Poor nutritional status and dynapenia are highly prevalent in post-acute COVID-19

Malnutrition estimates range between 5 and 69% in acute Coronavirus disease 2019 (COVID-19) patients. With respect to body composition (BC) and muscle function, low values of phase angle (PhA) and handgrip strength (HGS) have been related to poor disease outcomes. Little evidence is available in post-acute patients. We aimed to combine the evaluation of nutritional status, BC, and muscle strength in a real-life cross-sectional cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. The study population included 144 patients (M=95;mean age 64.8yrs), of which 37% bedridden (M=60%). Nutritional status was evaluated with the Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT) scores. Fat-free mass (FFM), skeletal muscle (SM), and raw variables, i.e. PhA, were estimated with bioelectrical impedance analysis. HGS was measured with a digital handle dynamometer for both dominant and non-dominant body sides. Dynapenia was identified according to the 2019 EWGSOP criteria. According to MNA, 18% of patients were malnourished and 62% at risk of malnutrition. As for CONUT, 21% of patients had moderate-severe malnutrition, while 58%light malnutrition. Overall, malnutrition was highly prevalent in older patients with more comorbidities. Marked abnormalities of PhAand HGSwere more frequent in bedridden or malnourished patients, and when FFM or SM were low. Dynapenic patients were 65% males and 47% females. Malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients. Future studies will help to tailor screening algorithms for full nutritional status assessment to appropriate care processes and rehabilitation strategies.

Pentobarbital for Sedation of Adults Receiving Extracorporeal Membrane Oxygenation for Covid-19

INTRODUCTION: Sedation for ventilated patients with COVID-19 is challenging given the severity and duration of the disease. Complicating this is the introduction of extracorporeal membrane oxygenation (ECMO) for patients with refractory respiratory failure. An ECMO circuit can meaningfully alter drug pharmacokinetics by sequestering drug, increasing the volume of distribution, and altering clearance. Many common sedatives are known to be significantly impacted, thus altering standard dosing. In circumstances warranting deep sedation, such as ARDS, clinicians need a wide array of sedatives and analgesics available when managing patients receiving ECMO support. To our knowledge, no studies have assessed the use of pentobarbital as a sedative in adult patients receiving ECMO support for severe ARDS. We aimed to characterize the use of pentobarbital infusions as part of a multi-modal sedation regimen in adult patients with COVID-19 who were receiving ECMO. METHOD(S): Adults with COVID-19 who were receiving both pentobarbital and VV-ECMO support between March 2020 and December 2021 were included. The primary outcome was change in the dose of concomitant sedatives at 24- and 48-hours post-initiation of pentobarbital. Secondary outcomes included depth of sedation, ventilator synchrony, mean arterial pressure (MAP), and vasopressor doses in norepinephrine equivalents. Additionally, we assessed for adverse drug reactions (ADRs) which included hypotension and transaminitis. RESULT(S): Five patients were included. All patients were initiated on a pentobarbital infusion for the indication of ventilator dyssynchrony. Patients received pentobarbital at an initial rate of 1 mg/kg/hr and infusion rates ranged between 0.5 - 2 mg/kg/hr. Following pentobarbital initiation, all patients became synchronous with the ventilator and doses of continuous sedative infusions decreased. Additionally, the total number and daily dose of rescue sedative medications decreased following pentobarbital initiation. ADRs were common and included hypotension (60%) and transaminitis (20%). CONCLUSION(S): A pentobarbital infusion can be used as part of a multimodal sedation regimen for patients requiring high doses of sedatives to achieve ventilator synchrony.

Protezione degli ospedali dall'infezione da SARS-CoV-2: una strategia completa basata sulla revisione per la prevenzione e il controllo del COVID-19

SUMMARY: SARS-CoV-2-related infection can determine hospital-acquired infections among patients and healthcare workers. Aim of this paper was to review the literature for developing a strategy for protecting healthcare workers, patients, and visitors by COVID-19 hospital infection. A critical and rapid revision of the literature and international standards and Regulations on this topic allowed us to propose an evidencebased strategy in the framework of the workplace risk assessment for preventing nosocomial COVID-19 outbreaks. The virus' high transmissibility, the high prevalence of asymptomatic carriers and false-negative Covid-19 rates on naso- and oropharingeal swabs, put hospitals at high-risk of COVID-19 outbreaks. A comprehensive strategy based on standard precautions, administrative, environmental, and engineering controls, a screening protocol for patients on their admission to hospital, and a testing-based strategy for HCWs within health surveillance programs may prevent the onset of hospital outbreaks, which are a threat to community, patients and HCWs, compromising the sustainability of healthcare facilities. Copyright© by GIMLE. SARS-CoV-2 pu  determinare infezioni acquisite in ospedale tra pazienti e operatori sanitari. Lo scopo di questo studio   rivedere la letteratura per lo sviluppo di una strategia per la protezione di operatori sanitari, pazienti e visitatori dall’infezione ospedaliera da COVID-19. Una revisione critica e rapida della letteratura e degli standard e regolamenti internazionali su questo argomento, ci ha permesso di proporre una strategia basata sull’evidenza nel quadro della valutazione del rischio sul posto di lavoro per prevenire le epidemie nosocomiali da COVID-19. L’elevata trasmissibilit  del virus, l’elevata prevalenza di portatori asintomatici e di tamponi naso e orofaringei falsi negativi, mettono gli ospedali ad alto rischio per lo sviluppo di focolai da COVID-19. Una strategia globale, basata su precauzioni standard, controlli amministrativi, ambientali e tecnici, su un protocollo di screening per i pazienti al momento del ricovero in ospedale, insieme ad una strategia operativa basata sui test di screening per gli operatori sanitari all’interno dei programmi di sorveglianza sanitaria, possono prevenire l’insorgenza di epidemie ospedaliere che rappresentano una minaccia per la comunit , per i pazienti e per gli operatori sanitari, compromettendo la sostenibilit  delle stesse strutture sanitarie.

Enhancing the role of occupational health services in the battle against Corona Virus Disease 2019.

Abstract: Occupational risk assessment is the core of any practice in occupational health and safety at the workplace. In Italy, the implementation of the preventive measures required by law (DPCM of April 26, 2020 and subsequent modifications and integrations) can exempt the employers from legal disputes in case of COVID-19 infection among employees. However, these laws have made meaningless the risk assessment process, which is the ideal setting where the preven-tive and protective measures must be identified and enhanced by individual employers, in collaboration with health and safety managers and occupational physicians, in the true exposure conditions. In this commentary, the authors stressed the role of workplace risk assessment and occupational health services for the valuable contribution that they may give to the battle against COVID-19, in terms of prevention, contact-tracing activity and COVID-19 rates of vaccinal coverage.

Asymptomatic detection of COVID-19 among cancer patients receiving infusional anti-cancer therapy

Introduction Little is known about the rates of asymptomatic COVID-19 carriers among cancer patients. The rate of asymptomatic carriers is important to understand in this population given the use of myelosuppressive and immunomodulating therapies and the risk of transmission to other patients in shared infusion centers. At UC San Diego, in June 2020, we implemented a COVID-19 asymptomatic screening protocol in which cancer patients receiving anti-cancer therapy in an infusion center must undergo symptom-based screening and then SARS-CoV-2 PCR testing prior to their infusion. Here, we describe the results of this asymptomatic screening protocol. Methods This was a single-center retrospective analysis of patients with active cancer receiving infusional anti-cancer therapy in 5 infusion centers who underwent at least 1 asymptomatic SARS-CoV-2 PCR test between 6/1- 12/1/2020. The primary endpoint was the rate of COVID-19 positivity among asymptomatic patients. Symptomatic patients were excluded. Secondary endpoints included COVID-19-related outcomes and patterns of oncologic management for asymptomatic COVID-19 positive patients. Results A cohort of 2,202 cancer patients received at least 1 asymptomatic SARS-CoV-2 PCR test prior to receipt of infusional anti-cancer therapy. 0.95% (N=21/2202) of patients were found to be PCR-positive on asymptomatic screening. Among positive patients, 9.5% (N=2/21) had hematologic malignancies and 90.5% (N=19/21) had solid tumors. In terms of therapy, 76.2% (N=16) were treated with cytotoxic chemotherapy, 9.5% (N=2) with targeted therapy, 4.7% (N=1) with immunotherapy, and 9.5% (N=2) were on a clinical trial. With a median follow-up of 122 days from positive PCR test (range: 8-186), only 2 of 21 (9.5%) of the cohort ultimately developed COVID-related symptoms. Both patients had a diagnosis of acute leukemia and 1 patient required hospitalization for COVID-related complications. No patients died from COVID-related complications. With regards to oncologic management, 95.2% (N=20/21) of patients had their therapy delayed or deferred with a median delay of 21 days (range: 7- 77 days). Only 1 patient proceeded with cytotoxic chemotherapy on schedule in the setting of adjuvant chemoradiation for oropharyngeal squamous cell carcinoma. Among the overall cohort, an additional 26 patients (1.2%) developed cases of symptomatic COVID-19 infection during the study period. Conclusions A strategy of asymptomatic screening of cancer patients receiving anti-cancer therapy in an infusion center detected an extremely low rate of asymptomatic carriers of COVID-19. This low rate of asymptomatic carriers may be due to a number of factors including multiple symptom-based screenings prior to infusion, behavior modification among patients, and/or differential immune responses to COVID-19 infection. Asymptomatic carriers in this cohort appeared to have favorable outcomes with few developing symptoms or requiring hospitalization, though the number of positive patients in our cohort is low, precluding definitive conclusions in this population.

Working from home in the context of COVID-19: A systematic review of physical and mental health effects on teleworkers

Introduction: Working from home (WFH) has been endorsed in the face of the COVID-19 pandemic for all cadre of workers. This study aimed to describe the mental and physical negative effects of WFH among workers during the COVID-19 pandemic. Methods: A rapid systematic review of literature was conducted on PubMed/Medline using pre-defined se-arch terms. For inclusion in this rapid review, studies were required to focus only on previously healthy adults, white collar/professional employees, and teachers (full-time or part-time) working from home during working hours, and to include mental or physical health related outcomes of workers. Data extraction was carried out using a standardized form and included country of study, study design, details of participants, industry setting, measure used, and health outcome of interest. Overall, 1,447 articles were retrieved, and 15 of these were included in the systematic review. Results: Physical effects of WFH included reduced physical activity, increased consumption of junk food, weight gain, poor sleep quality, and musculoskeletal pain. Mental effects of WFH included increased levels of anxiety, depression, stress, headache, fatigue, and lower job satisfaction. Furthermore, a significant decline in workplace comfort resulted in a reduction in workers’ efficiency and job satisfaction. Discussion and Conclusions: Due to the rapid stay-at-home recommendations required to break the chain of COVID-19 pandemic, WFH became pertinent for many categories of workers. Therefore, it is required that everyone identifies context-based strategies for healthy coping in ways that do not alter work functioning. © 2021 Francesco Chirico et al. Edizioni FS Publishers.

Mask Material Filtration Efficiency and Mask Fitting at the Crossroads: Implications during Pandemic Times

The COVID-19 pandemic triggered the widespread use and need for respirators and face masks for the healthcare workers and public. In this study, several generally available respirators and mask designs were fit tested, and their materials were evaluated for filtration efficiency using 250 nm polystyrene latex particles. Efficiency testing was performed for 2 and 0.5 h at low (2.6 L min(-1)) and high (7.4 L min(-1)) airflows, respectively, using similar to 17.4 cm(2) material area. As expected, all N95 and KN95 respirators passed the fit test, and their materials showed efficiencies > 95% for the entire experiment at both airflows. Of the three air filters used in the 3D-printed Montana masks, only the HEPA filter had a filtration efficiency > 95% at both airflows. Regardless of the insert material, the Montana mask failed all fit tests. Homemade duckbill masks made of Halyard H600 sterilization wrap and WypAll X80 reusable wipe also failed the fit test, and both filter materials had an average filtration efficiency < 95% at high airflows. To explain the filtration efficiency results, the structure and composition of all filter materials were determined using FE-SEM, and IR and Raman spectroscopy. In conclusion, when highly efficient materials are used in masks that do not fit the users properly, the potential of these materials to protect the users from aerosols is compromised. Therefore, the mask design is as important as the filtration efficiency of the mask material.

Early COVID-19 pandemic response in Italy: pros and cons

Since the beginning of the COVID-19 pandemic, Italy was one of the worst-affected European countries. The rapid surge of cases and the limited capacity of intensive care unit departments have posed a serious threat to the Italian national health system. In this paper we describe the first response and the main measures carried by Italian policy makers, as coordinated by a governmental committee of public health experts, which have succeeded in preventing the pandemic from turning into a disaster. Early closure of the school, quarantine measures and lockdown were put in place and the response of the population has been good overall. Despite the Italian health care system of universal coverage is considered the second-best in the world, during phase 1, the Italian decentralisation and fragmentation of health services probably restricted timely interventions and effectiveness. In northern Italy, Lombardy, Emilia Romagna, Piedmont, and Veneto, which reported most of the Italian cases, carried out different strategies against COVID-19, with great differences in testing, quarantine, and public health procedures. The improvement of the epidemiological situation has allowed an easing of the restrictive measures, with a progressive restarting of work activities. The government and technical-scientific bodies have prepared health strategies to support a possible second epidemic wave in the autumn.

COVID-19 and staff mental health: is there an evidence? An Italian field study

Since the early months of the COVID-19 epidemic, a large number of scientific papers have considered the possibility that healthcare professionals (HCWs) were affected by depression, anxiety, post-traumatic stress, and psychological distress. The abundance of research has also made it possible to produce several systematic reviews and meta-analyzes. All the studies retrieved in these reviews, however, were cross-sectional. Depressive symptoms and anxiety in HCWs were compared to “normal values”, administrative staff, or external sample;moreover, some studies had no control group. No longitudinal study has been produced so far. Some studies had negative results. Overall, there is still little evidence of an increase in mental health problems and sleep disturbances in HCWs during the outbreak. To fill this gap, we investigated the mental health of workers who have been monitored for many years in an Italian local health unit. Mental health was investigated with standardized questionnaires. 82 HCWs who tested positive at the COVID-19 nasopharyngeal swab, 152 exposed workers who tested negative and 361 unexposed controls participated in the survey. Anxiety was reported by 16.6% of COVID-19 cases and depression by 20.3%, with a significant increase in the estimated risk (OR = 4.3;CI95%=2.4-7.4 for anxiety, OR = 3.5;CI95% =2.0-6.0 for depression). In test-positive cases, sleep was a significant moderating factor in the relationship between occupational stress or PJ and anxiety. Exposed, negative HCWS also had an increased OR for anxiety (1.84, CI95% 1.1-3.1) and depression (2.2 CI95% 1.4-3.5). The frequency of anxiety and depression disorders in the population examined was not higher than that recorded in the years preceding the epidemic during periodic occupational health checks in the workplace. Mental health support and organizational interventions must mainly concern workers with positive tests and should also tend to improve sleep quality. Key messages Health care workers who have had unprotected exposure to COVID-19 patients, and even more those who have contracted the infection, have sleep problems, anxiety and depression. The psychological support intervention for health care workers should include the promotion of sleep hygiene.