ABSTRACT
Research Objectives To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes and trajectories at 6 and 12 months post-hospitalization. Design Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. Setting Acute care and post-acute telephone follow-up. Participants English- and Spanish- speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient rehabilitation for acute COVID-19 related illness (N = 61). Interventions N/A. Main Outcome Measures Physical, cognitive, and psychological symptoms;self-reported employment status and assistance with ADLs. Results Median age 60.8 years;59% male;72.1% white;72.1% non-Hispanic;26.2% preferred assessment in Spanish. 83% required mechanical ventilation in acute care. Comorbidities were common. We found a high prevalence of persistent symptoms at 6- and 12- months across physical, cognitive, and emotional health outcome domains. Three post-acute phenotypes were identified at 6 months;a "minimally symptomatic" subgroup with minimal symptom endorsement across all domains relative to other subjects (22.95%, n = 14), a “predominantly physical symptoms” subgroup (47.54%, n = 29), and a “globally symptomatic” subgroup (29.51%, n = 18). A similar pattern for phenotypes emerges at 12-months, with 67.21% of subjects falling into the same phenotype at both time points. In the Predominantly Physical Symptom phenotype, 31.0% declined into the Globally Symptomatic Phenotype and 10.3% improved. In the Globally Symptomatic phenotype, 11.1% of participants transitioned to the Minimally Symptomatic phenotype and 16.7% to the Predominantly Physical Symptom phenotype. Compared to premorbid level of employment (50.8%), 24.6% of participants were employed at 12-months. Phenotype at 6-months was a significant predictor of employment at 12-months (B = 2.26, p = .05, OR = 9.6). Conclusions Persons with severe COVID-19 illness experience persistent functional limitations and reduced employment up to 12 months post-hospitalization. Distinct recovery subgroups were found suggesting the need for comprehensive assessment and tailored treatment for recovery. Author(s) Disclosures The authors declare no relevant conflicts of interest.
ABSTRACT
Spain is a country with an important flow of cruises in Europe. Since the restarting of cruise activity, 1,106 events with 12,134 confirmed cases of COVID-19 were reported from 21 ports. 72.3% of cases and 73.7% of events were registered in the Balearic Islands, Barcelona, Tenerife and Las Palmas, ports with the highest number of layovers and passengers. The events reported increased from October 2021, with a peak in January and April 2022. The cases raised later, in December 2021 with two peaks in January and April and a substantial increase in June 2022. The peak of January coincides with the peak of COVID-19 cases registered in Spain and Europe. The increases in April and June 2022 coincides with the Easter period and the beginning of summer holidays.
ABSTRACT
To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes at 6 months post-hospitalization. Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. Acute care and post-acute telephone follow-up. Spanish- and English-speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient hospitalization for acute COVID-19 related illness (N = 52). N/A. Physical, cognitive, and psychological symptoms;Self-reported employment status and assistance with ADLs. Median age was 60.96 (IQR = 20.89), with race/ethnicity representative of the US adult population (71% White;13% Black;27% Hispanic). Compared to premorbid status, 33% of individuals were no longer employed full-time and 23% were no longer independent in basic ADLs. Latent profile analysis identified distinct subgroups within physical, cognitive, and emotional domains of functioning. Approximately 31% were in either the moderately or most symptomatic groups for both cognitive and emotional functioning, with 88% of these also falling into the most symptomatic group for physical functioning. There were 29% in the least symptomatic group across all domains. Persons with severe COVID-19 illness experience persistent functional limitations that interfere with employment and ADLs up to 6 months post-hospitalization. Although symptom variability is high at 6 months, we identified distinct subgroups, including those with co-occurring emotional and cognitive symptoms, that suggest the need for comprehensive assessment and tailored treatment for physical, emotional, and cognitive symptoms. The author's declare no relevant conflict of interests.
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Goal: The aim of the study herein reported was to review mobile health (mHealth) technologies and explore their use to monitor and mitigate the effects of the COVID-19 pandemic. Methods: A Task Force was assembled by recruiting individuals with expertise in electronic Patient-Reported Outcomes (ePRO), wearable sensors, and digital contact tracing technologies. Its members collected and discussed available information and summarized it in a series of reports. Results: The Task Force identified technologies that could be deployed in response to the COVID-19 pandemic and would likely be suitable for future pandemics. Criteria for their evaluation were agreed upon and applied to these systems. Conclusions: mHealth technologies are viable options to monitor COVID-19 patients and be used to predict symptom escalation for earlier intervention. These technologies could also be utilized to monitor individuals who are presumed non-infected and enable prediction of exposure to SARS-CoV-2, thus facilitating the prioritization of diagnostic testing.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view. METHODS: Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. RESULTS: Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period. CONCLUSION: During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately.