ABSTRACT
Background &Objective : Multi-Drug Resistant Tuberculosis (MDRTB) and depression act synergistically that magnify the burden of disease. The present study aims to understand the differences in depression scale using Patient Health Questionnaire-9 (PHQ-9) over the time during the COVID-19 pandemic which may cause mental and psychological changes in the patients with MDRTB. Method: A total of 155 treatment naive adults and adolescents MDRTB are enrolled in an ongoing cohort. Each participant completes PHQ-9 to assess depression at baseline, 2 weeks, 1, 2, 3, 4, 5, 6, 12, 18, 24 months of treatment and post treatment 6 and 12 months. Differences in the PHQ9 scores for visits before COVID-19, during 1st lockdown, in unlock phase and 2nd lockdown were assessed by Chi-squared test and t-test and p<0.05 were considered statistically significant. Results: Out of 155 participants with median age of 27 years' 102 (65.8%) were females A significant difference was seen in the overall PHQ-9 scores across each time period (p<0.001). Also, significant changes were seen in overall PHQ-9 scores before COVID-19 and 1st lockdown (p<0.001), during unlock phase, 2nd lockdown (p<0.001) and without lockdown and during 1st and 2nd lockdowns (p<0.001). During 1st lockdown and unlock phase (p=0.165), there were no significant differences seen in the PHQ-9 scores. Conclusion: In this ongoing study, changes in the overall depression scale were significantly associated with COVID-19 lockdown, during unlock phase and 2nd lockdown phase. PHQ-9 screening can be useful for patients who may benefit from additional support and counselling during the treatment during COVID-19 pandemic.
ABSTRACT
Background: Sustained molecular detection of SARS-CoV-2 RNA in the upper respiratory tract (URT) is common and confounds infection control efforts in the community. The mean duration of viral RNA detection is ∼17 days, and ∼14% of people with mild or no symptoms have detectable viral RNA for > 4 weeks. We sought to identify host and immune determinants of prolonged SARS-CoV-2 RNA detection in an intensively-sampled prospective observational cohort of outpatients with mild COVID-19 who had concomitant URT virus and mucosal IgG sampling. Methods: 95 participants ≥ 30 years old with known symptom onset date and at least two positive SARS-CoV-2 qRT-PCR results were enrolled. Participants self-collected mid-nasal, oropharyngeal, and oral crevicular fluid (OCF) samples 4-5 times within 3 weeks. 1-3 months after symptom onset, height and weight were measured and nasopharyngeal, salivary, OCF, and blood samples were collected. SARS-CoV-2 qRT-PCR was performed on samples, and positive samples were tested for propagation in virus culture. A multiplex mucosal IgG immunoassay with multiple SARS-CoV-2 antigens was performed on OCF. Plasma titers of neutralizing antibodies, SARS-CoV-2 spike (S) antibodies, and S-receptor binding domain (RBD) antibodies were obtained by microneutralization assay and indirect ELISA. Time to qRT-PCR clearance wasmeasured from symptom onset until the midpoint between the last positive qRT-PCR test and the next negative test. Associations were estimated using a Cox proportional hazard model. Hazards of viral RNA clearance were compared for different age, sex, race/ethnicity, and body mass index (BMI) groups and whether fever was one of the first three symptoms, adjusting for comorbidities and immunocompromised status. Results: See Table for participant characteristics. Of 56 participants with observed viral RNA clearance, mean time to clearance was 33.5 days. The hazard ratio for obesity vs overweight/normal weight was 0.37 (95% CI 0.18-0.78, p=0.009). Elevated mucosal SARS-CoV-2-specific IgG did not associate with faster viral RNA clearance. The maximum time from symptom onset to virus culture. positive sample was 12 days, which is just after the mean time of first positive mucosal SARS-CoV-2-specific IgG detection. Conclusion: Obesity is associated with prolonged SARS-CoV-2 RNA detection in outpatients. Mucosal SARS-CoV-2 IgG is not associated with faster clearance of viral RNA from the URT, suggesting that viral clearance is mediated by select host immune responses.