Clinical manifestations of EVALI in adolescents before and during the COVID-19 pandemic.

INTRODUCTION: E-cigarette, or vaping, product use-associated lung injury (EVALI) results from inhaling the aerosol of e-cigarettes and has similar clinical features to coronavirus disease 2019 (COVID-19). EVALI case counts since the declaration of the COVID-19 pandemic is unknown. METHODS: A retrospective electronic health record chart review of adolescents hospitalized at one institution with EVALI was conducted. Clinical characteristics and hospital course of patients hospitalized during the pandemic were compared to those prepandemic. RESULTS: The clinical presentation of adolescents hospitalized prior-to (n = 19) and during the COVID-19 pandemic (n = 22) were similar with respect to constitutional, respiratory, and gastrointestinal symptoms. All patients hospitalized during the pandemic were tested for COVID-19 at least once. Only one patient had a positive SARS-CoV-2 RT-PCR test result. Thirty-one out of 39 patients treated with corticosteroids had clinical improvement within 24 h (79%). Patients hospitalized during the pandemic had a shorter median length of stay (5 vs. 7 days, p < 0.01), and were less often discharged with home oxygen (1 vs. 6 patients, p = 0.04). Pulmonary function tests improved pre- to postcorticosteroid treatment and postcorticosteroid to follow-up. CONCLUSIONS: Eliciting a history of vaping in adolescents presenting with constitutional, respiratory, and gastrointestinal symptoms is important to identify EVALI cases, which have continued throughout the COVID-19 pandemic. A shorter length of stay with less need for mechanical ventilation and home oxygen in adolescents hospitalized during the pandemic may reflect increased familiarity with EVALI characteristics. Corticosteroids led to clinical and pulmonary function improvement.

Comparison of Long-Term Complications of COVID-19 Illness among a Diverse Sample of Children by MIS-C Status.

Most pediatric COVID-19 cases are asymptomatic; however, a small number of children are diagnosed with multisystem inflammatory syndrome in children (MIS-C), a rare but severe condition that is associated with SARS-CoV-2 infection. Persistent symptoms of COVID-19 illness in children diagnosed with/without MIS-C is largely unknown. A retrospective EHR review of patients with COVID-19 illness from one pediatric healthcare system to assess the presence of acute (<30 days) and chronic (≥30, 60-120, and >120 days) long-term COVID symptoms was conducted. Patients/caregivers completed a follow-up survey from March 2021 to January 2022 to assess the presence of long COVID. Results showed that non-MIS-C children (n = 286; 54.49% Hispanic; 19.23% non-Hispanic Black; 5.77% other ethnicity; 79.49% government insurance) were younger (mean age 6.43 years [SD 5.95]) versus MIS-C (n = 26) children (mean age 9.08 years, [SD 4.86]) (p = 0.032). A share of 11.5% of children with MIS-C and 37.8% without MIS-C reported acute long COVID while 26.9% and 15.3% reported chronic long COVID, respectively. Females were almost twice as likely to report long symptoms versus males and those with private insurance were 66% less likely to report long symptoms versus those with government insurance. In conclusion, a substantial proportion of ethnically diverse children from low resource backgrounds with severe COVID illness are reporting long-term impacts. Findings can inform pediatric professionals about this vulnerable population in post-COVID-19 recovery efforts.

Possible substance use disorders among first responders during the COVID-19 era: a quasi-experimental study of personal and residential vulnerability.

Background: During the COVID-19 pandemic possible substance use disorders (SUD) were exacerbated from increased stress and isolation. Experiences of symptomology differ widely by occupations.Objectives: The objectives were to determine if there is a temporal relationship between COVID-19 vulnerability and possible SUDs among first responders, and to examine the association with neighborhood vulnerability.Methods: We conducted an analysis with two distinct cohorts dependent on time of entry: 1) First responders that began counseling prior to COVID-19 and 2) First responders that began counseling after the start of COVID-19. Data were collected at intake from first responders seeking mental health services between 2017 and 2021 at an organization in Dallas/Fort Worth, Texas. The study sample included 195 mostly male (75%) first responders (51% law enforcement officers; 49% emergency medical technicians/firefighters). Bivariate models tested unadjusted relationships between covariates and possible SUD. Adjusted models consisted of a two-level multivariable logistic regression models.Results: Nearly 40% (n = 77) screened positive for a possible SUD. Those beginning counseling after COVID-19 did not have higher odds of SUDs. For every unit increase in neighborhood Severe COVID-19 Health Risk Index at a first responder's residential location there was an increase in the odds of a possible SUD (AOR = 3.14, 95% CI: 1.47, 6.75).Conclusions: Our study highlights the degree to which personal and residential vulnerability to COVID-19 impacted first responders. The increased occupational stress of this population, and an established pattern of maladaptive coping, elucidates the need for preventative and clinical approaches to strengthen the resilience of this population.

COVID-19 related employment change is associated with increased alcohol consumption during the pandemic.

Introduction: The COVID-19 pandemic has had sweeping impacts on income and employment. Previous research has indicated that loss of employment is associated with mental illness and increased alcohol consumption. However, no studies have explored this relationship in the context of the COVID-19 pandemic in the United States.Objective: The purpose was twofold: (1) Evaluate the association between pandemic-related employment status and alcohol consumption and (2) assess the interacting effect of depression and employment change on alcohol consumption. We hypothesized that (1) employment change would be associated with increased alcohol consumption during the pandemic and (2) the combined effects of depressive symptoms with pandemic-related-employment-change would strengthen the association with alcohol consumption.Methods: A self-report, web-based survey collected information on sociodemographics, COVID-19-related employment impact (e.g., decreased pay, laid off), change in alcohol consumption since the pandemic, reasons for consumption change, and depressive symptoms. Multinomial regression modeling explored the associations between variables.Results: One-third (33%) of participants (n = 2,441; 67% female) reported consuming more alcohol compared to pre-pandemic and 11% reported that COVID-19 had a negative impact on their employment. Participants reported drinking more alcohol due to having more time (28%) or boredom (22%). The adjusted odds of increased alcohol consumption were 47% greater among those who reported negative employment impact compared to those who reported no employment impact (AOR: 1.47, 95% CI: 1.03-2.11); depression did not moderate this relationship.Conclusion: Given the pandemic's far-reaching impact, the potential for alcohol harm is demonstrably great. Mitigating consumption should be considered when addressing loss of employment in this context.

Longer time spent at home during COVID-19 pandemic is associated with binge drinking among US adults.

Background: The COVID-19 pandemic has introduced and exacerbated stressors (e.g., job loss, poor mental health) for adults across the United States (US) since the first statewide shelter-in-place order on March 19, 2020. Limited research has evaluated if, and how, pandemic-related stressors are associated with changes in alcohol consumption and binge drinking.Objectives: This analysis aims to identify COVID-19-related stressors associated with changes in alcohol consumption and binge drinking since the outbreak of the coronavirus.Methods: Data were collected on sociodemographics, alcohol consumption, and COVID-19-related stressors (household composition, job status, essential worker, stay-at-home duration, and depression) using a web-based, self-report survey to US adults from mid-March to mid-April 2020. Multivariable logistic and multinomial regression models were used to assess associations between COVID-19-related stressors and binge drinking and changes in alcohol consumption. Among 1,982 participants, 69% were female and 31% male.Results: Thirty-four percent of the sample reported binge drinking during the COVID-19 pandemic. More binge drinkers increased alcohol consumption during the pandemic (60%) than non-binge drinkers (28%). After adjusting for sociodemographics, for every 1-week increase in time spent at home during the pandemic, there was 1.19 (95% CI: 1.06-1.34) greater odds of binge drinking. Additionally, binge drinkers with a previous diagnosis of depression and current depression symptoms had greater odds of increased alcohol consumption compared to those reporting no depression (AOR: 1.77, 95% CI: 1.16, 2.73).Conclusion: Specific COVID-19-related stressors are related to alcohol consumption. This highlights the ancillary and unintended effects of the COVID-19 pandemic which could have long-lasting population health consequences.