COVID-19 Scan for Oct 06, 2020

Neurologic symptoms in COVID-19
Gender differences in pandemic response
Aerosols from intubation / extubation

High rate of neurologic symptoms noted in hospitalized COVID-19 patients

A study yesterday found an 82.3% rate of neurologic symptoms among 509 hospitalized COVID-19 patients, with some symptoms associated with increased death rates.

SARS-CoV-2, the virus that causes COVID-19, appears to be unique among coronaviruses for its ability to cause multi-organ disease, including involvement of the brain and nervous system. A wide range of neurologic manifestations have been observed in COVID-19 patients, including headaches, dizziness, loss of taste or smell, and encephalopathy—a neurologic condition affecting the brain that can lead to altered mental states, confusion, and memory issues.

Researchers examined neurologic manifestations in 509 COVID-19 patients admitted to hospitals in the Chicago area to assess neurologic symptoms and determine if encephalopathy is associated with an increased risk of morbidity and mortality.

Neurologic symptoms were present at COVID-19 onset in 215 patients (42.2%), at hospital admission in 319 patients (62.7%), and at any time during the course of the disease in 419 patients (82.3%). The most frequent neurologic symptoms were myalgias (muscle aches), headaches, encephalopathy, dizziness, and loss of taste and smell.   

Patients presenting with neurologic symptoms were younger than those without, and had a longer time from disease onset to hospitalization. Patients with encephalopathy were older, had a shorter time from onset to hospitalization, and were more likely to be male and have other comorbidities. Patients with neurologic symptoms had longer hospitalization stays, with encephalopathy patients experiencing triple the length of stay as those without neurologic symptoms.

The study authors found no significant differences in functional outcome or mortality at discharge for patients experiencing neurologic symptoms with the exception of encephalopathy patients, who showed lower functional outcomes and greater likelihood of death 30 days after hospitalization (adjusted odds ratio 2.92, 95% confidence interval 1.17, 7.57; P = 0.02).

"Only 9 months into the pandemic, the long-term effects of Covid-19 on the nervous system remain uncertain. Our results suggest that, of all neurologic manifestations, encephalopathy is associated with a worse functional outcome in hospitalized patients with Covid-19, and may have lasting effects," the study authors wrote.
Oct 5 Ann Clin Transl Neurol study


Women more likely to embrace COVID-19 prevention behaviors

A report in Behavioral Science & Policy finds that women are more likely than men to embrace preventive public health practices, including physical distancing, mask wearing and hand hygiene, to combat COVID-19.  

The report details the findings of three studies showing gender differences in pandemic-related behavior during the peak period of the pandemic in the United States: an 800-participant online survey of public health behaviors, an observational study of mask wearing among 300 pedestrians in three large metro areas, and a county-level analysis of movement using anonymous cell phone data from 15 million users nationwide.

The researchers found that women surveyed were more likely to report following practices such as physical distancing, staying at home, frequent hand washing, and limiting in-person contact with family and friends. Women were also more likely than men to report relying on medical experts, other countries' experiences, their governor, and social media as sources of information to inform their practices.

"Previous research before the pandemic shows that women had been visiting doctors more frequently in their daily lives and following their recommendations more so than men," said lead author Irmak Olcaysoy Okten, PhD, in a New York University press release. "They also pay more attention to the health-related needs of others. So it's not surprising that these tendencies would translate into greater efforts on behalf of women to prevent the spread of the pandemic," Okten wrote.

The study also found a greater proportion of mask wearing among women pedestrians (57.7%) than men (42.3%) in New York City, New Haven, CT, and New Brunswick, NJ, even though gender distributions in these areas are roughly equivalent.

Nationwide GPS location data from cell phone users showed men practicing comparatively less physical distancing than women from Mar 9 to May 29 as measured by movement and visits to nonessential retailers, even after accounting for COVID-19 cases per capita, stay-at-home orders, demographics, gender differences in employment in various professions, and political affiliation.

The study authors caution that these findings may place men at higher risk of catching and spreading COVID-19. "Fine-tuning health messages to alert men in particular to the critical role of maintaining social distancing, hygiene, and mask wearing may be an effective strategy in reducing the spread of the virus," Okten says.
Oct 4 Behav Sci Policy report
Oct 5 New York University news release


Study finds intubation, extubation produce fewer aerosols than a cough

In a study published today in Anaesthesia, researchers measured how many aerosols are produced during intubation and extubation, which have both been considered a high-risk aerosol-generating procedure (AGP) during anesthesia for COVID-19.

Best practices have been to wear high-level personal protective equipment (PPE) and go through extensive operating room cleaning, slowing down operations, but this study found that the AGPs' maximum aerosol production was still less than 25% of the aerosol created by a voluntary cough.

Intubation involves inserting an artificial ventilation tube into the trachea to enhance breathing, and extubation refers to the removal of that tube.

Researchers from the North Bristol NHS Trust and the University of Bristol conducted their tests in ultraclean ventilation operating theaters on non–COVID-19 patients and went through face-mask ventilation, airway suction, repeated attempts of intubation, and extubation to reflect a real clinic setting with providers of varying experience. In all, they measured 19 intubations and 14 extubations.

Using high-resolution environmental monitoring, the scientists found that intubation created one-one thousandth the amount (0.001) of aerosol of a large cough and that extubation, even when accompanied by a weak cough, produced less than 25% of aerosols of a voluntary cough. To reduce the potential risk, the authors suggested that operators use practices to mitigate the patient's involuntary coughing or to simply step away from the face and behind the patient's head during extubation.

Although they concede the study worked off the aerosol/COVID-19 correlation and did not look at SARS-CoV-2 directly, the authors said in a news release, "If we can agree these procedures do not generate aerosols we can reduce the PPE we wear and we can eliminate the major delays that currently exist between one patient leaving the operating room and starting the next case."
Oct 6 Anaesthesia study

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