Post-acute sequelae of COVID-19 infection.

To determine if people infected with SARS-CoV-2 were at higher risk of developing selected medical conditions post-recovery, data were extracted from the database of a large health maintenance organization (HMO) in Israel between March 2020 and May 2021. For each condition, a condition-naïve group prior to COVID-19 (PCR-positive) infection were compared to a condition-naïve, non-COVID-19 infected group, matched by gender, age, socioeconomic status, minority group status and number of months visited primary care physician (PCP) in previous year. Diagnosis and recuperation dates for each COVID-19 infected participant were applied to their matched comparison participant (1:1 ratio). Incidence of each condition was measured between date of recuperation and end of study period for each group and Cox regression models developed to determine hazard ratios by group status, controlling for demographic and health variables. Crude and adjusted incidence rates were higher for the COVID-19 infected group than those not infected with COVID-19 for treatment for depression/anxiety, sleep disturbance, diagnosis of deep venous thrombosis, lung disease and fibromyalgia. Differences in incidence were no longer observed between the two groups for treatment of sleep disturbance, and diagnosis of lung disease when those hospitalized during the acute-phase of illness (any reason) were excluded. No difference was found by COVID-19 infection status for post-acute incidence of diabetes, cerebrovascular accident, myocardial infarction, acute kidney disease, hypertension and ischemic heart disease. Patients post-COVID-19 infection should be evaluated for depression, anxiety, sleep disturbance, DVT, lung disease and fibromyalgia.

Mental health assessment of Israeli adolescents before and during the COVID-19 pandemic (preprint)

The measures used to contain the COVID-19 pandemic caused severe disruption to the lives of children and adolescents, compromising their mental health and wellbeing. In this study we assessed the incidence rates of psychiatric diagnoses and drugs in Israeli adolescents before and during the COVID-19 pandemic. Analysis of health records data of over 200,000 12-17 years old adolescents identified a significant increase in all mental health diagnoses and most psychiatric drugs dispensation during the COVID-19 period compared to a corresponding pre-COVID period. A gender sub-analysis revealed that most of this increase was associated with adolescent girls. Girls exhibited increases of 68% in depression, 67% in eating disorders, 42% in anxiety and 29% in stress-related diagnoses during the COVID-19 period, which are significantly higher rates than those seen in boys and in the pre-COVID period. Sector sub-analysis showed that the increase was mainly in the general Jewish sector with almost no significant increases in the Arab and ultra-orthodox sectors. Our study highlights the mental health burden of Israeli adolescents during the pandemic and suggests that careful consideration should be given to it while deciding on measures to mitigate the pandemic.

COVID-19 community care in Israel-- A nationwide cohort study from a large health maintenance organization (preprint)

Introduction: Among the many medical challenges presented by the COVID-19 pandemic, management of the majority of COVID-19 patients in community outpatient settings rather than in hospital is crucial for the resource allocation of healthcare systems. This real-life study describes COVID-19 patients in three management settings: two outpatient settings and one inpatient. Methods: A retrospective database cohort study was conducted in a large Israeli Health Maintenance Organization. All laboratory-confirmed SARS-CoV-2 cases diagnosed 2/28/2020-6/20/2020, were included. Cases in the community setting were managed by physicians and other healthcare personnel through a nationwide remote monitoring center, using preliminary telehealth triage, 24/7 virtual care , all based on the individual patient’s clinical and social circumstances. Data were extracted from medical records. Outcome parameters included hospital admission, disease severity, need for respiratory support and mortality. Results: 5,525 cases tested positive. Seventy-seven cases who live in long- term facilities were excluded. 5448 cases, aged 36.36±20.31 (range 0-97 years) were enrolled. 88.7% were initially managed as outpatient either at home or in designated hotels, and 11.3% were hospitalized. 3.1% and 2.1% of the patients who were initially allocated for home or hotel stay, respectively, later required hospitalization. The main reason for hospitalization was dyspnea; twelve were diagnosed with severe disease. Fifty-six patients (1.3%) died, five (0.1%) of whom were initially allocated to the outpatient settings. Conclusions: Care for appropriately selected COVID-19 patients in the community provides a safe and effective option. This can contribute to reducing the hospitalization burden, with no evidence of increased morbidity or mortality.

Risk Factors For COVID-19 Positivity in Hospitalized Patients in A Low Prevalence Setting (preprint)

Background: Identifying hospitalized patients with Coronavirus disease 2019 (COVID-19) in a low prevalence setting is challenging.  We aimed to identify differences between COVID-19 positive and negative patients. Methods: Hospitalized patients with respiratory illness, or fever, were isolated in the emergency room and tested for COVID-19. Patients with a negative PCR and low probability for COVID-19 were taken out of isolation. Patients with a higher probability for COVID-19 remained in isolation during hospitalization and were retested after 48 hours. Risk factors for COVID-19 were assessed using logistic regression. Results: 254 patients were included, 37 COVID-19-positive (14.6%) and 217 COVID-19-negative (85.4%). Median age was 76 years, 52% were males. In a multivariate regression model, variables significantly associated with COVID-19 positivity were exposure to a confirmed COVID-19 case, length of symptoms before testing, bilateral and peripheral infiltrates in chest X-ray, neutrophil count within the normal range, and elevated LDH. In an analysis including only patients with pneumonia (N=78, 18 positive for COVID-19), only bilateral and peripheral infiltrates, normal neutrophil count and elevated LDH were associated with COVID-19 positivity. Conclusions: The clinical presentation of COVID-19 positive and negative patients is similar, but radiographic and laboratory features may help to identify COVID-19 positive patients and to initiate quick decisions regarding isolation.