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Early experiences of the your COVID recovery programme for individuals with long COVID Background: There is a significant prolonged symptom burden for a high proportion of patients after an initial acute infection with COVID. Objective measures in large cohorts have demonstrated that exercise capacity is disrupted in a large proportion of the Long COVID population. Recommendations for rehabilitation are emerging but clinical pathways and models of rehabilitation are lacking. Your COVID Recovery (YCR) is an online 'light touch' digital recovery programme for individuals recovering from Long COVID. Aim(s): To describe the early data from the YCR phase two site and to understand the data collected from the two outcome measures. Method(s): Participants were referred on the YCR programme. Basic demographics and questionnaire (EQ5D5L and the CAT) data were extracted from the site for the period February - November 2021. Result(s): 110 patients completed the programme (68% female, 88% White British, age: 46 +/- 11 years, height: 170 +/- 10 cm, weight: 87 +/- 21 kg). 47% of patients had comorbidities. Patients were on the programme for 9 +/- 4.3 weeks. There was an increase in EQ5D5L VAS score (pre = 49 +/- 19.5;post = 60 +/- 22.1;p<0.01) and EQ5D5L Index Value pre- to post-intervention (pre = 0.52 +/- 0.25;post = 0.57 +/- 0.27;p=0.09). CAT total score improved pre- to postintervention (pre = 19.8 +/- 7.2;post = 15.6 +/- 7.6, p<0.01). Discussion(s): This early data describes the impact of the YCR programme on the first cohort of patients to complete the programme. The outcome data is promising and should promote adoption by HCPs. Future research should focus on the comparing the YCR programme versus best usual care.
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Introduction: Following a SARS-CoV-2(COVID)infection,individuals often present with complex needs and multiple comorbidities. However, it is currently unknown if comorbidities differ between those who were hospitalised or remained in the community during their covid infection. Aim(s): To explore the baseline characteristics and impact of comorbidities in individuals who were hospitalised or managed their covid infection at home and referred into a Covid Rehabilitation programme (CoR). Method(s): An observational cohort analysis of individuals who attended a CoR assessment between July 2020 and November 2021. Routine characteristics including age, gender, BMI, ethnicity and significant comorbidities were collected. Result(s): 466 individuals (age: 54 +/- 14 yrs;BMI:7.4 +/-30kg/m ;Female: 271[58%],White British: 296[64%], South Asian:111[26%],Other Ethnic groups:36[9.1%])were assessed. Those who were hospitalised had more comorbidities than those in the community;Median IQR1(1-2) vs 2 (1-4);p<0.05. The top 5 comorbidities were different in each group;Hospital: Total 544;Respiratory (n=101;18.6%), Metabolic (100;18.4%), Vascular (79;14.5%), MSK (72;13.2%), Psychiatric (71;19%) and Community: Total: 391;Psychiatric (97;25%), MSK (72;19.5%), Respiratory (74;19%), Metabolic (38;9.7%), Gastroenterology (38;9.7%). Conclusion(s): Patients who were hospitalised had more comorbidities than the community referrals. It will be important to consider these comorbidities when assessing for and delivering CoR.
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Introduction: It is unknown how pre-existing comorbidities affect recovery after a hospital admission for COVID-19. Aim(s): To explore the impact of comorbidities on symptoms, exercise capacity and QoL 5 months after a hospital admission for COVID-19. Method(s): Patients hospitalised with COVID-19 were recruited to an observational longitudinal cohort study (PHOSPCOVID). Patients were categorised into three comorbid categories (0, 1, >=2). The Incremental Shuttle Walking Test (ISWT), FACIT, Dyspnoea-12 and the EQ5D-VAS were assessed 5 months post-discharge. Patient perceived preadmission EQ5D-VAS scores were collected retrospectively. One-way ANOVA were used to compare groups. Result(s): 1516 patients completed the assessment: 61% male, mean[SD];age 58[12], length of stay 14[19] days, BMI 32[7], number of comorbidities 2[2] with 813(53%) patients having >=2 comorbidities. The EQ5D was reduced pre admission to 5 months for all groups (p<0.01), however the difference between pre EQ5D-VAS and at 5 months was similar between groups (p=0.18). There was a significant difference in ISWT (m, %), FACIT and EQ5D between those that had >=2 comorbidities compared to no, and 1 comorbidity (p<0.01)(table 1). Conclusion(s): Although patients with more co-morbidities have a greater symptom burden and lower exercise capacity at five months post-discharge, important morbidity also persists in adults without pre-existing co-morbidity.
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Background: Fatigue is a common symptom after a COVID-19 infection. There is evidence to support COVID-19 rehabilitation (CoR) improving symptoms. However, there is concern that exercise therapies may increase postexertional symptom exacerbation (PESE). Aim(s): To determine the effect of 6 weeks of CoR on fatigue and symptoms of PESE. Method(s): 148 patients (55 +/- 13 y;56 [38%] male) completed 6 weeks of CoR including symptom-titrated exercise and education. Fatigue was assessed pre- and post-CoR using the Functional Assessment Chronic Illness TherapyFatigue questionnaire (FACIT). Patients with a FACIT score <30 were defined as having severe fatigue. PESE symptoms were assessed in a sub-group of patients (n=44) using a subscale of the DePaul Symptom Questionnaire (DSQ). A mean composite score was calculated for DSQ symptom questions. Result(s): FACIT score reduced pre- to post-CoR with a mean change of -5 +/- 9;p<0.01. The DSQ composite score improved by 20 +/- 21 (p<0.01, n=44). The magnitude of change in the DSQ composite score pre- to post-CoR was not different in those with (26 +/- 22) and without (19 +/- 21) severe fatigue (p=0.44). Conclusion(s): CoR has demonstrated improvements in fatigue and symptoms associated with PESE. The improvement in PESE symptoms pre- to post-CoR was similar in patients with and without severe fatigue, advocating the use of CoR in both cohorts.
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Introduction: Exercise tolerance, a strong predictor of morbidity and mortality, is reduced 2-3 months after a COVID19 hospitalisation. However, the long-term effects of COVID-19 on exercise tolerance in this population remain largely unknown. Aim(s): This study aimed to assess exercise tolerance 5 and 12 months after hospital discharge for COVID-19 and compare groups according to the limiting symptom. Method(s): Patients discharged from hospital after COVID-19 were invited to a multicentre long-term follow up study (PHOSP-COVID). 378 participants (58 +/- 12 y;BMI: 32.2 +/- 7.4 kg/m2;143 [38%] female;106 [28%] had received mechanical ventilation) performed an incremental shuttle walk test (ISWT) to intolerance 5 and 12 months after hospital discharge. Self-reported reason for intolerance was recorded. Result(s): ISWT distance 5 months post-discharge was 465 +/- 263 m (63 +/- 29% predicted;heart rate: 66 +/- 17% agepredicted max). At exercise intolerance, modified Borg ratings of perceived exertion and breathlessness were 3 +/- 2 and 4 +/- 2, respectively. Participants terminated the test due to breathlessness (n = 107;28%), leg fatigue (38;10%), breathlessness and leg fatigue (85;23%) or other reason (148;39%). There was no increase in ISWT distance 5 to 12 months post-hospital discharge (12 months;476 +/- 264 m;64 +/- 29% predicted;p = 0.09), with no differences between participants based on their reason for exercise intolerance at 5 months (p = 0.29). Conclusion(s): Between 5 and 12 months after hospital discharge, exercise tolerance did not increase, irrespective of patient reported exercise limitations, underscoring the need for effective rehabilitation strategies in this population.
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Introduction: After acute COVID infection, individuals experience fatigue and a reduced exercise tolerance, however the relationship between these variables has not been established. Aim(s): This study explored the impact of fatigue severity on exercise tolerance in individuals post-COVID infection. Method(s): This observational cohort analysis of individuals attending COVID-rehabilitation was assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) questionnaire and Incremental Shuttle Walk Test (ISWT) pre- to post- rehabilitation. Individuals were split into mild and severe fatigue (FACIT-F</>=30) groups. Result(s): 295 individuals were assessed (64% male, mean[SD] age 54[15] years, BMI 30.1[8.7] kg/m ). 193 (65%) individuals were in the severe fatigue group. Baseline ISWT distance was reduced in the severe fatigue group (287[181]m) compared to the mild fatigue group (396[217]m, p<0.05). There was a weak positive correlation between Pre-FACIT-F and baseline ISWT (r=0.28). There was a significant improvement in ISWT following rehabilitation of 90[114]m and 62[77]m for severe and mild fatigue groups respectively but there was no differences between groups (p=0.13)Conclusion: Those with severe fatigue had reduced exercise tolerance compared to those with mild fatigue prior to rehabilitation. Rehabilitation improves exercise tolerance in those with mild and severe fatigue, and there are no differences between groups.
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Background: Ovarian torsion is a gynecologic emergency that requires surgical intervention to avoid functional loss of the ovary. Our objective was to determine predictors of ovarian preservation in the setting of torsion, primarily time from initial presentation to surgery. Method(s): We conducted a retrospective cohort study of women aged 12-40 who presented to the Emergency Department (ED) at a single institution between 2008 and 2021 and had surgical confirmation of torsion. Cases were identified using diagnosis codes for ovarian torsion, and we performed chart review to confirm inclusion criteria. We compared ovarian preservation by time to surgery after ED presentation. Covariates included age, parity, sonographic doppler flow, presence of ovarian mass, intraoperative attempt at detorsion, intraoperative concern for necrosis, and night or weekend presentation. We considered the potential effect of COVID-19 pandemic on time to surgery. We assessed predictive factors for ovarian preservation based on preoperative sonographic findings and patient characteristics using multivariable logistic regression. Institutional IRB approved a waiver of consent. Result(s): We identified 60 surgical cases of confirmed ovarian torsion, of which 25 underwent oophorectomy (42%). The median time from initial presentation in ED to surgery was 8.6 hours (IQR: 5.9-12.9;8.3 hours in preserved versus 8.7 in removed;p=0.68). When time to surgery was < 4 hours (n=6), the ovary was preserved in 83% of cases, compared to 56% when time to surgery was >=4 hours (n=54;p=0.39). When time to surgery was < 8 hours (n=28), 61% had ovarian preservation compared to 56% at >=8 hours (n=32;p=0.73) (Figure). The COVID-19 pandemic was not associated with a longer time to surgery (n=7). Ovarian preservation was significantly more likely with present doppler flow on sonographic exam (60% vs 27%;p=0.02). Preservation was less likely with necrosis suspected intraoperatively (20% vs 84%;p< 0.01). Detorsion was attempted in 64% of cases, resulting in preservation of 35% of necrotic-appearing ovaries. 76% of cases underwent oophorectomy based on intraoperative concern for necrosis;however, only 48% of ovarian specimens had necrosis confirmed on pathology. Age, parity and night or weekend ED admission were not associated with ovarian preservation. Conclusion(s): Predictors with the greatest likelihood of ovarian preservation after torsion include surgical goal time of < 4 hours after ED presentation, present doppler flow on sonographic exam, and attempt at detorsion intraoperatively despite necrotic appearance. Intraoperative methods to confirm ovarian viability would reassure surgeons. The surgical decision for oophorectomy may be based on factors unrelated to functional loss of the ovary. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1375800-1-ANY(2).docxCopyright © 2023
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Background: Case investigation and contact tracing (CI/CT) is a key component of the response to COVID-19. CI/CT seeks to ensure that people exposed to SARS-CoV2 learn of their exposure and that infected persons and their contacts adhere to isolation and quarantine (I/Q) guidance. CI/CT programs also have the potential to address pandemic-related health inequities through the provision of support services. We evaluated the Public Health-Seattle & King County (PHSKC) CI/CT program, including its reach, timeliness, and case-reported impact on I&Q adherence. Methods: The PHSKC CI/CT case interview assessed case demographics, recently visited places, contacts, and service needs. In March 2021, a random sample of cases completed an End of I&Q Survey to assess their adherence to I&Q guidance and opinions of CI/CT. We calculated descriptive statistics to evaluate survey and programmatic data collected between July 2020 and June 2021. Results: The PHSKC CI/CT team interviewed 42,018 cases (81% of cases contacted) a mean of 6.1 days after symptom onset, and 3.4 days after SARS-CoV2 testing. Cases disclosed the names and addresses of 10,650 worksites (mean= 0.8/interview) and 11,269 other recently visited locations (mean= 0.5/interview), and provided contact information for 61,969 household members (mean=2.7/interview) and 8,753 non-household contacts (mean= 0.3/interview). The CI/CT team helped arrange COVID-19 testing for 5,660 contacts from 3,104 households, facilitated grocery delivery for 7,257 households, and referred 9,127 households for financial assistance. End of I&Q Survey participants (n=304, 54% of sampled) reported self-notifying an average of 4 non-household contacts and 69% agreed that the information and referrals provided by the CI/CT team helped them stay in isolation. Conclusion: CI/CT reached many persons with COVID-19 and their household contacts and identified thousands of possible exposure venues. The intervention's effectiveness was likely limited by the inability to interview cases during their period of peak infectiousness and cases' reluctance to name non-household contacts, though cases notified many non-household contacts themselves. CI/CT was effective in linking people to testing, food, and financial assistance, and most cases reported that the intervention helped them isolate. These findings provide evidence that CI/CT can help mitigate the impact of COVID-19 on disproportionately impacted communities through the promotion of I&Q guidance and provision of support services.
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Cardiac microthrombi are postulated to underlie cardiac injury in critical COVID-19. To determine pathogenic mechanism(s) of cardiac injury in fatal COVID-19, we conducted a single-center prospective cohort study of 69 consecutive COVID-19 decedents. Microthrombi was the most commonly detected acute cardiac histopathologic feature (n=48, 70%). We tested associations of cardiac microthrombi with biomarkers of inflammation, cardiac injury, and fibrinolysis and with inhospital antiplatelet therapy, therapeutic anticoagulation, and corticosteroid treatment, while adjusting for multiple clinical factors, including COVID-19 therapies. Higher peak ESR and CRP during hospitalization were independently associated with higher odds of microthrombi (ESR, Pnonlinearity 0.015, Passociation=0.008;CRP per 20mg/L increase, OR 1.17, 95%CI 1.00-1.36). Using single nuclei RNA-sequence analysis, we discovered an enrichment of prothrombotic, anti-fibrinolytic, and extracellular matrix signaling amongst cardiac fibroblasts in microthrombi-positive COVID-19 hearts, compared with microthrombi-negative COVID-19 hearts and non-COVID-19 donor hearts. Our cumulative findings identify these specific transcriptomic changes in cardiac fibroblasts as salient features of COVID-19-associated cardiac microthrombi.
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Rationale: Over 60 million people have had coronavirus disease 2019 (COVID-19), but consequences of severe infection are unknown. We sought to characterize interstitial lung abnormalities (ILA) after COVID-19, and to identify risk factors for the development of lung fibrosis.Methods: We performed a prospective single-center cohort study with 4-month follow-up after COVID-19 hospitalization. We sequentially enrolled 76 community-dwelling adults who were hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and required supplemental oxygen between March and May 2020. Participants had no prior history of interstitial lung disease and were discharged to acute rehabilitation or home, with sampling weighted to include half who were mechanically ventilated. We used a radiologic scoring system to quantify non-fibrotic ILA (ground glass opacities alone) and fibrotic ILA (defined as presence of reticulations, traction bronchiectasis, or honeycombing) on chest high-resolution computed tomography scans four months after hospital admission. We assessed measures of severity of illness during hospitalization, as well as pulmonary function and leukocyte telomere length at followup. Results: Participants had a mean age of 54 (SD14) years;most were male (61%) and Hispanic (57%). Thirty-two (43%) required mechanical ventilation. After a median (IQR) of 4.4 (4.0-4.8) months following hospital admission, the most common ILAs were ground glass opacities, reticulations, and traction bronchiectasis, which correlated with lower diffusion capacity (ρ -0.34, - 0.64, and -0.49, respectively, all p<0.01). A total of 31 participants (41%) had no ILA, 13 (17%) had only non-fibrotic ILA, and 32 (42%) had fibrotic ILA. Fibrotic ILA was more common in mechanically ventilated patients (72%) than non-mechanically ventilated patients (20%), (p=0.001). In adjusted analyses, each 1 point increase in admission SOFA score, additional day of ventilator support, and 10% decrease in blood leukocyte telomere length were associated with fibrotic ILA [OR 1.49 (95%CI 1.17 - 1.89), 1.07 (95%CI 1.03-1.12), and 1.35 (95%CI 1.06 - 1.72), respectively].Conclusions: Radiographic evidence of lung fibrosis four months after severe COVID-19 infection is associated with initial severity of illness, duration of mechanical ventilation, and telomere length.
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Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.
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COVID-19 , Heuristics , Cognition , Decision Making , Humans , Risk Assessment , SARS-CoV-2ABSTRACT
The 'climate crisis' describes human-caused global warming and climate change and its consequences. It conveys the sense of urgency surrounding humanity's failure to take sufficient action to slow down, stop and reverse global warming. The leading direct cause of the climate crisis is carbon dioxide (CO2) released as a by-product of burning fossil fuels,i which supply ∼87% of the world's energy. The second most important cause of the climate crisis is deforestation to create more land for crops and livestock. The solutions have been stated as simply 'leave the fossil carbon in the ground' and 'end deforestation'. Rather than address fossil fuel supplies, climate policies focus almost exclusively on the demand side, blaming fossil fuel users for greenhouse gas emissions. The fundamental reason that we are not solving the climate crisis is not a lack of green energy solutions. It is that governments continue with energy strategies that prioritize fossil fuels. These entrenched energy policies subsidize the discovery, extraction, transport and sale of fossil fuels, with the aim of ensuring a cheap, plentiful, steady supply of fossil energy into the future. This paper compares the climate crisis to two other environmental crises: Ozone depletion and the COVID-19 pandemic. Halting and reversing damage to the ozone layer is one of humanity's greatest environmental success stories. The world's response to COVID-19 demonstrates that it is possible for governments to take decisive action to avert an imminent crisis. The approach to solving both of these crises was the same: (1) identify the precise cause of the problem through expert scientific advice;(2) with support by the public, pass legislation focused on the cause of the problem;and (3) employ a robust feedback mechanism to assess progress and adjust the approach. This is not yet being done to solve the climate crisis, but working within the 2015 Paris Climate Agreement framework, it could be. Every nation can contribute to solving the climate crisis by: (1) changing their energy strategy to green energy sources instead of fossil fuels;and (2) critically reviewing every law, policy and trade agreement (including transport, food production, food sources and land use) that affects the climate crisis. © 2020 The Author(s).