Impact of the COVID-19 pandemic on people living with migraine: Results of the MiCOAS qualitative study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an ongoing global health crisis that has had a range of impacts on people living with migraine. METHODS: Qualitative interviews performed as part of the Migraine Clinical Outcome Assessment System project, a multi-stage Food and Drug Administration-grant funded program to develop a patient-centered core set of outcome measures for use in migraine clinical trials, offered an opportunity to explore the experience of living with migraine during the pandemic as well as to examine whether migraine treatment priorities, symptoms, and associated disability changed due to the pandemic. Semi-structured interviews were conducted in the United States between the summer and fall of 2020 with 40 individuals with self-reported, medically diagnosed migraine who self-reported that they had not tested positive for or been diagnosed with COVID-19. RESULTS: Seventy percent (n = 28) of the sample reported ≥1 pandemic-related impact on their life with migraine. Fourteen participants reported both positive and negative impacts, twelve reported negative impacts only, and two reported positive impacts only. Among those reporting ≥1 pandemic-related impact, nine participants (32%) reported more frequent and five (17%) reported less frequent migraine attacks. Other negative impacts included interrupted medical care (n = 9; 32%), and greater stress (n = 13; 46%). The most frequent positive impact reported was greater access to health care (n = 8; 29%). Ictal and interictal symptoms were not noted to change due to the pandemic, but some respondents reported less disability due to increased flexibility of schedules and reduced expectations. Treatment priorities did not change due to the pandemic. CONCLUSION: The global COVID-19 pandemic has resulted in both negative and positive impacts for people living with migraine. Lessons to be considered when moving into a post-pandemic world include benefits of and satisfaction with telehealth and the benefits and importance of healthy lifestyle habits and flexibility such as improved sleep, reduced stress, and fewer social expectations.

Pre-existing sars-cov-2 reactive t cells in renal transplant patients

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused unprecedented public health and economical challenges worldwide. Cellular immunity is known to be crucial for the virus clearance. Recent data demonstrate pre-existing SARS-CoV-2-reactive T cells in samples of healthy blood donors collected before SARS-CoV-2 pandemics. The presence of these potentially protective T cells in SARS-CoV-2 naive population can be explained by cross-reactivity to the endemic common cold coronavirus. Whether such cells are also detectable in immunosuppressed patients is not known so far. Methods: We analysed the presence of SARS-CoV-2-cross-reactive T cell immunity in samples of 10 renal transplant patients (RTX) collected in 2019 before the onset of SARS-CoV-2 pandemics. Samples of 10 non-immunosuppressed/ immune competent SARS-CoV-2 naive patients matched to transplant patients were analysed as controls. T-cell reactivity against Spike-, Nucleocapsid-, and Membrane-SARS-CoV-2 proteins were analysed by multiparameter flow cytometry. Results: 50% of analysed RTX showed CD4 + T-cells reactive against at least one SARS-CoV-2 protein. CD8 + T cells reactive against at least one SARSCoV2 protein were demonstrated in 30% of RTX. Notably, the detected cells were of differentiated memory phenotype producing several Th1 cytokines including IFNg, TNFa, IL-2, as well as Granzyme B. The frequencies and cytokine expression pattern of SARS-CoV-2 reactive T-cells did not differ between transplant and non-transplant cohorts. Conclusion: Despite immunosuppressive treatment and underlined renal disease, transplant patients were able to generate cellular immunity crossreactive to SARS-CoV-2. The magnitude and functionality of the pre-existing immunity was non-inferior compared to the immune competent cohort. Although several pro-inflammatory cytokines were produced by the detected T cells, further studies are required to prove their antiviral protection.

[COVID-19 in old age-The geriatric perspective]. / COVID-19 im Alter ­ Die geriatrische Perspektive.

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.