Prevalence, severity, and risk factor of breakthrough infection after vaccination with either the Covaxin or the Covishield among healthcare workers: A nationwide cross-sectional study.

Background and Aims: The coronavirus disease-2019 (COVID-19) pandemic has grappled the entire globe since the beginning of 2020. In India, two vaccines were released in January 2021, the Covaxin® and the Covishield™. However, despite vaccination, many breakthrough infections were reported during the second wave in India. The present cross-sectional study aimed to find out prevalence, severity, and associated risk factors of breakthrough infection among healthcare workers (HCWs) vaccinated against COVID-19. Material and Methods: After ethical approval and CTRI registration, a validated questionnaire was circulated as Google form-based survey to HCWs across the nation through e-mail over 3 weeks. Biweekly reminders were sent to nonresponders till the desired sample size was attained, after which the survey was closed, and responses were charted. Data obtained from the responses were collated and analyzed. Results: A total of 1096 HCWs responded to the survey (54.8% response rate) and 23.36% had breakthrough infection. The severity of infection was more in the 30-50 years age group (P = 0.0170) and doctors belonging to clinical branches (P = 0.0005). The point estimate for effectiveness in preventing infection was significantly better with Covishield™ (78.5% vs. 72.4%) (P = 0.0260). Nearly all those who were infected after vaccination thought that vaccination decreased disease severity. Conclusion: Breakthrough COVID-19 infection still occurred after vaccination though the prevalence of severe infection was low. Covishield™ performed significantly better than Covaxin® in terms of preventing the disease. Clinical branches of medicine were found at a higher risk and younger HCWs or those with comorbidities had a higher severity of the disease.

An Update on Initial Epidemiological Profile, Clinical Course, and Outcome of COVID-19 Patients at a Tertiary Care Center in India.

BACKGROUND AND AIM: Coronavirus disease 2019 (COVID-19) has become a global pandemic with the spectrum of disease from asymptomatic or mild disease to severe cases requiring intensive care unit (ICU) admission. In India, it started with milder presentation affecting younger population. Later on, an increase in disease severity was observed involving older age group as well. However, there is a paucity of published data regarding patients requiring ICU care in India. This case series describes the initial experience of an ICU in India regarding epidemiological profile, clinical course, and outcome of critically ill COVID-19 patients. METHODS: This case series included 27 consecutive laboratory-confirmed COVID-19 patients who were admitted in a tertiary care ICU over 14 days period, followed up till their discharge from ICU. Demographic and clinical data, including laboratory and radiological findings, were compiled with special attention to co-morbidities of the patients. The management of these patients was done as per the institutional protocol for critically ill COVID-19 patients. RESULTS: The median age of the patients was 50 years with no difference in gender. Comorbid conditions were seen in 85% of the patients with diabetes (43.7%) and hypertension (37.5%) as the most common conditions. The median duration of symptoms before admission was 6 days with fever as the most common clinical symptom at presentation. Chest roentogram showed bilateral lung infiltrates in 88.8% of the patients. Mild, moderate, and severe hypoxia were observed in 3, 8, and 16 patients, respectively. Ten patients were managed with oxygen therapy. Seventeen patients (62.9%) required ventilatory support. Mortality rate among patients admitted to our ICU was 59.2%. CONCLUSIONS: This case series shows middle-aged patients with comorbid diseases present with severe COVID-19 disease and have poor outcome.

COVID 19: The New Normal in the Clinic: Overcoming Challenges in Palliative Care.

BACKGROUND AND AIM: In the wave of COVID-19 pandemic, the whole world has come to a standstill. This led to a major setback for cancer patients jeopardizing their treatment plans. This study analyzes the coping mechanisms of running outpatient and inpatient palliative care services in these COVID-19 times - the New Normal. MATERIALS AND METHODS: An observational study was conducted in the pain and palliative care unit at a tertiary care hospital, India. The data were collected from March 23, 2020, to May 22, 2020, of all patients coming to the clinic and inpatient referrals. Using manual and electronic records, demographic data was collected along with clinical data. Additional data were compiled with special attention to the patient's pain and its management. RESULTS: Despite complete lockdown and initial low patient load, we saw a progressive increase in the number of patients coming to the clinic. A total of 108 patients visited our clinic (65 male and 43 female), of which 78% of the patients were from Delhi. The median age was 43.94 years (range 6 years to 76 years). We had 33 new and 75 old registered cases coming. The main reason was new-onset pain because of noncompliance of drugs; the opioid stock finished with the patient. We saw a very high number of patients requiring strong and weak opioids. Proper personal protection and social distancing helped in preventing crossinfection. None of our staff or patients fell ill during this time. Communication skills were modified to convey feelings and empathize patients. Telemedicine using phone and video calls was used and found to be useful. CONCLUSION: We share our experience and challenges of providing palliative care in our clinic which can be modified as per the individual requirements in other setups.

Social Stigma of COVID-19 Experienced by Frontline Healthcare Workers of Department of Anaesthesia and Critical Care of a Tertiary Healthcare Institution in Delhi.

BACKGROUND: Social stigma is associated with Coronavirus Disease-2019 (COVID-19) particularly against people who have contracted the disease or have come in contact with it. There is paucity of studies regarding the prevalence of social stigma against healthcare workers (HCWs) in COVID-19 hospitals in India. The objective of this study was to measure social stigma faced by frontline HCWs of Department of Anaesthesia and Critical Care in a COVID-19 hospital and to assess the relationship between sociodemographic characteristics and social stigma. PATIENTS AND METHODS: A cross-sectional study using a questionnaire (sociodemographic characteristics along with modified Berger HIV Stigma Scale) was conducted from October 10, 2020 to October 30, 2020, in the Department of Anaesthesia and Critical Care. The survey was distributed among frontline HCWs using Google Forms as well as Bilingual Physical Form. Total stigma and subgroups of stigma scale were measured for different sociodemographic parameters and compared. Data were presented as mean ± standard deviation. p-value <0.05 was taken as significant. RESULTS: Out of 120 frontline HCWs participated in the study, 68 (56.6%) reported severe level of COVID-19-related stigma. The mean score of COVID-19-related stigma was 41 + 7.69. Mean scores for subgroups of stigma scale, i.e., personalized stigma, disclosure concerns, negative self-image, and concerns with public attitude, were 15.60 + 4.01, 6.68 + 3.21, 5.46 + 3.22, and 13.25 + 2.44, respectively. In the univariate analysis, the overall COVID-19-related stigma scores were associated with age >30 years, male gender, lower designation (technicians and nursing orderly), lesser education, and married HCWs. In logistic regression model, only male gender was significantly associated with severity of COVID-19 stigma. CONCLUSION: This study concluded that more than half of frontline HCWs in the Department of Anaesthesia and Critical Care experienced severe social stigma during COVID-19 pandemic, with highest stigma in concerns with public attitude subgroup. Severity of stigma was associated with age, male gender, designation, education, and marital status of HCW. HIGHLIGHTS: Frontline HCWs of Department Anaesthesia and Critical Care experienced significant stigma related to COVID-19. HOW TO CITE THIS ARTICLE: Jain S, Das AK, Talwar V, Kishore J, Heena, Ganapathy U. Social Stigma of COVID-19 Experienced by Frontline Healthcare Workers of Department of Anaesthesia and Critical Care of a Tertiary Healthcare Institution in Delhi. Indian J Crit Care Med 2021;25(11):1241-1246.

Neurological Manifestations of COVID-19: A Series of Seven Cases.

Identification of neurological manifestations associated with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) in patients with no or mild pulmonary infection proves to be a challenge. The incidence of neurological associations of COVID-19 may be small as compared with respiratory disease; however, in the present scenario with an increasing number of cases each day, the overall incidence of patients with neurological manifestations and their health-related socioeconomic impact might be large. Hence it is important to report such cases so that healthcare providers and concerned authorities are aware of and may prepare for the growing burden. The literature on primary neurological manifestations of COVID-19 is limited, and hence our case series is relevant in the current scenario. The most commonly reported neurological complications are cerebrovascular accidents, encephalopathy, encephalitis, meningitis, and Guillain-Barr é syndrome (GBS). We present a series of seven cases with various neurological presentations and possible complications from this novel virus infection. HOW TO CITE THIS ARTICLE: Goel K, Kumar A, Diwan S, Kohli S, Sachdeva HC, Usha G, et al. Neurological Manifestations of COVID-19: A Series of Seven Cases. Indian J Crit Care Med 2021;25(2):219-223.

Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study.

BACKGROUND: Healthcare workers (HCWs) are at increased risk of exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Personal protective equipment (PPE) is mandated for HCWs. However, the physiological effects on the HCWs while working in the protective gear remains unexplored. This study aimed to assess the physiological effects of the prolonged use of PPE on HCWs. MATERIALS AND METHODS: Seventy-five HCWs, aged 18-50 years were enrolled in this prospective, observational, cohort study. The physiological variables [heart rate, oxygen saturation, and perfusion index (PI)] were recorded at the start of duty, 4 hours after wearing N95 filtering facepiece respirator (FFR), pre-donning, and post-doffing. The rating of perceived exertion (RPE) score and modified Borg scale for dyspnea was evaluated. The physiological variables were represented as the mean ± standard deviation. Wilcoxon signed-rank test was used to show any difference in RPE and modified Borg scale for dyspnea. A p value of <0.05 was considered significant. RESULTS: There is a statistically significant difference in the physiological parameters post-doffing compared with baseline: Heart rate (p < 0.001); oxygen saturation (p < 0.001); PI (p < 0.001). RPE score showed increased discomfort with continuous use of N95 FFR. However, exertion increased only marginally. The major adverse effects noted with PPE use were fogging, headache, tiredness, difficulty in breathing, and mask soakage, with a resultant mean duration of donning to be 3.1 hours. CONCLUSION: The use of PPE can result in considerable changes in the physiological variables of healthy HCWs. The side effects may lead to excessive exhaustion and increased tiredness after prolonged shifts in the intensive care unit (ICU) while wearing PPE. HOW TO CITE THIS ARTICLE: Choudhury A, Singh M, Khurana DK, Mustafi SM, Ganapathy U, Kumar A, et al. Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(12):1169-1173.