Prevalence of probable post-COVID cardiac sequelae and its health seeking behaviour among health care workers: A cross-sectional analytical study

Background Post-COVID Sequelae are considered as the signs and symptoms that develop during or after an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by alternative diagnosis. The prevalence of post-COVID cardiac sequelae ranges from 2% to 71% across the globe and it is reported to be around 22% in India. With this background, the study was conducted to assess the prevalence of probable post-COVID cardiac sequelae (PCCS) and delay in health-seeking for post-COVID cardiac sequelae among healthcare workers. Methods A facility-based cross-sectional study was conducted among health workers and students in a medical educational institute in Karnataka from May 2022 to July 2022. Health workers and students who had a past history of COVID-19 during the COVID pandemic were included in the study. Socio-demographic details, clinical profile, symptoms of post-COVID cardiac sequelae, and health-seeking behavior were collected. Data were collected in Epicollect5 and analyzed using STATA statistical software. The prevalence of probable PCCS was expressed with 95% confidence interval. Univariate binomial logistic regression was done to assess the determinants of probable post-COVID sequelae. Results A total of 336 health workers were included in the study with a mean (SD) age of 25.6 (8.6) years. A majority (68.2%) of them were females and only 25 (7.4%) belonged to the age group of 45-60 years. The prevalence of probable post-COVID cardiac sequelae among health workers and medical students was 11.9% (95% CI: 8.76 - 15.7). Among the 40 participants who had probable post-COVID cardiac sequelae, 55% (95% CI: 40% - 70%) were not evaluated further which was their treatment-seeking behavior. Females, hypertensive individuals, and those who had moderate-severe disease during acute COVID-19 disease were at higher risk of developing probable post-COVID cardiac sequelae. Conclusion Around one out of ten individuals had experienced probable post-COVID cardiac sequelae, but only half of them got evaluated for it. An appropriate screening program for post-COVID cardiac sequelae needs to be implemented along with awareness-raising activities about long COVID to prevent the morbidity and mortality associated with it.

Clinical presentation and mortality risk factors for COVID-19 among diabetic patients in a tertiary care center in South India.

BACKGROUND: Non-communicable diseases (NCD) like hypertension, diabetes, cardiovascular and cerebrovascular diseases are the most common comorbidities among COVID-19 patients. The clinical presentation and mortality pattern of COVID-19 are different for patients with comorbidities and without comorbidities. OBJECTIVE: To determine the clinical presentation of COVID-19 and risk factors for COVID-19 mortality among diabetic patients in a tertiary care hospital in South India. METHODS: A record-based cross-sectional study was conducted by reviewing the case records of COVID-19 patients admitted for treatment from June 2020 to September 2020 in a tertiary care centre in South India. Potential risk factors for COVID-19 mortality were analysed using univariate binomial logistic regression, generalized linear models (GLM) with the Poisson distribution. Survival curves were made using the Kaplan-Meier method. RESULTS: Out of 200 COVID-19 patients with diabetes with a mean (SD) age of 56.1 (11.8) years, 61% were men. The median survival time was slightly lesser in male COVID-19 patients (15 days) as compared to female patients (16 days). The risk of mortality among COVID-19 patients with diabetes is increased for patients who presented with breathlessness (aRR = 4.5 (95% CI: 2.3-8.8)), had positive history of smoking (aRR = 1.9 (95% CI: 1.1-3.8)), who had CKD (aRR = 1.8 (95% CI: 1.1-2.8)) and who had cardiac illness (aRR = 1.6 (95% CI: 0.9-2.7)). CONCLUSION: Diabetes patients with COVID-19 need to be given additional care and monitoring especially if they present with breathlessness, positive history of smoking, cardiac illness and, CKD. Public health campaigns and health education activities to control smoking is needed to reduce the COVID-19 mortality in diabetes patients.

White paper on challenges and opportunities for TB elimination with focus on COVID & Post-COVID era developed through scientific roundtable resolutions at NATCON 2020.

A group of TB experts with vast clinical and epidemiological experience were drawn from a pool of doctors, epidemiologists and scientists participating in NATCON 2020 Conference in a closed-door session to discuss, highlight, and prioritize key resolutions that are most pertinent at present to eliminate TB from India and other developing countries in the Covid and post-COVID era. These Scientific experts were non-industry persons who met on 17th December, 2020 and used the prevailing scientific literature along with 2019 Joint Monitoring Mission document as a starting point of the discussion on this specific topic to build an agreement upon the resolutions. After the meeting on the virtual platform, all the attending doctors gave a set of recommendations on rebuilding TB Elimination programme in the Covid and Post-Covid era. Focused scientific roundtable discussion on rebuilding TB Elimination Post-Covid. Develop actionable recommendations for the scientific community and the government leadership to consider in moving forward. To prioritize the recommendations in the categories of Build-Prevent-Detect-Treat.

COVID-19 and tuberculosis: A mathematical model based forecasting in Delhi, India.

BACKGROUND: There is emerging evidence that patients with Latent Tuberculosis Infection(LTBI) and Tuberculosis(TB) disease have an increased risk of the SARS-CoV-2 infection and predisposition towards developing severe COVID-19 pneumonia. In this study we attempted to estimate the number of TB patients infected with SARS-CoV-2 and have severe disease during the COVID-19 epidemic in Delhi, India. METHODS: Susceptible-Exposed-Infectious-Recovered (SEIR) model was used to estimate the number of COVID-19 cases in Delhi. Assuming the prevalence of TB in Delhi to be 0.55%, 53% of SARS-CoV2 infected TB cases to present with severe disease we estimated the number of SARS-CoV2 infected TB cases and the number of severe patients. The modelling used estimated R0 for two scenarios, without any intervention and with public health interventions. RESULTS: We observed that the peak of SARS-CoV-2-TB co-infected patients would occur on the 94th day in absence of public health interventions and on 138th day in presence of interventions. There could be 20,880 SARS-CoV-2 infected TB cases on peak day of epidemic when interventions are implemented and 27,968 cases in the absence of intervention. Among them, there could be 14,823 patients with severe disease when no interventions are implemented and 11,066 patients with severe disease in the presence of intervention. CONCLUSION: The importance of primary prevention measures needs to be emphasized especially in TB patients. The TB treatment centres and hospitals needs to be prepared for early diagnosis and management of severe COVID-19 in TB patients.