Risk factors tied to COVID symptoms 2 to 7 months after hospital release
Female sex, middle age, two or more chronic diseases, and more severe initial illness were predictive of difficulty recovering from COVID-19 6 months after release from a hospital, finds a multicenter UK study yesterday in The Lancet Respiratory Medicine.
University of Leicester researchers led the study, which involved an assessment of 1,077 adults 2 to 7 months after release from the hospital for treatment of COVID-19. The patients left the hospital from Mar 5 to Nov 30, 2020.
After a median of 5.9 months of follow-up, 29% of 830 participants said they felt fully recovered, while 20% had a new disability and 19% had to change jobs due to their health.
The researchers identified four clusters involving 767 patients with different degrees of coronavirus-related mental and physical impairment. Seventeen percent had very severe impairments, 21% were severely affected, 17% had moderate impairment with cognitive problems, and 46% were mildly impaired.
Three percent of 113 patients in the very severe group reported feeling fully recovered, as did nine of 129 (7%) in the severe cluster, 36 of 99 (36%) in the moderate group, and 114 of 267 (43%) in the mild cluster. Persistently increased serum C-reactive protein (indicating inflammation) was positively associated with impairment severity. The degree of physical and mental—but not cognitive—impairments were also closely associated with each other.
The authors said that the findings suggest the presence of underlying mechanisms, regardless of the degree of lung injury and perhaps related to lingering systemic inflammation.
“The four clusters highlight the potential to stratify and personalise care, and emphasise the need for wide access to interventions to improve mental, physical, and cognitive health,” they wrote, adding that patients will also need a proactive approach and holistic clinical care.
In a related commentary, Linda Denehy, PhD, and Zudin Puthucheary, MBBS, PhD, called for large clinical trials on the effectiveness of individual treatments (eg, drugs, multidisciplinary rehabilitation).
“As with the trajectory of research over the past two decades in critical care, we need to identify responders to specific interventions, map impairments across time, and involve patients and caregivers in the process of recovery,” they wrote.
Oct 7 Lancet Respir Med study and commentary
Nursing home profit model linked to higher COVID-19 death rate
Prior to COVID-19 vaccine availability, nursing home residents had a 9.4% COVID-19 death rate and private ownership was tied to a 22% higher risk of death, according to a study published in the Journal of Infectious Diseases yesterday.
The researchers looked at 608,251 residents 65 years and older and using Medicare in US nursing homes from Apr 1 to Dec 22, 2020. About 9.4% died of COVID-19. Higher mortality risk was associated with men (hazard ratio [HR], 1.69), end-stage renal disease (HR, 1.42), cognitive impairment (HR, 1.34), and immunocompromised status (HR, 1.20). Data also showed that residents at for-profit nursing homes had a higher risk of COVID mortality (HR, 1.22).
While residents in a facility with a higher health inspection rating had a lower mortality risk (five stars vs 1 star, HR 0.79), the researchers say that quality measure ratings had inconsistent effects on death compared with hospitalization.
Compared with community rates, mortality was higher in nursing home residents (9.4% vs 0.3%) as was hospitalization rate (10.4% vs 1.2%). Among people who died with COVID-19, however, 46.9% of nursing home residents weren’t hospitalized, compared with15.3% in the community. In general, hospitalization for nursing home residents was less likely if the resident was 85 or older even though they were more likely to die.
Although the researchers say their data suggest that equal access to care can help resolve socioeconomic or racial differences, a commentary by Mack Roach III, MD, and others points out the disproportionate hospitalization and mortality rates among minorities.
“Clearly, Blacks and other minorities have an increased risk of hospitalization and death due to COVID-19,” the commentators write. “However, it is not obvious from the data provided whether the differences in hospitalizations and death are in fact due to the increased comorbidities, which might in turn be due to lack of access to care and appropriate screening for chronic disease prior to the individuals entering a nursing home.
“So, while the results of this study show no obvious evidence of racism in the nursing home care, it leaves open the contribution of structural racism to the increased chronic disease burden in minorities.”
Oct 7 J Infect Dis study and commentary
Three countries report vaccine-derived polio cases
Madagascar, Nigeria, and the Ukraine reported polio cases involving vaccine-derived subtypes, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI) and the European Centre for Disease Prevention and Control (ECDC) today.
Madagascar reported one new case of circulating vaccine-derived poliovirus type 1 (cVDPV1), in Boeni, where a case was also identified last week. The country has now reported nine cVDPV1 cases for 2021.
In Nigeria, GPEI said 17 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported; 4 in Bauchi, 3 each in Jigawa and Katsina, 2 each in Borno and Gombe, and 1 each in Kano, Taraba and Yobe. There are now 169 cases reported in 2021. Last year, Nigeria reported only 8 cases.
The ECDC also reported a case of acute flaccid paralysis caused by cVDPV2 in an unvaccinated 18-month-old girl from Rivne oblast, in the Ukraine. She had symptoms Sep 1 and was hospitalized on Sep 3 with paralyzed legs. Her parents refused polio vaccination because of religious beliefs.
Oct 6 GPEI weekly update
Oct 8 ECDC report