The impact of obesity on the outcome of severe SARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox.

PURPOSE: The aim was to verify the impact of obesity on the long-term outcome of patients with severe SARS-CoV-2 ARDS. MATERIALS AND METHODS: The retrospective study included patients admitted to the high-volume ECMO centre between March 2020 and March 2022. The impact of body mass index (BMI), co-morbidities and therapeutic measures on the short and 90-day outcomes was analysed. RESULTS: 292 patients were included, of whom 119(40.8%) were treated with veno-venous ECMO cannulated mostly (73%) in a local hospital. 58.5% were obese (64.7% on ECMO), the ECMO was most frequent in BMI > 40(49%). The ICU mortality (36.8% for obese vs 33.9% for the non-obese, p = 0.58) was related to ECMO only for the non-obese (p = 0.04). The 90-day mortalities (48.5% obese vs 45.5% non-obese, p = 0.603) of the ECMO and non-ECMO patients were not significantly influenced by BMI (p = 0.47, p = 0.771, respectively). The obesity associated risk factors for adverse outcome were age <50 (RR 2.14) and history of chronic immunosuppressive therapy (RR 2.11, p = 0.009). The higher dosage of steroids (RR 0.57, p = 0.05) associated with a better outcome. CONCLUSIONS: The high incidence of obesity was not associated with worse short and long-term outcomes. ECMO in obese patients together with the use of steroids in the later stage of ARDS may improve survival.

Antibodies against SARS-CoV-2 in employees of the national institute of public health in the first wave of the COVID-19 pandemic in the Czech Republic, april-may 2020

In the Czech Republic, the first wave of the COVID-19 epidemic, caused by the SARS-CoV-2 virus, occurred in the spring of 2020, peaking at the end of March. From March 1st to May 31st, a total of 9,230 people tested positive by PCR were detected. We assessed the prevalence of COVID-19 infections in employees of the National Institute of Public Health at the end of the first wave by detecting specific antibodies against SARS-CoV-2. Voluntary testing for the presence of IgA and IgG antibodies was performed by ELISA tests using Euroimmun SARS-CoV-2 IgA and Euroimmun SARS-CoV-2 IgG semi-quantitative commercial assays. The participants answered a questionnaire regarding symptoms of an acute respiratory infection in the last quarter and known contact with COVID-19 infection. A total of 78 out of 270 persons (29%) experienced symptoms of acute respiratory infection, 7 (2.6%) lost the olfactory sense or taste and 15 (5.6%) were in contact with an infected person. The first sampling was performed between April 6th and May 22nd, 2020. A total of 270 employees were tested, of which 224 (83%) were women. The IgA and IgG antibodies SARS-CoV-2 were positive or borderline in 31 subjects. The second sample was taken from 30 of them and the third sample was from taken two persons several weeks apart. Based on the dynamics of the antibodies, 10 (3.7% of the whole group) were evaluated as seropositive, in whom we indirectly infer a past SARS-CoV-2 infection. A total of 246 people had negative serology (of which 239 based on the first sample and 7 based on the second one). In 14 people it was not possible to determine whether an infection occurred, i.e. the result was evaluated as inconclusive. The positive association of persistent seroconversion in the symptomatic subjects compared to the asymptomatic ones was statistically insignificant with a relative risk of 1.61 (95% CI: 0.47–5.54), p = 0.449. © 2021, Czech Medical Association J.E. Purkyne. All rights reserved.

COVID-19 reinfections

Reports of SARS-CoV-2 reinfections are on the rise. This study focused on reinfections in patients with confirmed COVID-19 in the Czech Republic. Between 1 March 2020 and 9 November 2020, 362 084 cases with the onset of symptoms before 31 October 2020 were reported. Overall, 28 cases of symptomatic SARS-CoV-2 reinfections were identified, 11 in males and 17 in females, age range 25-80 years, median age 46 years. The interval between the first and second episodes of the disease ranged from 101 to 231 days, and the median interval was 201.5 days. During both symptomatic episodes, all patients have been tested by RT-PCR. Altogether 26 patients (92.9%) have been tested negative after recovery from the first episode of COVID-19. Symptomatic reinfections occurred in nearly 0.2% of all patients at risk. Most patients with reinfection had mild symptoms in both episodes, and only three episodes were moderate to severe. Thus, reinfections may have been underdiagnosed. In summary, COVID-19 reinfections are possible and not exceptional.