Elderly Population Has Higher Prevalence of Polypharmacy Associated with Poor Quality of Life and Low Compliance after Recovery from COVID-19.

Background: Long term effects of COVID are not fully understood yet. The geriatric population has been badly affected. The impact of COVID-19 on the health-related quality of life after recovery and patient compliance is a matter of concern especially in the geriatric population where polypharmacy is often prevalent. Aims and Objectives: This study intended to observe the occurrence of polypharmacy (PP) among COVID-19 recovered older patients with multimorbidity and explore its association with health-related quality of life and compliance in these patients. Materials and Methods: Total 90 patients, above 60 years of age having two or more co-morbidities and recovered from COVID-19 infection were included in this cross-sectional study. Number of pills taken daily by each patient was noted, to determine the occurrence of PP. WHO-QOL-BREF was used to assess the effect of PP on health-related quality of life (HRQOL). Medication adherence was measured using a self-reported questionnaire. Results: PP was found in 94.4% while hyper polypharmacy was found in 45.56% of patients. The overall mean score of HRQOL in patients with PP was 187.91 ± 32.98, indicating poor quality of life with PP (p value 0.0014) whereas the overall mean score of HRQOL in patients with hyper polypharmacy was 177.41 ± 26.11, showing poor quality of life with hyper polypharmacy (p value 0.0005). Increased number of pills corelated with poor quality of life (r =0.49). The medication adherence was found to be poor in patients who received mean number of pills 10.44 ± 2.62 whereas the adherence was good if the mean number of pills was 8.20 ± 2.63, (p value of 0.0001). Conclusion: Polypharmacy is highly prevalent among COVID-19 recovered patients and is associated with poor quality of life as well as poor medication adherence.

Early Warning Scores at Time of ICU Admission to Predict Mortality in Critically Ill COVID-19 Patients.

OBJECTIVE: To assess ability of National Early Warning Score 2 (NEWS2), systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), and CRB-65 calculated at the time of intensive care unit (ICU) admission for predicting ICU mortality in patients of laboratory confirmed coronavirus disease 2019 (COVID-19) infection. METHODS: This prospective data analysis was based on chart reviews for laboratory confirmed COVID-19 patients admitted to ICUs over a 1-mo period. The NEWS2, CRB-65, qSOFA, and SIRS were calculated from the first recorded vital signs upon admission to ICU and assessed for predicting mortality. RESULTS: Total of 140 patients aged between 18 and 95 y were included in the analysis of whom majority were >60 y (47.8%), with evidence of pre-existing comorbidities (67.1%). The most common symptom at presentation was dyspnea (86.4%). Based upon the receiver operating characteristics area under the curve (AUC), the best discriminatory power to predict ICU mortality was for the CRB-65 (AUC: 0.720 [95% confidence interval [CI]: 0.630-0.811]) followed closely by NEWS2 (AUC: 0.712 [95% CI: 0.622-0.803]). Additionally, a multivariate Cox regression model showed Glasgow Coma Scale score at time of admission (P < 0.001; adjusted hazard ratio = 0.808 [95% CI: 0.715-0.911]) to be the only significant predictor of ICU mortality. CONCLUSIONS: CRB-65 and NEWS2 scores assessed at the time of ICU admission offer only a fair discriminatory value for predicting mortality. Further evaluation after adding laboratory markers such as C-reactive protein and D-dimer may yield a more useful prediction model. Much of the earlier data is from developed countries and uses scoring at time of hospital admission. This study was from a developing country, with the scores assessed at time of ICU admission, rather than the emergency department as with existing data from developed countries, for patients with moderate/severe COVID-19 disease. Because the scores showed some utility for predicting ICU mortality even when measured at time of ICU admission, their use in allocation of limited ICU resources in a developing country merits further research.

Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent.

The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.

Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent

The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.

JUE insights: Does mobility explain why slums were hit harder by COVID-19 in Mumbai, India?

SARS-CoV-2 has had a greater burden, as measured by rate of infection, in poorer communities within cities. For example, 55% of Mumbai slums residents had antibodies to COVID-19, 3.2 times the seroprevalence in non-slum areas of the city according to a sero-survey done in July 2020. One explanation is that government suppression was less severe in poorer communities, either because the poor were more likely to be exempt or unable to comply. Another explanation is that effective suppression itself accelerated the epidemic in poor neighborhoods because households are more crowded and residents share toilet and water facilities. We show there is little evidence for the first hypothesis in the context of Mumbai. Using location data from smart phones, we find that slum residents had nominally but not significantly (economically or statistically) higher mobility than non-slums prior to the sero-survey. We also find little evidence that mobility in non-slums was lower than in slums during lockdown, a subset of the period before the survey.

Effect of convalescent plasma therapy on mortality in moderate-to-severely Ill COVID-19 patients.

INTRODUCTION: The role of plasma therapy in the management of the COVID-19, pandemic has been speculated. However, in view of the varied response regarding its effectiveness from various multicenter studies, there is a need to conduct more single center population-specific studies. We, thus, aimed to assess the role of convalescent plasma therapy in COVID-19 patient management in a single -center. METHODS: This retrospective study was conducted using records of all COVID-19 patients who received plasma therapy over a period of 6 months in a dedicated COVID-19 hospital in Delhi. Information pertaining to transfusion, disease severity, associated comorbidities, the treatment given and patient outcome were recorded. Data was analyzed using SPSSv23. RESULTS: Of the141 patients who received plasma therapy, 62% were discharged after treatment. Mortality was found to be significantly higher in patients > 60 years of age (p < 0.001), those with severe COVID-19 infection (p < 0.05) and pre-existing renal disease (p < 0.05). The admission-transfusion interval was significantly correlated to mortality and was a sensitive parameter for predicting outcome at cut off value of < 5 days (p < 0.001). There was no significant association of mortality with patient blood group, plasma antibody levels or donor hemoglobin levels. CONCLUSIONS: We report improvement and recovery in a large number of patients who received convalescent plasma within the first 5 days of hospitalization with moderate to severe disease. Further research to compare dosage and administration protocols to delineate role of CCP in survival of COVID-19 patients is needed before it is prematurely shelved.

Thyroid Function Abnormalities in the Acute Phase of COVID-19: A Cross-Sectional Hospital-Based Study From North India.

Introduction Viral illnesses like mumps, cytomegalovirus (CMV), and Cocksakievirus have been shown to affect the endocrine system, specifically the thyroid as a product of their systemic inflammatory process. The thyroid gland, having high levels of angiotensin-converting enzyme 2 (ACE2) is also predisposed to dysfunction due to coronavirus disease 2019 (COVID-19). Methodology A cross-sectional study was conducted using retrospective data of thyroid function tests in patients with COVID-19. Results The majority of patients with COVID-19 had normal thyroid function while low serum T3, seen in 47.3% of patients with severe disease, stood out as the most common thyroid abnormality in the acute phase of the disease. The disease severity was seen to correlate with the extent of thyroid function abnormalities, with severely diseased patients having lower T3 values and normal to low thyroid-stimulating hormone (TSH) values. Furthermore, a significant negative correlation was seen between TSH and the bio-inflammatory marker, C-reactive protein (CRP). Conclusion The acute phase of COVID-19 affects thyroid function in direct correlation with the severity of the disease.

A systematic review of the smartphone applications available for coronavirus disease 2019 (COVID19) and their assessment using the mobile app rating scale (MARS)

The global impact of COVID-19 pandemic has increased the need to rapidly develop and improve utilization of mobile applications across the healthcare continuum to address rising barriers of access to care due to social distancing challenges and allow continuity in sharing of health information, assist with COVID-19 activities including contact tracing, and providing useful information as needed. Here we provide an overview of mobile applications being currently utilized for COVID-19 related activities. We performed a systematic review of the literature and mobile platforms to assess mobile applications been currently utilized for COVID-19, and quality assessment of these applications using the Mobile Application Rating Scale (MARS) for overall quality, Engagement, Functionality, Aesthetics, and Information. Finally, we provide an overview of the key salient features that should be included in mobile applications being developed for future use. Our search identified 63 apps that are currently being used for COVID-19. Of these, 25 were selected from the Google play store and Apple App store in India, and 19 each from the UK and US. 18 apps were developed for sharing up to date information on COVID-19, and 8 were used for contact tracing while 9 apps showed features of both. On MARS Scale, overall scores ranged from 2.4 to 4.8 with apps scoring high in areas of functionality and lower in Engagement. Future steps should involve developing and testing of mobile applications using assessment tools like the MARS scale and the study of their impact on health behaviors and outcomes.

Does Mobility Explain Why Slums Were Hit Harder by COVID-19 in Mumbai, India?

SARS-CoV-2 has had a greater burden, as measured by rate of infection, in poorer communities within cities. For example, 55% of Mumbai slums residents had antibodies to COVID-19, 3.2 times the seroprevalence in non-slum areas of the city according to a sero-survey done in July 2020. One explanation is that government suppression was less severe in poorer communities, either because the poor were more likely to be exempt or unable to comply. Another explanation is that effective suppression itself accelerated the epidemic in poor neighborhoods because households are more crowded and residents share toilet and water facilities. We show there is little evidence for the first hypothesis in the context of Mumbai. Using location data from smart phones, we find that slum residents had nominally but not significantly (economically or statistically) higher mobility than non-slums prior to the sero-survey. We also find little evidence that mobility in non-slums was lower than in slums during lockdown, a subset of the period before the survey.

Plasma Von Willebrand Factor Levels Predict Survival in COVID-19 Patients Across the Entire Spectrum of Disease Severity.

BACKGROUND: Characterization of reticulo-endothelial activation in COVID-19 may guide treatment. OBJECTIVES: To assess reticulo-endothelial activation and its correlation with disease severity and death in patients across the entire spectrum of COVID-19 severity. METHODS: Consecutive hospitalized COVID-19 patients were studied, with similar number of patients in each disease severity category. Baseline serum ferritin, sCD163 (macrophage activation markers) and plasma von Willebrand factor (VWF) antigen (endothelial activation marker) levels were studied. Clinical parameters and plasma D-dimer levels were also studied. The study parameters were correlated with COVID-19 severity and survival. RESULTS: The 143 patients (104 males [80%], age 54 [42 - 65] years, median [inter-quartile range]) presented 4 (3-7) days after symptom onset. Thirty-four patients had mild disease, 36 had moderate disease, 36 had severe disease and 37 had critical disease at baseline. With increasing COVID-19 severity, ferritin, sCD163, VWF and D-dimer levels significantly increased at baseline, however, 139 patients had normal sCD163 levels. Of the reticulo-endothelial markers, VWF level independently correlated with COVID-19 severity and with survival. VWF level > 332.6 units/dl correlated with COVID-19 severity (odds ratio [OR]: 2.77 [95% confidence interval (C.I): 1.1 - 6.99], p value: 0.031) and in-hospital death (OR [95% CI]: 29.28 [5.2 - 165], p value < 0.001). CONCLUSIONS: Reticulo-endothelial activation markers increased incrementally with worsening COVID-19 severity. Baseline endothelial activation marker (VWF), and not macrophage activation markers, independently correlated with COVID-19 severity and death.

Correlates of In-Hospital COVID-19 Deaths: A Competing Risks Survival Time Analysis of Retrospective Mortality Data.

INTRODUCTION: Several aspects of the coronavirus disease 2019 (COVID-19) pandemic remain ambiguous, including its transmission, severity, geographic, and racial differences in mortality. These variations merit elaboration of local patterns to inform wider national policies. METHODS: In a retrospective analysis, data of patients treated at a dedicated COVID hospital with moderate and severe illness during 8 wk of the pandemic were reviewed with attention to mortality in a competing risks framework. RESULTS: A total of 1147 patients were hospitalized, and 312 (27.2%) died in hospital. Those who died were older (56.5 vs 47.6 y; P < 0.0001). Of these, 885 (77.2%) had tested positive on reverse transcriptase polymerase chain reaction (RT-PCR), with 219 (24.2%) deaths (incidence rate, 1.9 per 100 person-days). Median time from onset of symptoms to death was 11 days. A competing risks analysis for in-hospital death revealed an adjusted cause-specific hazard ratio of 1.4 for each decade increase in age. CONCLUSIONS: This retrospective analysis provides broad patterns of disease presentation and mortality. Even COVID test-negative patients will receive treatment at dedicated facilities, and 33% presenting cases may die within the first 72 h, most with comorbid illness. This should be considered while planning distribution of services for effective health-care delivery.

COVID-19 and Psychological Disaster Preparedness - An Unmet Need.

OBJECTIVE: The coronavirus disease (COVID-19) pandemic is a disaster of unprecedented proportions with global repercussions. Psychological preparedness, the primed cognitive awareness and anticipation of dealing with emotional responses in an adverse situation, has assumed a compelling relevance during a health disaster of this magnitude. METHODS: An anonymized eSurvey was conducted in India to assess psychological preparedness toward the ongoing pandemic with a focus on knowledge, management of own and others' emotional response, and anticipatory coping mechanisms among the survey population. An adapted version of the qualitative Psychological Preparedness for Natural Disaster Scale validated by the World Health Organization was widely circulated over the Internet and various social media platforms for assessment. Results are expressed as median ± standard deviation. Descriptive statistics were used and figures downloaded from surveymonkey.com. RESULTS: Of the 1120 respondents (M:F 1.7:1, age 35 years ±14.1), most expressed a high level of perceived knowledge and confidence of managing COVID-19, such as awareness of the symptoms of the illness (95.1%), actions needed (94.4%), hospital to report to (88.9%), and emergency contact number (89.1%). A majority (95%) monitored regularly the news bulletins and scientific journals regarding COVID-19. However, nearly one-third (29.2%) could not assess their likelihood of developing COVID-19, and 17.5% were unaware of the difference between a mild and severe infection. Twenty-three percent (23.3%) were unfamiliar with the materials needed in an acute illness situation. CONCLUSION: Psychological disaster preparedness is reasonable, although lacking in specific domains. Timely but focused interventions can be a cost-efficient administrative exercise, which federal agencies may prioritize working on.

Private Health Sector in India-Ready and Willing, Yet Underutilized in the Covid-19 Pandemic: A Cross-Sectional Study.

Background: The private medical sector is a resource that must be estimated for efficient inclusion into public healthcare during pandemics. Methods: A survey was conducted among private healthcare workers to ascertain their views on the potential resources that can be accessed from the private sector and methods to do the same. Results: There were 213 respondents, 80% of them being doctors. Nearly half (47.4%) felt that the contribution from the private medical sector has been suboptimal. Areas suggested for improved contributions by the private sector related to patient care (71.8%) and provision of equipment (62.4%), with fewer expectations (39.9%) on the research front. Another area of deemed support was maintaining continuity of care for non-COVID patients using virtual consultation services (77.4%), tele-consultation being the preferred option (60%). 58.2% felt that the Government had not involved the private sector adequately; and 45.1% felt they should be part of policy-making. Conclusion: A streamlined pathway to facilitate the private sector to join hands with the public sector for a national cause is the need of the hour. Through our study, we have identified gaps in the current contribution by the private sector and identified areas in which they could contribute, by their own admission.

Profile of Patients Suspected to be COVID-19: A Retrospective Analysis of Early Pandemic Data.

Background and Objectives Coronavirus disease 2019 (COVID-19), a global public health emergency of profound magnitude, has brought life to an unprecedented near-standstill. The clinical profile of the disease is still emerging and is marked by considerable geographical variability in terms of transmissibility, clinical profile, virulence, and mortality of the disease. As clinical data is being reported from around the globe, it becomes important to focus on local subjects in a global milieu, lest one misses the trees for the forest. Our study is a short retrospective analysis of the demographic and clinical profiles of subjects presenting with a mild flu-like illness to our hospital who were tested for COVID-19. It compares the differences in age and sex of those who tested positive with those negative. In addition, it reviews the length of time it might take for a case testing positive on reverse transcriptase-polymerase chain reaction (RT-PCR) test to become negative. Methodology A retrospective analysis of data from adults who presented to our hospital with a mild flu-like illness between the months of March and May 2020 was conducted to understand the disease profile. The nasal/oropharyngeal swabs were collected from each patient and were transported to state-approved laboratories chain for RT-PCR analysis. Information was collected from reports received, clinical information forms, and sample collection forms that were being maintained as a part of the clinical management protocol. Data were analysed using Stata software, version 13 (StataCorp LLC, College Station, TX, USA). Observations and Results Three thousand twenty-six subjects presented to our hospital with either mild flu-like symptoms or with suspected exposure to a confirmed case of COVID-19. The subjects had a mean age of 37.3 (± 15.1) years and 1,805 (60.3%) were males. A regression analysis revealed an adjusted odds of 1.6 (95% confidence interval (CI): 1.2, 2.1) for testing positive for males as compared to females. For every one year increase in age, the odds for testing positive increased by 1.02 (95% CI: 1.01, 1.03). Of the 2,592 individuals for whom data was available, 201 (7.6%) were found positive on RT-PCR analysis. Those testing positive were significantly older (41.0 years vs 36.8 years; p = 0.001) and more likely to be male (number: 138; 9.0% vs 6.7%; p = 0.05). Cough, followed by fever, was a common presenting feature. A survival time analysis using data from 54 participants documented 455 days of the total observation period. A median time of eight days was required for the test to convert from positive to negative if the patient remained mildly symptomatic and did not develop a severe complicated illness. The time to conversion did not differ with age or sex. Conclusions Our analysis shows that patients with COVID-19 have presented with milder symptoms and have recovered well. The low test positivity rate is indicative of the early phase of the pandemic in the country and is a reflection of active infection control measures.

A Systematic Review of Smartphone Applications Available for Corona Virus Disease 2019 (COVID19) and the Assessment of their Quality Using the Mobile Application Rating Scale (MARS).

The global impact of COVID-19 pandemic has led to a rapid development and utilization of mobile health applications. These are addressing the unmet needs of healthcare and public health system including contact tracing, health information dissemination, symptom checking and providing tools for training healthcare providers. Here we provide an overview of mobile applications being currently utilized for COVID-19 and their assessment using the Mobile Application Rating Scale. We performed a systematic review of the literature and mobile platforms to assess mobile applications currently utilized for COVID-19, and a quality assessment of these applications using the Mobile Application Rating Scale (MARS) for overall quality, Engagement, Functionality, Aesthetics, and Information. Finally, we provide an overview of the key salient features that should be included in mobile applications being developed for future use. Our search identified 63 apps that are currently being used for COVID-19. Of these, 25 were selected from the Google play store and Apple App store in India, and 19 each from the UK and US. 18 apps were developed for sharing up to date information on COVID-19, and 8 were used for contact tracing while 9 apps showed features of both. On MARS Scale, overall scores ranged from 2.4 to 4.8 with apps scoring high in areas of functionality and lower in Engagement. Future steps should involve developing and testing of mobile applications using assessment tools like the MARS scale and the study of their impact on health behaviours and outcomes.