News Scan for Jun 02, 2020

Doctors' mental health in COVID-19
Recovered COVID-19 patients

COVID-19 takes heavy toll on new doctors' mental health, study finds

First-year medical residents in Shanghai—500 miles away from the Chinese COVID-19 epicenter of Wuhan—had a steep decline in mood, increased depression and anxiety, and twice the level of fear of workplace violence in the first month of the pandemic, according to a research letter published yesterday in JAMA Network Open.

The study involved 385 medical residents beginning work at 12 hospitals in August 2019 who tracked their mood each day on a smartphone app and answered questionnaires about their mental health and whether they had experienced, seen, or feared physical violence or verbal abuse at work. The questionnaires were given 2 weeks before residency and at 3 and 6 months.

Daily mood scores decreased significantly between 3 months (before the pandemic) and 6 months (at the pandemic peak), while scores for depression, anxiety, and fear of or observations of patient or patient family violence rose significantly.

The results contrasted sharply with the scores of residents who participated in the same study the previous year and had stable scores over the same period. Previous research had shown that first-year residencies are associated with large increases in depressive symptoms.

In a press release, coauthor Elena Frank, PhD, of the University of Michigan at Ann Arbor, said that infectious disease outbreaks can fray healthcare workers' physical and psychological health.

"It's easy to forget that they face many of the same additional stresses as the rest of us—concerns about elderly or at-risk family, loss of childcare—while simultaneously managing an increased clinical workload, and all while placing themselves and their families at greater risk of infection," she said.

The authors concluded that hospitals should ensure that doctors receive adequate support and access to mental health services.
Jun 1 JAMA Netw Open research letter
Jun 1 University of Michigan press release


Wuhan data show less than 1% of recovered COVID-19 patients suffered relapse

Editor's Note: This item was edited on Jun 3 with the correct percent of patients who suffered a relapse: 0.78%, not 7.7%.

A study today in the International Journal of Infectious Diseases showed that, of 1,673 recovered COVID-19 patients from two fever clinics in Wuhan, China, 13 experienced a relapse of mild disease within 20 days of symptom resolution from initial infections.

To conduct the study, 1,673 cured patients—defined as having negative test results, clear chest scans, and resolution of symptoms—were followed up two to six times between Mar 1 and Mar 20. Relapses were confirmed with positive test results and chest imaging. All 13 (0.78%) of patients who relapsed also had respiratory symptoms, but none required admittance to the intensive care unit. All relapsed patients also had high levels of C-reactive protein.

"Only 7.7% patients experienced recurrence during isolation and observation, and all presented with mild symptoms. No nosocomial transmission was found in this process," the authors wrote.

Serologic tests for immunoglobulin G (IgG) antibody was negative in 10 of the relapsed cases, IgM antibody was positive in 3 cases, and both IgG and IgM were positive in 3, the authors wrote. In patients who did not experience relapse, IgG antibody was negative in 1,543 cases (92.9%). However, IgM antibody was positive in 1,170 cases (70.9%), and both IgG and IgM were positive in 178 patients (10.7%).
Jun 2 Int J Infect Dis study

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