Becker's Clinical Quality & Infection Control

29 PATIENT SAFETY AND OUTCOMES 'Not just the most vulnerable': Who gets 'long COVID' and 4 other questions, answered By Gabrielle Masson P roviders are seeing more and more "long-haulers" experienc- ing lingering COVID-19 symptoms or entirely new symptoms weeks aer recovery. Researchers conducted an observational cohort study from 38 hospitals in Michigan, evaluating the outcomes of 1,250 COVID-19 patients discharged at 60 days. During the study, 6.7 percent of patients died, while 15.1 percent required readmission. e findings were published March 22 in Nature. What is "long-haul" or post-acute COVID-19? Post-acute COVID-19 is defined as persistent symptoms and/or delayed or long-term complications beyond four weeks from the onset of symptoms. How common is long-haul COVID-19? Of 488 patients who completed the survey, 32.6 percent of patients reported persistent symptoms, including 18.9 percent with new or worsened symptoms. What are the most common long-haul symptoms? Dyspnea, or shortness of breath, while walking up the stairs (22.9 per- cent) was most commonly reported. Other symptoms included cough (15.4 percent) and persistent loss of taste and/or smell (13.1 percent). Other common symptoms observed in post-acute COVID-19 are fatigue, decline in quality of life, muscular weakness, joint pain, per- sistent oxygen requirement, anxiety/depression, sleep disturbances, PTSD, cognitive disturbances (brain fog), headaches, palpitations, chest pain, thromboembolism, chronic kidney disease and hair loss. COVID-19 can also unveil previously unrecognized diabetes, and a small number of patients experience strokes, pulmonary embolisms and other complications from blood clots. Who gets long-haul COVID-19? Many people who experience long-term symptoms may have had health issues before contracting the virus or developed very severe illness during infection. "But really, any of these issues can happen to any patient who had COVID-19," Elaine Wan, MD, the review's senior author and Esther Aboodi Assistant Professor of Medicine in Cardiology and Cardiac Electrophysiology at New York City-based Columbia University, said in a March 22 news release. "For example, we've seen young patients without prior medical illness who developed autonomic dysfunction and fast heart rates aer COVID-19. It's not just the most vulnerable who have issues aer COVID." "ere really is a post-COVID syndrome and it doesn't always cor- relate with the severity of the acute COVID infection itself," said Ani Nalbandian, MD, review author and cardiology fellow at Columbia University Vagelos College of Physicians and Surgeons. e majority of COVID-19 patients experiencing long-term symp- toms never come to the hospital for treatment, Dr. Nalbandian added. What can be done? "Based on this review, all of us recognized that there needs to be interdisciplinary care to treat patients longitudinally," said Dr. Nal- bandian. "Care for patients with COVID-19 should not conclude at the time of hospital discharge." To provide such care, systems should set up "COVID-19 clinics." Setting up these clinics in the U.S. has been challenging since physicians are still caring for new COVID-19 patients, Dr. Nal- bandian said, adding that many patients have said their providers don't recognize that symptoms may be related to COVID-19. n COVID-19 virus doesn't infect brain, but damages it, study suggests By Mackenzie Bean A n analysis of brain autopsies from 41 COVID-19 patients suggests that the SARS-CoV-2 virus does not infect the brain, but can still cause significant neurological damage. Researchers at the Columbia University Vagelos Col- lege of Physicians and Surgeons in New York City con- ducted the study, which was published April 15 in the journal Brain. The 41 patients included in the analysis ranged in age from 38 to 97 and all died while hospital- ized for COVID-19. Researchers used various techniques to search for the virus in more than two dozen regions of the brain. They found no evidence of the SARS-CoV-2 virus in patients' brain cells. However, they did find brain damage in all 41 patients. Many patients had hypoxic brain injuries due to a lack of oxygen, which researchers said were likely from blood clots or stroke. Most patients also had a large number of activat- ed microglia — a type of immune cell — that were attacking neurons in the brain even though the virus was not present. Researchers said the microglia may have been triggered by inflammation or hypoxia. At the time of publication, the study represented the largest COVID-19 brain autopsy report to date. The findings suggest that neurological issues associated with the illness may stem from inflammation the virus triggers in other parts of the body or in the brain's blood vessels, researchers said. n

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