Viral reactivations and co-infections in COVID-19 patients: a systematic review.

BACKGROUND: Viral reactivations and co-infections have been reported among COVID-19 patients. However, studies on the clinical outcomes of different viral reactivations and co-infections are currently in limit. Thus, the primary purpose of this review is to perform an overarching investigation on the cases of latent virus reactivation and co-infection in COVID-19 patients to build collective evidence contributing to improving patient health. The aim of the study was to conduct a literature review to compare the patient characteristics and outcomes of reactivations and co-infections of different viruses. METHODS: Our population of interest included confirmed COVID-19 patients who were diagnosed with a viral infection either concurrently or following their COVID-19 diagnosis. We extracted the relevant literature through a systematic search using the key terms in the online databases including the EMBASE, MEDLINE, Latin American Caribbean Health Sciences Literature (LILACS), from inception onwards up to June 2022. The authors independently extracted data from eligible studies and assessed the risk of bias using the Consensus-based Clinical Case Reporting (CARE) guidelines and the Newcastle-Ottawa Scale (NOS). Main patient characteristics, frequency of each manifestation, and diagnostic criteria used in studies were summarized in tables. RESULTS: In total, 53 articles were included in this review. We identified 40 reactivation studies, 8 coinfection studies, and 5 studies where concomitant infection in COVID-19 patients was not distinguished as either reactivation or coinfection. Data were extracted for 12 viruses including IAV, IBV, EBV, CMV, VZV, HHV-1, HHV-2, HHV-6, HHV-7, HHV-8, HBV, and Parvovirus B19. EBV, HHV-1, and CMV were most frequently observed within the reactivation cohort, whereas IAV and EBV within the coinfection cohort. In both reactivation and coinfection groups, patients reported cardiovascular disease, diabetes, and immunosuppression as comorbidities, acute kidney injury as complication, and lymphopenia and elevated D-dimer and CRP levels from blood tests. Common pharmaceutical interventions in two groups included steroids and antivirals. CONCLUSION: Overall, these findings expand our knowledge on the characteristics of COVID-19 patients with viral reactivations and co-infections. Our experience with current review indicates a need for further investigations on virus reactivation and coinfection among COVID-19 patients.

The Enhancing Life Research Laboratory: Tools for Addressing Orientational Distress in the Medical Profession.

PURPOSE: To explore distress in the medical profession and how it was highlighted by the ongoing COVID-19 pandemic. The term "orientational distress" was developed to name the experience of a breakdown in the patterns of moral self-understanding and one's capacity to navigate professional responsibilities. METHOD: The Enhancing Life Research Laboratory at the University of Chicago convened a 5-session online workshop (total 10 hours, May-June 2021) to explore orientational distress and to promote collaboration between academics and physicians. Sixteen participants from Canada, Germany, Israel, and the United States engaged in discussions of the conceptual framework and toolkit to address orientational distress within institutional settings. The tools included 5 dimensions of life, 12 dynamics of life, and the role of counterworlds. Follow-up narrative interviews were transcribed and coded using a consensus-based iterative process. RESULTS: Participants reported that the concept of orientational distress helped explain their professional experiences better than burnout or moral distress. Moreover, participants strongly endorsed the project's supporting thesis that collaborative work on orientational distress and the tools provided in the research laboratory had a specific intrinsic value and provided benefits not found in other support instruments. CONCLUSIONS: Orientational distress compromises medical professionals and threatens the medical system. Next steps include the dissemination of materials from the Enhancing Life Research Laboratory to more medical professionals and medical schools. In contrast to burnout and moral injury, the concept of orientational distress may better enable clinicians to understand and more fruitfully navigate the challenges of their professional situations.