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1.
J Psychiatr Pract ; 26(4): 309-312, 2020 07.
Article in English | MEDLINE | ID: covidwho-1172669

ABSTRACT

This column anticipates challenges likely to be faced by psychotherapists and their patients after the coronavirus disease 2019 (COVID-19) pandemic subsides. It looks beyond the current impact of loneliness, isolation, thwarted belongingness, and loss toward the longer term impact of moral injury and blocked opportunities for mourning.


Subject(s)
Coronavirus Infections , Grief , Pandemics , Pneumonia, Viral , Psychotherapy , Survivors , Betacoronavirus , Coronavirus/isolation & purification , Coronavirus Infections/mortality , Coronavirus Infections/psychology , Humans , Pneumonia, Viral/mortality , Pneumonia, Viral/psychology
2.
J Acquir Immune Defic Syndr ; 85(1): 6-10, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-1165584

ABSTRACT

BACKGROUND: SARS-CoV-2 infection continues to cause significant morbidity and mortality worldwide. Preliminary data on SARS-CoV-2 infection suggest that some immunocompromised hosts experience worse outcomes. We performed a retrospective matched cohort study to characterize outcomes in HIV-positive patients with SARS-CoV-2 infection. METHODS: Leveraging data collected from electronic medical records for all patients hospitalized at NYU Langone Health with COVID-19 between March 2, 2020, and April 23, 2020, we matched 21 HIV-positive patients with 42 non-HIV patients using a greedy nearest-neighbor algorithm. Admission characteristics, laboratory test results, and hospital outcomes were recorded and compared between the 2 groups. RESULTS: Although there was a trend toward increased rates of intensive care unit admission, mechanical ventilation, and mortality in HIV-positive patients, these differences were not statistically significant. Rates for these outcomes in our cohort are similar to those previously published for all patients hospitalized with COVID-19. HIV-positive patients had significantly higher admission and peak C-reactive protein values. Other inflammatory markers did not differ significantly between groups, although HIV-positive patients tended to have higher peak values during their clinical course. Three HIV-positive patients had superimposed bacterial pneumonia with positive sputum cultures, and all 3 patients died during hospitalization. There was no difference in frequency of thrombotic events or myocardial infarction between these groups. CONCLUSIONS: This study provides evidence that HIV coinfection does not significantly impact presentation, hospital course, or outcomes of patients infected with SARS-CoV-2, when compared with matched non-HIV patients. A larger study is required to determine whether the trends we observed apply to all HIV-positive patients.


Subject(s)
Betacoronavirus , Coinfection/virology , Coronavirus Infections/complications , HIV Infections/complications , Pneumonia, Viral/complications , Adult , Aged , Aged, 80 and over , Case-Control Studies , Cohort Studies , Coinfection/mortality , Coronavirus Infections/mortality , Critical Care , Female , HIV Infections/mortality , Hospitalization , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Respiration, Artificial , Retrospective Studies , Treatment Outcome
3.
Prehosp Disaster Med ; 36(2): 141-144, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1164743

ABSTRACT

OBJECTIVE: This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020). METHODS: Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient. RESULTS: These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico. CONCLUSION: The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.


Subject(s)
/mortality , Disaster Planning , Pneumonia, Viral/mortality , Security Measures , Female , Humans , Male , Pandemics , Pneumonia, Viral/virology , Predictive Value of Tests , Puerto Rico/epidemiology , United States/epidemiology
4.
J Coll Physicians Surg Pak ; 31(3): 258-261, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1156235

ABSTRACT

OBJECTIVE: To evaluate the temporal changes on serial chest radiographs (CXRs)of hospitalised COVID-19 positive patients till their outcome(discharge/death); to determine the severity of CXR score and its correlation with clinical outcome (hospital stay, chest intubation and mortality). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Shifa International Hospital (SIH), Islamabad from March to June 2020. METHODOLOGY: After IRB approval, 112 patients were consecutively enrolled, having laboratory-confirmed SARS-CoV-2 and hospitalised in SIH. Patients' demographics and clinical data were retrieved from Radiology Information System (RIS). Chest radiographs (CXR) were retrieved from picture archive and communication system (PACS). CXR severity scoring was determined by three radiologists, and results were analysed. RESULTS: Lung opacities (98.2%), involvement of both lungs (96.4%), both peripheral and central region involvement (62.5%) and upper/mid/lower zone distribution (61.6%) were the most frequent findings. Males affected more than females with a mean age of 58.9 ± 13.1 years. Zonal involvement, density and extent of opacities peaked on 10-13th day of illness. In the last CXR, opacities showed decrease in extent as well as density, reduction in zonal involvement, and few having mixed interstitial thickening/fibrosis. One hundred and five out of 112 (93.8%) patients had residual radiographic abnormalities on discharge. CONCLUSION: Serial chest radiography can be used to monitor disease progression and temporal changes after initial HRCT. Patients who have CXR severity score of 4 or more at the time of admission, is a red flag for prolonged hospital stay and possible intubation. Severity of CXR findings peaked at 10-13 days. It is recommended to repeat CXRs every 3-4th day during hospital stay. Majority of the patients has residual radiographic abnormality on discharge. Key Words: COVID-19, Radiography, Thoracic, Pandemic, Chest X-ray.


Subject(s)
/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Radiography, Thoracic/methods , Adult , Aged , Disease Progression , Female , Humans , Intubation/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Pakistan/epidemiology , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Severity of Illness Index , Time Factors
6.
Aging Clin Exp Res ; 32(7): 1195-1198, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1152155

ABSTRACT

WHO declared SARS-CoV-2 a global pandemic. The present aim was to propose an hypothesis that there is a potential association between mean levels of vitamin D in various countries with cases and mortality caused by COVID-19. The mean levels of vitamin D for 20 European countries and morbidity and mortality caused by COVID-19 were acquired. Negative correlations between mean levels of vitamin D (average 56 mmol/L, STDEV 10.61) in each country and the number of COVID-19 cases/1 M (mean 295.95, STDEV 298.7, and mortality/1 M (mean 5.96, STDEV 15.13) were observed. Vitamin D levels are severely low in the aging population especially in Spain, Italy and Switzerland. This is also the most vulnerable group of the population in relation to COVID-19. It should be advisable to perform dedicated studies about vitamin D levels in COVID-19 patients with different degrees of disease severity.


Subject(s)
Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Vitamin D Deficiency/epidemiology , Betacoronavirus , Coronavirus Infections/etiology , Coronavirus Infections/prevention & control , Humans , Italy/epidemiology , Pandemics/prevention & control , Pneumonia, Viral/etiology , Pneumonia, Viral/prevention & control , Spain/epidemiology , Vitamin D/blood , Vitamin D Deficiency/complications
7.
BMJ Glob Health ; 6(3)2021 03.
Article in English | MEDLINE | ID: covidwho-1148158

ABSTRACT

BACKGROUND: The burden of COVID-19 in low-income and conflict-affected countries remains unclear, largely reflecting low testing rates. In parts of Yemen, reports indicated a peak in hospital admissions and burials during May-June 2020. To estimate excess mortality during the epidemic period, we quantified activity across all identifiable cemeteries within Aden governorate (population approximately 1 million) by analysing very high-resolution satellite imagery and compared estimates to Civil Registry office records. METHODS: After identifying active cemeteries through remote and ground information, we applied geospatial analysis techniques to manually identify new grave plots and measure changes in burial surface area over a period from July 2016 to September 2020. After imputing missing grave counts using surface area data, we used alternative approaches, including simple interpolation and a generalised additive mixed growth model, to predict both actual and counterfactual (no epidemic) burial rates by cemetery and across the governorate during the most likely period of COVID-19 excess mortality (from 1 April 2020) and thereby compute excess burials. We also analysed death notifications to the Civil Registry office over the same period. RESULTS: We collected 78 observations from 11 cemeteries. In all but one, a peak in daily burial rates was evident from April to July 2020. Interpolation and mixed model methods estimated ≈1500 excess burials up to 6 July, and 2120 up to 19 September, corresponding to a peak weekly increase of 230% from the counterfactual. Satellite imagery estimates were generally lower than Civil Registry data, which indicated a peak 1823 deaths in May alone. However, both sources suggested the epidemic had waned by September 2020. DISCUSSION: To our knowledge, this is the first instance of satellite imagery being used for population mortality estimation. Findings suggest a substantial, under-ascertained impact of COVID-19 in this urban Yemeni governorate and are broadly in line with previous mathematical modelling predictions, though our method cannot distinguish direct from indirect virus deaths. Satellite imagery burial analysis appears a promising novel approach for monitoring epidemics and other crisis impacts, particularly where ground data are difficult to collect.


Subject(s)
/mortality , Cemeteries , Pneumonia, Viral/mortality , Satellite Imagery , Humans , Pandemics , Pneumonia, Viral/virology , Registries , Risk Factors , Yemen/epidemiology
10.
Aging Clin Exp Res ; 32(7): 1189-1194, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1139406

ABSTRACT

The early stages of the COVID-19 pandemic have focused on containing SARS-CoV-2 infection and identifying treatment strategies. While controlling this communicable disease is of utmost importance, the long-term effect on individuals with non-communicable diseases (NCD) is significant. Although certain NCDs appear to increase the severity of COVID-19 and mortality risk, SARS-CoV-2 infection in survivors with NCDs may also affect the progression of their pre-existing clinical conditions. Infection containment measures will have substantial short- and long-term consequences; social distancing and quarantine restrictions will reduce physical activity and increase other unhealthy lifestyles, thus increasing NCD risk factors and worsening clinical symptoms. Vitamin D levels might decrease and there might be a rise in mental health disorders. Many countries have made changes to routine management of NCD patients, e.g., cancelling non-urgent outpatient visits, which will have important implications for NCD management, diagnosis of new-onset NCDs, medication adherence, and NCD progression. We may have opportunities to learn from this unprecedented crisis on how to leverage healthcare technologies and improve procedures to optimize healthcare service provision. This article discusses how the COVID-19 outbreak and related infection control measures could hit the most frail individuals, worsening the condition of NCD patients, while further jeopardizing the sustainability of the healthcare systems. We suggest ways to define an integrated strategy that could involve both public institutional entities and the private sector to safeguard frail individuals and mitigate the impact of the outbreak.


Subject(s)
Coronavirus Infections/complications , Frail Elderly/psychology , Frailty/complications , Healthy Aging , Noncommunicable Diseases/epidemiology , Pneumonia, Viral/complications , Aged , Betacoronavirus , Chronic Disease/epidemiology , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Delivery of Health Care , Disease Outbreaks , Disease Progression , Europe/epidemiology , Frailty/psychology , Humans , Infection Control , Loneliness , Pandemics/prevention & control , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , Prevalence , Quarantine
11.
Rev Peru Med Exp Salud Publica ; 37(2): 253-258, 2020.
Article in Spanish, English | MEDLINE | ID: covidwho-1128200

ABSTRACT

In order to describe manifestations from patients with coronavirus disease 2019 (COVID-19), sociodemographic variables such as, previous medical history, clinical and radiological manifestations, treatments and evolution of patients were evaluated. This took place from March 6th to 25th, 2020, in the "Edgardo Rebagliati Martins" National Hospital in Lima. Seventeen patients were registered: 76% were male, with an average age of 53.5 years (range 25-94); 23.5% had returned from abroad; 41.2% were referred from other health facilities; 41.2% were admitted to mechanical ventilation; 29.4% (5 patients) died. The risk factors detected were: advanced age, arterial hypertension and obesity. The main symptoms detected were: cough, fever and dyspnea. Frequent laboratory findings were: elevated C-reactive protein and lymphopenia. The predominant radiological presentation was bilateral interstitial lung infiltrate. A first experience in the management of patients diagnosed with severe COVID-19 in Peru is reported.


Subject(s)
Coronavirus Infections/physiopathology , Hospitalization , Pneumonia, Viral/physiopathology , Respiration, Artificial , Adult , Aged , Aged, 80 and over , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Cough/epidemiology , Cough/etiology , Dyspnea/epidemiology , Dyspnea/etiology , Female , Fever/epidemiology , Fever/etiology , Humans , Male , Middle Aged , Pandemics , Peru , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Retrospective Studies , Risk Factors , Severity of Illness Index
12.
Int J Antimicrob Agents ; 56(4): 106129, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1121213

ABSTRACT

INTRODUCTION: The effect of anti-infective agents in COVID-19 is unclear. The impact of changes in practice on prognosis over time has not been evaluated. METHODS: Single center, retrospective study in adults hospitalized in a medicine ward for COVID-19 from March 5th to April 25th 2020. Patient characteristics were compared between two periods (before/after March 19th) considering French guidelines. The aim of the study was to evaluate how medical care impacted unfavorable outcome, namely admission to intensive care unit (ICU) and/or death. RESULTS: A total of 132 patients were admitted: mean age 59.0±16.3 years; mean C-reactive protein (CRP) level 84.0±71.1 mg/L; 46% had a lymphocyte count <1000/mm3. Prescribed anti-infective agents were lopinavir-ritonavir (n=12), azithromycin (AZI) (n=28) and AZI combined with hydroxychloroquine (HCQ) (n=52). There was a significant decrease in ICU admission, from 43% to 12%, between the two periods (P<0.0001). Delays until transfer to ICU were similar between periods (P=0.86). Pulmonary computerized tomography (CT)-scans were performed significantly more often with time (from 50% to 90%, P<0.0001), and oxygen-dependency (53% vs 80%, P=0.001) and prescription of AZI±HCQ (from 25% to 76%, P<0.0001) were also greater over time. Multivariate analyses showed a reduction of unfavorable outcome in patients receiving AZI±HCQ (hazard ratio [HR]=0.45, 95% confidence interval [CI: 0.21-0.97], P=0.04), particularly among an identified category of individuals (lymphocyte ≥1000/mm3 or CRP ≥100 mg/L). CONCLUSION: The present study showed a significant decrease in admission to ICU over time, which was probably related to multiple factors, including a better indication of pulmonary CT-scan, oxygen therapy, and a suitable prescription of anti-infective agents.


Subject(s)
Anti-Infective Agents/therapeutic use , Azithromycin/therapeutic use , Betacoronavirus/drug effects , Coronavirus Infections/drug therapy , Hydroxychloroquine/therapeutic use , Lopinavir/therapeutic use , Pneumonia, Viral/drug therapy , Ritonavir/therapeutic use , Adult , Aged , Betacoronavirus/pathogenicity , C-Reactive Protein/metabolism , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Disease Progression , Drug Combinations , Female , Humans , Intensive Care Units , Male , Middle Aged , Multivariate Analysis , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , Prognosis , Retrospective Studies , Survival Analysis , T-Lymphocytes/pathology , T-Lymphocytes/virology , Tomography, X-Ray Computed , Treatment Outcome
13.
BMC Infect Dis ; 21(1): 241, 2021 Mar 05.
Article in English | MEDLINE | ID: covidwho-1119412

ABSTRACT

BACKGROUND: Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD: This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS: Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION: Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.


Subject(s)
Antibodies, Monoclonal, Humanized/administration & dosage , Cytokine Release Syndrome , Hypoxia , Interleukin-6/antagonists & inhibitors , Pneumonia, Viral , /epidemiology , /physiopathology , Compassionate Use Trials/statistics & numerical data , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/immunology , Cytokine Release Syndrome/therapy , Female , Humans , Hypoxia/etiology , Hypoxia/therapy , India/epidemiology , Interleukin-6/immunology , Male , Middle Aged , Pneumonia, Viral/blood , Pneumonia, Viral/etiology , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Respiration, Artificial/methods , Retrospective Studies , Severity of Illness Index , Survival Analysis , Treatment Outcome
14.
J Glob Health ; 10(2): 020503, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1116992

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19), the most hectic pandemic of the era, is increasing exponentially and taking thousands of lives worldwide. This study aimed to assess the prevalence of pre-existing comorbidities among COVID-19 patients and their mortality risks with each category of pre-existing comorbidity. Methods: To conduct this systematic review and meta-analysis, Medline, Web of Science, Scopus, and CINAHL databases were searched using pre-specified search strategies. Further searches were conducted using the reference list of the selected studies, renowned preprint servers (eg, medRxiv, bioRxiv, SSRN), and relevant journals' websites. Studies written in the English language included if those were conducted among COVID-19 patients with and without comorbidities and presented survivor vs non-survivor counts or hazard/odds of deaths or survivors with types of pre-existing comorbidities. Comorbidities reported in the selected studies were grouped into eight categories. The pooled likelihoods of deaths in each category were estimated using a fixed or random-effect model, based on the heterogeneity assessment. Publication bias was assessed by visual inspection of the funnel plot asymmetry and Egger's regression test. Trim and Fill method was used if there any publication bias was found. Results: A total of 41 studies included in this study comprised of 27 670 samples. The most common pre-existing comorbidities in COVID-19 patients were hypertension (39.5%), cardiovascular disease (12.4%), and diabetes (25.2%). The higher likelihood of deaths was found among COVID-19 patients who had pre-existing cardiovascular diseases (odds ratio (OR) = 3.42, 95% confidence interval (CI) = 2.86-4.09), immune and metabolic disorders (OR = 2.46, 95% CI = 2.03-2.85), respiratory diseases (OR = 1.94, 95% CI = 1.72-2.19), cerebrovascular diseases (OR = 4.12, 95% CI = 3.04-5.58), any types of cancers (OR = 2.22, 95% CI = 1.63-3.03), renal (OR = 3.02, 95% CI = 2.60-3.51), and liver diseases (OR = 2.35, 95% CI = 1.50-3.69). Conclusions: This study provides evidence that COVID-19 patients with pre-existing comorbidities had a higher likelihood of death. These findings could potentially help health care providers to sort out the most susceptible COVID-19 patients by comorbidities, take precautionary measures during hospitalization, assess susceptibility to death, and prioritize their treatment, which could potentially reduce the number of fatalities in COVID-19.


Subject(s)
Betacoronavirus , Cardiovascular Diseases/mortality , Coronavirus Infections/mortality , Diabetes Mellitus/mortality , Hypertension/mortality , Pneumonia, Viral/mortality , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/virology , Comorbidity , Coronavirus Infections/virology , Diabetes Mellitus/virology , Female , Humans , Hypertension/virology , Male , Middle Aged , Neoplasms/mortality , Neoplasms/virology , Pandemics , Pneumonia, Viral/virology , Prevalence
15.
Neurology ; 95(7): e910-e920, 2020 08 18.
Article in English | MEDLINE | ID: covidwho-1115264

ABSTRACT

OBJECTIVE: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19). METHODS: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period. RESULTS: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission. CONCLUSIONS: Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Inpatients/statistics & numerical data , Nervous System Diseases/epidemiology , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Betacoronavirus/isolation & purification , Case-Control Studies , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Female , Hospital Mortality , Humans , Italy/epidemiology , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/mortality , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Retrospective Studies , Severity of Illness Index
17.
Pan Afr Med J ; 35(Suppl 2): 1, 2020.
Article in English | MEDLINE | ID: covidwho-1106450

ABSTRACT

The epidemic of Coronavirus disease 2019 (COVID-19) in China caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become a global concern and subsequently labeled a pandemic by the World Health Organization on March 11th. As the world mobilizes to contain the COVID-19, scientists and public health experts are increasingly alarmed about the potentially catastrophic effects of an outbreak in Africa. The establishment of Africa Centres for Disease Control and Prevention by the Africa Union in 2017 was an unprecedented move toward strengthening national responses, so far enabling all fifty member states with confirmed cases of COVID-19 to adequately respond, break chains of transmission and effectively contain the spread of SARS-CoV-2. We enter an uncertain and challenging period that may severely test the preparedness, organizational resource and resilience of African states and the fabric of their societies. However, we speculate that the fear associated with COVID-19 may also lead to some of the long-standing messages about simple measures to reduce the spread, such as hand washing, finally becoming absorbed and more universally adopted by health workers and the public. Is it possible that regardless of the terrible threat posed by SARS-CoV-2, the increased adoption of these health protection measures may result in a reduction in the spread of other infectious diseases?


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Africa/epidemiology , Coronavirus Infections/economics , Coronavirus Infections/mortality , Hand Disinfection , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/mortality , Humans , International Cooperation , Pandemics/economics , Pneumonia, Viral/economics , Pneumonia, Viral/mortality , Universal Precautions
18.
Am J Ther ; 27(6): e599-e610, 2020.
Article in English | MEDLINE | ID: covidwho-1105027

ABSTRACT

BACKGROUND: Venous thromboembolism (VTE) is increasingly reported in seriously ill patients with COVID-19 infection. Incidence of VTE has been reported before and results varied widely in study cohorts. AREA OF UNCERTAINTY: Incidence of major VTE (segmental pulmonary embolism and above and proximal deep vein thrombosis) which is a contributor to mortality and morbidity is not known. Also, data is unclear on the optimal anticoagulation regimen to prevent VTE. DATA SOURCES: Multiple databases including PubMed were searched until May 12, 2020, to include studies reporting VTE in hospitalized COVID-19 adult patients. MOOSE guidelines were followed in selection, and 11 studies were included. We conducted a systematic review and meta-analysis to quantitatively assess the VTE burden in hospitalized COVID-19 patients and potential benefits of therapeutic dosing of anticoagulation compared with prophylaxis dosing for VTE prevention. THERAPEUTIC ADVANCES: Many societies and experts recommend routine prophylactic anticoagulation with heparin for VTE prevention in hospitalized COVID-19 patients. In this meta-analysis, the pooled rate of major VTE was 12.5% in hospitalized patients and 17.2% in intensive care unit patients. When therapeutic anticoagulation dosing was compared with prophylactic anticoagulation, the pooled odds ratio of VTE was 0.33 (95% confidence interval 0.14-0.75; P = 0.008, I = 0%) suggesting statistical significance with therapeutic dosing of anticoagulation for primary prevention of VTE in all hospitalized patients. However, this should be interpreted with caution as the bleeding events and safety profile could not be ascertained because of lack of adequate information. We recommend applying this finding to hospitalized COVID 19 patients only after carefully weighing individual bleeding risks and benefits. CONCLUSION: Major VTE events, especially pulmonary embolism, seem to be high in COVID-19 patients admitted to the intensive care unit. Therapeutic anticoagulation dosing seems to significantly benefit the odds of preventing any VTE when compared with prophylactic dosing in all hospitalized patients.


Subject(s)
Anticoagulants/administration & dosage , Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Pneumonia, Viral/complications , Pulmonary Embolism/epidemiology , Venous Thrombosis/epidemiology , Coronavirus Infections/mortality , Coronavirus Infections/virology , Dose-Response Relationship, Drug , Humans , Incidence , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/virology , Pulmonary Embolism/drug therapy , Pulmonary Embolism/prevention & control , Pulmonary Embolism/virology , Venous Thrombosis/drug therapy , Venous Thrombosis/prevention & control , Venous Thrombosis/virology
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