ABSTRACT
SARS-CoV-2 infectious virions have been reported in exhaled breath, but their source remains elusive: breath sampling systems used to date do not separate breath aerosols by size, fail to prevent salivary/fomite contamination, or aerosol size evolution before sample capture. We hypothesised that sampling end-tidal, oral exhaled breath condensate (EBC), after separating large droplets by inertial impaction 4cm from the lips, would quantify viral loads in distal lung-derived fine aerosols (FA). We used a collector (PBM-HALE ) that captures mechanically aerosolised viruses to sample adult participants for <30 min under informed consent;cases symptomatic for <5 days (n=30) or >5 days (n=12), positive by nasopharyngeal swab RT-PCR (Ct>=13.1), were sampled in clinical triage 'red zones', or COVID-19 wards with no mechanical ventilation or open windows. Salivary alpha amylase activity (Salimetrics LLC), or SARS-CoV-2 viral load (VIASURE SARS-CoV-2 (ORF1ab and N gene)) after QIAsymhpony DSP midi extraction, was quantified in 0.2mL FA EBC fractions. No salivary alpha amylase activity was detected in healthy participant FA EBC (>1:1,750 dilution of paired saliva vs assay detection limit (n=300)). No SARS-CoV-2 RNA was detected in FA EBC (1.18mL +/- 0.32 total volume) among any COVID-19 cases (Aug 2020-Jan 2022) at limits of detection of 120 genomes/mL FA EBC or 4.72 genomes/min exhalation. No pre-extraction spike-in control reaction inhibition was observed. No ambient contamination of the alveolar FA EBC was detected with this sampling device. The alveolar fraction of orally exhaled tidal breath lacks detectable SARS-CoV-2 viral load.
ABSTRACT
Introduction: SARS-COV-2 infection may result in pneumonia leading to ARDS and ICU treatment. Activation of the complement system was verified in COVID-19 patients as a driving factor of thromboinflammation contributing to disease progression. Aim(s): To investigate C3a and C5b-9 levels as markers of COVID-19 severity and outcome. Method(s): 79 patients with a positive polymerase chain reaction (PCR) test for SARS-COV-2 were recruited;38 severe and 42 critical. Serum samples were collected on admission and analysed for C3a and C5b-9 levels by ELISA methodology. Patients were grouped into severe vs critical, non-intubated vs intubated and survivors vs nonsurvivors for comparisons. Statistical analysis by Mann-Whitney for non-parametric analysis and receiving operating curve (ROC) analysis was performed in GraphPad Prism. Result(s): A statistically significant increase for C3a and C5b-9 levels was observed between: a) severe vs critical (p<0.001 and p<0.0001), b) non-intubated vs intubated (p<0.001 and p<0.05) survivors vs non-survivors (p<0.001 and p<0.01). ROC analysis for ICU admission revealed a higher AUC for C5b-9 (0.771, p<0.001) compared to C3a (AUC= 0.686, p<0.01). A higher AUC was observed for C3a when analysis was performed for intubation need (AUC=0.746, p<0.001) or mortality (AUC=0.758, p<0.0001) compared to C5b-9 (intubation need AUC=0.663, p<0.05 and mortality AUC=0.637, p NS). Combining C3a and C5b9 revealed a powerful prediction tool for ICU admission (AUC=0.773, p<0.0001), intubation (AUC=0.756, p<0.0001) and mortality (AUC=0.753, p<0.001). Conclusion(s): C3a and C5b-9 may serve as prognostic tools either separately or in combination for the progression and outcome of COVID-19.
ABSTRACT
Background: Experience from previous coronavirus outbreaks had shown that infected patients are at risk for developing psychiatric disorders, such as mood and sleep disturbances. Similarly, accumulating evidence suggests that patients with COVID-19 infection experience an excess of adverse psychological outcomes and neuropsychiatric complications [1,2]. The aim of this study was to investigate the impact of COVID-19 infection and hospitalization on the mental health, quality of life, and sleep of patients following hospital discharge. Methods: Patients were assessed during follow up visits in the outpatient clinic 1-2 months after hospital discharge from a large Covid-19 reference hospital in Athens, Greece (from May 8th 2020 till February 4th 2021) using validated screening tools for Depression and Anxiety (HADS), post-traumatic stress disorder (IES-R), sleeping difficulties (Athens Insomnia Scale, AIS), and Quality of Life (EQ-5D-5L). Sociodemographic information, smoking history, co-morbidities and severity of disease (hospitalization, ICU) were also collected. Results: A total of 131 eligible patients who provided informed consent were included. Overall, Covid-19 patients experienced considerable levels of mental health symptoms following hospital discharge. Moreover, rates were significantly higher for female compared to male patients despite having shorter duration of hospitalizations (14.89 vs 18.82 bed days) and/or ICU admissions (13.51 vs 14.92). This finding was consistent across all recorded psychological outcomes i.e. depression (p=0.004), anxiety (p=0.017), traumatic stress (p<0.001), fear (p<0.001) and insomnia (p=0.002). In addition, differences in prevalence rates between genders were particularly marked for moderate levels of depression and traumatic stress and for severe levels of anxiety. Smoking and comorbidities were not found to significantly correlate with the presence of affective symptoms or sleep dysfunction. However, an association was observed between severity and the existence of comorbidity with the proportion of patients with comorbidities increasing from 67.5% of the patients with minimal depression to 91.43% to those with mild and 80% with moderate depression (p-value=0.018). Finally, quality of life was worse for patients that have had an admission in the ICU (EQ-5D-5L: 15.82 ± 5.27) compared to those who were hospitalized but did not require ICU treatment (EQ-5D-5L: 8.39 ± 2.81) (p-value<0.001). Conclusion: COVID-19 disease can have a significant psychological impact on hospitalized patients and particularly women despite the relative less severe course of their illness. This finding is in line with a previous study, showing that, despite significantly lower levels of baseline inflammatory markers, female patients suffered more for both anxiety and depression at one-month follow-up following hospital admission (3). Regardless of potential sex differences, the prevalence of moderate and severe mental illness symptoms in COVID‐19 patients may be higher compared with the general population or other high risk groups such as different patient groups or healthcare workers [2-4]. Our results highlight the need for appropriate interventions to promote physical and mental wellbeing of COVID-19 survivors and cater for long-term needs. No conflict of interest