The impact of Covid-19 on physical activity one year after hospital discharge

Introduction: The long-term impact of severe COVID-19 on the physical activity (PA) of patients is unknown. Method(s): Forty-nine patients (63% male, 47% ICU stay, mean+/-SD 61+/-10 y, BMI 29.6+/-4.5 kg/m2) were assessed 1 year after hospital discharge for severe COVID-19. PA was objectively measured with the Dynaport Movemonitor for 1 week. Pulmonary function (FEV1, diffusion capacity (DL,co)), physical functioning (6 minute walking distance (6MWD), quadriceps force (QF)) and symptoms of dyspnea were assessed. Pearson correlations were used, to explore the association between PA (mean step count) and these outcomes. Low PA levels was defined as a mean step count of <7500 steps/day. Result(s): Patients had a mean daily total walking time of mean+/-SD 80+/-41 min/day and a mean movement intensity of 1.99+/-0.35 m/s2. They performed 6817+/-3567 steps/day. One year after discharge 65% of patients retained low PA levels. PA was not different between patients who had an ICU stay and those who did not (6667+/-4650 steps/day vs. 6943+/-2408 steps/day, p=0.80;71% vs 64% with low PA levels, p=0.29). 20% of patients reported mMRC dyspnea scale scores >1;90% of them had low PA levels. PA was associated with 6MWD, but not with QF, FEV1 and DL,co (figure 1). Conclusion(s): A significant proportion of patients was inactive 1 year after severe COVID-19 with no difference between patients with or without ICU stay. PA was positively associated with exercise capacity.

SOLID MEDICAL HOSPITAL WASTE IN TIMES OF CORONA: INCREASED VOLUME BUT NO INCREASED BIOHAZARD RISK

The effect of the COVID-19 pandemic on medical waste EWC/EURAL code 180103* (infectious medical waste) and 180104 (non-infectious medical waste) was investigated in 6 university hospitals and 6 general hospitals. Data on the number of in-hospital patients and on quantity and volume of waste were obtained during 2019 (control period) and in 2020 up to March 2021 (COVID-19 period) for the hospitals, from the waste managing company, and from the regional destruction facility. The presence of SARS-CoV-2 on the surface of waste recipients was analyzed using RTPCR. We found that the effect of the pandemic on the total weight of waste is limited during the first wave (March 2020), while during the second wave, the quantity of waste type 180103* increased. The main effect is a nearly doubling of the volume of waste during both waves caused by the use of cardboard hospital boxes with a yellow inner plastic bag. We demonstrated that the average weight of these cardboard boxes generated for the treatment of COVID-19 patients is significantly lower compared to the weight of the waste from non-COVID-19 patients. COVID-19-related health care activities caused a weight increase of the 180103* waste from historical data (0.2-1.4 kg/day/bed) up to 5-8 kg/day/bed. RT-PCR analysis of swabs demonstrated the absence of viral RNA on personal protection materials and on the surface of recipients containing the waste. We conclude that COVID-19-related hospital waste is predominantly of the EWC 180104 type.

Antimicrobial prescription in severe COVID-19 and CAP: a matched case-control study.

BACKGROUND: In severe coronavirus diseases 2019 (COVID-19), a high and potentially excessive use of antimicrobials for suspected bacterial co-infection and intensive care unit (ICU)-acquired infections has been repeatedly reported. OBJECTIVES: To compare an ICU cohort of community-acquired pneumonia (CAP) with a cohort of severe COVID-19 pertaining to co-infections, ICU-acquired infections and associated antimicrobial consumption. METHODS: We retrospectively compared a cohort of CAP patients with a cohort of COVID-19 patients matched according to organ failure, ICU length of stay (LOS) and ventilation days. Patient data such as demographics, infection focus, probability and severity, ICU severity scores and ICU and in-hospital mortality, days of antimicrobial therapy (DOT) and number of antimicrobial prescriptions, using an incremental scale, were registered and analysed. The total number of cultures (sputum, urinary, blood cultures) was collected and corrected for ICU LOS. FINDINGS: CAP patients (n = 148) were matched to COVID-19 patients (n = 74). Significantly less sputum cultures (68.2% versus 18.9%, P < 0.05) and bronchoalveolar lavages (BAL) (73.7% versus 36.5%, P < 0.05) were performed in COVID-19 patients. Six (8.1%) COVID-19 patients were diagnosed with a co-infection. Respectively, 58 of 148 (39.2%) CAP and 38 of 74 (51.4%) COVID-19 patients (P = 0.09) developed ICU-acquired infections. Antimicrobial distribution, both in the number of prescriptions and DOT, was similar in both cohorts. CONCLUSIONS: We found a low rate of microbiologically confirmed bacterial co-infection and a high rate of ICU-acquired infections in COVID-19 patients. Infection probabilities, antimicrobial prescriptions and DOT were comparable with a matched CAP cohort.

Diagnosing COVID-19; towards a feasible COVID-19 rule-out protocol.

INTRODUCTION: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. RESULTS: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. CONCLUSION: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.