POST-COVID-19 SYNDROME: CHARACTERIZATION OF A COHORT AND ASSOCIATION WITH ACUTE DISEASE SEVERITY

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Post-COVID syndrome is defined as signs and symptoms that develop during or after COVID-19, continue for more than 12 weeks, not explained by other diagnosis. Symptoms are variable and involve any organ system1. The syndrome and risk factors are still under investigation. This study aimed to describe symptoms present at 2 and 6-month follow-up of patients with COVID-19 discharged from a tertiary hospital in Brazil and investigate association of post-COVID syndrome with severity of acute illness. METHODS: This is an observational study. Demographic characteristics and data from hospital admission were obtained through review of medical records. Patients that were admitted to Clementino Fraga Filho University Hospital with laboratory confirmed COVID-19 from March to December, 2020 were eligible to follow-up at the Post-COVID outpatient clinic. Appointments were scheduled 2 and 6 months after discharge. Symptoms and limitations were obtained. Patients were stratified into groups based on severity of acute phase: mild, moderate, severe pneumonia and critical disease2. RESULTS: 90 patients were included in the 2-month and 67 in the 6-month assessment. Average age was 60y and 52,2% were female. 24 patients had pneumonia, 52 severe pneumonia and 14 critical disease. There were no differences between groups regarding sex, age or comorbidities. At admission, patients with severe and critical disease had higher prevalence of cough (p=0.001) and dyspnea (p<0.001). Dyspnea on admission was associated with higher risk of severe or critical disease (RR = 4.207;CI 2.03-8.68). Length of hospital stay was longer and use of corticosteroids was more frequent with increased severity (p= 0.001). At 2-month follow-up, the most common symptoms were dyspnea (55,6%), fatigue (51,1%) and muscle weakness (50%). Anxiety was present in 47,8%. Fatigue was more frequent in patients with critical when compared to severe disease (78.6x40.4%, p = 0.01). This finding was associated with greater corticosteroid use in critical patients. Cough was more common in groups with greater severity (p = 0.01). All critical patients reported some or severe limitation to daily activities. At 6-month follow-up, dyspnea persisted in 47%, fatigue 50% and muscle weakness 40,9%. There was no difference in prevalence of symptoms between groups except for cough that was most seen in critical disease group (p = 0.01). CONCLUSIONS: We observed high prevalence of symptom persistence even 6 months after hospital discharge, remarkably dyspnea, fatigue and muscle weakness. The presence of symptoms was associated with acute disease severity at 2, but not at 6-month follow-up. CLINICAL IMPLICATIONS: Post-COVID syndrome is a new clinical entity that lacks research and better understanding of predisposing and maintenance factors. Long-term follow-up after COVID infection is necessary. DISCLOSURES: No relevant relationships by Marcos Bethlem, source=Web Response No relevant relationships by Michelle Cailleaux-Cezar, source=Web Response No relevant relationships by Fábio Kunita, source=Web Response No relevant relationships by Fernanda Oliveira Baptista da Silva, source=Web Response No relevant relationships by Bianca Peixoto, source=Web Response No relevant relationships by Nina VISCONTI, source=Web Response

Decontaminating N95 respirators during the COVID-19 pandemic: simple and practical approaches to increase decontamination capacity, speed, safety and ease of use.

BACKGROUND: The COVID-19 pandemic has caused a severe shortage of personal protective equipment (PPE), especially N95 respirators. Efficient, effective and economically feasible methods for large-scale PPE decontamination are urgently needed. AIMS: (1) to develop protocols for effectively decontaminating PPE using vaporized hydrogen peroxide (VHP); (2) to develop novel approaches that decrease set-up and take-down time while also increasing decontamination capacity; (3) to test decontamination efficiency for N95 respirators heavily contaminated by make-up or moisturizers. METHODS: We converted a decommissioned Biosafety Level 3 laboratory into a facility that could be used to decontaminate N95 respirators. N95 respirators were hung on metal racks, stacked in piles, placed in paper bags or covered with make-up or moisturizer. A VHP® VICTORY™ unit from STERIS was used to inject VHP into the facility. Biological and chemical indicators were used to validate the decontamination process. FINDINGS: N95 respirators individually hung on metal racks were successfully decontaminated using VHP. N95 respirators were also successfully decontaminated when placed in closed paper bags or if stacked in piles of up to six. Stacking reduced the time needed to arrange N95 respirators for decontamination by approximately two-thirds while almost tripling facility capacity. Make-up and moisturizer creams did not interfere with the decontamination process. CONCLUSIONS: Respirator stacking can reduce the hands-on time and increase decontamination capacity. When personalization is needed, respirators can be decontaminated in labelled paper bags. Make up or moisturizers do not appear to interfere with VHP decontamination.

Use, re-use or discard? Quantitatively defined variance in the functional integrity of N95 respirators following vaporized hydrogen peroxide decontamination during the COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 has stretched the ability of many institutions to supply needed personal protective equipment, especially N95 respirators. N95 decontamination and re-use programmes provide one potential solution to this problem. Unfortunately, a comprehensive evaluation of the effects of decontamination on the fit of various N95 models using a quantitative fit test (QNFT) approach is lacking. AIMS: To investigate the effects of up to eight rounds of vaporized hydrogen peroxide (VHP) decontamination on the fit of N95 respirators currently in use in a hospital setting, and to examine if N95 respirators worn by one user can adapt to the face shape of a second user with no compromise to fit following VHP decontamination. METHODS: The PortaCount Pro+ Respirator Fit Tester Model 8038 was used to quantitatively define functional integrity, measured by fit, of N95 respirators following decontamination with VHP. FINDINGS: There was an observable downward trend in the functional integrity of Halyard Fluidshield 46727 N95 respirators throughout eight cycles of decontamination with VHP. Functional integrity of 3M 1870 N95 respirators was reduced significantly after the respirator was worn, decontaminated with VHP, and then quantitatively fit tested on a second user. Furthermore, inconsistencies between qualitative fit test and QNFT results were uncovered that may have strong implications on the fit testing method used by institutions. CONCLUSIONS: The data revealed variability in the functional integrity of different N95 models after VHP decontamination, and exposed potential limitations of N95 decontamination and re-use programmes.