Respiratory disorders and their association with clinical outcomes in COVID-19: a narrative review of current literature.

BACKGROUND AND OBJECTIVE: The coronavirus disease 2019, also known as COVID-19, has caused significant worldwide morbidity and mortality. Given the direct effect of severe acute respiratory syndrome virus-2 (SARS-CoV-2) on the respiratory system, it is important that clinicians who manage chronic respiratory conditions are familiar with the pathophysiology and impact of COVID-19 on pre-existing respiratory disease. METHODS: Literature review relating to COVID-19 and respiratory disorders from PubMed and Google Scholar was conducted, with aim to encompass all publications relating to the most commonly encountered respiratory diseases in clinical practice, namely chronic obstructive lung disease (COPD), asthma, interstitial lung disease (ILD), obstructive sleep apnea (OSA), as well as obesity given it's known effect on both gas exchange and mechanistic aspects of respiration. The publications were analyzed for relevance to clinical implications and pathophysiologic mechanisms. Additional manual literature review was conducted based on citations from large review articles and society guidelines/statement papers. KEY CONTENT AND FINDINGS: Certain respiratory disorders such as COPD, ILD, OSA, and obesity carry higher burden of morbidity and mortality associated with COVID-19. Surprisingly, and in contrast to previously studied viral epidemics, asthma does not carry increased associated risk of contracting the virus or worse clinical outcomes. CONCLUSIONS: A thorough understanding of the mechanisms responsible for control of breathing and the effect of COVID-19 on pulmonary pathophysiology will allow clinicians who manage chronic respiratory disease to effectively predict associated clinical outcomes as well as improve management strategies.

Identifying Social Determinants of Health and Allocating Resources During the COVID-19 Pandemic.

Currently, the world has found itself in a global pandemic with coronavirus. At its start, to limit the spread of this virus, countries, states, and counties have implemented stay-at-home orders and shutdowns. These shutdowns had great impacts on people's well-being and exacerbated social determinants of health. This project aims to identify patient social determinants of health and their associations during the COVID-19 pandemic via telemedicine. METHODS: A total of 104 patients were surveyed within Pittsburgh, Pennsylvania, who had not been seen for at least 4 weeks before March 23, 2020 and who did not have a scheduled visit within 4 weeks of the initial survey. Based on a patient's specific response, resources were then allocated to them. RESULTS: Most patients surveyed identified at least 1 social determinant of health, the most common being financial issues (27%), mental health issues (26%), and access to food (19%). A statistically significant relationship was found between patients who identified finances with access to food, access to medication with struggling to care for themselves or others, and physical wellness with mental health. Lastly, an association was found between those who did not identify any difficulties and wanting more information. CONCLUSIONS: By identifying needed barriers via telemedicine, we can properly allocate resources to those who need it the most and hope to decrease the potential long-term effects of this current pandemic.

Improving Emergency Room Utilization During the COVID-19 Pandemic: A Telemedicine Social Determinants of Health Outreach Approach.

High-risk patients over the age of 65, who had chronic medical conditions, and had not yet had a primary care visit within 2020 were identified. A subgroup of patients participated in a survey to assess social determinants of health (SDOH) in the setting of a pandemic. Outcomes of those who participated in the survey, and those who did not participate were compared. Notably, those who were surveyed and lived within zip codes with low socioeconomic status had significantly decreased emergency department visits, which we defined as a discharge from the emergency department without hospitalization, as compared to those who did not receive outreach. Rates of inpatient hospitalization did not differ significantly. These findings suggest that patient outreach to evaluate SDOH during a pandemic leads to more appropriate emergency department and hospital resource utilization. This finding is particularly impactful given the current pandemic, which may place a strain on emergency department, and healthcare resources.

Bedside Healers: An approach to increase humanistic practices in the inpatient setting.

In light of the COVID-19 pandemic and resulting visitor restrictions, the inpatient setting has become isolative for many patients. We initiated a program, Bedside Healers, in which medical students rotating at Allegheny General Hospital in Pittsburgh, Pennsylvania dedicate time to bedside discussions with patients in the Complex Medical Care Unit in an effort to provide more individualized care to patients and enable them to feel connected with their physicians. After collecting their weekly entries detailing the patient experiences the students had, we found that this program was able to increase patient-centric humanistic practices and improved the overall patient care experience for patients and physicians alike. We encourage other inpatient settings to adopt similar initiatives especially during these unprecedented and isolating times.