Impact of the COVID-19 Pandemic on Treatment for Mental Health Needs: A Perspective on Service Use Patterns and Expenditures from Commercial Medical Claims Data (preprint)

Objective: To examine changes in use patterns, cost of healthcare services before and after the outbreak of the COVID-19 pandemic, and their impacts on expenditures for patients receiving treatment for depression, anxiety, eating disorders, and substance use. Methods: This cross-sectional study employed statistical tests to analyze claims in Marketscan® Commercial Database in March 2020-February 2021 and quarterly from March 2020 to August 2021, compared to respective pre-pandemic periods. Results: Comparing year-over-year changes before and after the pandemic outbreak, proportion of patients receiving anxiety treatment among all individuals obtaining healthcare services grew at a higher rate (13.7% versus 10.0%) which, along with a higher rate of increase in price per episode (5.5% versus 4.3%) resulted in a greater increase in per claimant expenditure ($0.61 versus $0.41 per month); proportion of patients receiving treatment for depression grew at a lower rate (3.7% versus 6.9%), but per claimant expenditure grew by same amount due to an increase in price per episode (4.8%). Proportion of patients receiving treatment for anorexia started to increase in the fall of 2020 (21.1% or higher). Patient proportion of alcohol use in age group 18-34 decreased (17.9%) during the pandemic but price per episode increased (26.3%). Patient proportion of opioid use increased in March-May 2020 (11.5%) but decreased or had no significant changes in subsequent periods. Conclusions: The COVID-19 pandemic resulted in use pattern and expenditure changes for patients receiving mental health services that varied across conditions and time periods. Some use patterns were unexpected.

Recent smell loss is the best predictor of COVID-19: a preregistered, cross-sectional study (preprint)

Background: COVID-19 has heterogeneous manifestations, though one of the most common symptoms is a sudden loss of smell (anosmia or hyposmia). We investigated whether olfactory loss is a reliable predictor of COVID-19. Methods: This preregistered, cross-sectional study used a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified singular and cumulative predictors of COVID-19 status and post-COVID-19 olfactory recovery. Results: Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean{+/-}SD, C19+: -82.5{+/-}27.2 points; C19-: -59.8{+/-}37.7). Smell loss during illness was the best predictor of COVID-19 in both single and cumulative feature models (ROC AUC=0.72), with additional features providing no significant model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms, such as fever or cough. Olfactory recovery within 40 days was reported for ~50% of participants and was best predicted by time since illness onset. Conclusions: As smell loss is the best predictor of COVID-19, we developed the ODoR-19 tool, a 0-10 scale to screen for recent olfactory loss. Numeric ratings [≤]2 indicate high odds of symptomatic COVID-19 (10

Standardized Testing Demonstrates Altered Odor Detection Sensitivity and Hedonics in Asymptomatic College Students as SARS-CoV-2 Emerged Locally (preprint)

Background Anosmia is a recognized symptom of COVID-19, but the relationship of SARS-CoV-2 exposure with olfactory dysfunction remains enigmatic. This report adds unique data from healthy students tested as the virus emerged locally. Methods Psychometrically validated measures assessed odor detection, identification and hedonics in healthy university students. Data from asymptomatic students (N=22), tested as SARS-CoV-2 unknowingly emerged locally, were compared to students tested just prior to local virus transmission (N=25), and our normative sample (N=272) tested over the previous 4 years. Results The exposed cohort demonstrated significantly reduced odor detection sensitivity compared to the students in the prior group (P=.01; d=0.77; CI 0.17, 1.36), with a distribution skewed towards less detection sensitivity (P=.03). Categorically, the exposed group was significantly more likely to have hyposmia (OR=7.7; CI, 3.1, 19.4), particularly the subset assessed in the final week before campus closure (OR=13.6; CI, 3.4, 35.7). The exposed group also rated odors as less unpleasant (P

More than just smell - COVID-19 is associated with severe impairment of smell, taste, and chemesthesis (preprint)

Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, generally lacked quantitative measurements, were mostly restricted to data from single countries. Here, we report the development, implementation and initial results of a multi-lingual, international questionnaire to assess self-reported quantity and quality of perception in three distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, 8 other, ages 19-79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change+/-100) revealed a mean reduction of smell (-79.7+/- 28.7, mean+/- SD), taste (-69.0+/- 32.6), and chemesthetic (-37.3+/- 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell, but also affects taste and chemesthesis. The multimodal impact of COVID-19 and lack of perceived nasal obstruction suggest that SARS-CoV-2 infection may disrupt sensory-neural mechanisms.