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Rhode Island Medicine ; 104(10):53-55, 2021.
Article in English | MEDLINE | ID: covidwho-1539511
Circulation Research ; 127(12):e273, 2020.
Article in English | EMBASE | ID: covidwho-1186419


COVID-19, the clinical syndrome caused by severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) infection, has affected 15 million people globally as of August 2020. Myocardial injury, as evidenced by troponin elevation, is common during early SARS-CoV-2 infection and is predictive of poor outcomes. However, studying the effects of SARS-CoV-2 on the heart is difficult as tissue is generally only available from autopsy specimens late in the disease course. The non-human primate Rhesus macaque (RM) shares 91% homology of the ACE2 receptor to humans and has a similar susceptibility to infection and organ involvement as humans. Here, we sought to assess the acute effects of SARS-CoV-2 infection on the heart. Four (4) adult RM were infected with SARSCoV- 2 by intratracheal and intranasal inoculation and followed for 10 days. The virus was undetectable in cardiac tissue 10 days post inoculation (DPI), but we observed systemic inflammation at 4/5 DPI, with elevated CRP and ferritin levels. Immune cell infiltration was limited on flow cytometry of dissociated left ventricular tissue (n=1-2). Leukocyte numbers were about 32 CD45+ cells/mg, split evenly between macrophages and neutrophils. Half the macrophages were M2 (CD163+). About 71% of neutrophils were positive for the ACE2 receptor and CXCR2, and less than 10% had markers of NETosis. Surprisingly, we detected increased cardiac fibrosis assessed at necropsy (n=9), as well as elevated inflammatory cytokines IL-6 and TNF-alpha (n=5), compared to non-infected controls. In conclusion, while we saw no evidence of direct viral infection or significant immune response in the heart, the systemic inflammatory response to SARS-CoV-2 could be triggering adverse remodeling and fibrosis in the heart.

Pediatric Pulmonology ; 55(SUPPL 2):277, 2020.
Article in English | EMBASE | ID: covidwho-1063728


Background: Mental health (MH) providers have become more integrated into CF teams over the past several years, in large part due to the 2015 guidelines for mental health care. (Quittner, et al. 2016). Distance between CF care centers often presents as a barrier to collaboration and consultation among MH providers. We sought to better understand MH providers' experience of their work and to continue peer consultation groups as a way of promoting resilience, connectedness, and skill building among MH providers (Morse, 2012;Beidas, 2013). Methods: MH providers were invited via several professional listservs to participate in 6 monthly, one-hour consultation groups via a video conferencing. Providers (N=93) were assigned to 12 groups (65 clinical social workers, 20 psychologists, 13 other), with an average of 9 per group. Providers were from both adult and pediatric clinics across the US, with at least 85 different institutions represented. Facilitators were encouraged to guide a supportive and case-based peer discussion. Although not required, several groups began meeting more frequently shortly after COVID-19 was declared a pandemic. Results: Providers (N=50) completed a survey prior to beginning group meetings and identified three main goals: 1) skill building (60%), 2) support (58%), and 3) sense of community (32%). About half reported feeling connected (“somewhat” or “very”) to the larger CF community (56%), while almost everyone reported feeling connected to providers within their own CF center (98%). The majority indicated feeling that the work they do within CF is somewhat or very emotionally difficult (70%), and many (30%) indicated feeling overwhelmed/burned out at times by their work in CF. Notably, all endorsed greatly enjoying their work in CF. Attrition has been minimal (N=13) and primarily due to scheduling issues. Several groups started meeting twice/month, both to discuss patient needs and work/life balance related to the COVID-19 pandemic. Analysis of postgroup feedback is ongoing with plans to survey after conclusion of six sessions. Conclusions: Peer consultation groups have been very well received by CF MH providers as indicated by low attrition rates and positive feedback. Although MH providers indicated greatly enjoying their work in CF, more than half feel the work is emotionally difficult and for many the work has resulted in feeling overwhelmed/burned out. This format may serve as a model for burnout prevention for MH providers, as well as other allied health providers in CF care with the same barriers to discipline-specific support and consultation.