Post-Acute Effect of SARS-CoV-2 Infection on the Cardiac Autonomic Function

Background Recent studies reported a long-lasting effect of COVID-19 infection that extends beyond the active disease and disrupts various body systems besides the respiratory system. The current study aims to investigate the post-acute effect of SARS-CoV-2 infection on cardiovascular autonomic activity, reactivity and sensitivity in patients who had the infection at least 3 months before. Methods This was a comparative cross-sectional observational study. Fifty-nine subjects were allocated into two groups, controls (n=31), who had no history of positive COVID-19 infection, and the post-COVID patients (n=28) who were recruited 3 to 8 months after testing positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Baseline cardiovascular autonomic activity was evaluated through recording of baseline heart rate variability (HRV), autonomic reactivity was determined through standard cardiovascular autonomic reflex tests (CART), and cardiac autonomic sensitivity was assessed through cardiac baroreceptor sensitivity (cBRS). Results Higher incidence of orthostatic hypotension was observed in post-COVID patients compared to controls (39.3% and 3.2%, respectively, p <0.001). Additionally, significantly reduced handgrip test, and heart rate response to head-up tilt was illustrated in the post-COVID group (p <0.001). About 85.7% of post-COVID participants had at least one abnormal cardiovascular reflex test (CART) compared to the control group (p <0.001). Although HRV parameters (TP, LF, HF, SDRR, RMSSD, pRR50), and the cBRS were numerically lower in the post-COVID-19 group, this did not reach the level of significance. Conclusion The results of the present study are suggestive of altered cardiovascular reactivity in post-acute COVID patients and demand further investigation and longer term follow up.

Factors Affecting Health Care Professionals' Adherence to COVID-19 Precautionary Measures.

Objective: COVID-19 is a public health emergency of international concern. There is still no definitive cure for this highly transmittable illness. Immunization and breaking the chain of infection is the only successful approach to mitigate its spread. Our study explored the adherence to COVID-19 preventive measures and its associating factors among Health Care Professionals (HCPs) working in Saudi Arabia. Methods: For this cross-sectional study, an online survey was conducted from December 01, 2020, to March 31, 2021, among 978 HCPs in Saudi Arabia. The self-administered questionnaire consisted of demographic information, COVID-19 preventive behaviors, knowledge, attitude, fear, and risk. Mann-Whitney U-test, Kruskal-Wallis one-way analysis, Spearman correlation, and binary logistic regression tests were used in data analysis. Results: Most of the HCPs were Saudi nationals (86.9%), females (63.1%), age group 20-29 years (42.3%), Middle Eastern ethnicity (82.5%), and working in the government sector (80.8%). A 52.2% of the participants were compliant with COVID-19 preventive behavior. The most and the least compliant preventive behaviors were "wearing masks" (88.8% compliance) and "keeping social distancing" (60.7% compliance). Preventive behavior was significantly higher in HCPs having a) more knowledge of COVID-19 (U=104849; p 0.001); b) positive attitude (U=84402; p 0.001); c) higher fear (U=103138; p less than 0.001) and d) nursing profession (p 0.01). COVID-19 knowledge (p<0.001), attitude (p<0.001), and fear (p<0.001) contributed significantly to the prediction of preventive behavior compliance. A unit increase in COVID-19 knowledge, attitude, and fear scores raised the odds of being compliant with preventive behavior by factors of 2.34, 1.87, and 1.53 respectively. Conclusion: About half of the study participants were compliant with COVID-19 preventive behavior. Preventive behavior is significantly higher among HCPs having more knowledge of COVID-19, more fear, a positive attitude, and the "nursing" profession. Having more knowledge, a positive attitude, and more fear of COVID-19 may increase the likelihood of being compliant with preventive behavior.

The Psychological Impact of COVID-19 on Residents of Saudi Arabia.

Purpose: This study aimed to determine the stress levels and identify various factors responsible for causing high-stress scores during the COVID-19 pandemic in the Saudi population. Patients and Methods: This cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Dammam, from June 2020 until December 2020 on 4052 respondents from the Eastern province of Saudi Arabia. An online survey was used to collect information about various stress factors. The psychological impact of COVID-19 was measured by using the COVID-19 impact event scale (COVID-19 IES), whereas general stress levels were assessed by K10 Kessler Psychological Distress Scale (K10). Results: The psychological impact of the COVID-19 outbreak revealed that 35.4% of participants suffered from moderate or severe psychological impact (score>33); 19.7% had a mild psychological impact (scores24-32), whereas 44.9% reported minimal psychological impact (score <23). The factors significantly associated with higher stress scores and COVID-19 IES included male gender, low monthly income, having a private business, living in apartments/residential complexes, poor general health status, visit hospital/doctor in the past three months, presence of chronic disease, direct/indirect contact with someone diagnosed with/suspected to have COVID-19, contact with surfaces/tools infected with COVID-19, getting screened or quarantined for COVID-19, follow-up of the latest news about COVID-19 and knowledge of a greater number of people infected and died with COVID-19 (p < 0.05). In contrast, being an elementary school student, having 4-10 children, observing various protective measures, and staying home for 4-12 hours were associated with lower COVID-19 IES (p < 0.05). Conclusion: During the initial six months of the COVID-19 outbreak in Saudi Arabia, 35.4% participants suffered from moderate to the severe psychological impact. This study identified various factors responsible for high COVID-19 IES and K10 stress scores. These findings can help formulate psychological interventions for improving the stress scales in vulnerable groups during the COVID-19 pandemic.

A Cross-Sectional Survey of Knowledge, Attitude, and Practices of University Students in Pakistan Regarding COVID-19.

The COVID-19 pandemic is striking the world with serious public health and socioeconomic complications. The pandemic has influenced all forms of daily life, including educational institutions. Therefore, this cross-sectional survey was conducted to understand knowledge, attitudes, and practices related to COVID-19 among the students of the University of Veterinary and Animal Sciences, Lahore. The data was collected using an online self-directed questionnaire. The survey form includes six items about sociodemographic characteristics, 14 knowledge-based questions, seven questions on attitude, and eight questions on practices. The sample number was calculated using the Raosoft sample size calculator. A total number of 3,854 students, including 1,823 men and 2,031 women, were engaged in this survey, having student representation from all the provinces in the country. The data were analyzed using a chi-square test. A total of 97% of the students knew that the etiological agent of COVID-19 is a virus and that it is a disease of the respiratory system (94%). Many students kept visiting their relatives during the lockdown (45%), and their relatives kept visiting them at home (59%). The responses from the students varied a lot on specific questions about the transmission of the virus. Women tended to have less information regarding precautionary travel measures (p < 0.01), but supplemental knowledge of prevention of disease transmission from positive patients (p < 0.01). Conclusively, the majority of the university students surveyed had imperative knowledge, a good attitude, and active practice in response to the COVID-19 outbreak. Moreover, the KAP scores have varied by demography, gender, and the number of family members. Therefore, continuous awareness of preventative behaviors should be disseminated regularly in emergencies.

COVID-19: Risk Stratification of Healthcare Workers in the Eastern Province of Saudi Arabia and Their Knowledge, Attitude, and Fears.

Introduction With the expeditious spread of coronavirus disease 2019 (COVID-19), healthcare workers have undoubtedly faced a higher risk of contracting the disease compared to the general public. This study aimed to stratify the risk of coronavirus disease 2019 infection among healthcare workers in the Eastern province of Saudi Arabia and shed light on their level of knowledge, attitude, and fear towards the disease. Methods A quantitative cross-sectional study, involving 978 Arabic and English-speaking healthcare workers, was conducted using a self-administered online questionnaire. The knowledge, attitude, and fear scales were developed by researchers using the most updated information regarding coronavirus disease 2019. The Objective Risk Stratification tool developed in the United Kingdom was used to measure the risk level of contracting coronavirus disease 2019. Collected data were analyzed and interpreted using the Statistical Package for Social Sciences software. Results Out of the 978 participants, 63.1% were female, 74.6% were 20-39 years old, 86.9% were Saudis, and 31.3% worked as physicians. The most common health-related risk factors for severe coronavirus disease 2019 among the study participants were smoking (23.4%), sickle cell trait (22.8%), and asthma (21.2%). The risk of contracting coronavirus disease 2019 was found to be low in 87.2% of participants, with those significantly at higher risk being male, non-Saudis, black Africans, and 70-79 years old. The knowledge level was found to be high among 54.7% of participants, with significantly higher levels being reported among females, non-Saudis, and participants who were either physicians or pharmacists. The most commonly cited source of knowledge was the Saudi Ministry of Health (82%). Participants largely demonstrated a positive attitude towards the disease (53.9%), particularly those working as physicians and in the governmental sector. The majority of participants (54.4%) were found to have a high level of fear toward the disease, with significantly higher levels being reported among females, 30-39 years old, and those who were either nurses or pharmacists. Conclusion The present study demonstrated significant sociodemographic variability among healthcare workers in the Eastern province, with respect to their risk of contracting coronavirus disease 2019 and their levels of knowledge, attitude, and fear toward the disease.

The Long-Term Impact of COVID-19 Pneumonia on the Pulmonary Function of Survivors.

BACKGROUND: The sequelae of COVID-19 pneumonia on pulmonary function and airways inflammation are still an area of active research. OBJECTIVE: This research aimed to explore the long-term impact of COVID-19 pneumonia on the lung function after three months from recovery. METHODS: Fifty subjects (age 18-60 years) were recruited and classified into two groups: the control group (30 subjects) and the post-COVID-19 pneumonia group (20 patients). Pulmonary function tests, spirometry, body plethysmography [lung volumes and airway resistance (Raw)], diffusion capacity for carbon monoxide (DLCO), and fractional exhaled nitric oxide (FeNO), were measured after at least 3 months post-recovery. RESULTS: Significant reduction in total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume (FEV1), FEV1/FEV, and diffusing capacity for carbon monoxide (DLCO) was observed in post-COVID-19 subjects compared to controls. Restrictive lung impairment was observed in 50% of post-COVID-19 cases (n = 10) compared to 20% in the control group (n = 6, P = 0.026). In addition, mild diffusion defect was detected in 35% (n = 7) of the post-COVID-19 group compared to 23.3% (n = 7) in the controls (P = 0.012). CONCLUSION: COVID-19 pneumonia has an impact on the lung functions in terms of restrictive lung impairment and mild diffusion defect after three months from recovery. Therefore, a long-term follow-up of the lung function in post-COVID-19 survivors is recommended.