Long COVID’s daunting toll seen in study of pandemic’s earliest patients

Authors: Melissa Healy   6 hrs ago

COVID-19 patients in Wuhan were among the pandemic’s first victims, and a comprehensive new study finds that a year after shaking the coronavirus, survivors were more likely than their uninfected peers to suffer from mobility problems, pain or discomfort, anxiety and depression.

detailed accounting of 1,276 people hospitalized for COVID-19 in the pandemic’s opening months reveals that a full year later, almost half continued to report at least one lingering health problem that is now considered a symptom of “long COVID.”

One out of five said they had continued fatigue and/or muscle weakness, and 17% said they were still experiencing sleep difficulties. Just over one in four said they were suffering anxiety or depression in the wake of their bout with the SARS-CoV-2 virus.

For the growing number of patients who identify themselves as COVID “long haulers,” the new accounting offers cause for optimism — and concern. The period from six to 12 months after infection brought improvement for many. But most patients struggling with symptoms at the six-month mark were not yet well six months later.

The findings, catalogued by a team of Chinese researchers, were published late Thursday in the medical journal Lancet.

“This is not good news,” said David Putrino, a rehabilitation specialist who works with COVID long haulers at Mount Sinai Hospital in New York. “If you run the numbers here, about one-third of the group that had persistent symptoms are getting better after 12 months, while two-thirds are not.”

Putrino also called the findings a “wake-up call” to public health officials that even when the pandemic is over — a distant enough prospect in the midst of a fourth wave of infections — its downstream consequences will not be.

“We’re going to need resources for many years to come to deal with these patients,” he said.

There will be a lot of them. More than 87,000 COVID-19 patients are being hospitalized each day in the United States, and 2.7 million have receiving hospital care in the past year alone.

The half who contend with persistent symptoms will show up in doctors’ offices with clusters of vague and perplexing complaints including brain fog, heart palpitations, pain and exhaustion. And despite emerging evidence that time and specialized treatment can help many to improve, few will have the wherewithal to spend months in intensive rehabilitation for their symptoms, Putrino said.

An editorial published alongside the new study noted that only 0.4% of COVID long haulers are receiving rehabilitative treatment for their symptoms.

Even as scientists puzzle over the common biological mechanisms of long COVID’s diverse symptoms, healthcare providers “must acknowledge and validate the toll of the persistent symptoms of long COVID on patients, and health systems need to be prepared to meet individualised, patient-oriented goals, with an appropriately trained workforce,” Lancet’s editors wrote.

The new research also offered some glimmers of hope.

When the study’s COVID-19 patients were examined at six months, 68% said they had at least one of 15 symptoms considered hallmarks of long COVID, which is also known as Post-Acute Sequelae of COVID, or PASC. At one year, 49% were still afflicted by at least one of those symptoms.

The proportion of patients with ongoing muscle weakness and fatigue dropped from 52% to 20% during that time. Patients experiencing loss of smell dropped from 11% to 4%, and those afflicted with sleep problems fell from 27% to 17%. The 22% who reported hair loss at six months dwindled to 11% a full year out.

At the same time, the numbers of patients reporting breathing difficulties saw a slight increase, rising from 26% at six months to 30% after a year. Likewise, patients who reported new depression or anxiety increased from 23% to 26% during that period.

Study co-author Xiaoying Gu from the China-Japan Friendship Hospital in Beijing said the slight uptick in anxiety and depression was, like all of long COVID’s symptoms, hard to explain.

The psychiatric symptoms “could be caused by a biological process linked to the virus infection itself, or the body’s immune response to it,” he said. “Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness.”

Patients who required mechanical ventilation were more likely than those with less severe illness to have measurable lung impairment and abnormal chest X-rays at both six and 12 months.

But in the tally of more subjective long COVID symptoms, the difference between the most severely ill and those who required no supplemental oxygen at all was very small.

That finding underscores the fact that even patients who are only mildly ill are at risk of developing a range of persistent symptoms.

Of the study population’s 479 patients who held jobs when the pandemic struck, 88% had returned to work a year after their illness. Most of the 57 who did not return said they either could not or were unwilling to do the tasks required of them.

The findings from the Wuhan patients also tracked with the widespread observation that persistent post-COVID infection symptoms are more common in women than in men. Women who had been hospitalized for COVID-19 were twice as likely as their male counterparts to report depression or anxiety 12 months later. In addition, they were close to three times as likely to show evidence of impaired lung function, and 43% more likely to report symptoms of fatigue and muscle weakness.

All of the study’s participants were treated at a single hospital in Wuhan, where reports of a mysterious new form of pneumonia first surfaced in December 2019. The researchers followed a large group of patients sickened in the first five months that the outbreak.

That makes the Lancet report one of the earliest and largest accounts of lingering COVID-19 symptoms to be tallied and vetted by other researchers, and the only one to compare such patients to a group of uninfected peers matched on a wide range of demographic and health attributes.

One thing is already clear, the journal editors noted: “Long COVID is a modern medical challenge of the first order.”

This story originally appeared in Los Angeles Times.

Some COVID-19 patients have brain complications, study suggests

Authors: Mary Van Beusekom | News Writer | CIDRAP News  | Jun 26, 2020

Some COVID-19 patients, including those younger than 60 years old, appear to develop neurologic and neuropsychiatric complications such as stroke, brain inflammation, psychosis, and dementia-like symptoms, according to a study published yesterday in The Lancet Psychiatry.

The early-stage study of 153 hospitalized patients with confirmed, probable, or possible COVID-19 in the United Kingdom (UK) from Apr 2 to 26 identified 125 patients with complete data, of whom 77 (62%) had a stroke.

Of 125 patients, 114 (92%) had confirmed coronavirus infection, 5 (4%) had probable infection, and 5 (4%) were classified as possibly infected.

Stroke, encephalopathy, psychiatric diagnoses

Fifty-seven of 77 stroke patients (74%) had an ischemic stroke caused by a blood clot in the brain, 9 (12%) had a stroke caused by a brain hemorrhage, and 1 (1%) had a stroke caused by inflammation in the brain’s blood vessels. Sixty-one of the 77 stroke patients for whom age was available (82%) were older than 60 years.

Thirty-nine of 125 patients (31%) had behavioral changes indicative of an altered mental state, of whom 9 (23%) had unspecified brain dysfunction known as encephalopathy, and 7 (18%) had brain inflammation, or encephalitis.

The remaining 23 patients with altered mental states had psychiatric diagnoses, including 10 with new-onset psychosis, 7 with depression or anxiety, and 6 with a dementia-like syndrome. Only 2 patients (9%) had exacerbations of a chronic mental illness, although the authors noted that they cannot exclude the possibility that cases classified as new were simply undiagnosed before the pandemic.

Of the 37 of 39 COVID-19 patients with an altered mental state for whom age was available, 18 (49%) were younger than 60 years, which could be because they were more likely to be referred to a psychiatrist or other specialist, while physicians may be likely to attribute confusion or behavioral changes in older patients to delirium without further investigation, the authors said.

Altered mental states in younger patients

While altered mental states are not uncommon in hospitalized patients with infections, especially those requiring intensive care, they occur most often in older patients.

“In this study, we observed a disproportionate number of neuropsychiatric presentations in younger patients and a predominance of cerebrovascular complications in older patients, which might reflect the state of health of the cerebral vasculature and associated risk factors, exacerbated by critical illness in older patients,” the authors said.

For More Information: https://www.cidrap.umn.edu/news-perspective/2020/06/some-covid-19-patients-have-brain-complications-study-suggests

Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic

Authors: Ram Lakhan1 Amit Agrawal2 Manoj Sharma3

Introduction

The outbreak of the third coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), also named coronavirus disease 2019 (COVID-19), has occurred more rapidly than people could have ever imagined from the experience of the past two SARS-CoV and Middle East respiratory syndrome coronavirus.1,2 To control the spread of this virus, the entire world acted fast and in collaboration, but the COVID-19 pandemic could not be controlled as it has rather impacted human lives across the globe. In 6 months, in 216 countries including territories, 13,876,441 people got confirmed for infection and 593,087 lost their lives.3 To reduce the risk of COVID-19 exposure, social distancing was suggested and enforced. People of all walks are required to stay in their homes and maintain physical distance in any given situation while they are out for any essential reason.4,5 This intervention has not only impacted all ongoing activities but has led to a tremendous negative effect on the mental health of people. The fear of contracting the virus, lack of treatment, higher mortality associated with the virus, and uncertainty about when the virus would be controlled and when a vaccine would be available are the major factors that were found to be highly responsible in increasing psychological distress, adjustment, and even more serious mental health problems. Economic loss, interrupted daily routine, the inability of engaging in social events, and constant news exposure are additional factors that affected mental health. The crisis became an unmanageable stressor. Incidences were even noticed where some people could not handle the mental pressure, and as an escape from traumatizing reality, they committed suicide.6,7 Editorials, scientific letters, perspectives, and commentaries in scientific literature and reports in print and visual media have pointed out an increase in mental health problems. Experts across the world expressed concerns for an increasing toll of mental health problems and urged for mental health support.8 The increase in mental health problems in every society and age group in every nation has turned out to be another important global public health concern during this pandemic. 9-16 Experts have suggested appropriate and cost-effective ways to address psychological distress and their resulted effects.17 A lot of attention has been given to this emerging situation with mental health concerns. However, we still lack quantifiable information about the increase in mental health problems due to the pandemic. Policy makers need to know the extent of the problem before making the appropriate arrangements for addressing this issue of increased mental health problems. This scoping review was conducted to provide an estimate of various mental health problems that occurred due to COVID-19. Objective The aim of this study was to review the prevalence of depression, anxiety, stress, and sleep problems during the first 7 months of COVID-19 pandemic.

For More Information: https://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1411&context=community_health_sciences_fac_articles

Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic

Authors: Ram Lakhan 1Amit Agrawal 2Manoj Sharma 3

Abstract

The coronavirus disease 2019 (COVID-19) crisis has greatly affected human lives across the world. Uncertainty and quarantine have been affecting people’s mental health. Estimations of mental health problems are needed immediately for the better planning and management of these concerns at a global level. A rapid scoping review was conducted to get the estimation of mental health problems in the COVID-19 pandemic during the first 7 months. Peer-reviewed, data-based journal articles published in the English language were searched in the PubMed, Medline, and Google Scholar electronic databases from December 2019 to June 2020. Papers that met the inclusion criteria were analyzed and discussed in this review. A total of 16 studies were included. Eleven studies were from China, two from India, and one from Spain, Italy, and Iran. Prevalence of all forms of depression was 20%, anxiety 35%, and stress 53% in the combined study population of 113,285 individuals. The prevalence rate of all forms of depression, anxiety, stress, sleep problems, and psychological distress in general population was found to be higher during COVID-19 pandemic.

For More Information: https://pubmed.ncbi.nlm.nih.gov/33144785/

Psychological Impact of COVID-19 on Children and Adolescents: A Systematic Review

Authors: Nishtha Chawla,1Ashlyn Tom,1Mahadev Singh Sen,1 and Rajesh Sagar1

Abstract

Background and aims:

The outbreak of COVID-19 led to a significant psychological impact on individuals, particularly those belonging to vulnerable groups. This study aimed to synthesize literature on the psychological impact of COVID-19 among children and adolescents.

Methods:

Electronic search engines were used to identify studies till March 2021 that reported symptoms of psychological origin in children and adolescents. Information was extracted using a predefined template, and qualitative analysis was conducted using STROBE.

Results:

One hundred and two relevant papers were identified. Most of the studies were conducted online or telephonically. The study designs were primarily single group cross-sectional, though a few prospective/retrospective designs were also identified. Studies assessing emotional distress showed variable levels of anxiety and depressive symptoms in the study population, with greater severity of anxiety symptoms among females and older adolescents. Reduced physical activity; delayed sleep time; increased sleep duration, screen time, internet use, and sedentary habits, poor quality of life were other notable findings, often correlating with anxiety/depression. Efforts to address bias, discussion on generalizability of their results, and sample size calculation were not reported in most studies.

Conclusion:

Psychological impact on children/adolescents is significant, either due to the fear of the illness or social isolation related to COVID-19. One may focus on improving sleep habits and physical activity and regulating internet use for maintaining psychological well-being.

For More Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327877/

Covid-19 Pandemic-Scared-Vaccinated

Authors: Authored by Emily Miller via Emily Posts

The Scared Vaccinated and the Grateful Vaccinated

Fauci, CNN and Aniston are spokesmen for the Scared Vaccinated. Their opposites are the Grateful Vaccinated, who have little to worry about COVID. Nine out of 10 of the vaccinated will not catch the virus. That one “breakthrough” case will be much less severe or no symptoms. None of them will die of COVID.

As it stands now, 71 percent of adults have gotten one shot and 61 percent are fully vaccinated. When you add in the under 18 kids, the average is still 51% of the country is fully vaccinated. Most likely, that number will only increase with children vaccinations because the adults have had time to make a final decision. 

The Grateful Vaccinated have gone back to their normal lives — sightseeing, parties, traveling, unmasking. They wonder why other vaccinated people are so angry as things have improved so much.

What splits the vaccinated is fear. The Scared Vaccinated are scared of what they can’t control, which at this point in the pandemic, is simply other people’s health decisions. They are driven by emotions, not facts.

When we are traumatized — which I believe much of the country is from the March 2020 lockdowns — our frontal lobe turns off and our bodies take over for survival. This is why the Scared Vaccinated are so reactive. They are constantly in a state of fight or flight. They see someone without a mask and feel like they could die. They hear someone say he or she is not vaccinated, and they feel like they are being personally attacked. 

It is impossible to reason with someone whose body is pumping cortisol and adrenaline. This is why the facts of vaccine effectiveness and the pandemic don’t work when trying to debate with the Scared Vaccinated. 

For More Information: https://www.zerohedge.com/covid-19/pandemic-scared-vaccinated

How to combat ‘COVID fatigue’: Medical experts on what works — and doesn’t

Authors: Meredith Deliso

“Throughout pandemics, the psychological footprint is often way bigger than the medical footprint,” Dr. Claude Mellins, a medical psychologist who co-leads a pandemic initiative called CopeColumbia for the Columbia University Irving Medical Center community, told ABC News.

One of the challenges is the pandemic makes it hard to turn to our normal coping strategies, such as being with people and engaging in fun activities, said Mellins, a professor of medical psychology in the Psychiatry Department at Columbia University Irving Medical Center and the Sociomedical Sciences Department at the Mailman School of Public Health.

People are “feeling unbelievably anxious of the uncertainty, and so they don’t want to be isolated, and they don’t want to do some of the things that we need to be there,” she added.

In the face of COVID fatigue, people are continually urged to not let their guard down. But how can public health officials accomplish this?

For More Information: https://abcnews.go.com/Health/combat-covid-fatigue-medical-experts-works/story?id=73861469