Pandemic health consequences: Grasping the long COVID tail

Emerging evidence suggests that approximately 10% of people who survive Coronavirus Disease 2019 (COVID-19) will have lingering symptoms that negatively affect their quality of life, ability to work, and function [1,2]. This important group of people with the post-COVID-19 condition may seem small in comparison to the overall number of people with COVID-19 infection [3]. However, many patients who survive COVID-19 are likely to have considerable symptom burden, high resource utilization and health service needs, reduced economic productivity, and possibly a shortened life expectancy. The study by Bhaskaran and colleagues published in PLOS Medicine addresses an evolving, poorly studied, and important area of health policy and planning related to the care of patients who survive hospitalization for COVID-19 [4].

At face value, the scope of the COVID-19 pandemic is enormous. Within 2 years, nearly 300 million people have been infected with the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, and more than 5 million people have died from it [5]. But, there is also a long tail to this statistical distribution of hardship. Studies report that numerous patients will continue to experience fatigue, shortness of breath, pain, sleep disturbances, anxiety, and depression [6]. More serious organ dysfunction such as pulmonary fibrosis, cognitive impairment, myocarditis, and renal failure may also develop [6]. Whether these translate into clinical diagnoses of chronic diseases like interstitial lung disease, dementia, heart failure, and chronic kidney disease remains to be seen. Collectively, the prospect for immense suffering among these individuals will undoubtedly have huge and enduring impacts on healthcare systems globally. As the world continues its largest vaccination effort in history and looks to eliminate the impacts of acute COVID-19, we must not forget that a meaningful minority who survive will transition from an acute to chronic disease state. In turn, management strategies and health resource planning must also appropriately transition. As a multisystem disease, the post-COVID-19 condition will require the involvement of multidisciplinary care teams [7]: Who will help to look after these patients?

Bhaskaran and colleagues studied over 164,000 hospitalized adults with COVID-19 matched to an “active control” group of adults hospitalized with influenza and to general population controls. They compared the medium- and long-term risks of hospital admission and death across the 3 study groups. The main findings were that people discharged following hospitalization for COVID-19 had a 2-fold higher associated risk for rehospitalization and death than the general population and similar risks compared to those hospitalized for influenza. These outcomes were most pronounced in the first 30 days following discharge yet remained substantially elevated over time. Further, those hospitalized with COVID-19 were more likely to be rehospitalized or die from mental health or cognitive-related causes, especially if they had preexisting dementia, compared to those hospitalized with influenza.

Initial hospitalization with COVID-19 represents a crucial touch point within the healthcare system. The study by Bhaskaran and colleagues sheds important light on the health service needs of patients who survive hospitalization for COVID-19. It further helps disentangle the effects of hospitalization from respiratory viral infection on important outcomes. The current work builds on similar findings from a recent study of 47,780 hospitalized adults with COVID-19 who survived to discharge with a mean follow-up of 140 days [8]. In that study, rates of hospital readmission and mortality were 3.5 and 7.7 times greater in the previously hospitalized group of COVID-19 patients, compared to general population controls, respectively. Other studies from the United States and China followed patients hospitalized for COVID-19 and reported lower 60-day and 1-year rehospitalization rates ranging from 13% to 19.9%. However, these studies did not account for the competing risk of death as was done in the current study [911].

There were also noteworthy limitations of Bhaskaran and colleagues’ study. First, cause-specific outcomes among adults with COVID-19 may be artificially higher than those with influenza due to availability bias. Put simply, patients and providers may be much more aware of COVID-19 and its complications, including those related to return to hospital, than might be the case for those with pneumonia or even confirmed influenza. Second, the study used administrative data from primary care. While 98% of the population in England are registered with a general practice (thereby minimizing selection biases due to health-seeking behaviors), there are some geographical differences in the use of the OpenSAFELY platform, which may introduce the potential for selection bias. Third, this study was conducted in a high-income nation with substantial resources to support patients following infection with COVID-19. The generalizability of these findings to middle- and low-income nations, or those with limited resources, is unknown.

The study by Bhaskaran and colleagues has clear applications to healthcare resource planning and policy in the care of individuals who survive COVID-19. This suggests a substantial added burden on global healthcare systems. It further builds on our evolving knowledge of the post-COVID-19 condition and its lingering impacts, including on many previously healthy adults in their prime years of productivity. Still, a wealth of research is required to develop prediction tools to proactively identify and support the healthcare needs of survivors, including end-of-life care, develop new strategies to prevent and treat the post-COVID-19 condition, and encourage interprofessional teams to provide longitudinal care through innovative health policy interventions.

Early pandemic public messaging strategies focused on flattening the peak of the acute COVID-19 infection curve to preserve healthcare system capacity and its ability to deliver high-quality care. These efforts were generally successful. To preserve ongoing system capacity and provide high-quality patient care, the long COVID tail does not require further flattening, but rather demands new clinical and health policy strategies to address its potential for long-term suffering. Here, we must recognize that the head of the pandemic often demands our immediate attention, but we must not ignore its long and deadly tail.

References

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Colchicine could cut COVID-19 deaths – Israeli scientist

Authors: By MAAYAN JAFFE-HOFFMAN Published: DECEMBER 14, 2021 17:37

An ancient Greek drug derived from the saffron plant could improve the treatment of people with severe COVID-19 and reduce the COVID mortality rate by as much as 50%, according to a report published earlier this month in the European Journal of Internal Medicine by an Israeli researcher from the Hebrew University of Jerusalem and Hadassah Medical School. The drug, colchicine, dates back thousands of years to ancient Egypt, where it was known for its special healing properties. It is one of a few medicines that survived until modern times. Most recently, it has been used to treat and prevent inflammation caused by gout that can lead to painful arthritis and Familial Mediterranean Fever (FMF), which is common among Jewish people of North African descent.

Prof. Ami Schattner researched and analyzed all patients treated in controlled trials of this ancient drug for the past 20 years. He found that among its uses and potential uses, colchicine also appears effective in treating COVID-19.So far, four controlled studies of around 6,000 coronavirus patients have been published on the effect of colchicine, Schattner said, each showing a “significant improvement in severe coronavirus indices and, most importantly, there was a decrease in mortality by about 50% compared to those who were not treated with colchicine. ”The drug is cheap, a small half-milligram dose is needed per day, and it has already been proven safe to use, he said, making colchicine “an important discovery that could significantly contribute to improving the morbidity and mortality of many patients, if confirmed in further studies.”

The drug is also well-tolerated, the doctor said. The only side-effects in some patients can be bouts of diarrhea; about 10% of patients discontinue the use of the drug for this reason. The drug has been tested in the treatment of the COVID-19 pandemic around the world, including in Canada, Greece, South Africa, Spain and Brazil. Many of the tests were double-blind placebo studies, increasing their likelihood of accuracy. “The results were impressive,” he said. Colchicine was first mentioned in an ancient Egyptian papyrus dating back to 1550 BC, even before the Jewish people left Egypt, according to the biblical story. Later, it was used by physicians in ancient Greece, in the Byzantine period and then by Arab physicians more than 1,000 years ago. Some 50 years ago, using the drug to treat FMF was verified by researchers at Sheba Medical Center at Tel Hashomer and Hadassah, not only against the sharp attacks associated with the disease and their prevention, but also in protection against a serious complication of FMF – amyloidosis, which affects the kidneys. More recently, several studies have started to prove its effectiveness in the treatment of acute pericarditis (swelling around the heart, and in the prevention of post-cardiac injury syndrome and atrial fibrillation following cardiac surgery.“As is well known, patients who have had a heart attack are at a significantly increased risk of recurrence and stroke, and these are very many patients,” Schattner said. “Studies from recent years have found that thanks to its anti-inflammatory activity on the atherosclerotic layers in the arteries, colchicine in small daily doses is able to effectively protect these patients. “The level of protection was to the point of preventing about half of the recurrent events, and this impressive beneficial effect was also achieved in patients who had already undergone therapeutic catheterization and had taken optimal preventive treatment by aspirin and statins,” he added. “This is important news for a very large number of patients.”

Further randomized controlled trials are needed to confirm these preliminary results, according to Schattner, which he believes will likely lead to expanding indications for low-dose colchicine. But he said there is no reason that the drug could not start being used right now.“Even though initial data on the effect of colchicine on coronavirus patients is very promising, more patients need to be in randomized controlled trials,” Schattner said. “But that would not prevent me from using the drug already in patients with high risk, to hopefully lower their chances of developing severe disease.“The drug is low-cost for the patients and the community,” he continued. “By using it in corona patients, we have nothing to lose and much to gain.”

Risk of severe COVID-19 disease with ACE inhibitors and angiotensin receptor blockers: cohort study including 8.3 million people

  1. Julia Hippisley-Cox1, Duncan Young2,3, Carol Coupland4, Keith M Channon5, Pui San Tan6, David A Harrison7, Kathryn Rowan8,  Paul Aveyard6, Ian D Pavord9, Peter J Watkinson5,10
  2. Correspondence to Prof Julia Hippisley-Cox, Primary Care Health Sciences, University of Oxford, Oxford OX1 

Abstract

Background 

There is uncertainty about the associations of angiotensive enzyme (ACE) inhibitor and angiotensin receptor blocker (ARB) drugs with COVID-19 disease. We studied whether patients prescribed these drugs had altered risks of contracting severe COVID-19 disease and receiving associated intensive care unit (ICU) admission.

Methods 

This was a prospective cohort study using routinely collected data from 1205 general practices in England with 8.28 million participants aged 20–99 years. We used Cox proportional hazards models to derive adjusted HRs for exposure to ACE inhibitor and ARB drugs adjusted for sociodemographic factors, concurrent medications and geographical region. The primary outcomes were: (a) COVID-19 RT-PCR diagnosed disease and (b) COVID-19 disease resulting in ICU care.

Findings 

Of 19 486 patients who had COVID-19 disease, 1286 received ICU care. ACE inhibitors were associated with a significantly reduced risk of COVID-19 disease (adjusted HR 0.71, 95% CI 0.67 to 0.74) but no increased risk of ICU care (adjusted HR 0.89, 95% CI 0.75 to 1.06) after adjusting for a wide range of confounders. Adjusted HRs for ARBs were 0.63 (95% CI 0.59 to 0.67) for COVID-19 disease and 1.02 (95% CI 0.83 to 1.25) for ICU care.

There were significant interactions between ethnicity and ACE inhibitors and ARBs for COVID-19 disease. The risk of COVID-19 disease associated with ACE inhibitors was higher in Caribbean (adjusted HR 1.05, 95% CI 0.87 to 1.28) and Black African (adjusted HR 1.31, 95% CI 1.08 to 1.59) groups than the white group (adjusted HR 0.66, 95% CI 0.63 to 0.70). A higher risk of COVID-19 with ARBs was seen for Black African (adjusted HR 1.24, 95% CI 0.99 to 1.58) than the white (adjusted HR 0.56, 95% CI 0.52 to 0.62) group.

Interpretation 

ACE inhibitors and ARBs are associated with reduced risks of COVID-19 disease after adjusting for a wide range of variables. Neither ACE inhibitors nor ARBs are associated with significantly increased risks of receiving ICU care. Variations between different ethnic groups raise the possibility of ethnic-specific effects of ACE inhibitors/ARBs on COVID-19 disease susceptibility and severity which deserves further study.

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