Tag: COVID19

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Severe COVID-19 increases risk of future cardiovascular events

Study: COVID-19 severity and risk of subsequent cardiovascular events. Image Credit: Yurchanka Siarhei / Shutterstock.com

To date, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for the coronavirus disease 2019 (COVID-19), has infected over 603 million individuals and claimed more than 6.4 million lives worldwide.

About 30% of COVID-19 survivors continue to experience a wide range of persistent symptoms for several weeks since their initial diagnosis. This condition is commonly referred to as post-acute sequelae of SARS-CoV-2 infection (PASC) or “long COVID.”

Study: COVID-19 severity and risk of subsequent cardiovascular events. Image Credit: Yurchanka Siarhei / Shutterstock.com

Study: COVID-19 severity and risk of subsequent cardiovascular events. Image Credit: Yurchanka Siarhei / Shutterstock.com

Background

Even though multisystem inflammatory syndrome is the most common PASC syndrome in adults and children, a wide range of other symptoms, including sleep difficulties, persistent fatigue, type 1 diabetes, and neurological disorders, have been reported. The incidence of these symptoms varies from one person to another based on their demographic and clinical characteristics.

Several studies have indicated the manifestation of multiple cardiovascular complications, such as arrhythmia, hypertension, acute myocardial infarction, thromboembolism, and cerebrovascular accidents, in individuals who have recovered from COVID-19. However, a limited number of studies have confirmed that severe COVID-19 leads to a high risk of cardiovascular diseases.

A recent Clinical Infectious Diseases journal study determines the relationship between COVID-19 severity and risk of subsequent cardiovascular events (CVEs) in a large cohort.

Study findings

A retrospective cohort study was performed using nationwide health insurance claims data of adults from the United States Health Verity Real-Time Insights and Evidence database. Increased COVID-19 severity was found to enhance the risk of developing subsequent CVEs among individuals without a cardiac history in previous years. 

As compared to COVID-19 patients who required outpatient care, those who required hospital admission were more likely to experience CVEs. Among COVID-19 hospitalized patients, those admitted to the intensive care unit (ICU) were almost 80% more likely to develop CVEs than non-ICU hospitalized patients.

In fact, non-ICU hospitalized patients exhibited only a 28% possibility of experiencing CVEs thirty days after initial COVID-19 symptoms. Additionally, as compared to COVID-19 outpatients, hospitalized patients were more likely to be admitted for a CVE after recovering from COVID-19.

In younger adults, the incidence of cardiovascular sequelae was lower as compared to older adults. Aside from CVEs, other severe outcomes, such as thrombotic events and cerebrovascular accidents, were observed in patients who recovered from severe COVID-19. However, such observations were less likely in COVID-19 patients who required only outpatient care.

The study findings emphasize the importance of vaccination, as demonstrated by its ability to reduce severe disease. Similarly, prompt antiviral treatment of acute COVID-19 has been recommended, which would help reduce the possibility of transition to severe illness.

Both COVID-19 vaccination and timely therapeutic interventions would alleviate the risk of severe COVID-19 and subsequently decrease the possibility of experiencing CVEs.

The findings of the present study are consistent with previous research that has reported a higher incidence of myocarditis and pericarditis in patients who recovered from severe SARS-CoV-2 infection. Nevertheless, it was observed that elevated cardiovascular risk after acute infection may not be exclusive to COVID-19.

In fact, some other diseases that have been associated with an increased risk of long-term CVEs are influenza and pneumonia bacteremia. Additionally, 22-65% of sepsis survivors are at an increased risk of CVEs.

The underlying mechanism responsible for the increased risk of CVEs following SARS-CoV-2 infection has not been determined. SARS-CoV-2 infects cardiac myocytes through their interaction with the angiotensin-converting enzyme 2 (ACE-2) receptor, which might remain persistent; therefore, this interaction induces chronic inflammatory responses and subsequent tissue damage or fibrosis.

Another mechanism related to the development of CVEs following recovery from COVID-19 is an autoimmune response to cardiac antigens that causes delayed damage to cardiac tissues. Anti-heart antibodies also correlated with cardiovascular manifestation and COVID-19.

Viral toxicity is another possible mechanism that might cause long-term cardiac damage or thrombosis in vasculitis. However, in the future, more research is needed to confirm the mechanisms related to cardiac damage after SARS-CoV-2 infection.

Conclusions

Due to the lack of a COVID-19-negative control group, the authors failed to quantify the elevated risk of CVEs in COVID-19 patients. The unwanted inclusion of patients with a history of CVEs could have overestimated the result as well. The impact of vaccination status on the incidence of CVE was not studied.

Despite these limitations, the present study strongly emphasized that patients who recovered from severe COVID-19 were at a greater risk of developing CVEs. As compared to COVID-19 patients who required outpatient care, those who were admitted to the ICU were at a higher risk of experiencing CVEs.

The importance of COVID-19 vaccination in preventing severe infection was strongly emphasized in this study.

Journal reference:

  • Wiemken, L. T., McGrath, L. J., Andersen, K. M., et al. (2022). COVID-19 severity and risk of subsequent cardiovascular events. Clinical Infectious Diseases. doi:10.1093/cid/ciac661.
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Launch event: “Implication of the COVID-19 Pandemic for Patient Safety: a rapid review”

 

Tuesday 9 August 2022

14:00 – 15:30  CET

 

 

The COVID-19 pandemic has profoundly impacted nearly all countries’ health systems and diminished their capability to provide safe health care, specifically due to errors, harm and delays in diagnosis, treatment and care management. “Implications of the COVID-19 pandemic for patient safety: a rapid review” emphasizes the high risk of avoidable harm to patients, health workers, and the general public, and exposes a range of safety gaps across all core components of health systems at all levels. The disruptive and transformative impacts of the pandemic have confirmed patient safety as a critical health system issue and a global public health concern.

The objectives of the event are :

•provide an overview of implications of the COVID-19 pandemic for patients, health workers, and the general public

•highlight importance of managing risks and addressing avoidable harm in a pandemic situation

•discuss implications of the pandemic for patient safety within broader context of preparedness, response and recovery

•lay the foundation for follow-up work around generating more robust evidence and supporting countries in their efforts to build resilient and safer health care systems. 

The session will be available in English, French and Spanish.

 

 

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Alberta, Calgary see rise in COVID-19 cases as large events return

Alberta, Calgary see rise in COVID-19 cases as large events return


The lack of restrictions and return of large events could be behind Alberta’s latest rise in COVID-19 cases, according to a Calgary developmental biologist.


“One could map it even when you have regions with a lot of festivals, a lot of large gatherings, then the spread might be bigger,” said Gosia Gasperowicz, developmental biologist and researcher at the University of Calgary.


“For example, with Stampede, it’s not only people being at Stampede but all the parties and especially indoor parties that people have after.”


The latest COVID-19 numbers as of July 18 show the test positivity rate increasing across the province — even more so in Calgary.


Hospitalizations in Alberta are also rising.


Gasperowicz said COVID might not turn out to be a seasonal virus, like the flu, that spikes in the winter.


“That’s not what we could have predicted by seeing how it’s evolving, so we can in the future, we can see those waves of new variants several times a year,” she told CTV News.


MIXED THOUGHTS ON COVID RISK


While life continues to look more like it used to before COVID-19, some Calgarians are still worried about their risk of getting infected.


“It’s still something that’s a concern for us. That’s why we’re still wearing our masks, even if we’re outside,” Gabriel Gana said.


Dino Gana agreed, adding, “even with Stampede, there’s a lot of people outside, so I guess COVID could rise. I know some people that just got it.”


Others like Katerina Palova believe the risk is low.


“I have three vaccines, three shots, and I think the precautions are pretty good here. I think people are kind of careful as well and whoever has symptoms stays at home,” she said.


With the pandemic entering the seventh wave, some people are choosing to put their masks back on and get another booster shot — two things Gasperowicz recommends.  

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Institutions and events consider masking requirements amongst summer COVID-19 surge

Institutions and events consider masking requirements amongst summer COVID-19 surge


A New Brunswick university will continue its campus mask mandate this fall.


Mount Allison University in Sackville, N.B., says masks will continue to be mandatory inside buildings, but won’t be required outside.


In a letter to students and staff, the university says exceptions to wearing a mask inside will include faculty who are teaching, students who are making a presentation, anyone sitting in the library or designated study space, as well as anyone participating in sports, fitness, or arts performances.


In an interview Thursday, Mount Allison president and vice-chancellor Jean-Paul Boudreau said the “low risk, high reward” decision was an easy one to make.


“This was the right call for our university, our community,” said Boudreau. “We had a very strong Mount Allison-Sackville bubble as we referred to it as. And that was really a strong commitment from our community, our faculty, our staff, and our students to be safe.”


“We appreciate that of course cases are increasing in New Brunswick and elsewhere. We know that the BA.5 variant is of concern not just in our community but beyond our borders.”


The University of New Brunswick, St. Thomas University, and Université de Moncton haven’t announced what, if any, masking policies may be in place this fall.


Mount Allison announced it would also be reaching out to new students to ask for their vaccination status, but noted the sharing of that information would be voluntary.


Mount Allison was the first university in the Maritimes to announce a campus-wide vaccination policy last summer. Post-secondary institutions around the region later implemented similar vaccination policies.


MANDATES AND DISCRETION


New Brunswick’s indoor masking policy came to an end in March.


Some events and organizations — including post-secondary institutions — kept the masking requirement in place.


Indoor events scheduled at next month’s Fredericton Pride will have masking requirements.


Fredericton Pride board member Brianna Matchett said chronically ill and immunocompromised individuals haven’t been able to participate in many other gatherings since the provincial mask mandate was lifted.


“I think people are appreciative of the fact there’s going to be spaces in the city where people, who’ve been excluded from a lot of events recently, will have a place to go,” said Matchett.


Medical grade air purifiers will also be used at Fredericton Pride’s indoor events. KN-95 masks will be provided at no cost for events happening indoors and outdoors, and areas will be cordoned off at outdoor events where masking will be required.


Infectious disease specialist Dr. Anna Banerji said COVID-19 transmission risks were lower outside, but not impossible particularly in crowded situations.


“And I think that’s where people use their discretion,” said Banerji, in an interview Thursday with CTV’s Your Morning.


The increase this summer in COVID-19 cases should put masking policies back on the table for some environments, according to Banerji.


“We thought that this summer that COVID would really go down, that we wouldn’t have another peak. But things are changing,” said Banerji. “Many people I know are getting COVID again or for the first time, so the whole environment is changing. A lot of people haven’t had their boosters in a long time.”


Banerji said masking mandates for certain crowded indoor situations, like public transportation, should be considered.


“Or certain places where you had vulnerable people, it would make sense to have mask mandates,” said Banerji. “I’m not saying in general, but I think where there are vulnerabilities.”

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Macau confirms 31 positive cases of COVID-19 as events, offices shut down

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Macau’s Novel Coronavirus Infection Response Coordination Center confirmed late Sunday that 31 people had tested positive to COVID-19, representing the SAR’s first major outbreak since the start of the pandemic almost two-and-a-half years ago.

Among the confirmed cases are 21 females and 10 males ranging in age from eight months to 89 years. Eight of the 31 are symptomatic confirmed cases with 23 asymptomatic at this stage. In their epidemiological investigations, authorities have followed up a total of 602 people, including what they describe as “146 close contacts, 375 non-core close contacts (people with common trails), 36 secondary close contacts, 10 general contacts and four accompanying persons.”

The detection of the 31 cases comes after the Health Bureau initially announced 12 positive cases of COVID-19 in the Macau community, with Kiang Wu Hospital reporting at 6pm on Saturday evening (18 June) the detection of a positive test result in a “10 mixed into one” nucleic acid test. One of the patients was later confirmed to be positive.

The government immediately checked the place of residence and work of the confirmed patient, and found that “at least 10” people were confirmed positive in the building where the patient lives.

This led to the declaration of an “immediate state of prevention” with all government events to be suspended or cancelled and all sports facilities to be shut down. The government also announced the closure of most of its offices today and tomorrow (Monday and Tuesday).

At a press conference on Sunday morning outlining some restrictions, Secretary for Social Affairs and Culture, Ao Ieong U, said, “In addition to supermarkets and so on, I hope that some venues will close down, and casinos can also take the same measures, but for the time being, there will not be any instructions, and I hope that enterprises will voluntarily comply and reduce the movement of people in the community.

“I hope people will stay at home, and I hope restaurants will suspend the supply of dining-in food.”

All departures from Macau are now required to present a negative NAT report from a test conducted within the past 24 hours.

The Macau government also announced that all Macau residents will be required to undergo a NAT test between 12 noon on Sunday 19 June and 12 noon on Tuesday 21 June.

The number of confirmed cases was updated to 21 on Sunday afternoon and then 31 on Sunday evening, with more likely to follow.

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COVID-19 superspreader events typically originate from few carriers

Study: Analysis of overdispersion in airborne transmission of COVID-19. Image Credit: oxinoxi / Shutterstock

A recent research paper published in the journal Physics of Fluids analyzed the overdispersion in the coronavirus disease 2019 (COVID-19) airborne transmission.

Study: Analysis of overdispersion in airborne transmission of COVID-19. Image Credit: oxinoxi / ShutterstockStudy: Analysis of overdispersion in airborne transmission of COVID-19. ​​​​​​​Image Credit: oxinoxi / Shutterstock

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been characterized by overdispersion and superspreading events comparable to SARS and other respiratory virus outbreaks. Any incident that results in more than the typical number of secondary transmissions is referred to as superspreading.

Overdispersion is a non-random trend of grouping in the context of contagious diseases, which frequently involves a large proportion of zero cases and a limited percentage of large outbreaks.

Nevertheless, the specific functions and influences of established physical and viral factors correlated to transmission processes on overdispersion are still unknown. Moreover, the characteristics and nature of superspreading episodes are instrumental in explaining the spread of SARS-CoV-2. To date, mechanistic simulations depicting airborne transmission have not been combined with real-world occupancy and distribution data to better explain large-scale characteristics of disease dynamics, such as transmissibility overdispersion.

About the study

In the present study, the authors used real-world occupancy information from over 100,000 social contact contexts in 10 United States (US) metropolises to undertake mechanistic modeling of COVID-19 point-source transmission via infectious aerosols. The primary purpose of this study was to use the molecular basis of airborne disease transmission to investigate event-level SARS-CoV-2 spread overdispersion utilizing real-world data from a significant number of social engagements.

The team tried to establish an algorithm centered on aerosol dispersion with randomized data and obtainable occupancy information to derive the distribution of the number of secondary infections for every infectious case. They investigated whether observed trends of overdispersion in secondary transmissions could be replicated through simulations utilizing the above algorithm.

Further, the scientists aimed to develop an analytical function (rather than a fit) that may explain the probability density function of the number of secondary infections arising from the dynamics of the problem. Furthermore, they attempted to determine the dominant factors that cause overdispersion and the consequences for mitigation strategies.

To achieve this, the scientists used 100,000 random social-contact conditions to solve an aerosol dispersal model by combining real-world area and occupancy data with practical ventilation and viral load rate to attain the probability distributions for the number of secondary infections for each infectious case in those situations.

Results and discussions

According to the simulated results, the aerosol transmission pathway was compatible with overdispersed individual COVID-19 infectivity. In addition, with exposure time, ventilation rate, and speaking time, SARS-CoV-2 load fluctuation was the most substantial factor controlling secondary attack rates. According to the authors, they, for the first time, generated analytical equations that precisely characterized the modeled probability density functions of secondary attack and infection rates. Besides, the generated analytical expressions revealed how the quantitative link among personal-level viral load variance and event-level occupancy governs overdispersion simultaneously.

These findings reveal that even in the case of airborne transmission, about 4% of index cases in indoor contexts were responsible for 80% of secondary cases, underlining the need for identifying and concentrating mitigation efforts on superspreading event causes. The results emphasize the significance of interventions, including isolation through rapid testing to identify intense viral shedding periods, for reducing exposures during stages of heightened viral shedding, improved ventilation, and the higher likelihood of outbreaks with SARS-CoV-2 variants of concern (VOCs) correlated with superior viral loads. Ultimately, considering viral burden and occupancy over indoor environments, the present analytical function may predict the spatially specified likelihood of outbreaks and outbreak magnitude via point-source transmission events.

Conclusions

Overall, the study findings demonstrated that around 4% of COVID-19 index cases possibly caused 80% of secondary SARS-CoV-2 infections, resulting in an extended tail probability distribution function of secondary infections per infectious event. Overdispersion appears to be notably driven by personal-level heterogeneity in SARS-CoV-2 load, with occupancy coming in second. The team then developed an analytical function that mimics the modeled SARS-CoV-2 overdispersion. Further, they illustrated the efficacy of potential COVID-19 mitigation techniques using this analytical function.

The present analysis adds a relevant dimension to the growing body of proof regarding SARS-CoV-2 airborne transmission by linking the mechanistic insights of COVID-19 aerosol spread with reported large-scale epidemiological features of outbreaks and thus unfolds as a potent tool for evaluating the likelihood of epidemics and the possible effects of mitigation actions on extensive disease dynamics. The simulation in this article covers overdispersion in the number of secondary cases rendered by each infectious case over an hour in such 100000 instances, assuming one index case at each site. The team mentioned that when combined with appropriate data, the current analytical expressions created and confirmed using simulations could explain overdispersion through drastically broader timeframes and contact vicinities.

Journal reference:

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After Two Years of COVID-19, Americans’ Anxiety Turns to Global Events, Says APA Annual Mental Health Poll

Children’s Mental Health Also a Top Concern

NEW ORLEANS, May 22, 2022 /PRNewswire/ — According to the annual Healthy Minds Poll from the American Psychiatric Association, adults’ anxiety about COVID-19 is at its recorded lowest, with 50% indicating they’re anxious about it, down from 65% in 2021 and 75% in 2020. Instead, adults say they are somewhat or extremely anxious about current events happening around the world (73%), keeping themselves or their families safe (64%), or their health generally (60%).   

Overall, about a third of Americans (32%) said they were more anxious than last year, 46% said their level of anxiety was about the same, and 18% were less anxious. One-quarter (26%) indicated they had talked with a mental health care professional in the past few years, down from 34% in 2021. Hispanic (36%) and Black (35%) adults were more likely to have done so than white (25%) adults.  

The poll, conducted by Morning Consult between April 23 and 24, 2022, was among a sample of 2,210 adults. The interviews were conducted online, and the data were weighted to approximate a target sample of adults based on gender, age, race, educational attainment, and region. Results from the full study have a margin of error of +/-2 percentage points.  

“It’s not surprising that recent events, such as the war in Ukraine, racially motivated mass shootings or the impacts of climate change, are weighing heavily on Americans’ minds,” said APA President Vivian Pender, M.D. “COVID-19 in a way has taken a back-seat, but the pandemic and its mental health effects are very much still with us. It’s important that we are cognizant of that and continue to work to ensure people who need psychiatric care, whether the causes are tied to the pandemic or to other issues, can access it.”  

Despite the backdrop of the Surgeon General’s recent advisory, Americans were less concerned about their children’s mental health than last year, with 41% of parents saying their children’s mental state concerned them this year compared to 53% saying so in 2021.  

Meanwhile, 40% of parents reported their children had received help from a mental health professional since the pandemic began. Of that group, 36% reported that they had sought help before the pandemic, and 50% indicated the pandemic had caused problems for their children’s mental health. A third of the group indicated they had encountered difficulties scheduling mental health care appointments for their children.  

“While the overall level of concern has dropped, still four in 10 parents are worried about how their children are doing, and a third are having issues with access to care,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “This is unacceptable and as a nation, we need to invest in the kind of systems that will ensure any parent who’s worried about their child has access to lifesaving treatment.”  

See other Healthy Minds Poll results on workplace mental health and government support. 

For a copy of the poll results, contact [email protected]. 

American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 37,000 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA’s vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.

SOURCE American Psychiatric Association