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      Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study

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          Abstract

          Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [ 20– 29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO 2/FiO 2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO 2/FiO 2 <324 and BMI ≥33 Kg/m 2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            Dawei Wang, Bo Hu, Fangfang Zhu … (2020)
            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

              Emily A. Holmes, Rory C O'Connor, V. Perry … (2020)
              Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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                Author and article information

                Contributors
                Rebecca De Lorenzo: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing
                Caterina Conte: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Chiara Lanzani: Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Francesco Benedetti: Role: ConceptualizationRole: Data curationRole: InvestigationRole: Writing – review & editing
                Luisa Roveri: Role: InvestigationRole: Writing – review & editing
                Mario G. Mazza: Role: ConceptualizationRole: Data curationRole: InvestigationRole: Writing – review & editing
                Elena Brioni: Role: InvestigationRole: Project administrationRole: Writing – review & editing
                Giacomo Giacalone: Role: InvestigationRole: Writing – review & editing
                Valentina Canti: Role: InvestigationRole: Writing – review & editing
                Valentina Sofia: Role: Data curationRole: InvestigationRole: Writing – review & editing
                Marta D’Amico: Role: Data curationRole: Investigation
                Davide Di Napoli: Role: ConceptualizationRole: Project administrationRole: Writing – review & editing
                Alberto Ambrosio: Role: ConceptualizationRole: Project administrationRole: Writing – review & editing
                Paolo Scarpellini: Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Antonella Castagna: Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Giovanni Landoni: Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Alberto Zangrillo:
                ORCID: http://orcid.org/0000-0002-7687-7648
                Role: ConceptualizationRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Emanuele Bosi: Role: ConceptualizationRole: InvestigationRole: Writing – review & editing
                Moreno Tresoldi: Role: ConceptualizationRole: SupervisionRole: Writing – review & editing
                Fabio Ciceri: Role: ConceptualizationRole: InvestigationRole: SupervisionRole: Writing – review & editing
                Patrizia Rovere-Querini:
                ORCID: http://orcid.org/0000-0003-2615-3649
                Role: ConceptualizationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – review & editing
                Muhammad Adrish: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 14 October 2020
                Publication date Collection: 2020
                Publication date PMC-release: 14 October 2020
                Volume: 15
                Issue: 10
                Electronic Location Identifier: e0239570
                Affiliations
                [1 ] School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
                [2 ] Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [3 ] Unit of Nephrology, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [4 ] Unit of Psychiatry and Clinical Psychobiology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [5 ] Department of Neuroscience, INSPE, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [6 ] Clinical Governance Division, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [7 ] Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
                [8 ] Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
                BronxCare Health System, Affiliated with Icahn School of Medicine at Mount Sinai, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7687-7648
                http://orcid.org/0000-0003-2615-3649
                Article
                Publisher ID: PONE-D-20-16962
                DOI: 10.1371/journal.pone.0239570
                PMC ID: 7556454
                PubMed ID: 33052920
                SO-VID: 1f1e3e23-0588-4608-9a8b-08caa24060e5
                Copyright © © 2020 De Lorenzo et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 June 2020
                Date accepted : 9 September 2020
                Page count
                Figures: 4, Tables: 5, Pages: 16
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Infectious Diseases
                Subject: Viral Diseases
                Subject: Covid 19
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Neuropsychiatric Disorders
                Subject: Anxiety Disorders
                Subject: Post-Traumatic Stress Disorder
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Neuroses
                Subject: Anxiety Disorders
                Subject: Post-Traumatic Stress Disorder
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Cardiovascular Diseases
                Subject: Coronary Heart Disease
                Subject: Medicine and Health Sciences
                Subject: Cardiology
                Subject: Cardiovascular Medicine
                Subject: Cardiovascular Diseases
                Subject: Coronary Heart Disease
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Coronary Heart Disease
                Subject: Medicine and Health Sciences
                Subject: Critical Care and Emergency Medicine
                Subject: Medicine and Health Sciences
                Subject: Endocrinology
                Subject: Endocrine Disorders
                Subject: Diabetes Mellitus
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Metabolic Disorders
                Subject: Diabetes Mellitus
                Subject: Medicine and Health Sciences
                Subject: Medical Conditions
                Subject: Respiratory Disorders
                Subject: Dyspnea
                Subject: Medicine and Health Sciences
                Subject: Pulmonology
                Subject: Respiratory Disorders
                Subject: Dyspnea
                Subject: Biology and Life Sciences
                Subject: Nutrition
                Subject: Malnutrition
                Subject: Medicine and Health Sciences
                Subject: Nutrition
                Subject: Malnutrition
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognitive Neuroscience
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Neuroscience
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cognitive Neurology
                Subject: Cognitive Impairment
                Custom metadata
                Data Availability All relevant data are within the manuscript and its Supporting Information files.
                Outbreaks COVID-19

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                ScienceOpen disciplines: Uncategorized

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