ABSTRACT
The purpose — to study the peculiarities of the course of COVID-19 according to data of content analysis and the verbal-communicative method among children with SARS-CoV-2 infection. Materials and methods. The study of features of the course of COVID-19 among children was carried out using two methods: content analysis of 54 medical records of inpatients and a verbal-communicative method by surveying 53 patients with further subsequent comparative evaluation of these methods. SARS-CoV-2 infection was diagnosed by an express method with the TESTSEALABS testing kit. Verification of SARS-CoV-2 infection was carried out by detection of SARS-CoV-2 RNA by PCR. The data of both methods included age, sex, epidemiologi-cal history, complaints, assessment of the general condition, clinical manifestations, forms of the course of the disease, etc. Results. A comparative assessment of the two research methods showed that the verbal-communicative method, in comparison with the content analysis, made it possible to study in detail the features of the course of disease among children. In particular, the study found that the fever in most patients was remitting (significantly increased in the evening), lasting more than 5 days or more. Infants most often had pulmonary manifestations: cough, difficult breathing through the nose, shortness of breath at rest, fever, intermittent sucking of the breast or refusal of it, crying, restlessness;in isolated cases — febrile convulsions. In early and preschool age, in addition to pulmonary manifestations, the equivalent of anosmia/ageusia — «bad food» was detected;high frequency of gastrointestinal (abdominal pain, nausea, vomiting, acetonuria) and skin manifestations (covid cheilitis, injected sclera, papulo-vesicular rash, covid fingers). A milder course of the disease took place in junior and senior school age. In high school age, headache, musculoskeletal pain/ache, sore throat, hoarseness of voice, anosmia, ageusia were the most often noted — which resembled the course of COVID-19 in adults. Conclusions. A comparative assessment of content analysis and the verbal communicative method confirmed that in medical practice, for the in-depth study of features of the course of COVID-19, these two methods should be used in combination as complementary and mutually clarifying. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. © 2022, Group of Companies Med Expert, LLC. All rights reserved.
ABSTRACT
Background. Over 32 million cases of COVID-19 have been reported in the US. Outcomes range from mild upper respiratory infection to hospitalization, acute respiratory failure, and death. We assessed risk factors associated with severe disease, defined as hospitalization within 21 days of diagnosis or death, using US electronic health records (EHR). Methods. Patients in the Optum de-identified COVID-19 EHR database who were diagnosed with COVID-19 in 2020 were included in the analysis. Regularized multivariable logistic regression was used to identify risk factors for severe disease. Covariates included demographics, comorbidities, history of influenza vaccination, and calendar time. Results. Of the 193,454 eligible patients, 36,043 (18.6%) were hospitalized within 21 days of COVID-19 diagnosis, and 6,397 (3.3%) died. Calendar time followed an inverse J-shaped relationship where severe disease rates rapidly declined in the first 25 weeks of the pandemic. BMI followed an asymmetric V-shaped relationship with highest rates of disease severity observed at the extremes. In the multivariable model, older age had the strongest association with disease severity (odds ratios and 95% confidence intervals of significant associations in Figure). Other risk factors were male sex, uninsured status, underweight and obese BMI, higher Charlson Comorbidity Index, and individual comorbidities including hypertension. Asthma and overweight BMI were not associated with disease severity. Blacks, Hispanics, and Asians experienced higher odds of disease severity compared to Whites. Conclusion. Odds of hospitalization or death have decreased since the start of the pandemic, with the steepest decline observed up to mid-August, possibly reflecting changes in both testing and treatment. Older age is the most important predictor of severe COVID-19. Obese and underweight, but not overweight, BMI were associated with increased odds of disease severity when compared to normal weight. Hypertension, despite not being included in many guidelines for vaccine prioritization, is a significant risk factor. Pronounced health disparities remain across race and ethnicity after accounting for comorbidities, with minorities experiencing higher disease severity.