Characterization of Long COVID and Its Contributing Factors among a Population of Health Care Workers in a 6-Month Follow-up.

Background: Health care workers (HCWs) are at the frontline of the fight against the coronavirus disease 2019 (COVID-19). Long COVID is defined as "the persistence of some symptoms of COVID-19, more than 4 weeks after the initial infection." The aim of the present study was to investigate the prevalence of long COVID status among HCWs in the largest hospital complex of Iran. Methods: In this cross-sectional study, all patients with COVID-19 who had taken sick leave were included in the study (n = 445). Data regarding sick leave characteristics were collected from the records of the nursing management department of the hospital. Study variables included demographic and occupational information, variables related to mental health assessment, organ systems involved in COVID-19, and duration of symptoms. Frequencies, percentage distributions, means, standard deviation, and range (minimum, maximum) were used as descriptive analysis methods. Associations between symptoms' persistency and clinical characteristics were assessed by logistic and linear regressions. Results: Age, N95 mask use, and respiratory protection significantly contributed to the persistence of COVID-19 symptoms (P < 0.05). The prevalence of long COVID among HCWs was 9.44% among 445 participants. The loss of taste persisted longer than the other symptoms before returning to normal. Among the postrecovery complications asked, anxiety was the most common persistent mental symptom (58.5%), followed by gloomy mood (46.3%) and low interest (46.2%), respectively. Conclusion: HCWs with COVID-19 symptoms had prolonged symptoms of COVID-19 that can affect their work performance, thus, we recommend evaluating COVID-19 symptoms in HCWs with infection history.

SARS-CoV-2 Seroprevalence Among Health Care Workers in Major Private and Public Hospitals With COVID-19 Patient's Referral in Tehran, Iran.

Estimating the prevalence of SARS-CoV-2 antibody seropositivity among health care workers (HCWs) is crucial. In this study, the seroprevalence of anti-SARS-CoV-2 antibodies among HCWs of five hospitals of Tehran, Iran with high COVID-19 patient's referrals from April to June, 2020, was assessed. In this cross-sectional study, HCWs from three public and two private hospitals, selected randomly as a pilot, were included. Participants were asked questions on their demographic characteristics, medical history, hospital role, and usage of personal protective equipment (PPE). Iran FDA-approved SARS-CoV-2 ELISA kits were used to detect IgG and IgM antibodies in blood samples. The seroprevalence was estimated on the basis of ELISA test results and adjusted for test performance. Among the 2,065 participants, 1,825 (88.4%) and 240 (11.6%) HCWs were recruited from public and private hospitals, respectively. A total of 340 HCWs were tested positive for SARS-CoV-2-specific IgG or IgM antibodies, and 17.9% of seropositive individuals were asymptomatic. The overall test performance-adjusted seroprevalence estimate among HCWs was 22.6 (95% CI: 20.2-25.1), and PPE usage was significantly higher among HCWs of public vs. private hospitals (66.5 vs. 20.0%). This study found that seroprevalence of SARS-CoV-2 among HCWs was higher in private hospitals (37.0%; 95% CI: 28.6-46.2) than public hospitals (20.7%; 95% CI: 18.2-23.3), and also highest among assistant nurses and nurses, and lowest among janitor or superintendent categories. The PPE usage was especially suboptimal among HCWs in private hospitals. Continued effort in access to adequate PPE and regular screening of hospital staff for detecting asymptomatic personnel, especially during the upcoming wave of infection, are warranted.

COVID-19 Fear Association with Depression, Anxiety, and Insomnia: A National Web-Based Survey on the General Population.

Objective: COVID-19 pandemic has influenced almost every country worldwide. Being in a pandemic situation can cause psychological distress to people, which can lead to sleep disorders. The present study aimed to assess prevalence of depression, anxiety, and insomnia among Iranian people and their relations with COVID-19 fear in the early stages of COVID-19 pandemic. Method: A cross-sectional and population-based online study was designed. We created an online form and used Fear of COVID-19 scale (FCV-19), Generalized Anxiety Disorder 2 scale (GAD-2), Patient Health Questionnaire-2 (PHQ-2), and Insomnia Severity Index (ISI), to assess fear of COVID-19, anxiety, depression, and insomnia, respectively. We sent the link to the online survey to Iranians interested in participating in the study via social media, and 1223 Iranian completed the form. Results: A total of 1223 individuals with a mean age of 39.82 ± 10.75 years participated in the study. Prevalence of insomnia, depression and anxiety among our participants were 55.2%, 61.5%, and 50.9%, respectively. The mean FCV-19 score among the participants was 19.70 ± 5.08. Insomnia was more common among those who were 50 years or older. Fear of COVID-19 was related to a more risk of progression toward depression, anxiety, and insomnia. Conclusion: Fear of COVID-19 has a considerable association with depression, anxiety, and insomnia in the pandemic, and strategies to reasonably decrease people's fears can help to reduce incidence of psychological issues during the pandemic.

Cluster analysis of insomnia symptoms during COVID-19 pandemic: a general population web-based survey in Iran.

OBJECTIVE: To investigate the prevalence of insomnia and its different phenotypes as well as their association with fear of COVID-19 in the general population. MATERIAL AND METHODS: This was a cross-sectional study conducted using an online survey (e-poll). All available participants who completed the online survey form were included in the current study. All individuals with a history of sleep problems were excluded. A questionnaire package consisted of insomnia severity index (ISI), and FCV-19 for corona fear was administered for all participants. Insomnia was defined as ISI≥8. Insomnia phenotypes were considered as: (a) DIS: difficulty initiating sleep; (b) DMS: difficulty maintaining sleep; (c) EMA: early morning awakening; and (d) combined insomnia. RESULTS: A total of 1,223 participants [827 (67.6%) female, mean age=39.82±10.75 years old], enrolled in the current survey. Based on ISI, 675 (55.2% [95%CI=52.40-57.98]) were categorized into the insomnia group. Insomnia was more prevalent in females (p=0.006), participants with 50 years old or higher (p=0.04), or high fear of COVID-19 (p<0.0001). Totally, 67.4%, 66.4%, and 55% of all participants had DIS, DMS, and EMA, respectively, in the current outbreak. Besides, 79% had impaired daily functioning, 51.6% had impaired quality of life, and 62% were worried about their sleep problem. Notably that a considerable percentage of individuals with normal ISI scores had at least one insomnia phenotype or impaired daily functioning and quality of life. Further analyses revealed a significant increasing trend in all four insomnia phenotypes prevalence with an increase in fear of COVID-19 (all p-values<0.0001). CONCLUSION: Individuals with higher age, female gender, or higher fear of COVID-19 are at higher risk of all types of insomnia as well as impaired daytime performance or quality of life.

Dynamics of the COVID-19 Clinical Findings and the Serologic Response.

The factors affecting the dynamics of lengthening of symptoms and serologic responses are not well known. In order to see how the serologic responses change in relation to the clinical features, we selected a group of 472 adults with a positive IgM/IgG antibody test result from a baseline study of the anti-SARS-CoV-2 seropositivity, assessed their COVID-19 and past medical histories, and followed them up in about 3 months. Nearly one-fourth of the subjects were asymptomatic at the baseline; 12.8% subjects became symptomatic at the follow-up (FU) when 39.8% of the subjects had some persisting symptoms. At the baseline, 6.1% showed anti-SARS-CoV-2 IgM positive, 59.3% only for IgG, and 34.5% for both. At the FU, these figures declined to 0.6, 54.0, and 4.4%, respectively, with the mean IgM and IgG levels declining about 6.3 and 2.5 folds. Blood group A was consistently linked to both sustaining and flipping of the gastrointestinal (GI) and respiratory symptoms. The baseline IgM level was associated with GI symptoms and pre-existing cirrhosis in multivariate models. Both of the baseline and FU IgG levels were strongly associated with age, male, and lung involvement seen in chest computed tomography (CT)-scan. Finally, as compared with antibody decayers, IgM sustainers were found to be more anosmic [mean difference (MD): 11.5%; P = 0.047] with lower body mass index (BMI) (MD: 1.30 kg/m2; P = 0.002), while IgG sustainers were more commonly females (MD: 19.2%; P = 0.042) with shorter diarrhea duration in the FU (MD: 2.8 days; P = 0.027). Our findings indicate how the anti-SARS-CoV-2 serologic response and COVID-19 clinical presentations change in relation to each other and basic characteristics.

COVID-19: sleep research perspectives.

Coronavirus disease of 2019 (COVID-19) pandemic originated from Wuhan in December 2019 and has been spread in whole China and the world. Worldwide outbreaks of COVID-19 triggered a large number of morbidities and mortalities beside its economic and social burdens, which are discussed a lot, in scientific literature and different types of media. As a sleep medicine specialist, we may wonder how we can be involved in this field. In this short theoretical essay, we will discuss about the known facts as well as the hypotheses, which associate the sleep medicine to COVID-19. The discussed points may provide a source of research ideas throughout the world for better understanding of novel coronavirus-19 that has devastating effects on humanity.

Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran.

BACKGROUND: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran. METHODS: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters. RESULTS: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63-38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06-10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00-8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64-3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07-2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study. CONCLUSION: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups.

The effect of apnea management on novel coronavirus infection: A study on patients with obstructive sleep apnea.

OBJECTIVE: To assess the frequency of coronavirus disease-2019 (COVID-19) and the effect of obstructive sleep apnea (OSA) management on COVID-19 among patients with confirmed OSA. DESIGN: Cross-sectional telephone interview survey. SETTING: Academic sleep labs. PARTICIPANTS: Iranian adults ≥ 18 years old with confirmed OSA. RESULTS: Among 275 participants with OSA, 20% (n = 55) were suspected to have history of COVID-19 but had no positive test, and 18% (n = 51) were in the definite COVID-19 group according to their reported symptoms or confirmed positive test. Having severe OSA (apnea hypopnea index ≥ 30) was associated with an increased risk of definite COVID-19, with an odds ratio (OR) with 95% confidence interval (95% CI) of 2.31 (0.87-5.55) compared to having mild OSA in definite COVID-19 group. Those not undergoing treatment for OSA had an OR (95% CI) of 2.43 (1.26-4.67) for definite COVID-19 compared to those accepting treatment in definite COVID-19 group. Total sleep times (TSTs) were 354, 340, and 320 minutes in healthy, suspected, and COVID-19 groups, respectively; TST was associated with COVID-19 (P-value = .04). Similarly, sleep efficiency (SE) scores were 75.7, 74.2, and 67.9% for the healthy, suspected, and COVID-19 groups, respectively (P-value = .005); Beck Depression scores were 13.8, 13.0, and 17.7, respectively (P-value = .056). CONCLUSIONS: OSA as a proinflammatory condition with multiple comorbidities may be a contributing factor to developing COVID-19. Greater OSA severity, no treatment for OSA, and lower TST and SE were associated with increased COVID-19 prevalence among patients with OSA.

Twelve Lessons on Hospital Leadership during COVID-19 Pandemic.

Coronavirus pandemic has been announced by World Health Organization Director General on March 11th, 2020. Imam Khomeini Hospital Complex, affiliated to Tehran University of Medical Sciences, was one the first referral hospitals in the capital city of Tehran, I.R.Iran that entered the crisis and started a serious battle with the disease. The hospital had to change many routine operations to cope with the situation and during this journey, we used published leadership principles and reached to some new experiences. As this is probably the most severe health-related crisis in Iran in the past 100 years, we gathered our lessons learned in the first fifty days of epidemic from the leadership point of view to share those with all colleagues worldwide. We know that leadership is of pivotal role in such a massive crisis and focused leadership experiences can help health care providers to manage the crisis while we are in the middle of it.