15-Month Attributes of Post-Covid Syndrome in Therapeutically Vaccinated Outpatients

Background: In the third year of the coronavirus disease 2019 (COVID-19) pandemic, long-term post-COVID syndrome (PCS) following severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections poses the significant challenge for patients and health systems globally. Whilst COVID-19 vaccinations prior to SARS-CoV-2 infection reduce the risk of PCS, the role of therapeutic vaccination in PCS recovery remains controversial. We present a 15 months longitudinal, prospective observational cohort study to examine long-term clinical courses, PCS recovery with and without vaccination as well as humoral immune responses in initially unvaccinated PCS patients. Method(s): A total of 227 COVID-19 convalescents of our initial mild COVID-19 outpatient cohort (N=958) from which longitudinal data was available were included in this study. PCS was defined according to the WHO definition. 76.7% (174/227) of individuals received at least one vaccination between 10 and 15 months after first SARS-CoV-2 infection. Receptor binding domain (RBD)- specific SARS-CoV-2 immunoglobulin G (IgG) and distinct symptom phenotypes (P) were longitudinally assessed for 15 months. Using binomial regression models, odds ratios (OR) with 95% confidence interval (95%CI) of descriptive, longitudinal variables associated with long-term PCS were calculated. Result(s): 35.8% (82/227) and 31.3% (71/227) of patients had PCS at months 10 and 15 (figure 1A). SARS-CoV-2 IgG titers were equally distributed over time among age groups, sex, and PCS. PCS occurred in 30.5% (53/174) of vaccinated and 34.0% (18/53) of unvaccinated patients. Between 6 and 10 months (DELTAT2/T3: not yet vaccinated) and 10 and 15 months (DELTAT3/T4: vaccinated) after symptom onset (figure 1B), a comparable fraction of PCS patients recovered (DELTAT2/T3: 22.5% and DELTAT3/T4: 20.0%). Fatigue/dyspnea (P2) and not anosmia/ageusia (P1) constituted PCS at month 15 (P2 23.9% versus P1 1.4%). Headache (P4) and diarrhea (P5) at baseline were risk factors for PCS at months 15, respectively (P4: OR 2.01 (95%CI 1.11-3.52), p= .018;P5: OR 3.01(95%CI 1.44-5.94), p= .002). Conclusion(s): Our results indicate, that distinct symptom phenotypes can constitute and predict long-term PCS 15 months after mild COVID. Recovery of PCS was observed similarly in both therapeutically vaccinated and unvaccinated patients. Thus, development of targeted PCS therapeutics is needed to improve patient care and future epidemiological investigations. (Figure Presented).

Guidance for Doctors to Communicate with Vaccine-hesitant Patients

Background Communication between doctors and patients is essential for making therapeutic decisions. Regarding the COVID-19 pandemic, a relevant proportion of patients is hesitant to receive vaccination. Search Methods Pragmatic search (no language limit) for the terms „vaccine hesitancy doctor communication“ and „vaccine hesitancy medical communication“ and the German terms “Gesprächsführung“ and „Impfskepsis“ in the databank PubMed in April 2021 without restricting article type or time of publication. Main Messages Communication concerning vaccine hesitancy should include treating patients as allies, appreciating individual anxieties and concerns, inquiring compassionately reasons for hesitancy, and avoiding confrontation or limiting patients’ autonomy. Generally, doctors should address and understand patients’ emotions such as worries and concerns before sharing evidence-based information on vaccines. Recognizing and appreciating vaccine hesitancy and the respective emotions appears to be a prerequisite for a successful discussion of the benefits of vaccination. Conclusions How doctors communicate with patients appears to be highly relevant to address and successfully reduce vaccine hesitancy. Vaccination is an emotional topic for both sides – doctors and patients – that cannot be covered only on a factual, objective level. A compassionate approach trying to understand the worries and reasons for vaccine hesitancy should be favored over mere confrontation.

Rapid response infrastructure for pandemic preparedness in a tertiary care hospital: lessons learned from the COVID-19 outbreak in Cologne, Germany, February to March 2020

The coronavirus disease (COVID-19) pandemic has caused tremendous pressure on hospital infrastructures such as emergency rooms (ER) and outpatient departments. To avoid malfunctioning of critical services because of large numbers of potentially infected patients seeking consultation, we established a COVID-19 rapid response infrastructure (CRRI), which instantly restored ER functionality. The CRRI was also used for testing of hospital personnel, provided epidemiological data and was a highly effective response to increasing numbers of suspected COVID-19 cases.

A pre-infection laboratory score identifies cancer patients at risk for severe COVID-19: An analysis of the ADHOK coronavirus tumor registry

Introduction: Cancer patients (pts.) are considered susceptible to severe COVID-19 after SARS-CoV-2 infection, however, represent a heterogeneous population with variable risk. Pts. with active tumor disease and hematological neoplasms are particularly vulnerable to the infection. In a retrospective analysis of the ADHOK coronavirus tumor registry, the absolute neutrophil count (ANC) determined prior to infection showed a strong and independent correlation with COVID-19 mortality (Kiani et al, Cancer Med, in press). Here, we present an extended analysis of pre-infection laboratory parameters and COVID-19 severity in the registry pts., with the aim to establish an objective and easy-to-obtain predictor of infection outcome. Methods: Pts. with malignant tumor disease and PCR-confirmed SARSCoV- 2 infection were included in the registry by 22 German clinical institutions. Detailed information about tumor disease and treatment was collected retrospectively. Results of routine laboratory testing, performed at least 10 days prior to infection, were obtained. The course of SARSCoV- 2 infection was graded according to the WHO. Results: By May 10, 2021, 268 pts. (68% with solid tumors, 32% with hematological neoplasms) were included in the registry. Pre-infection routine laboratory values were available from 166 pts., obtained at a median of 21 days before infection. The pre-infection ANC, the neutrophil-to-lymphocyte ratio, and serum levels of CRP and LDH significantly correlated with COVID-19 severity after infection. In multivariable analysis, the ANC was found to be the strongest prognostic predictor for COVID-19 mortality (ANC > 4,4 /nL: OR 10.5, p=0.02) and was independent of age, sex, tumor activity, and CRP. Combining ANC and CRP to a score of 0, 1, or 2 points allowed to separate three groups of pts. with significantly different COVID-19 mortality (2% vs. 29 % vs. 64%, p< 0.001). Significant association of the 'pre-infection COVID-19 score' with COVID-19-related mortality was consistently found in the first and second waves of the pandemic and, in multivariable analysis, was independent of pre-infection LDH, a surrogate marker for tumor activity. Conclusions: A combined score of pre-infection ANC and CRP, determined as part of routine clinical testing prior to SARS-CoV-2 infection, strongly and consistently correlates with COVID-19 severity in cancer pts. It may serve as an easy-to-obtain parameter for COVID-19 risk assessment of cancer pts. prior to infection.

Prognostic value of preinfectionroutine laboratory parameters for COVID-19 mortality in tumor patients: Results of the ADHOK Coronavirus Tumor Registry

Background: Tumor patients (pts.) are considered susceptible to severe COVID-19 after SARS-CoV-2 infection. However, they represent a heterogeneous group of individuals with variable risk. Identification of vulnerable subgroups is important for prioritization of vaccination strategies and possible early therapeutic intervention after infection. Methods: Tumor pts. with PCRconfirmed SARS-CoV-2 infection were included in the multicentric ADHOK registry by 22 institutions. Detailed information about tumor disease and treatment, as well as routine laboratory parameters determined at least 10 days prior to SARS-CoV-2 infection, was collected retrospectively. The primary endpoint was defined as the outcome of the SARS-CoV-2 infection, graded according to the WHO: asymptomatic, mild, moderate, severe, critical, and COVID-19-related death. Results: Until Feb. 5, 2021, 215 pts. (67% with solid tumors, 33% with hematological neoplasms) were included in the registry. 74% of the pts. had an active malignancy. The course of SARS-CoV-2 infection was rather variable: 66% of the pts. remained asymptomatic or showed a mildto- moderate course, while the rest developed severe or critical disease. The COVID-19-related mortality rate was 24%. Pre-infection routine laboratory values were available for 104 pts., obtained at a median of 21 days before SARSCoV- 2 infection. Compared to COVID-19 survivors, COVID-19 non-survivors showed significantly higher median levels of absolute neutrophil count (ANC: 3.6 vs. 6.4 /nL;p = 0.006, n = 91), neutrophil-to-lymphocyte ratio (NLR: 2.2 vs. 7.2;p = 0.005, n = 75), C-reactive protein (CRP: 9.9 vs. 42.0 mg/L;p = 0.001, n = 104), and lactate dehydrogenase (LDH: 213.0 vs. 267.0 U/L;p = 0.016, n = 78). When categorized by a median split, COVID-19 mortality was significantly higher in pts. with ANC > 4.4 /nL (4% vs. 55%, p < 0.001), NLR > 4.1 (5% vs. 58%, p < 0.001), CRP > 15.4 mg/L (18% vs. 46%, p = 0.003), LDH > 236 U/L (15% vs. 49%, p = 0.003) and lymphocytes < 1.3 /nL (41% vs. 11% p = 0.002). In multivariable analysis, ANC and CRP showed a strong and significant association with COVID-19-related death (OR 23.0 and 7.7, p = 0.007 and 0.029, respectively). To develop an easy-to-apply preinfection score, we combined ANC and CRP and were able to separate three groups of pts. With significantly different COVID-19 outcomes (p < 0.001) (Table). Conclusions: Our results unveil subgroups of tumor pts. who may be at increased risk of severe COVID-19 and point to preinfection routine laboratory parameters with potential prognostic power: ANC and CRP may help identify pts. at risk for severe COVID-19 before SARS-CoV-2 infection.

Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes on quality of life issues in dermatologic patients during the COVID-19 pandemic.

The pandemic of COVID-19 is a global challenge for health care, and dermatologists are not standing apart from trying to meet this challenge. The European Academy of Dermatology and Venereology (EADV) has collected recommendations from its Task Forces (TFs) related to COVID-19. The Journal of the EADV has established a COVID-19 Special Forum giving free access to related articles. The psychosocial effects of the pandemic, an increase in contact dermatitis and several other skin diseases because of stress, disinfectants and protective equipment use, especially in healthcare workers, the temporary limited access to dermatologic care, the dilemma whether or not to pause immunosuppressive therapy, and, finally, the occurrence of skin lesions in patients infected by COVID-19 all contribute to significant quality of life (QoL) impairment. Here, we present detailed recommendations of the EADV TF on QoL and patient-oriented outcomes on how to improve QoL in dermatologic patients during the COVID-19 pandemic for several different groups of patients and for the general population.