric aspects of the COVID-19. Construct a rationale for the use of NiN techniques in the management of patients with COVID-19.Results: There is recent evidence that COVID-19 affects many aspects of the PNS and CNS activities, a phenomenon that seems to be mediated by neuroimmune mechanisms. There is also evidence that NiN techniques, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), transcutaneous vagus nerve stimulation (tVNS), transcutaneous spinal direct current stimulation (tsDCS), and transcutaneous peripheral electric stimulation (tPES), can be used to decrease the inflammatory response of the infection. Moreover, they might also help in the management of musculoskeletal, and neuropsychiatric symptoms, and in accelerating the discharge of patients. Conclusion: The neuroimmune mechanisms of SARS-CoV-2 are emerging with recent reports showing the impacts on the nervous system. NiN to decrease inflammatory reflex may be useful in the management of patients with COVID-19. It is urgent to initiate evaluation of NiN usage in basic research and clinical trials in order to establish its actual potential.