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      An International Commentary on Dysphagia and Dysphonia During the COVID-19 Pandemic

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          Abstract

          COVID-19 has had an impact globally with millions infected, high mortality, significant economic ramifications, travel restrictions, national lockdowns, overloaded healthcare systems, effects on healthcare workers’ health and well-being, and large amounts of funding diverted into rapid vaccine development and implementation. Patients with COVID-19, especially those who become severely ill, have frequently developed dysphagia and dysphonia. Health professionals working in the field have needed to learn about this new disease while managing these patients with enhanced personal protective equipment. Emerging research suggests differences in the clinical symptoms and journey to recovery for patients with COVID-19 in comparison to other intensive care populations. New insights from outpatient clinics also suggest distinct presentations of dysphagia and dysphonia in people after COVID-19 who were not hospitalized or severely ill. This international expert panel provides commentary on the impact of the pandemic on speech pathologists and our current understanding of dysphagia and dysphonia in patients with COVID-19, from acute illness to long-term recovery. This narrative review provides a unique, comprehensive critical appraisal of published peer-reviewed primary data as well as emerging previously unpublished, original primary data from across the globe, including clinical symptoms, trajectory, and prognosis. We conclude with our international expert opinion on what we have learnt and where we need to go next as this pandemic continues across the globe.

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            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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              Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

              There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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                Author and article information

                Contributors
                a.miles@auckland.ac.nz
                Journal
                Dysphagia
                Dysphagia
                Dysphagia
                Springer US (New York )
                0179-051X
                1432-0460
                4 January 2022
                4 January 2022
                : 1-26
                Affiliations
                [1 ]GRID grid.9654.e, ISNI 0000 0004 0372 3343, Speech Science, School of Psychology, , The University of Auckland, ; Grafton Campus, Private Bag 92019, Auckland, New Zealand
                [2 ]GRID grid.264200.2, ISNI 0000 0000 8546 682X, Centre for Allied Health, , St George’s, University of London/University College London Hospitals NHS Foundation Trust, ; London, UK
                [3 ]GRID grid.417895.6, ISNI 0000 0001 0693 2181, Imperial College London & Clinical Specialist SLT (Airways/ENT), , Imperial College Healthcare NHS Trust, ; London, UK
                [4 ]GRID grid.411596.e, ISNI 0000 0004 0488 8430, Clinical Specialist SLT, Voice & Swallowing Clinic, , Mater Misericordiae University Hospital, ; Dublin, Ireland
                [5 ]GRID grid.256115.4, ISNI 0000 0004 1761 798X, SLHT, Faculty of Rehabilitation, School of Health Sciences, , Fujita Health University, ; Toyoake, Japan
                [6 ]GRID grid.10417.33, ISNI 0000 0004 0444 9382, Division of Speech Pathology, Department of Rehabilitation, , Radboud University Medical Centre / Donders Centre for Neuroscience, ; Nijmegen, The Netherlands
                [7 ]GRID grid.16463.36, ISNI 0000 0001 0723 4123, Speech-Language Therapy, , University of KwaZulu-Natal, ; Durban, South Africa
                [8 ]GRID grid.31410.37, ISNI 0000 0000 9422 8284, Sheffield Teaching Hospitals NHS Foundation Trust, ; Sheffield, UK
                [9 ]GRID grid.52996.31, ISNI 0000 0000 8937 2257, Consultant SLT Royal National ENT and EDH University College London Hospitals NHS Foundation Trust, ; London, UK
                [10 ]Mobile Dysphagia Diagnostics, Medical SLP Collective, Buffalo, USA
                [11 ]GRID grid.412915.a, ISNI 0000 0000 9565 2378, SLT, Belfast City Hospital, , Belfast Health & Social Care Trust, ; Belfast, UK
                [12 ]GRID grid.498924.a, Consultant SLT, Wythenshawe Hospital, , Manchester University NHS Foundation Trust, ; Manchester, UK
                [13 ]GRID grid.21107.35, ISNI 0000 0001 2171 9311, Division of Pulmonary and Critical Care Medicine, Department of Physical Medicine and Rehabilitation, Outcomes After Critical Illness and Surgery (OACIS) Research Group, , Johns Hopkins University, ; Baltimore, MD USA
                Author information
                http://orcid.org/0000-0003-3260-5824
                Article
                10396
                10.1007/s00455-021-10396-z
                8723823
                34981255
                91c29f9a-b47b-4709-8122-a78a20c71523
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 12 April 2021
                : 1 December 2021
                Categories
                Review

                Otolaryngology
                covid-19,dysphagia,deglutition,dysphonia,icu,voice
                Otolaryngology
                covid-19, dysphagia, deglutition, dysphonia, icu, voice

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