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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Longitudinal symptom dynamics of COVID-19 infection MESHD in primary care

    Authors: Barak Mizrahi; Smadar Shilo; Hagai Rossman; Nir Kalkstein; Karni Marcus; Yael Barer; Ayya Keshet; Na'ama Shamir-Stein; Varda Shalev; Anat Ekka Zohar; Gabriel Chodick; Eran Segal

    doi:10.1101/2020.07.13.20151795 Date: 2020-07-14 Source: medRxiv

    Objective : Data regarding the clinical characteristics of COVID-19 infection MESHD is rapidly accumulating. However, most studies thus far are based on hospitalized patients and lack longitudinal follow up. As the majority of COVID-19 cases are not hospitalized, prospective studies of symptoms in the population presenting to primary care are needed. Here, we assess the longitudinal dynamic of clinical symptoms in non-hospitalized individuals prior to and throughout the diagnosis of SARS-CoV-2 infection MESHD. Design Data on symptoms were extracted from electronic health records (EHR) consisting of both results of PCR tests and symptoms recorded by primary care physicians, and linked longitudinal self reported symptoms. Setting The second largest Health Maintenance Organization in Israel , Maccabi Health Services Participants From 1/3/2020 to 07/06/2020, information on symptoms from either surveys or primary care visits was available for 206,377 individuals, including 2,471 who tested positive for COVID-19. Main Outcomes Longitudinal prevalence SERO of clinical symptoms in COVID-19 infection MESHD diagnosed by PCR testing for SARS-CoV-2 from nasopharyngeal swabs. Results: In adults TRANS, the most prevalent symptoms recorded in EHR were cough MESHD cough HP (11.6%), fever MESHD fever HP (10.3%), and myalgia MESHD myalgia HP (7.7%) and the most prevalent self-reported symptoms were cough MESHD cough HP (21%), fatigue MESHD fatigue HP (19%) and rhinorrhea HP and/or nasal congestion (17%). In children TRANS, the most prevalent symptoms recorded in the EHR were fever MESHD fever HP (7%), cough MESHD cough HP (5.5%) and abdominal pain MESHD abdominal pain HP (2.4%) . Emotional disturbances were documented in 15.9% of the positive adults TRANS and 4.2% of the children TRANS. Loss of taste and smell, either self-reported or documented by a physician, 3 weeks prior to testing, were the most discriminative symptoms in adults TRANS (OR =11.18 and OR=5.47 respectively). Additional symptoms included self reported headache MESHD headache HP (OR = 2.03) and fatigue MESHD fatigue HP (OR = 1.73) and a documentation of syncope MESHD syncope HP, rhinorrhea HP (OR = 2.09 for both ) and fever MESHD fever HP (OR= 1.62 ) by a physician. Mean time to recovery TRANS was 23.5 +- 9.9 days. Children TRANS had a significantly shorter disease MESHD duration (21.7 +- 8.8 days, p-value=0.01). Several symptoms, including fatigue MESHD fatigue HP, myalgia MESHD myalgia HP, runny nose and shortness of breath were reported weeks after recovery. Conclusions As the COVID-19 pandemic progresses rapidly worldwide, obtaining accurate information on symptoms and their progression is of essence. Our study shed light on the full clinical spectrum of symptoms experienced by infected individuals in primary care, and may alert physicians for the possibility of COVID-19 infection MESHD.

    Syncope MESHD Syncope HP at SARS-CoV-2 onset due to impaired baroreflex response

    Authors: Ciro Canetta; Silvia Accordino; Elisabetta Buscarini; Gianpaolo Benelli; Giuseppe La Piana; Alessandro Scartabellati; Giovanni Vigano'; Roberto Assandri; Alberto Astengo; Chiara Benzoni; Gianfranco Gaudiano; Daniele Cazzato; Sebastiano Davide Rossi; Susanna Usai; Irene Tramacere; Giuseppe Lauria

    doi:10.1101/2020.05.29.20114751 Date: 2020-06-02 Source: medRxiv

    We describe clinical and laboratory findings in 35 consecutive patients tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction on nasopharyngeal swab that presented one or multiple syncopal events at disease MESHD onset. Neurological examination and electrocardiographic findings were normal. Chest computed tomography showed findings consistent with interstitial pneumonia MESHD pneumonia HP. Arterial blood SERO gas analysis showed low pO2, pCO2, and P/F ratio indicating hypocapnic hypoxemia HP, while patients did not show the expected compensatory heart rate increase. Such mechanism could have led to syncope MESHD syncope HP. We speculate that SARS-CoV-2 could have caused angiotensin-converting enzyme-2 (ACE2) receptor internalization in the nucleus of the solitary tract (NTS), thus altering the baroreflex response and inhibiting the compensatory tachycardia MESHD tachycardia HP during acute hypocapnic hypoxemia HP.

    Characteristics of patients presenting, and not presenting, to the emergency MESHD department during the early days of COVID-19

    Authors: Bjorn C Westgard; Matthew W Morgan; Gabriela Vazquez-Benitez; Lauren O Erickson; Michael D. Zwank

    doi:10.1101/2020.05.05.20090795 Date: 2020-05-08 Source: medRxiv

    Objective: Societal responses to the COVID-19 pandemic have had a substantial effect upon the number of patients seeking healthcare. An initial step in estimating the impact of these changes is characterizing the patients, visits, and diagnoses for whom care is being delayed or deferred. Methods: We conducted an observational study, examining demographics and diagnoses for all patient visits to the ED of an urban Level-1 trauma center before and after the state declaration and compared them to visits from a similar period in 2019. We estimated the ratios of the before and after periods using Poisson regression, calculated the percent change with respect to 2019 for total ED visits, patient characteristics, and diagnoses, and then evaluated the interactions between each factor and the overall change in ED visits. Results: There was a significant 35.2% drop in overall ED visits after the state declaration. Disproportionate declines were seen in visits by pediatric and older patients, women, and Medicare recipients as well as for presentations of syncope MESHD syncope HP, cerebrovascular accidents, urolithiasis MESHD, abdominal and back pain MESHD back pain HP. Significantly disproportionate increases were seen in ED visits for potential symptoms of COVID-19, including URIs, shortness of breath, and chest pain MESHD chest pain HP. Conclusions: Patient concerns about health care settings and public health have significantly altered care-seeking during the COVID-19 pandemic. Overall and differential declines in ED visits for certain demographic groups and disease MESHD processes should prompt efforts to encourage care-seeking and research to monitor for the morbidity and mortality that is likely to result from delayed or deferred care.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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