Uptake of the Post COVID-19 Condition ICD-10-CM Diagnosis Code By Social Factors

Objectives: Post-COVID conditions (PCC) are increasingly reported in people who had COVID. Certain racial or socioeconomic groups may be at greater risk for PCC and less likely to seek care. We examined the uptake of the new ICD-10-CM diagnosis code for PCC in routine clinical practice in the United States and how it varied by race and payer group. Method(s): Using the Optum de-identified Electronic Health Record (EHR) dataset, we identified patients with an ICD-10-CM code for PCC (U09.9) between October 1, 2021, through March 31, 2022, with 6 months of prior EHR activity. The earliest diagnosis defined the index date. All concurrent diagnoses were measured on the index date. Prior COVID diagnosis was assessed using all available data before the index date. Result(s): There were 23,647 patients: 9.9% were African American, 12.1% had Medicaid, and 2.4% were uninsured. There was an overrepresentation of white patients among those with PCC (78.6% compared with 69.6% of the overall EHR in 2021). More African American (24.1%), Medicaid (23.1%), and uninsured (27.5%) patients were diagnosed in the inpatient setting or emergency department than whites (14.0%) and commercially insured patients (10.0%). Among racial groups, African Americans had the highest percentage of documented prior COVID diagnosis at 63.6%. Of concurrent diagnoses, shortness of breath and acute respiratory failure with hypoxia were higher among African Americans (13.9% and 6.1%, respectively) than whites (11.5% and 4.3%, respectively). The same pattern was seen when comparing Medicaid and uninsured to commercial payors. Conclusion(s): The PCC code was used differently across racial groups and payor types and captures varying manifestations of PCC. The differences in diagnosis locations underscore the importance of using data capturing all care settings when conducting studies using this code. Subgroup analyses are important for future studies using U09.9 due to variability in code application.Copyright © 2023

Resilience in adolescence during the COVID-19 crisis in Canada.

BACKGROUND: The COVID-19 pandemic constitutes a social crisis that will have long-term health consequences for much of the global population, especially for adolescents. Adolescents are triply affected as they: 1) are experiencing its immediate, direct effects, 2) will carry forward health habits they develop now into adulthood, and 3) as future parents, will shape the early life health of the next generation. It is therefore imperative to assess how the pandemic is influencing adolescent wellbeing, identify sources of resilience, and outline strategies for attenuating its negative impacts. METHODS: We report the results of longitudinal analyses of qualitative data from 28 focus group discussions (FGDs) with 39 Canadian adolescents and of cross-sectional analyses of survey data from 482 Canadian adolescents gathered between September 2020 and August 2021. FGD participants and survey respondents reported on their: socio-demographic characteristics; mental health and wellbeing before and during the pandemic; pre- and during-pandemic health behaviours; experiences living through a crisis; current perceptions of their school, work, social, media, and governmental environments; and ideas about pandemic coping and mutual aid. We plotted themes emerging from FGDs along a pandemic timeline, noting socio-demographic variations. Following assessment for internal reliability and dimension reduction, quantitative health/wellbeing indicators were analyzed as functions of composite socio-demographic, health-behavioural, and health-environmental indicators. RESULTS: Our mixed methods analyses indicate that adolescents faced considerable mental and physical health challenges due to the pandemic, and were generally in poorer health than expected in non-crisis times. Nevertheless, some participants showed significantly better outcomes than others, specifically those who: got more exercise; slept better; were food secure; had clearer routines; spent more time in nature, deep in-person social relationships, and leisure; and spent less time on social media. CONCLUSIONS: Support for youth during times of crisis is essential to future population health because adolescence is a period in the life course which shapes the health behaviours, socio-economic capacities, and neurophysiology of these future parents/carers and leaders. Efforts to promote resilience in adolescents should leverage the factors identified above: helping them find structure and senses of purpose through strong social connections, well-supported work and leisure environments, and opportunities to engage with nature.

COVID-19 AND PERFORMANCE OF COSMETICS COMPANIES

Skincare, hair care, make-up, perfumes, toiletries and deodorants, and oral cosmetics are the main product categories of the cosmetic market. Since the early twentieth century, the production of cosmetics and beauty products has been controlled by a handful of multi-national corporations. COVID-19 impacted the cosmetics industry in several different and sometimes conflicting ways. This study benchmarks the performance of 20 largest cosmetics companies against their competition as well as against their previous years to analyze the impact of COVID-19. We find that only one company has consistently performed than its peers over the period of 2015–2020. We also find that average efficiency score of cosmetics companies declines in 2020 relative to 2019. © Emerald Group Holdings Ltd.. All rights reserved.

Covid-19 reinfection in a kidney transplant patient

Purpose: Several cases have demonstrated positive SARS-CoV-2 PCR testing in patients who were initially shown to have cleared the infection. These reinfections may represent new strains of SARS-CoV-2 that can have significant clinical implications in the transplant population and affect public health initiatives aimed at controlling this pandemic. The purpose of this case is to highlight the presentation of COVID-19 reinfection in a kidney transplant recipient. Methods: We present a 66-year-old male patient with a history of ESRD due to lithium toxicity, status post deceased donor kidney transplant, maintained on Belatacept, prednisone and mycophenolate mofetil. He was first diagnosed with COVID-19 in March 2020 after presenting with cough, fever and hypoxia. Chest x-ray revealed bilateral infiltrates. Treatment included atazanavir, hydroxychloroquine and tocilizumab. Mycophenolate was withheld for the duration of his treatment. Despite resolution of all symptoms, nasopharyngeal PCR testing remained positive for SARS-CoV-2 even on discharge. He subsequently cleared his infection and tested negative twice, 3 months apart. He was later found to have AKI and a biopsy showed Banff 2A Acute Cellular Rejection which was treated with steroids and thymoglobulin. He was readmitted in November with fatigue and shortness of breath and tested positive again for SARS-CoV-2 by nasopharyngeal swab PCR. There was no hypoxia and chest x-ray did not show any infiltrates. Prerenal azotemia resolved with IV hydration. Serological studies showed presence of SARS-CoV2 IgG antibodies. Mycophenolate was again held. There was concern that this could be prolonged intermittent shedding from his previous infection. However genetic sequencing from samples of his first and current infection were compared and revealed a different strain consistent with a new infection. He recovered and was discharged. Results: COVID-19 reinfection in the transplant population is of significant interest as these patients may be susceptible to prolonged recovery. Several points of interest can be derived from this case. Firstly, the clinical significance of different viral strains and its effect on vaccination efforts may provide significant public health information. Second, the utility and importance of SARS-COV2 antibody testing may provide insight into the course of reinfection and degree of protection conferred by antibodies thereby providing guidance about the appropriate management of immunosuppression. Our patient had SARS-CoV-2 antibodies and his mild course allowed us to re-institute his immunosuppression early. Lastly, the potential for reinfection may necessitate continued testing and protective measures beyond vaccination efforts. Conclusions: To the best of our knowledge this is the first reported case of COVID-19 reinfection in a kidney transplant recipient with a different viral strain confirmed by genetic sequencing.