ABSTRACT
BACKGROUND: Adaptive mutations of the severe acute respiratory syndrome-related coronavirus (SARS-CoV-2) virus have emerged throughout the coronavirus disease 2019 (COVID-19) pandemic. The characterization of outcomes in patients requiring extracorporeal membrane oxygenation (ECMO) for severe respiratory distress from COVID-19 during the peak prevalence of different variants is not well known. METHODS: There were 131 patients with laboratory-confirmed SARS-CoV-2 infection supported by ECMO at two referral centers within a large healthcare system. Three predominant variant phase time windows (Pre-Alpha, Alpha, and Delta) were determined by a change-point analyzer based on random population sampling and viral genome sequencing. Patient demographics and outcomes were compared. RESULTS: The average age of patients was 46.9 ± 10.5 years and 70.2% (92/131) were male. Patients cannulated for ECMO during the Delta variant wave were younger compared to earlier Pre-Alpha (39.3 ± 7.8 vs. 48.0 ± 11.1 years) and Alpha phases (39.3 ± 7.8 vs. 47.2 ± 7.7 years) (p < .01). The predominantly affected race in the Pre-Alpha phase was Hispanic (52.2%; 47/90), while in Alpha (61.5%; 16/26) and Delta (40%; 6/15) variant waves, most patients were White (p < .01). Most patients received a tracheostomy (82.4%; 108/131) with a trend toward early intervention in later phases compared to Pre-Alpha (p < .01). There was no significant difference between the duration of ECMO, mechanical support, intensive care unit (ICU) length of stay (LOS), or hospital LOS over the three variant phases. The in-hospital mortality was overall 41.5% (54/131) and was also similar. Six-month survival of patients who survived to discharge was 92.2% (71/77). CONCLUSIONS: There was no significant difference in survival or time on ECMO support in patients during the peak prevalence of the three variants.
Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Respiratory Insufficiency , Adult , COVID-19/therapy , Extracorporeal Membrane Oxygenation/adverse effects , Female , Humans , Male , Middle Aged , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Retrospective Studies , SARS-CoV-2ABSTRACT
Loneliness is significantly associated with health and well-being among oldest-old adults. Due to the outbreak of the COVID-19, physical and social distancing policies might elevate loneliness among the oldest-old population. This study examined the trends and changes in the prevalence of feeling lonely using the 2020 HRS COVID-19 module merged to the 15 waves of the HRS RAND longitudinal datasets from 1992 to 2018. A total of 14,371 respondents, including 614 respondents aged 80 years and older were included. Generalized linear models compared age group differences within the 2020 module. Generalized estimating equations assessed the longitudinal change at the individual level and the trend of feeling loneliness among oldest-old adults from 1992 to 2020. Loneliness was assessed with one item of the CES-D scale (i.e., during the past week, felt lonely). After adjusting for demographic characteristics and health, the results showed that oldest-old adults were more likely to feel lonely compared to younger age groups (18% for 80’s vs. 14% for 50’s) during the early months of the pandemic. A longitudinal trajectory also showed that they feel lonelier than in prior years (19% in 2020 vs. 14% in 2018). However, compared to same-age groups from earlier years, a significantly lower prevalence of feeling lonely was observed (18% in 2020 vs. 27% in 1994). The results show that the outbreak of the COVID-19 may elevate feeling lonely, but the recent cohorts be less lonely than earlier cohorts. Future research should continue to explore protective factors for loneliness among oldest-old adults.