COVID-19 Symptoms Research Articles

The effect of spatio-temporal sample imbalance in epidemiologic surveillance using opportunistic samples: An ecological study using real and simulated self-reported COVID-19 symptom data

Open surveys complementing surveillance programs often yield opportunistically sampled data characterised by spatio-temporal imbalance. We set up our study to understand to what extent spatio-temporal statistical models using such data achieve in describing epidemiological trends. We used self-reported symptomatic COVID-19 data from two Belgian regions, Flanders and the Brussels-Capital Region. These data were collected in a large-scale open survey with spatio-temporally imbalanced participation rates. We compared incidence estimates of both self-reported symptoms and test-confirmed COVID-19 cases obtained through generalised linear mixed models correcting for spatio-temporal correlation. We additionally simulated symptom incidences under different sampling strategies to explore the impact of sample imbalance, sample size and disease incidence, on trend detection. Our study shows that spatio-temporal sample imbalance generally does not lead to bad model performances in spatio-temporal trend estimation and high-risk area detection. Except for low-incidence diseases, collecting large samples will often be more essential than ensuring spatio-temporally sample balance.

Multiple Evanescent White Dot Syndrome following COVID-19 Vaccination: Two Case Reports

Purpose: We present two cases of multiple evanescent white dot syndrome (MEWDS) following COVID-19 vaccination.Case summary: We present two cases of visual field defects following BNT162b2 (Pfizer-BioNTech, Kronach, Germany) COVID-19 vaccination. A 14-year-old male experienced reduced visual acuity in the temporal field of his left eye after his second dose. Similarly, a 38-year-old woman experienced decreased visual acuity in her right eye after her first dose. Notably, neither patient had pre-existing medical conditions or exhibited COVID-19 symptoms following vaccination. Funduscopic examination revealed multifocal peripapillary hyperreflective lesions in both cases. Visual field defects and hyperreflective lesions spontaneously resolved within 6 weeks, with normal visual acuity and fundus findings at the 7-month follow-up.Conclusions: The recent COVID-19 pandemic has led to a significant increase in vaccination rates. Notably, MEWDS demonstrated a significant association with previous vaccines, including influenza and hepatitis, and the cases describe herein also suggest a potential association between BNT162b2 vaccination and MEWDS.

Importance of Blood Glucose Measurement for Predicting the Prognosis of Long COVID: A Retrospective Study in Japan.

Purpose: The present study aimed to clarify the effects of a hyperglycemic condition on the clinical consequences of long COVID. Methods: Among 643 patients who visited the outpatient clinic of our hospital from February 2021 to September 2023, long COVID patients were classified into a hyperglycemic (HG) group with casual blood glucose levels above 140 mg/dL and a normoglycemic (NG) group. The patients' backgrounds, clinical symptoms, health status including the QOL evaluation scale (EQ-5D-5L), self-rating depression scale (SDS), and F-scale questionnaire (FSSG), blood test data, and recovery periods were analyzed. Results: The NG group included 607 patients with long COVID and the HG group included 36 patients with long COVID. Patients in the HG group were older than those in the NG group (55 vs. 41 years; p < 0.001) and included a larger percentage of males (67% vs. 44%; p = 0.009). The HG group had a larger percentage of patients with moderate-to-severe conditions in the acute infection phase (28% vs. 12%; p = 0.008), a higher BMI (25 vs. 22 kg/m2; p < 0.001), higher blood pressure (138/81 vs. 122/72 mmHg; p < 0.001), and a larger percentage of patients with an alcohol drinking habit (53% vs. 34%; p = 0.031). Long COVID symptoms and self-rated scales were not differed between the two groups; however, the laboratory data showed that liver and renal functions and metabolic data were significantly worse in the HG group. Although there was no apparent difference between the two groups in duration from the infection to the first visit, the HG group had a significantly longer period of recovery from long COVID (median period of 421 vs. 294 days; p = 0.019). Conclusion: A hyperglycemic state associated with other lifestyle-related diseases is associated with the prolongation of recovery from long COVID.

Evaluation of the Effect of Influenza Vaccine on the Development of Symptoms in SARS-CoV-2 Infection and Outcome in Patients Hospitalized due to COVID-19.

COVID-19 is an infectious disease caused by SARS-CoV-2. It is unclear whether influenza vaccination reduces the severity of disease symptoms. Previous studies have suggested a beneficial effect of influenza vaccination on the severity of COVID-19. The aim of this study was to evaluate the possible protective effect of the influenza vaccine on the occurrence of SARS-CoV-2 infection symptoms and prognosis in patients hospitalized with COVID-19. This was a retrospective cohort study of patients who tested positive for SARS-CoV-2, identified by quantitative real-time polymerase chain reaction. Chi-square tests, Kaplan-Meier analysis, and multivariate analysis were performed to assess the association between influenza vaccination and the presence of symptoms in hospitalized patients with COVID-19 and their outcome. In this study, 1712 patients received positive laboratory tests for SARS-CoV-2; influenza vaccination was a protective factor against the presence of characteristic COVID-19 symptoms such as polypnea, anosmia, dysgeusia, and fever (p < 0.001). Influenza-vaccinated patients had fewer days of hospitalization (p = 0.029). The findings of this study support that influenza vaccination is associated with a decrease in the number of symptoms in patients hospitalized due to COVID-19, with fewer days of hospitalization, but not with the outcome of disease.

The impact of the COVID-19 vaccination programme on symptomatic and severe SARS-CoV-2 infection during a period of Omicron variant dominance in Ireland, December 2021 to March 2023.

BackgroundAs Ireland prepared for an autumn 2023 COVID-19 vaccination booster campaign, there was concern that vaccine fatigue would affect uptake, which has been abating.AimThis study aimed to quantify the direct impact of the COVID-19 vaccination programme in Ireland on averted COVID-19-related outcomes including symptomatic presentations to primary care/community testing centres, emergency department (ED) presentations, hospitalisations, intensive care unit (ICU) admissions and deaths, in individuals aged ≥ 50 years, during Omicron dominance.MethodsWe conducted a retrospective observational COVID-19 vaccine impact study in December 2021-March 2023 in Ireland. We used national data on notified outcomes and vaccine coverage, as well as vaccine effectiveness (VE) estimates, sourced from the World Health Organization's live systematic review of VE, to estimate the count and prevented fraction of outcomes in ≥ 50-year-olds averted by the COVID-19 vaccination programme in this age group.ResultsThe COVID-19 vaccination programme averted 48,551 symptomatic COVID-19 presentations to primary care/community testing centres (36% of cases expected in the absence of vaccination), 9,517 ED presentations (53% of expected), 102,160 hospitalisations (81% of expected), 3,303 ICU admissions (89% of expected) and 15,985 deaths (87% of expected).ConclusionsWhen Omicron predominated, the COVID-19 vaccination programme averted symptomatic and severe COVID-19 cases, including deaths due to COVID-19. In line with other international vaccine impact studies, these findings emphasise the benefits of COVID-19 vaccination for population health and the healthcare system and are relevant for informing COVID-19 booster vaccination programmes, pandemic preparedness and communicating the reason for and importance of COVID-19 vaccination in Ireland and internationally.

Liver and Inflammatory Biomarkers Are Related to High Mortality in Hospitalized Patients with COVID-19 in Brazilian Amazon Region.

COVID-19 is a multisystem disease with many clinical manifestations, including liver damage and inflammation. The objective of this study is to analyze inflammation biomarkers in relation to the clinical outcome and respiratory symptoms of COVID-19. This is a retrospective cohort of patients with COVID-19 admitted to the Hospital Regional do Baixo Amazonas from 2020 to 2022. Data were collected from electronic medical records from admission to the 30th day of hospitalization and soon after hospital discharge. A total of 397 patients were included in the study. In the longitudinal follow-up of liver markers, a significant difference was found for AST on day 14, with a higher median in the death group. Among the hematological markers, lymphopenia was observed throughout the follow-up, with the death group having the most altered values. When comparing the evolution of biomarkers in the Non-Invasive Ventilation (NIV) and Invasive Mechanical Ventilation (IMV) groups, AST showed a significant difference only on day 14 and GGT on day 1, being greater in the IMV group, and indirect bilirubin on day 7 being more altered in the NIV group. In conclusion, death during hospitalization or a more severe form of COVID-19 was related to significant changes in liver and inflammatory biomarkers.

Motor and Respiratory Tele-Rehabilitation in Patients with Long COVID-19 after Hospital Discharge: An Interventional Study.

The persistence of symptoms following COVID-19 infection represents a significant challenge in healthcare management. During the outbreak, tele-rehabilitation emerged as a new tool to support healthcare structures in providing rehabilitation services. This study assessed the effectiveness and the feasibility of a 3-week home-based motor and respiratory rehabilitation program for individuals with long COVID-19 after traditional rehabilitation. Twenty-three patients completed the program and underwent functional tests at different time points (i.e., baseline, at discharge from in-hospital rehabilitation and after tele-rehabilitation). Motor function was evaluated using the instrumented Six-Minutes Walking Test (i6MWT), with monitored heart rate and oxygen saturation. Additionally, respiratory function was measured via forced vital capacity (FVC) and maximal voluntary ventilation (MVV) tests. Significant improvements (p < 0.05) in motor and respiratory function were observed throughout the intervention, including an 18.3% increase in walked distance from the baseline. The findings suggest that the proposed home-based tele-rehabilitation shows potential in enhancing motor and respiratory function in patients with long COVID. Despite limitations such as the small sample size, lack of control group and the preliminary nature of the outcomes observed, the overall findings seem to support the feasibility of the proposed tele-rehabilitation program in managing long COVID symptoms and promoting functional recovery. Nevertheless, further research is needed to validate these findings and explore tele-rehabilitation's potential in broader and different patient populations.

Diagnostic accuracy of chest x-ray in covid -19, taking high resolution computed tomography as gold standard

ABSTRACT Objective: To determine sensitivity &amp; specificity of chest X-ray in COVID-19, taking High-Resolution Computed Tomography as gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Radiology Deptt, Margalla Hospital, Taxila and Islamabad Diagnostic Centre, Wah. Two years (February 2020 to February 2022). Patients and Methods: The sample comprised 100 COVID-19 patients (Positive Polymerase chain reaction (PCR) test). Their HighResolution Computed Tomography (HRCT) was done which was considered a gold standard for diagnosing COVID-19. Their Chest X-rays (CXR) were performed, and findings of both modalities were compared. Patients having respiratory tract symptoms but PCR negative for COVID-19 were excluded. Results: The research had 49 males &amp; 51 females having a median (IQR) age of 46.50(35-55.75) years. The minimum &amp; maximum ages were 6 years and 83 years respectively. Among 100 PCR-positive patients, 29 were found normal on HRCT and 30 on CXR. For moderate cases, the chest X-rays were 72% sensitive &amp; 90.67% specific, with Positive Predictive Value (PPV), Negative Predictive Value (NPV) &amp; diagnostic efficacy of 72%,90.67% &amp; 86% respectively. Similarly, other severity levels were assessed. Conclusion: CXR has acceptable diagnostic accuracy for COVID-19 patients, especially with good sensitivity for moderate cases and better specificity for severe cases. A portable chest radiograph might be regarded as an initial alternative imaging modality for patients with COVID-19 signs and symptoms in remote areas. Key words: COVID-19, CXR , HRCT

Medical oxygen production, supply, and infrastructure augmentation during the COVID-19 pandemic in India: A narrative review

According to the World Health Organization, the primary symptoms of COVID-19 include fever, cough, and fatigue, while more serious cases present with dyspnea (difficulty breathing) and chest pain. The medical use of oxygen therapy is a common life support treatment for numerous diseases at multiple levels of health care in India. An abrupt spike in medical oxygen demand (nearly 100 &amp;ndash; 200 fold) has been observed in regions such as South America, Africa, and Asia, including India. Governments of the respective countries have implemented policy decisions to tackle medical oxygen shortage during the pandemic. In this narrative review, we describe and summarize the actions taken by the Indian government to manage the medical oxygen requirement during the deadly COVID-19 waves in India. Searches were conducted on PubMed, Scopus, Google Scholar databases, and websites of various ministries and departments of the Government of India, covering the period from January 2020 to January 31, 2023. Qualitative data were extracted using pre-defined themes from published documents related to medical oxygen supply during the COVID-19 pandemic in the Indian context. This narrative review summarizes the state of medical oxygen during the COVID-19 pandemic, focusing on medical oxygen production, supply, infrastructure augmentation, pressure swing adsorption plants, capacity building, web application, and monitoring mechanisms. The 76th World Health Assembly has also adopted the Access to Medical Oxygen Resolution to prevent deaths and ensure that no country faces an oxygen shortage, as seen during the COVID-19 pandemic.

COVID-19 Infection in Ultramarathon Runners: Findings of the Ultrarunners Longitudinal TRAcking Study.

Ultramarathon runners are a unique patient population who have been shown to have a lower rate of severe chronic medical conditions. This study aimed to determine the effect that COVID-19 infection has had on this population and their running behavior. The Ultrarunners Longitudinal TRAcking (ULTRA) Study is a large longitudinal study of ultramarathon runners. Questions on health status, running behavior, and COVID-19 infection were included in the most recent survey. Community survey. Seven hundred thirty-four ultramarathon runners participated in the study. None. Personal, exercise, and COVID-19 infection history. 52.7% of study participants reported having been symptomatic from a COVID-19 infection, with 6.7% testing positive multiple times. Participants required a total of 4 days of hospitalization. The most common symptoms included fever (73.6%), fatigue (68.5%), sore throat (68.2%), runny nose (67.7%), and cough (67.4%). Cardiovascular symptoms, which are of particular interest in the running population, included shortness of breath (46.3%), tachycardia (44.7%), chest pain (36.2%), and wheezing (33.3%). A total of 50 subjects (6.8%) reported long COVID (symptoms lasting more than 12 weeks). Severe COVID-19 infection has been rare in this population of ultramarathon runners, although symptomatic infection that affects running is common. To support the well-being of this group of highly active athletes, clinicians should appreciate that cardiovascular symptoms are common and the long-term significance of these symptoms in runners is unknown. Level 2 prospective study.

COVID-19 and Pneumonia detection and web deployment from CT scan and X-ray images using deep learning.

During the COVID-19 pandemic, pneumonia was the leading cause of respiratory failure and death. In addition to SARS-COV-2, it can be caused by several other bacterial and viral agents. Even today, variants of SARS-COV-2 are endemic and COVID-19 cases are common in many places. The symptoms of COVID-19 are highly diverse and robust, ranging from invisible to severe respiratory failure. Current detection methods for the disease are time-consuming and expensive with low accuracy and precision. To address such situations, we have designed a framework for COVID-19 and Pneumonia detection using multiple deep learning algorithms further accompanied by a deployment scheme. In this study, we have utilized four prominent deep learning models, which are VGG-19, ResNet-50, Inception V3 and Xception, on two separate datasets of CT scan and X-ray images (COVID/Non-COVID) to identify the best models for the detection of COVID-19. We achieved accuracies ranging from 86% to 99% depending on the model and dataset. To further validate our findings, we have applied the four distinct models on two more supplementary datasets of X-ray images of bacterial pneumonia and viral pneumonia. Additionally, we have implemented a flask app to visualize the outcome of our framework to show the identified COVID and Non-COVID images. The findings of this study will be helpful to develop an AI-driven automated tool for the cost effective and faster detection and better management of COVID-19 patients.

Investigating fear, depressive symptoms and coping mechanisms among Egyptian nursing students amidst the covid-19 pandemic: a cross-sectional study

BackgroundAmidst the ongoing COVID-19 pandemic, nursing students' contribution to combating this global health crisis is becoming more significant. However, we need a more comprehensive understanding of the psychological impact of this crisis on these students. Therefore, this study holds immense importance as it offers valuable insights into the connection between COVID-19 pandemic fear, coping strategies, and depressive symptoms among nursing students.MethodsA cross-sectional survey was conducted to collect and analyze data from 319 undergraduate nursing students. They participated in the study by responding to an online questionnaire. The questionnaire consisted of the Fear of the Coronavirus Questionnaire, Brief Coping Orientation to Problems Experienced, and the Beck Depression Inventory-II.ResultsThe study revealed that 45.5% of the participants had a severe fear of COVID-19, 21.9% showed severe depressive symptoms, and 64.6% used moderate coping mechanisms. A positive correlation (r = 0.160, p = 0.01) was found between the fear of COVID-19 and depressive symptoms. Interestingly, this correlation turned negative (r = -0.074, p = 0.01) when adaptive coping strategies such as religion, acceptance, planning, positive reframing, instrumental support, emotional support, active coping, and humor were used. However, when participants resorted to maladaptive coping strategies like venting, self-distraction, self-blame, behavioral disengagement, denial, and substance abuse, the correlation between high fear levels and depressive symptoms became positive (r = 0.352, p = 0.01).ConclusionThe study demonstrated that the fear of COVID-19 and depressive symptoms among nursing students are significantly correlated. However, the nature of this correlation is influenced by the type of coping strategies employed. Adaptive coping mechanisms can mitigate the impact of fear on depressive symptoms. In contrast, maladaptive coping can exacerbate the relationship between fear and depressive symptoms. Therefore, promoting adaptive coping strategies could be a crucial approach to managing the psychological impact of the COVID-19 pandemic.

Evaluation of diseases complicating long COVID: A retrospective chart review

AbstractBackgroundEvidence for the pathogenesis and treatment of postacute coronavirus disease 2019 (COVID‐19) (long COVID) is lacking. As long COVID symptoms are predicted to have an impact on the global economy, clarification of the pathogenesis is urgently needed. Our experiences indicated that some symptoms were complicated by diseases established before the COVID‐19 pandemic.MethodsUsing a retrospective, cross‐sectional study, we aimed to evaluate the diseases complicating long COVID. Using the medical records of patients with confirmed COVID‐19 exhibiting residual symptoms lasting ≥60 days postinfection who visited our clinic in January 2021–February 2023, we investigated the symptoms and diseases observed. We identified diseases that occurred after COVID‐19 and excluded those that were exacerbations of existing diseases.ResultsDuring the first visit, the most common symptoms reported in a total of 798 patients were fatigue (523 patients), anxiety (349 patients), and lack of motivation (344 patients). Complicating diseases were observed in 452 patients (57%). There were 115, 65, and 60 patients with postural tachycardia syndrome, postural syndrome without tachycardia, and mood disorders, respectively. Some diseases requiring immediate treatment included pulmonary thromboembolism, purulent shoulder arthritis, cerebellopontine angle tumors, myasthenia gravis, and cervical myelopathy.ConclusionNot all symptoms that occur after COVID‐19 should be treated as long COVID. Similar to normal medical treatment, a list of differential diagnoses should be maintained based on symptoms to obtain definitive diagnoses.

The depression and anxiety status and influencing factors survey of international students during COVID-19 outbreak period in Hunan, China: A cross-sectional study

International students are susceptible to several mental health disorders, including anxiety and depression amid the COVID-19 pandemic due to the implementation of epidemic control measures such as lockdown, quarantine, etc. The study aimed to investigate the depression and anxiety status as well as influencing factors of international students in Hunan, China during the COVID-19 outbreak lockdown. An online cross-sectional survey was conducted between May and June 2020. A snowball sampling technique was used to recruit participants. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) were used to assess depression and anxiety status, respectively. 450 participants completed the online survey. The overall prevalence of depression and anxiety was 28.7 % and 36.9 %, respectively. Multivariate logistic regression analyses showed that having suspected symptoms of COVID-19 (aOR = 3.54, 95 %CI = 1.30–9.64) and having family members or friends infected with COVID-19 (aOR = 1.51, 95 %CI = 1.31–3.84) were positively associated with depression. Being single was positively associated with anxiety (aOR = 3.10, 95 %CI = 1.46–6.57). Also, obtaining news or updates about the COVID-19 daily (aOR = 1.76, 95 %CI = 1.13–3.75), and using electronic devices for 5–6 h every day (aOR = 2.21, 95 %CI = 1.17–4.17) showed a positive association with anxiety. Furthermore, having a high coping strategy was negatively associated with anxiety (aOR = 0.33, 95 %CI = 0.12–0.92). Although implementing lockdown was an excellent measure, it resulted in a high prevalence of depression and anxiety symptoms. The findings support previous studies that reported an increased in depression and anxiety status due to the COVID-19 pandemic. Therefore, mental health education and psychological support should be provided to this population during the pandemic or future epidemic diseases.

Relationship between acute SARS-CoV-2 viral clearance with Long COVID Symptoms: a cohort study.

The relationship between SARS-CoV-2 viral dynamics during acute infection and the development of long COVID is largely unknown. A total of 7361 asymptomatic community-dwelling people enrolled in the Test Us at Home parent study between October 2021 and February 2022. Participants self-collected anterior nasal swabs for SARS-CoV-2 RT-PCR testing every 24-48 hours for 10-14 days, regardless of symptom or infection status. Participants who had no history of COVID-19 at enrollment and who were subsequently found to have ≥1 positive SARS-CoV-2 RT-PCR test during the parent study were recontacted in August 2023 and asked whether they had experienced long COVID, defined as the development of new symptoms lasting 3 months or longer following SARS-CoV-2 infection. Participant's cycle threshold values were converted into viral loads, and slopes of viral clearance were modeled using post-nadir viral loads. Using a log binomial model with the modeled slopes as the exposure, we calculated the relative risk of subsequently developing long COVID with 1-2 symptoms, 3-4 symptoms, or 5+ symptoms, adjusting for age, number of symptoms, and SARS-CoV-2 variant. Adjusted relative risk (aRR) of individual long COVID symptoms based on viral clearance was also calculated. 172 participants were eligible for analyses, and 59 (34.3%) reported experiencing long COVID. The risk of long COVID with 3-4 symptoms and 5+ symptoms increased by 2.44 times (aRR: 2.44; 95% CI: 0.88-6.82) and 4.97 times (aRR: 4.97; 95% CI: 1.90-13.0) per viral load slope-unit increase, respectively. Participants who developed long COVID had significantly longer times from peak viral load to viral clearance during acute disease than those who never developed long COVID (8.65 [95% CI: 8.28-9.01] vs. 10.0 [95% CI: 9.25-10.8]). The slope of viral clearance was significantly positively associated with long COVID symptoms of fatigue (aRR: 2.86; 95% CI: 1.22-6.69), brain fog (aRR: 4.94; 95% CI: 2.21-11.0), shortness of breath (aRR: 5.05; 95% CI: 1.24-20.6), and gastrointestinal symptoms (aRR: 5.46; 95% CI: 1.54-19.3). We observed that longer time from peak viral load to viral RNA clearance during acute COVID-19 was associated with an increased risk of developing long COVID. Further, slower clearance rates were associated with greater number of symptoms of long COVID. These findings suggest that early viral-host dynamics are mechanistically important in the subsequent development of long COVID.

Prevalence and Predictors of Long COVID-19 and the Average Time to Diagnosis in the General Population: A Systematic Review, Meta-Analysis and Meta-Regression

Objectives: We aimed to assess the prevalence of long COVID-19 and estimate the average time to its diagnosis and meta-regression for covariates. Methods: We conducted a systematic review, meta-analysis, and meta-regression from 43 studies (367,236 patients) (June 2020–August 2022). With the random-effects model, the pooled prevalence of long COVID-19 was measured. Publication bias was ascertained, and meta-regression analysis was performed on predetermined covariates. The trial was registered with PROSPERO (CRD42022328509). Results: The pooled prevalence of long COVID-19 was 42.5% (95% CI 36% to 49.3%), with 25% and 66% at four and two months, respectively. Mostly, long COVID-19 signs and symptoms occurred at three (54.3%) to six (57%) months (p &lt; 0.0001), further increasing at 12 months (57.9%, p = 0.0148). Hypertension was significantly associated with long COVID-19 at 32% (0.322 (95% CI 0.166, 0.532) (p &lt; 0.001) and hospital re-admission contributed to 17% (Q = 8.70, df = 1, p = 0.0032) (R2 = 0.17). All the covariates explained at least some of the variance in effect size on long COVID-19 at 53% (Q = 38.81, df = 19, p = 0.0047) (R2 analog = 0.53). Conclusion: The prevalence of long COVID-19 was 42.5% when linked with a cardiovascular disorder. Hospital re-admission majorly predicted the incidence of long COVID-19. Clinical and methodological characteristics in a specific study contributed to over 50% of long COVID-19 events, with most signs and symptoms occurring between 3 and 6 months and increasing at 12 months.

Hospital outcomes for young adults with COVID-19

BackgroundOlder adults are at higher risk of severe outcomes from COVID-19 with comorbidities increasing such risk. Much less is known about the outcomes of young adults with COVID-19 despite their having had high infection rates. ObjectivesOur objective was to determine outcomes of hospitalized young adults with COVID-19 infection including rates of oxygen use, mortality, ICU admission, intubation, duration of hospitalization, and factors associated with adverse outcomes. Study designThis retrospective cohort study included EHR data from 21 health systems in the United States on 18–29-year-olds hospitalized with COVID-19 from March 1, 2020 – January 31, 2022. Oxygen need was used to identify symptomatic COVID-19. Rates for mortality, ICU admission, and intubation were calculated for the symptomatic and asymptomatic groups. Effects of demographic and health characteristics on outcomes were assessed as were changes in hospital outcomes over time. ResultsOur sample included 9871 young adults hospitalized with COVID-19; 35% required oxygen. Of those who required oxygen, 53.5% were female, 23.7% had an anxiety disorder, 2.6% died (n = 89), 27.7% were admitted to the ICU (n = 955), and 15.8% were intubated (n = 547). A past-year history of any cancer was associated with a 2.1 times increased odds of death. Vaccination was associated with a >40% reduction in the odds of ICU admission. Mortality rates did not change significantly across the study period. ConclusionsCOVID-19 caused significant morbidity and mortality in hospitalized young adults who required oxygen. A cancer history was associated with increased risk of death. Vaccination appeared to have had a protective effect on illness severity.

Variability in COVID-19 symptom presentation during pregnancy and its impact on maternal and infant outcomes across the pandemic

BackgroundWith the dominance of different SARS-CoV-2 variants, the severity of COVID-19 has evolved. We aimed to investigate the difference in symptom prevalence and the association between symptoms and adverse pregnancy outcomes during the dominance of Wild-type/Alpha, Delta, and Omicron. MethodsCOVID-19 related symptom prevalence, maternal and specific neonatal outcomes of 5431 pregnant women registered in this prospective study were compared considering the dominant virus variant. Logistic regression models analyzed the association between specific symptoms and intensive care unit (ICU) admission or preterm birth. ResultsInfection with the Delta variant led to an increase in the symptom burden compared to the Wild-type/Alpha variant and the highest risk for respiratory tract symptoms, feeling of sickness, headache, and dizziness/drowsiness. An infection with the Omicron variant was associated with the lowest risk of dyspnea and changes in smell/taste but the highest risk for nasal obstruction, expectoration, headaches, myalgia, and fatigue compared to the Wild-type/Alpha and Delta variant dominant periods. With the progression of the Wild-type/Alpha to the Delta variant neonatal outcomes worsened. Dyspnea and fever were strong predictors for maternal ICU admission and preterm birth independent of vaccination status or trimester of infection onset. ConclusionThe symptom burden increased during the Delta period and was associated with worse pregnancy outcomes than in the Wild-type/Alpha area. During the Omicron dominance there still was a high prevalence of less severe symptoms. Dyspnea and fever can predict a severe maternal illness.

Regular Physical Activity Can Counteract LONG COVID Symptoms in Adults over 40.

To assess the impact of physical activity on the management and rehabilitation of LONG COVID, as well as to investigate the persistence of LONG COVID symptomatology in individuals over 40 years, beyond the pandemic. A total of 1004 participants (aged 53.45 ± 11.35) were recruited through an online snowball sampling strategy to complete a web-based survey. The following questionnaires were administered: Physical Activity Scale for Elderly (PASE), Shortness of Breath Questionnaire (SOBQ), Patient Health Questionnaire-9 item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), and Fatigue Scale for Motor and Cognitive Functions (FSMC). Significant gender differences were discovered, with women reporting higher symptoms than men (p < 0.001). Significant age differences were also found, with participants under 55 showing higher values than those over 55 (p < 0.001). No significant differences were found between aerobic and mixed physical activity (p > 0.05) while significant results emerged between physical activity groups and the no activity group (p < 0.001). The low-frequency group reported higher symptoms than the high-frequency group (all ps < 0.001). Regardless of the type of physical activity performed, our survey identified the frequency of training as a crucial factor to overcome LONG COVID symptoms; the challenge lies in overcoming the difficulties due to the persistent feelings of inefficiency and fatigue typical of those who have contracted the infection.

Recent symptomatic Omicron infection reduced COVID-19 pneumonia risk during reinfection: A computed tomography–based cohort study

ObjectivesSARS-CoV-2 infection could cause persistent lung injury or indicate potential genetic susceptibilities. Although infection-elicited hybrid immunity could protect against severe COVID-19, it remains unknown whether recent infection could reduce pneumonia risk during reinfection due to insufficient viral and chest computed tomography (CT) screening. MethodsA total of 15,598 patients, 96% fully vaccinated and 52% boosted, from Xiangyang, China, who had symptomatic COVID-19 and chest CT scans during the first Omicron BF.7 wave in December 2022 to January 2023, were followed through the second Omicron XBB.1.5 wave between May and August 2023. A total of 17,968 second-wave patients with COVID-19 with chest CT scans but without previous symptomatic COVID-19 were enrolled as first-time infection controls. ResultsA total of 19.6% (3,061 of 15,598) first-wave patients were diagnosed with pneumonia. Among second-wave reinfected patients, only 0.2% (four of 2202) developed pneumonia, which was lower than the 1.7% (311 of 17,968) pneumonia prevalence among the second-wave first-time patients, with an adjusted relative risk of 0.11 (95% confidence interval: 0.04-0.29). A total of 1.3% (40 of 3,039) first-wave pneumonia survivors showed residual abnormal patterns in follow-up CT scans within 8 months after pneumonia diagnosis. ConclusionsIn a highly vaccinated population, previous symptomatic Omicron infection within 8 months reduced pneumonia risk during reinfection. Uninfected individuals might need up-to-date vaccination to reduce pneumonia risk.