Sho Nakakubo et al.
Associations of COVID-19 symptoms with omicron subvariants BA.2 and BA.5, host status, and clinical outcomes in Japan: a registry-based observational study
The Lancet, June 2023 ; doi.org/10.1016/S1473-3099(23)00271-2
Abstract
Previous SARS-CoV-2 infection and vaccination, coupled with the rapid evolution of SARS-CoV-2 variants, have modified COVID-19 clinical manifestations. We aimed to characterise the clinical symptoms of COVID-19 individuals in omicron BA.2 and BA.5 Japanese pandemic periods to identify omicron and subvariant associations between symptoms, immune status, and clinical outcomes.
Methods
In this registry-based observational study, individuals registered in Sapporo's web-based COVID-19 information system entered 12 pre-selected symptoms, days since symptom onset, vaccination history, SARS-CoV-2 infection history, and background. Eligibility criteria included symptomatic individuals who tested positive for SARS-CoV-2 (PCR or antigen test), and individuals who were not tested for SARS-CoV-2 but developed new symptoms after a household member tested positive for SARS-CoV-2. Symptom prevalence, variables associated with symptoms, and symptoms associated with progression to severe disease were analysed.
Findings
Data were collected and analysed between April 25 and Sept 25, 2022. For 157 861 omicron-infected symptomatic individuals, cough was the most common symptom (99 032 [62·7%] patients), followed by sore throat (95 838 [60·7%] patients), nasal discharge (69 968 [44·3%] patients), and fever (61 218 [38·8%] patients). Omicron BA.5 infection was associated with a higher prevalence of systemic symptoms than BA.2 in vaccinated and unvaccinated individuals (adjusted odds ratio [OR] for fever: 2·18 [95% CI 2·12–2·25]). Omicron breakthrough-infected individuals with three or more vaccinations or previous infection were less likely to exhibit systemic symptoms (fever 0·50 [0·49–0·51]), but more likely to exhibit upper respiratory symptoms (sore throat 1·33 [1·29–1·36]; nasal discharge 1·84 [1·80–1·89]). Infected older individuals (≥65 years) had lower odds for all symptoms. However, when symptoms were manifest, systemic symptoms were associated with increased odds for severe disease (dyspnoea 3·01 [1·84–4·91]; fever 2·93 [1·89–4·52]), whereas upper respiratory symptoms were associated with decreased odds (sore throat 0·38 [0·24–0·63]; nasal discharge 0·48 [0·28–0·81]).
Interpretation
Host immunological status, omicron subvariant, and age were associated with a spectrum of COVID-19 symptoms and outcomes. BA.5 produced a higher systemic symptom prevalence than BA.2. Vaccination and previous infection reduced systemic symptom prevalence and improved outcomes but increased upper respiratory tract symptom prevalence. Systemic, but not upper respiratory, symptoms in older people heralded severe disease. Our findings could serve as a practical guide to use COVID-19 symptoms to appropriately modify health-care strategies and predict clinical outcomes for older patients with omicron infections.
Michael Gottlieb et al.
Severe Fatigue and Persistent Symptoms at 3 Months Following Severe Acute Respiratory Syndrome Coronavirus 2 Infections During the Pre-Delta, Delta, and Omicron Time Periods: A Multicenter Prospective Cohort Study
CID, June 2023; doi.org/10.1093/cid/ciad045
Abstract
Most research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants focuses on initial symptomatology with limited longer-term data. We characterized prevalences of prolonged symptoms 3 months post–SARS-CoV-2 infection across 3 variant time-periods (pre-Delta, Delta, and Omicron).
Methods
This multicenter prospective cohort study of adults with acute illness tested for SARS-CoV-2 compared fatigue severity, fatigue symptoms, organ system–based symptoms, and ≥3 symptoms across variants among participants with a positive (“COVID-positive”) or negative SARS-CoV-2 test (“COVID-negative”) at 3 months after SARS-CoV-2 testing. Variant periods were defined by dates with ≥50% dominant strain. We performed multivariable logistic regression modeling to estimate independent effects of variants adjusting for sociodemographics, baseline health, and vaccine status.
Results
The study included 2402 COVID-positive and 821 COVID-negative participants. Among COVID-positives, 463 (19.3%) were pre-Delta, 1198 (49.9%) Delta, and 741 (30.8%) Omicron. The pre-Delta COVID-positive cohort exhibited more prolonged severe fatigue (16.7% vs 11.5% vs 12.3%; P = .017) and presence of ≥3 prolonged symptoms (28.4% vs 21.7% vs 16.0%; P < .001) compared with the Delta and Omicron cohorts. No differences were seen in the COVID-negatives across time-periods. In multivariable models adjusted for vaccination, severe fatigue and odds of having ≥3 symptoms were no longer significant across variants.
Conclusions
Prolonged symptoms following SARS-CoV-2 infection were more common among participants infected during pre-Delta than with Delta and Omicron; however, these differences were no longer significant after adjusting for vaccination status, suggesting a beneficial effect of vaccination on risk of long-term symptoms.
Chaolin Huang et al.
6-month consequences of COVID-19 in patients discharged from hospital: a cohort study
The Lancet, June 2023 ; doi.org/10.1016/S0140-6736(23)00810-3
Abstract
The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.
Methods
We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. Patients who died before follow-up; patients for whom follow-up would be difficult because of psychotic disorders, dementia, or readmission to hospital; those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism; those who declined to participate; those who could not be contacted; and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received SARS-CoV-2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.
Findings
In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 years (IQR 47·0–65·0) and 897 (52%) were male and 836 (48%) were female. The follow-up study was done from June 16 to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 days (175·0–199·0). Fatigue or muscle weakness (52%, 855 of 1654) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1616) of patients. The proportions of 6-min walking distance less than the lower limit of the normal range were 17% for those at severity scale 3, 13% for severity scale 4, and 28% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) of 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·76 (1·05–2·96) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·87 (0·68–1·11) for scale 4 versus scale 3 and 2·75 (1·61–4·69) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with an estimated glomerular filtration rate (eGFR) of 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up.
Interpretation
At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.
Finlay A. McAlister et al.
The burden of incidental SARS-CoV-2 infections in hospitalized patients across pandemic waves in Canada
Nature, April 2023; doi.org/10.1038/s41598-023-33569-2
Abstract
Many health authorities differentiate hospitalizations in patients infected with SARS-CoV-2 as being “for COVID-19” (due to direct manifestations of SARS-CoV-2 infection) versus being an “incidental” finding in someone admitted for an unrelated condition. We conducted a retrospective cohort study of all SARS-CoV-2 infected patients hospitalized via 47 Canadian emergency departments, March 2020-July 2022 to determine whether hospitalizations with “incidental” SARS-CoV-2 infection are less of a burden to patients and the healthcare system. Using a priori standardized definitions applied to hospital discharge diagnoses in 14,290 patients, we characterized COVID-19 as (i) the “Direct” cause for the hospitalization (70%), (ii) a potential “Contributing” factor for the hospitalization (4%), or (iii) an “Incidental” finding that did not influence the need for admission (26%). The proportion of incidental SARS-CoV-2 infections rose from 10% in Wave 1 to 41% during the Omicron wave. Patients with COVID-19 as the direct cause of hospitalization exhibited significantly longer LOS (mean 13.8 versus 12.1 days), were more likely to require critical care (22% versus 11%), receive COVID-19-specific therapies (55% versus 19%), and die (17% versus 9%) compared to patients with Incidental SARS-CoV-2 infections. However, patients hospitalized with incidental SARS-CoV-2 infection still exhibited substantial morbidity/mortality and hospital resource use.
Erica A. Voss et al.
Contextualising adverse events of special interest to characterise the baseline incidence rates in 24 million patients with COVID-19 across 26 databases: a multinational retrospective cohort study
The Lancet, April 2023; doi.org/10.1016/j.eclinm.2023.101932
Abstract
Adverse events of special interest (AESIs) were pre-specified to be monitored for the COVID-19 vaccines. Some AESIs are not only associated with the vaccines, but with COVID-19. Our aim was to characterise the incidence rates of AESIs following SARS-CoV-2 infection in patients and compare these to historical rates in the general population.
Methods
A multi-national cohort study with data from primary care, electronic health records, and insurance claims mapped to a common data model. This study's evidence was collected between Jan 1, 2017 and the conclusion of each database (which ranged from Jul 2020 to May 2022). The 16 pre-specified prevalent AESIs were: acute myocardial infarction, anaphylaxis, appendicitis, Bell's palsy, deep vein thrombosis, disseminated intravascular coagulation, encephalomyelitis, Guillain- Barré syndrome, haemorrhagic stroke, non-haemorrhagic stroke, immune thrombocytopenia, myocarditis/pericarditis, narcolepsy, pulmonary embolism, transverse myelitis, and thrombosis with thrombocytopenia. Age-sex standardised incidence rate ratios (SIR) were estimated to compare post-COVID-19 to pre-pandemic rates in each of the databases.
Findings
Substantial heterogeneity by age was seen for AESI rates, with some clearly increasing with age but others following the opposite trend. Similarly, differences were also observed across databases for same health outcome and age-sex strata. All studied AESIs appeared consistently more common in the post-COVID-19 compared to the historical cohorts, with related meta-analytic SIRs ranging from 1.32 (1.05 to 1.66) for narcolepsy to 11.70 (10.10 to 13.70) for pulmonary embolism.
Interpretation
Our findings suggest all AESIs are more common after COVID-19 than in the general population. Thromboembolic events were particularly common, and over 10-fold more so. More research is needed to contextualise post-COVID-19 complications in the longer term.
YanXie et al.
Risk of Death in Patients Hospitalized for COVID-19vs Seasonal Influenza in Fall-Winter 2022-2023
JAMA, April 2023; doi:10.1001/jama.2023.5348
Abstract
In the first year of the COVID-19 pandemic, 2 US studies suggested that people hospitalized for COVID-19 had nearly 5 times the risk of 30-day mortality compared with those hospitalized for seasonal influenza.1,2 Since then, much has changed, including SARS-CoV-2 itself, clinical care, and population-level immunity; mortality from influenza may have also changed. This study assessed whether COVID-19 remains associated with higher risk of death compared with seasonal influenza in fall-winter 2022-2023.
Methods
We used the electronic health databases of the US Department of Veterans Affairs (VA). Between October 1, 2022, and January 31, 2023, we enrolled all individuals with at least 1 hospital admission record between 2 days before and 10 days after a positive test result for SARS-CoV-2 or influenza and an admission diagnosis for COVID-19 or seasonal influenza. We removed 143 participants hospitalized with both infections. The cohort was followed up until the first occurrence of death, 30 days after hospital admission, or March 2, 2023. Differences in baseline characteristics between the groups were evaluated through absolute standardized differences (<0.1 indicating good balance).
Results
There were 8996 hospitalizations (538 deaths [5.98%] within 30 days) for COVID-19 and 2403 hospitalizations (76 deaths [3.16%]) for seasonal influenza (Table). After propensity score weighting, the 2 groups were well balanced (mean age, 73 years; 95% male).
The death rate at 30 days was 5.97% for COVID-19 and 3.75% for influenza, with an excess death rate of 2.23% (95% CI, 1.32%-3.13%) (Figure). Compared with hospitalization for influenza, hospitalization for COVID-19 was associated with a higher risk of death (hazard ratio, 1.61 [95% CI, 1.29-2.02]).
The risk of death decreased with the number of COVID-19 vaccinations (P = .009 for interaction between unvaccinated and vaccinated; P < .001 for interaction between unvaccinated and boosted). No statistically significant interactions were observed across other subgroups (Figure).
Discussion
This study found that, in a VA population in fall-winter 2022-2023, being hospitalized for COVID-19 vs seasonal influenza was associated with an increased risk of death. This finding should be interpreted in the context of a 2 to 3 times greater number of people being hospitalized for COVID-19 vs influenza in the US in this period.3,4 However, the difference in mortality rates between COVID-19 and influenza appears to have decreased since early in the pandemic; death rates among people hospitalized for COVID-19 were 17% to 21% in 2020 vs 6% in this study, while death rates for those hospitalized for influenza were 3.8% in 2020 vs 3.7% in this study.1,2 The decline in death rates among people hospitalized for COVID-19 may be due to changes in SARS-CoV-2 variants, increased immunity levels (from vaccination and prior infection), and improved clinical care.5
The increased risk of death was greater among unvaccinated individuals compared with those vaccinated or boosted—findings that highlight the importance of vaccination in reducing risk of COVID-19 death.
Study limitations include that the older and predominantly male VA population may limit generalizability to broader populations. The results may not reflect risk in nonhospitalized individuals. The analyses did not examine causes of death, and residual confounding cannot be ruled out.
William J. O’Brien
Estimated Risk of Adverse Surgical Outcomes Among Patients With Recent COVID-19 Infection Using Target Trial Emulation Methods
JAMA, March 2023; doi:10.1001/jamanetworkopen.2023.4876
Abstract
The American Society of Anesthesiologists published recommendations on the timing of elective surgery for patients who have recently recovered from COVID-19.1,2 Several recent studies are conflicting about optimal timing of surgery relative to vaccination and infection. We emulated a trial within a large veteran population to assess the risk of adverse postoperative outcomes among patients with recent COVID-19 infection. We hypothesized that patients with infection in the 30 or 60 days before surgery would face increased risk compared with those without infection.
The end point was death, cardiac events, central nervous system outcomes, respiratory outcomes, surgical infection, or thromboembolic events within 30 days after surgery. Weighted logistic regression estimated the odds ratio (OR) of any outcome as a function of exposure group, perioperative factors (because they were not known at time zero), and any propensity score covariates unbalanced after weighting. The eMethods in Supplement 1 contain greater detail.
Results
A total of 29 093 patients (mean [SD] age, 66.1 [11.4] years; 90.0% men; 67.5% White patients) underwent surgery at 123 hospitals (Table 1). Among the 15 553 surgical procedures (53.5%) performed for inpatients, the mean (SD) length of stay was 5.0 (8.5) days. The median time between infection and surgery was 30 days (IQR, 13-44 days). Adverse postoperative outcomes occurred among 1337 of 28 635 patients (4.7%) within the group without COVID-19, 18 of 238 (7.6%) within the group with a 1- to 30-day infection, and 7 of 220 (3.2%) within the group with a 31- to 60-day infection. The ORs for postoperative outcomes were 1.40 (95% CI, 0.77-2.35) among those with infection in preoperative days 1 to 30 and 0.68 (95% CI, 0.26-1.42) among those with infection in preoperative days 31 to 60 (Table 2).
Discussion
These findings suggest that recent COVID-19 infection was not associated with risk of adverse postoperative outcomes, regardless of timing within the previous 60 days. A recent study found surgery within 8 weeks after a positive COVID-19 test result was associated with higher 90-day mortality vs matched controls.3 Another study found lower perioperative risk for vaccinated patients and for unvaccinated patients not given general anesthesia.4 These studies may shift the timing of surgery relative to recent infection. Our study further rebalances the scale in favor of performing surgery in recently recovered patients.
XiuchengLan et al.
A systematic review of the effect of COVID-19 on semen parameters
Cell, March 2023; doi.org/10.1016/j.heliyon.2023.e14776
Abstract
Background and objectives
Since the outbreak of COVID-19, more and more studies have proved that it has an impact on the male reproductive system. The purpose of this article is to investigate the effects of COVID-19 on male semen parameters, further analyze the incidence and risk factors of diseases related to semen parameters, and put forward to corresponding preventive measures.
Methods
Retrieved from PubMed, Embase, The Cochrane Library, Web of Science, Clinicaltrails, CNKI, CBM, Wanfang Database and VIP to collect research on the effects of COVID-19 on the male reproductive system. The literature search was conducted until January 2022. In strict accordance with the inclusion and exclusion criteria, two researchers independently screened the literature and comprehensively analyzed five cohort studies on the impact of COVID-19 on male reproductive system. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included cohort studies, and Revman 5.4.1 was applied for statistical analysis.
Results
Semen volume (RR = −0.10; 95% CI: 0.45, 0.26; P = 0.60), there was no significant difference between the test group and the control group; Sperm count (RR = −45.28; 95% CI: 66.38, 24.19; P = 0.0001), the sperm count of the COVID-19 test group was lower than that of the control group, and the difference was statistically significant; Sperm concentration (RR = −15.65 × 106; 95%CI: 31.52 × 106, 0.21 × 106; P = 0.05), there was no significant difference between the test group and the control group; progressive sperm motility (RR = 4.31; 95% CI: 4.62, 13.24; P = 0.34), there was no effect on progressive sperm motility in the COVID-19 test group compared with the control group.
Conclusions
COVID-19 can reduce semen quality and affect male fertility. However, due to the limitations of this study, this conclusion needs to be further verified by large-sample, high-quality prospective cohort studies on the long-term effects of COVID-19 on male reproductive function.
Anzhou Tao et al.
Olfactory impairment in COVID-19: Two methods for the assessment of olfactory function
Cell, March 2023; doi.org/10.1016/j.heliyon.2023.e14104
Abstract
Background
Olfactory impairment is a major symptom of COVID-19. Is it necessary for COVID-19 patients to perform the detection of olfactory function, even how to select the olfactory psychophysical assessment tool.
Methods
Patients infected with SARS-CoV-2 Delta variant were firstly taken into three categories (mild, moderate, and severe) according to the clinical classification. The Odor Stick Identification Test for the Japanese (OSIT-J) and the Simple Olfactory Test were used to assess olfactory function. Moreover, these patients were divided into three groups based on the results of the olfactory degree (euosmia, hyposmia, and dysosmia), too. The statistical analysis of the correlations between olfaction and clinical characteristics of patients were performed.
Results
Our study demonstrated that the elderly men of Han were more susceptible to infected SARS-CoV-2, the clinical symptoms of the COVID-19 patients showed a clear correspondence with the disease type and the degree of olfactory disturbance. Whether or not to vaccinate and whether to complete the whole course of vaccination was closely related to the patient's condition. OSIT-J Test and Simple Test were consistent in our work, indicating that olfactory grading would worsen with the aggravation of symptoms. Furthermore, the OSIT-J method maybe better than Simple Olfactory Test.
Conclusion
The vaccination has an important protective effect on the general population, and vaccination should be vigorously promoted. Moreover, it is necessary for COVID-19 patients to perform the detection of olfactory function, and the easier, faster and less expensive method for determination of olfactory function should be utilized to COVID-19 patients as the vital physical examination
Xiude Fan et al.
The Effects of Obesity and Metabolic Abnormalities on Severe COVID-19-related Outcomes after Vaccination: A Population-Based Study
Cell, February 2023; doi.org/10.1016/j.cmet.2023.02.016
Abstract
Breakthrough SARS-CoV-2 infections of vaccinated individuals are being reported globally, resulting in an increased risk of hospitalization and death among such patients. Therefore, it is crucial to identify the modifiable risk factors that may affect the protective efficacy of vaccine use against the development of severe COVID-19 and thus to initiate early medical interventions. Here, in population-based studies using the UK Biobank database and the 2021 National Health Interview Survey (NHIS), we analyzed 20,362 participants aged 50 years or older and 2,588 aged 18 years or older from both databases who tested positive for SARS-COV-2, of whom 33.1% and 67.7% received one or more doses of vaccine, respectively. In the UK Biobank, participants are followed from the vaccination date until Oct. 18, 2021. We found that obesity and metabolic abnormalities (namely, hyperglycemia, hyperlipidemia and hypertension) were modifiable factors for severe COVID-19 in vaccinated patients (All P < .05). When metabolic abnormalities were present, regardless of obesity, the risk of severe COVID-19 was higher than that of metabolically normal individuals (All P < .05). Moreover, pharmacological interventions targeting such abnormalities (namely, antihypertensive (adjusted hazard ratio (aHR) .64, 95% CI .48-.86; P = .003), glucose-lowering (aHR .55, 95% CI .36-.83; P = .004) and lipid-lowering treatments (aHR .50, 95% CI .37-.68; P < .001) were significantly associated with a reduced risk for this outcome. These results show that more proactive health management of patients with obesity and metabolic abnormalities is critical to reduce the incidence of severe COVID-19 after vaccination.
Rinki Deo et al.
Symptom and Viral Rebound in Untreated SARS-CoV-2 Infection
https://www.acpjournals.org/doi/10.7326/M22-2381
Abstract
Background:
Although symptom and viral rebound have been reported after nirmatrelvir–ritonavir treatment, the trajectories of symptoms and viral load during the natural course of COVID-19 have not been well described.
Objective:
To characterize symptom and viral rebound in untreated outpatients with mild to moderate COVID-19.
Design:
Retrospective analysis of participants in a randomized, placebo-controlled trial. (ClinicalTrials.gov: NCT04518410)
Setting:
Multicenter trial.
Patients:
563 participants receiving placebo in the ACTIV-2/A5401 (Adaptive Platform Treatment Trial for Outpatients With COVID-19) platform trial.
Measurements:
Participants recorded the severity of 13 symptoms daily between days 0 and 28. Nasal swabs were collected for SARS-CoV-2 RNA testing on days 0 to 14, 21, and 28. Symptom rebound was defined as a 4-point increase in total symptom score after improvement any time after study entry. Viral rebound was defined as an increase of at least 0.5 log10 RNA copies/mL from the immediately preceding time point to a viral load of 3.0 log10 copies/mL or higher. High-level viral rebound was defined as an increase of at least 0.5 log10 RNA copies/mL to a viral load of 5.0 log10 copies/mL or higher.
Results:
Symptom rebound was identified in 26% of participants at a median of 11 days after initial symptom onset. Viral rebound was detected in 31% and high-level viral rebound in 13% of participants. Most symptom and viral rebound events were transient, because 89% of symptom rebound and 95% of viral rebound events occurred at only a single time point before improving. The combination of symptom and high-level viral rebound was observed in 3% of participants.
Limitation:
A largely unvaccinated population infected with pre-Omicron variants was evaluated.
Conclusion:
Symptom or viral relapse in the absence of antiviral treatment is common, but the combination of symptom and viral rebound is rare.
Jiaxing Wang et al.
Evaluation and Follow-up of Myopia Prevalence Among School-Aged Children Subsequent to the COVID-19 Home Confinement in Feicheng, China
JAMA, February 2023; doi:10.1001/jamaophthalmol.2022.6506
Abstract
Importance Progression of myopia in a school-aged population due to home confinement (January to May 2021) during the COVID-19 pandemic has been previously reported. A key remaining question was whether the myopia spike in children aged 6 to 8 years persisted.
Objective To investigate the changes in refractive status and prevalence of myopia in school-aged children 1 year after home confinement ended in China.
Design, Setting, and Participants This cross-sectional study with a cohort substudy prospectively evaluated data from school-based photoscreening in Feicheng, China. Children aged 6 to 13 years participated in 8 screenings from 2015 to 2021.
Exposures Noncycloplegicphotorefraction was conducted using the Spot Vision photoscreener.
Main Outcomes and Measures The main outcomes were the differences in spherical equivalent refraction (SER) and prevalence of myopia between 2020 (during home confinement) and 2021 (after home confinement). The SER was recorded for each child, and the prevalence of myopia was calculated annually for each age group.
Results A total of 325 443 children participated in the study (51.4% boys, 48.6% girls; age range, 6 to 13 years). Compared with 2020, the mean SER of children in 2021 increased significantly for those aged 6 (0.42 diopters [D]), 7 (0.41 D), and 8 (0.33 D) years. The prevalence of myopia in 2021 was similar to in 2019 for each age group (aged 6 years: 7.9% vs 5.7%; aged 7 years: 13.9% vs 13.6%; aged 8 years: 29.5% vs 26.2%). Both the prevalence of myopia and mean SER for these children returned to their prepandemic levels.
Conclusions and Relevance
Compared with 2020, the prevalence of myopia among children aged 6 to 8 years in the 2021 screenings decreased, and the mean SER returned to prepandemic level. The refractive development in children aged 6 to 8 years may be most susceptible to environmental changes. These findings support the premise that age 6 to 8 years is a critical period for myopia development and suggest a need to focus preventive interventions for myopia control on children in this age range.
Thatcher MD et al.
Bilateral Purtscher-Like Retinopathy Associated With COVID-19 Infection
JAMA, February 2023; doi:10.1001/jamaophthalmol.2022.6255
Abstract
Purtscher retinopathy is an occlusive microvasculopathy related to trauma first described by Otmar Purtscher.1 When the condition occurs in the absence of trauma it is referred to as Purtscher-like retinopathy and has been described in conditions such as acute pancreatitis, fat embolism syndrome, kidney failure, and childbirth.1 Both conditions present with sudden unilateral or bilateral vision loss and nerve fiber layer infarcts, optic disc swelling, retinal hemorrhages, and pathognomonic Purtscherflecken (a term describing discrete areas of retinal whitening between the arterioles and venules) on fundus examination.1 The retinopathy typically spontaneously resolves within 1 to 3 months.1
Report of a Case
Here we describe a case of a 37-year-old female individual who presented with sudden-onset blurred vision in both eyes 4 days after testing positive for COVID-19. She reported mild symptoms of COVID-19 infection that did not require hospitalization, such as malaise, headaches, fever, and loss of taste and smell, but she did not endorse a cough. Infection was confirmed with a series of 3 positive rapid antigen test results for SARS-CoV-2. Prior to infection, she had received 2 doses of the messenger RNA–based Pfizer-BioNTech vaccine. Her ocular history was remarkable for a bilateral YAG peripheral iridotomy in 2019 for high hyperopia.
At initial presentation, visual acuity with habitual correction measured 20/150 OD and 20/80 OS. Her intraocular pressures were 17 mm Hg OD and 15 mm Hg OS. Anterior segment examination showed a relative afferent pupillary defect on the left. Dilated fundus examination revealed nerve fiber layer infarcts, intraretinalhemorrhages, and Purtscherflecken bilaterally (Figure 1A). Spectral-domain optical coherence tomography revealed thickening and hyperreflectivity of the nerve fiber layer and areas of subretinal fluid and intraretinaledema bilaterally (Figure 1B). No additional testing for thrombophilia (such as platelet levels, prothrombin time, or partial thromboplastin time) or complement levels was performed. Based on the clinical findings, the patient was diagnosed with Purtscher-like retinopathy and was counseled on the self-limiting nature of the condition.
Chang R. et al.
Risk of autoimmune diseases in patients with COVID-19: A retrospective cohort study
The Lancet, January 2023; doi.org/10.1016/j.eclinm.2022.101783
Abstract
There are a growing number of case reports of various autoimmune diseases occurring after COVID-19, yet there is no large-scale population-based evidence to support this potential association. This study provides a closer insight into the association between COVID-19 and autoimmune diseases and reveals discrepancies across sex, age, and race of participants.
Methods
This is a retrospective cohort study based on the TriNetX U.S. Collaborative Network. In the test-negative design, cases were participants with positive polymerase chain reaction (PCR) test results for SARS-CoV-2, while controls were participants who tested negative and were not diagnosed with COVID-19 throughout the follow-up period. Patients with COVID-19 and controls were propensity score-matched (1: 1) for age, sex, race, adverse socioeconomic status, lifestyle-related variables, and comorbidities. The primary endpoint is the incidence of newly recorded autoimmune diseases. Adjusted hazard ratios (aHRs) and 95% confident intervals (CIs) of autoimmune diseases were calculated between propensity score-matched groups with the use of Cox proportional-hazards regression models.
Findings
Between January 1st, 2020 and December 31st, 2021, 3,814,479 participants were included in the study (888,463 cases and 2,926,016 controls). After matching, the COVID-19 cohort exhibited significantly higher risks of rheumatoid arthritis (aHR:2.98, 95% CI:2.78–3.20), ankylosing spondylitis (aHR:3.21, 95% CI:2.50–4.13), systemic lupus erythematosus (aHR:2.99, 95% CI:2.68–3.34), dermatopolymyositis (aHR:1.96, 95% CI:1.47–2.61), systemic sclerosis (aHR:2.58, 95% CI:2.02–3.28), Sjögren's syndrome (aHR:2.62, 95% CI:2.29–3.00), mixed connective tissue disease (aHR:3.14, 95% CI:2.26–4.36), Behçet's disease (aHR:2.32, 95% CI:1.38–3.89), polymyalgia rheumatica (aHR:2.90, 95% CI:2.36–3.57), vasculitis (aHR:1.96, 95% CI:1.74–2.20), psoriasis (aHR:2.91, 95% CI:2.67–3.17), inflammatory bowel disease (aHR:1.78, 95%CI:1.72–1.84), celiac disease (aHR:2.68, 95% CI:2.51–2.85), type 1 diabetes mellitus (aHR:2.68, 95%CI:2.51–2.85) and mortality (aHR:1.20, 95% CI:1.16–1.24).
Interpretation
COVID-19 is associated with a different degree of risk for various autoimmune diseases. Given the large sample size and relatively modest effects these findings should be replicated in an independent dataset. Further research is needed to better understand the underlying mechanisms.
Hyams C. et al.
Severity of Omicron (B.1.1.529) and Delta (B.1.617.2) SARS-CoV-2 infection among hospitalised adults: A prospective cohort study in Bristol, United Kingdom
Lancet, December 2022; doi.org/10.1016/j.lanepe.2022.100556
Abstract
Background
There is an urgent public health need to evaluate disease severity in adults hospitalised with Delta and Omicron SARS-CoV-2 variant infections. However, limited data exist assessing severity of disease in adults hospitalised with Omicron SARS-CoV-2 infections, and to what extent patient-factors, including vaccination, age, frailty and pre-existing disease, affect variant-dependent disease severity.
Interpretation
We provide reassuring evidence that Omicron infection results in less serious adverse outcomes than Delta in hospitalised patients. Despite lower severity relative to Delta, Omicron infection still resulted in substantial patient and public health burden and an increased admission rate of older patients with Omicron which counteracts some of the benefit arising from less severe disease.
Bilinski A. et al.
COVID-19 and Excess All-Cause Mortality in the US and 20 Comparison Countries, June 2021-
March 2022
JAMA, November 2022; doi:10.1001/jama.2022.21795
Abstract
The US continued to experience significantly higher COVID-19 and excess all-cause mortality compared with peer countries during 2021 and early 2022, a difference accounting for 150 000 to 470 000 deaths. This difference was muted in the 10 states with highest vaccination coverage; remaining gaps may be explained by greater vaccination uptake in peer countries, better vaccination targeting to older age groups, and differences in health and social infrastructure.
This study also highlights the value of excess mortality in understanding effects of COVID-19. Excess all-cause mortality began to fall below COVID-19 mortality in several countries and highly vaccinated states during Omicron, perhaps owing to reductions in non–COVID-19 deaths. However, cross-location differences may also reflect differences in COVID-19 death coding.
Limitations include use of some provisional mortality estimates and lack of adjustment by age and comorbidities. Nevertheless, unadjusted estimates remain important, because a country’s response to COVID-19 should reflect risks in its population rather than a hypothetical standardized population.
These findings highlight that the US continued to lag peer countries in COVID-19 and excess all-cause mortality, albeit with lower mortality in highly vaccinated states.
Whitaker M. et al.
Variant-specific symptoms of COVID-19 in a study of 1,542,510 adults inEngland
Nature, November 2022; doi.org/10.1038/s41467-022-34244-2
Abstract
Infection with SARS-CoV-2 virus is associated with a wide range of symptoms. The REal-time Assessment of Community Transmission −1 (REACT-1) study monitored the spread and clinical manifestation of SARS-CoV-2 among random samples of the population in England from 1 May 2020 to 31 March 2022. We show changing symptom profiles associated with the different variants over that period, with lower reporting of loss of sense of smell or taste for Omicron compared to previous variants, and higher reporting of cold-like and influenza-like symptoms, controlling for vaccination status. Contrary to the perception that recent variants have become successively milder, Omicron BA.2 was associated with reporting more symptoms, with greater disruption to daily activities, than BA.1. With restrictions lifted and routine testing limited in many countries, monitoring the changing symptom profiles associated with SARS-CoV-2 infection and effects on daily activities will become increasingly important.
Hartman-Munick S.M et al.
Association of the COVID-19 Pandemic With Adolescent and Young Adult Eating Disorder Care Volume
JAMA, November 2022; doi:10.1001/jamapediatrics.2022.4346
Abstract
Importance: The COVID-19 pandemic has affected youth mental health. Increases in site-specific eating disorder (ED) care have been documented; however, multisite studies demonstrating national trends are lacking. Objective: To compare the number of adolescent/young adult patients seeking inpatient and outpatient ED care before and after onset of the COVID-19 pandemic. Design, Setting, and Participants Using an observational case series design, changes in volume in inpatient and outpatient ED-related care across 15 member sites (14 geographically diverse hospitalbased adolescent medicine programs and 1 nonhospital-based ED program) of the US National Eating Disorder Quality Improvement Collaborative was examined. Sites reported monthly volumes of patients seeking inpatient and outpatient ED care between January 2018 and December 2021. Patient volumes pre- and postpandemic onset were compared separately for inpatient and outpatient settings. Demographic data such as race and ethnicity were not collected because this study used monthly summary data. Exposures Onset of the COVID-19 pandemic. Main Outcomes and Measures Monthly number of patients seeking inpatient/outpatient ED-related care. Results: Aggregate total inpatient ED admissions were 81 in January 2018 and 109 in February 2020. Aggregate total new outpatient assessments were 195 in January 2018 and 254 in February 2020. Before the COVID-19 pandemic, the relative number of pooled inpatient ED admissions were increasing over time by 0.7% per month (95% CI, 0.2%-1.3%). After onset of the pandemic, there was a significant increase in admissions over time of 7.2% per month (95% CI, 4.8%-9.7%) through April 2021, then a decrease of 3.6% per month (95% CI, −6.0% to −1.1%) through December 2021. Prepandemic, pooled data showed relative outpatient ED assessment volume was stable over time, with an immediate 39.7% decline (95% CI, −50.4% to −26.7%) in April 2020. Subsequently, new assessments increased by 8.1% (95% CI, 5.3%-11.1%) per month through April 2021, then decreased by 1.5% per month (95% CI, −3.6% to 0.7%) through December 2021. The nonhospital-based ED program did not demonstrate a significant increase in the absolute number of admissions after onset of the pandemic but did see a significant increase of 8.2 (95% CI, 6.2-10.2) additional inquiries for care per month in the first year after onset of the pandemic. Conclusions and Relevance: In this study, there was a significant COVID-19 pandemic-related increase in both inpatient and outpatient volume of patients with EDs across sites, particularly in the first year of the pandemic. Given inadequate ED care availability prior to the pandemic, the increased postpandemic demand will likely outstrip available resources. Results highlight the need to address ED workforce and program capacity issues as well as improve ED prevention strategies.
Bersia M et al.
Suicide spectrum among young people during the COVID-19 pandemic: A systematic review and meta-analysis
Lancet, October 2021; doi.org/10.1016/j.eclinm.2022.101705
Abstract
Background
There are concerns that suicidal behaviors are arising among adolescents. The COVID-19 pandemic could have worsened the picture, however, studies on this topic reported contrasting results. This work aimed to summarise findings from the worldwide emerging literature on the rates of suicidality among young people during the COVID-19 pandemic.
Methods
A systematic review and meta-analysis were performed, searching five electronic databases for studies published from January 1, 2020 until July 27, 2022. Studies reporting rates for each of the three considered outcomes (suicide, suicidal behaviors, and suicidal ideation) among young people under 19 years old during the COVID-19 pandemic were included
Interpretation
During the pandemic, suicide spectrum issues seemed to follow the known pattern described in previous studies, with higher rates of suicidal ideation than of suicidal behaviors and suicide events. Governments and other stakeholders should be mindful that youth may have unique risks at the outset of large disasters like the COVID-19 pandemic and proactive steps are necessary to address the needs of youth to mitigate those risks.
Rofail D. et al.
Reliability and validity of an instrument of COVID-19 patient-reported symptoms in outpatients
JAMA, October 2022; doi:10.1001/jamanetworkopen.2022.39053
Abstract
Patient-reported outcome instruments are key in assessing COVID-19–related symptoms and associated burden but a valid and reliable instrument to assess symptom severity and progression among outpatients with COVID-19 is not yet available.
Abbasi J.
The COVID Heart—One Year After SARS-CoV-2 Infection, Patients Have an Array of Increased Cardiovascular Risks
JAMA,March 2022;doi:10.1001/jama.2022.2411
Abstract
What are COVID-19’s long-term cardiovascular outcomes? The study, published in Nature Medicine by researchers at the Veterans Affairs (VA) St Louis Health Care System, found that in the year after recovering from the illness’s acute phase, patients had increased risks of an array of cardiovascular problems.
A. Ozonoff et al.
Phenotypes of diseaseseverity in a cohort of hospitalized COVID-19 patients: results from the IMPACC
EBioMedicine, September2022; doi: 10.1016/j.ebiom.2022.104208
Abstract
To furtherimproveuponpatient management and outcomeitisimportant a betterunderstanding of the associationbetweencharacteristics of patientshospitalized with coronavirus disease 2019 (COVID-19). Longitudinal clinical phenotypingoffersimportant insights, and provides a framework for immunophenotyping for acute and long COVID-19.
N. Wolter et al.
Clinical severity of SARS-CoV-2 Omicron BA.4 and BA.5 lineages compared to BA.1 and Delta in South Africa
Nature Communications, October 2022 ; doi.org/10.1038/s41467-022-33614-0
Abstract
In South Africa the fifth wave of COVID-19 cases is linked to the Omicron BA.4 and BA.5 lineages. The authors use the presence/absence of the S-gene target as a proxy for SARS-CoV-2 variant/lineage for infections diagnosed using the TaqPath PCR assay between 1 October 2021 and 26 April 2022. Omicron lineages BA.4/BA.5 showed similar severity to the BA.1 lineage and continued to show reduced clinical severity compared to the Delta variant.
P. Arjmand et al.
Mucormycosis in pre-COVID-19 and COVID-19 era: A study of prevalence, risk factors and clinical features
Laryngoscope, September 2022; doi.org/10.1002/lio2.899
Abstract
Mucormycosis is a rare yet devastating fungal disease with a frequently fatal outcome. The purpose of this study was to compare the prevalence of mucormycosis, evaluate its risk factors, and assess the patients' outcomes in pre-COVID-19 and COVID-19 era.
The collected data were risk factors associated with mucormycosis including age, gender, underlying diseases, details of corticosteroid administration, and complications such as blindness and mortality.
The COVID-19 pandemic has led to an increased prevalence of mucormycosis, due to the convergence of interlinked risk factors such as diabetes mellitus, corticosteroid therapy, and COVID-19. Therefore, clinicians must be aware of the probable occurrence of mucormycosis in the first or second week of COVID-19 infection in vulnerable patients and use the steroids cautiously.
S. Warren
Le persone affette da long COVID potrebbero avere ancora proteine spike nel sangue
Le Scienze, July 2022;
https://www.lescienze.it/news/2022/07/25/news/long_covid_protenie_spike_sangue-9935973/
Abstract
È quanto suggerisce uno studio in cui alcuni ricercatori sono riusciti a individuare per la prima volta un possibile marcatore di questa condizione. E l'origine di questi frammenti potrebbero essere cellule ancora infette forse responsabili dei diversi sintomi riferiti dalle persone molto tempo dopo il primo contatto con il virus.
J. Wollborn et al.
COVID-19 increases the risk for the onset of atrial fibrillation in hospitalized patients
Nature Scientific Reports, July 2022; doi.org/10.1038/s41598-022-16113-6
Abstract
COVID-19 is associated with significant extrapulmonary symptoms. Myocardial involvement has been described for infections with SARS-CoV-2 which may lead to an increase in morbidity and mortality. The objective of our study was to investigate the association of COVID-19 and atrial fibrillation (AF) or atrial flutter (AFl) in hospitalized patients. This retrospective study used electronic medical records to detect patients with COVID-19 and their comorbidities within the Mass General Brigham hospital system. All patients ≥ 18 years who were hospitalized and received a PCR test for SARS-CoV-2 were screened for inclusion as well as patients from a pre-pandemic cohort. We matched on common risk factors for AF and then used multivariable logistic regression to estimate the odds for AF or AFl. Of 78,725 patients eligible for analysis, 11,004 COVID-19 negative patients were matched to 3,090 COVID-19 positive patients and 5005 pre-pandemic patients were matched to 2283 COVID-19 positive patients. After adjusting for demographics and comorbidities, COVID-19 positive patients had 1.19 times the odds (95% CI 1.00, 1.41) of developing AF compared to COVID-19 negative patients and 1.57 times the odds (95% CI 1.23, 2.00) of developing AF compared to pre-pandemic patients. Our study demonstrated an increased risk for AF, directing the attention for improved screening and treatment regimens for the sequelae of COVID-19. While COVID-19 continues to affect many people around the world, AF may be a significant cause for morbidity and mortality. Adequate detection and treatment of AF is essential to reduce the burden of disease.
Yian Xie et al.
Long-term cardiovascular outcomes of COVID-19
Nature Medicine, February 2022; doi.org/10.1038/s41591-022-01689-3
Abstract
The cardiovascular complications of acute coronavirus disease 2019 (COVID-19) are well described, but the post-acute cardiovascular manifestations of COVID-19 have not yet been comprehensively characterized. Here we used national healthcare databases from the US Department of Veterans Affairs to build a cohort of 153,760 individuals with COVID-19, as well as two sets of control cohorts with 5,637,647 (contemporary controls) and 5,859,411 (historical controls) individuals, to estimate risks and 1-year burdens of a set of pre-specified incident cardiovascular outcomes. We show that, beyond the first 30 d after infection, individuals with COVID-19 are at increased risk of incident cardiovascular disease spanning several categories, including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. These risks and burdens were evident even among individuals who were not hospitalized during the acute phase of the infection and increased in a graded fashion according to the care setting during the acute phase (non-hospitalized, hospitalized and admitted to intensive care). Our results provide evidence that the risk and 1-year burden of cardiovascular disease in survivors of acute COVID-19 are substantial. Care pathways of those surviving the acute episode of COVID-19 should include attention to cardiovascular health and disease.
