“I spoke to 6 doctors until one believed me”: women explain their long Covid frustration

Written by Hollie Richardson

Hollie is a digital writer at Stylist.co.uk, mainly covering the daily news on women’s issues, politics, celebrities and entertainment. She also keeps an ear out for the best podcast episodes to share with readers. Oh, and don’t even get her started on Outlander…

From not knowing how to articulate the symptoms to not being taken seriously, here’s why women are so frustrated by conversations with their GP about long Covid.

When we first went into lockdown in March last year, 36-year-old Hatty became really ill with coronavirus symptoms, including breathlessness, chest pain, swollen lymph nodes and night sweats. Because there wasn’t any official testing available at the start of the pandemic, she was never officially diagnosed with having Covid-19. 

“After that, I went through a series of symptoms, from losing a lot of my hair, my periods stopping, brain fog and fatigue,” she tells Stylist. “I’ve been suffering from long Covid but, because I didn’t get that initial diagnosis, my GP hasn’t been very helpful. Before getting coronavirus, I was hugely fit – going to the gym four to five times a week, but I was only just able to start exercising properly again after 15 months.”

Eden*, 29, also caught Covid in March, and again in January this year: “I’ve been having intermittent conversations with my GP over the last seven or eight months, whenever I’ve felt particularly unwell and worried. I’ve not been ‘diagnosed’ with long Covid, but the most prominent side effects from having it twice have remained consistent: ringing in my ears and an unreliable sense of smell. 

“Some of the other symptoms I’ve been experiencing – heart palpitations, chest pain, light-headedness, fevers and nausea – have been more temperamental during this time. The difficulty in articulating my concerns about having long Covid to my GP is definitely not helped by the potential that these symptoms are side effects of new medication or stress.”

It took Jess six months to find a doctor who believed she had long Covid symptoms: “The five doctors I spoke to before that told me I was experiencing anxiety,” she says. 

And NHS worker Rachael, who is waiting to have her first face-to-face GP appointment about her long Covid symptoms, is worried about crying in the consultation: “But is it not a normal reaction to cry when long Covid has left you completely debilitated and you want answers and support?” she asks. 

According to the NHS, many people who catch Covid-19 usually feel better in a few days or weeks, and most make a full recovery within 12 weeks. For some people, however, symptoms can last longer. This is called post-Covid-19 syndrome or long Covid. The Office for National Statistics has just announced that 6.2% of adults may have experienced long Covid since the start of the pandemic, which includes 3.6% who said they had and 2.6% who said they were unsure. People are advised to speak to their GP about any lingering symptoms to learn how to manage them and rule out any other conditions.

And yet, according to a number of women who Stylist spoke to, there is much hesitancy in reaching out to GPs about long Covid. Along with the knowledge that women’s medical issues are often not taken seriously by health professionals (it takes some women years to get an endometriosis diagnosis), there’s also the fact that long Covid wasn’t a known condition until last year after thousands of people started to self-diagnose. Then, there’s the issue that a lot of the symptoms mentioned are psychological as well as physical. In fact, ONS research shows that people who may have had long Covid are more likely to be depressed and anxious. Is this leading to a disconnect between GPs and patients in discussions around long Covid?

Long Covid: is there a disconnect between GPs and patients in long Covid discussions?

Charlie Palmer, MSK corporate clinical lead at Vita Health Group, says researchers and healthcare professionals are still working to understand the causes, treatment options, and potential recovery times of long Covid. But one recent study in China reviewed patients post-hospitalisation and found that most patients had at least one on-going symptom – particularly fatigue or muscle weakness, sleep difficulties, anxiety or depression – six months after the onset of symptoms.

“In some cases, due to the complexity of symptoms, the process of gaining a long Covid diagnosis may be frustrating and could affect mental wellbeing,” Palmer tells Stylist. “But individuals who feel unwell should definitely escalate their symptoms to their GP or healthcare professional, to seek appropriate medical help and potentially access the NHS Your Covid Recovery programme (an online resource developed for anyone to access).

For people who are struggling to articulate concerns about long Covid, she suggests: “Keep a diary of the symptoms you are experiencing and share this with your GP in your appointment. The symptoms of long Covid can fluctuate and if you see your GP on a low symptom day, this will help explain what you are experiencing, even if you are not feeling it at that moment.

“Describe the impact your symptoms are having on your everyday life. Does fatigue prevent you from walking to the shop? Do you find you have brain fog which prevents you from working? Also, have a think about any trade-offs you find yourself making. Are your symptoms causing you to pick between cooking dinner and having a shower, for example? Many of the symptoms of long Covid are invisible, and it can be difficult for people to recognise difficulty or discomfort in such cases.

“If you are concerned about potential bias in your appointment or feel anxious that you will not be taken seriously, don’t hesitate to explain this to your doctor. Know that your GP is there to support you and being upfront with your concerns will help you feel empowered. Your job is not to convince them to take you seriously.”

Beyond making sure your GP knows exactly what your symptoms are, there is also a growing conversation about how long Covid sufferers should approach the issue with their employer. According to a study by the Trades Union Congress, respondents described the poor treatment that they experienced at work because they had long Covid.  Workers were faced with disbelief and suspicion, with around one fifth (19%) having their employer question the impact of their symptoms and one in eight (13%) facing questions from their employer about whether they had long Covid at all.

Palmer advises: “Have an open discussion with your employer, not only to ensure the appropriate support is provided at work, but also as some companies may have access to mental and physical health services, as well as Covid recovery programmes through occupational health or private healthcare schemes.”

Clearly, there is still so much to learn about this disease, which no doubt feeds into the anxiety and frustration of long Covid sufferers. Right now, the main thing is to make sure you’re heard and you receive the right treatment and management tools to get through it.

The NHS has a whole website section dedicated to information on long Covid, and anyone can access the NHS Your Covid Recovery programme. 

Anyone who is worried about their mental health can contact Mind, Samaritans or The Help Hub.

And if you’re worried about working while suffering with long Covid, you can speak to someone at Citizens Advice.

Please always make an appointment with your GP about any symptoms mentioned above.

Images: Getty

*Name changed at contributor’s request

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COVID-19 hospitalization and mortality: Sex differences

covid patient

Males with COVID-19 had significantly higher rates of hospitalization and of transfer to the intensive care unit (ICU), according to a new study. A higher percentage of males died of COVID-19 than females, as reported in the study published in the peer-reviewed Journal of Women’s Health.

Joanne Michelle Gomez, MD, Rush University Medical Center, and coauthors studied the first 8,108 positive COVID-19 patients that presented to the Rush University System from March 1-June 21, 2020. Nineteen percent of males required hospitalization, compared to 13% of females. Eight percent of males compared to 4% of females required escalation of care to the ICU. The authors also reported significantly greater need for vasopressor support and endotracheal intubation among males.

“A significant independent association was observed between male sex and in-hospital mortality when accounting for the total cohort of positive COVID-19 patients,” state the authors. “The interplay among biological, hormonal, and gendered behavioral factors is likely responsible for the worse outcomes observed in males in COVID-19 infection.”

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Should we delay COVID-19 vaccination in children?

children

The net benefit of vaccinating children is unclear, and vulnerable people worldwide should be prioritized instead, say experts in The BMJ today.

But others argue that COVID-19 vaccines have been approved for some children and that children should not be disadvantaged because of policy choices that impede global vaccination.

Dominic Wilkinson, Ilora Finlay, and Andrew Pollard say for a health system to offer any vaccine to a child, two key ethical questions must be asked. First, do the benefits outweigh the risks? Second, if the vaccine is in short supply, does someone else need it more?

“Careful attention to both questions suggests that we should not yet roll out COVID-19 vaccination to otherwise healthy children.”

They acknowledge that in older adults, the benefits of COVID vaccines clearly outweigh the rare side effects. And in children with certain chronic or acute serious illnesses they probably do, and these children should therefore have access to a vaccine. “But in otherwise healthy children, no one can currently be sure.”

But they say one thing we can be sure of is that in the UK, some people are currently at much higher risk from COVID-19 than healthy children. And most lower income countries have fully vaccinated less than 5% of their community.

Some might ask, why do we have to choose? Can’t we vaccinate children as well as those overseas? But, to put it simply, there are right now a limited number of vaccine doses.

“As adults, we have had to wait our turn for the vaccine. We have understood that, given its scarcity, the vaccine has to be prioritized for people at the highest risk of dying.” This clear and inescapable ethic now applies to our children, they conclude. Their turn will come—but not yet.

But Lisa Forsberg and Anthony Skelton say that vaccinating children against COVID-19 protects them—and others—from the risk of harm and death from infection, and it is the best way to promote children’s wellbeing by minimizing need for restrictions or disruptions to their lives resulting from failure to properly manage infection spread.

They say the argument that children are less likely to be severely harmed by COVID-19 infection, and they therefore benefit less from a vaccination protecting them from it, is mistaken.

“It exposes children to unknown risks of severe disease and of long term health complications. Moreover, we now know that exposing children to those risks disproportionately harms already disadvantaged children.”

Another argument for delaying the vaccination of children is that priority should be given to older adults in developing countries where vaccine supply has been limited.

Yet they point out that currently global vaccine supply shortages result from policy choices.

“The ethically defensible choice is to exert whatever pressure we can to minimise vaccine hoarding and distribute vaccines to developing countries, while releasing patents and allowing the manufacture and supply of vaccines at a larger scale, to enable vaccination of adults and children everywhere,” they write.

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Prevalence of COVID-19 among hospitalized infants varies with levels of community transmission

COVID-19

How common COVID-19 is among infants may depend on the degree of the pandemic virus circulating in a community, a new study finds.

Published online June 30 in the journal Pediatrics, the study found specifically that rates of the infection with the virus that causes COVID-19 were higher among infants hospitalized, not for COVID-19—but instead because they were being evaluated for a potential serious bacterial infection (SBI) – during periods of high COVID-19 circulation in New York City. The study also found rates of COVID-19 positivity in this age group were lower when infection rates in the city were low.

Led by researchers from NYU Langone Health, the study also examined the clinical course of the infection in young infants and found that the most common presentation of COVID-19 was a fever without other symptoms.

“Enhancing our knowledge of how COVID-19 infection affects young infants is important for informing clinical practice, and for planning public health measures such as vaccination distribution,” says Vanessa N. Raabe, MD, assistant professor in NYU Langone’s Departments of Medicine and Pediatrics, in the Division of Pediatric Infectious Diseases, and one of the study’s principal investigators.

New York City was the early epicenter of COVID-19 in the United States, with more than 190,000 reported infections during the peak of the NYC epidemic between March and May in 2020. Three percent of the reported cases were in children under 18 years of age, although these numbers may underestimate the true incidence given the lack of adequate testing. Most children infected with the disease were asymptomatic or had mild symptoms. However, cases of severe illness have been reported and some reports suggest young infants may be at higher risk for severe disease than older children.

Young babies are often treated with antibiotics in the hospital when they run a fever until doctors can make sure they don’t have a serious bacterial infection, such as meningitis or a bloodstream infection, say the study authors.

“Because fever is a common symptom of COVID-19 in children, clinicians must consider COVID-19 as a potential cause of fever and not solely rely on laboratory or imaging results to guide decision-making on whether or not to test hospitalized infants for COVID-19,” says Dr. Raabe.

The current study analyzed data from infants less than 90 days of age admitted for SBI evaluation at NYU Langone Health hospitals and NYC Health + Hospitals/Bellevue Hospital between March and December 2020. Among 148 infants, 15 percent tested positive for COVID-19, and two of the 22 infants with COVID-19 required ICU admission, but were discharged safely. Specifically, the team found that only 3 percent of infants tested positive during periods of low community circulation, compared to 31 percent in communities with high infection rates.

The team also found a relatively low incidence (six percent) of infection of the hospitalized infants with other commonly occurring viruses, whether or not they had COVID-19. “This likely reflects community-wide decreases in other respiratory viruses reported in New York during the study period due to enhanced infection control practices, like social distancing and mask wearing, at the height of the pandemic,” says Raabe.

The researchers recommend clinicians continue to assess young infants that present with fevers for bacterial infections, regardless of the COVID-19 status, and given the potential severe consequences if not treated.

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Dual-Antibody Drugs Effective Against COVID-19 Variants in Animal Study

(Reuters) – COVID-19 therapies made from a cocktail of two types of antibodies were effective against a wide range of variants of the coronavirus in a mice and hamster study, researchers at the Washington University School of Medicine in St. Louis reported in the journal Nature on Monday.

Antibodies are used to treat cases of COVID-19, often early in the process. Former U.S. President Donald Trump was treated with an antibody cocktail by Regeneron Pharmaceuticals in October after he tested positive for COVID-19.

The latest study included three of the four variants that have been designated “variants of concern” by the World Health Organization, including Alpha, first identified in the UK, Beta, first found in South Africa, and Gamma found in Brazil, as well as a variant from India, B.1.617.1, in the same lineage as the Delta variant of concern.

The U.S. Food and Drug Administration in April revoked the emergency use authorization of Eli Lilly’s single antibody therapy, bamlanivimab, saying there was increased circulation of variants resistant to the therapy when used alone.

Other studies https://www.reuters.com/article/us-health-coronavirus-science-idUSKBN29W2P5 have previously shown that some antibody combination therapies remained potent against those emerging variants of the coronavirus that were resistant to single antibody therapies.

The latest study found that combinations of two antibodies often retained potency against variants even when one of the two antibodies lost some or all ability to neutralize the variant in lab studies.

The study, which was conducted in mice and hamsters, tested all single and combination antibody therapies authorized for emergency use by the FDA against emerging international and U.S. variants of the virus.

The researchers evaluated the FDA-authorized combination therapies made by Regeneron, Eli Lilly and a single antibody therapy, sotrovimab, by Vir Biotechnology Inc and GlaxoSmithKline Plc.

They also assessed the antibodies currently in clinical trials by AbbVie Inc, Vir and AstraZeneca.

“Resistance arose with some of the monotherapies, but never with combination therapy,” study co-author Jacco Boon noted in a statement.

SOURCE: https://go.nature.com/35K4XVU Nature, online June 21, 2021.

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Study links COVID-19 public health efforts to dramatic drop in COPD hospitalizations

covid

Researchers at the University of Maryland School of Medicine (UMSOM) analyzed data at the 13-hospital University of Maryland Medical System (UMMS) and found public health measures designed to reduce the spread of the COVID-19 virus may have fostered a substantial side benefit: Hospital admissions for chronic obstructive pulmonary disease (COPD) were reduced by 53 percent, according to a new study published in The American Journal of Medicine. This is likely due to a drop in circulating seasonal respiratory viruses such as influenza.

Hospitalizations for COPD, a group of lung diseases that make it hard to breathe and get worse over time, are commonly driven by flare-ups where symptoms are triggered by such factors as tobacco smoke, air pollution and respiratory infections. Seasonal respiratory viruses, including those that cause the common cold or influenza, trigger nearly half of those flare-ups.

In the wake of a marked drop in COPD admissions during the pandemic, the researchers theorized that COVID-19 behavior changes—a mix of stay-at-home orders, social distancing, masking mandates and strict limitations on large gatherings—not only protected against COVID-19, but they may have also reduced exposure to other respiratory infections.

Conversely, they worry that the return to normal behavior may lead to more COPD flare-ups.

“Our study shows there’s a silver lining to the behavior changes beyond protecting against COVID-19,” said senior author Robert M. Reed, MD, UMSOM Professor of Medicine and pulmonologist at the University of Maryland Medical Center (UMMC). “If we completely eliminate masks and distancing during cold and flu season, we’ll allow all those viruses that have been effectively suppressed to come raging back. There could be a lot of illness.”

Prior to the COVID-19 pandemic, COPD was the fourth-leading cause of death worldwide and a leading cause of hospital admissions in the United States. The pandemic has led to significant changes in health care delivery, including reduced admissions for COPD and other non-COVID illnesses, some of which may have stemmed from patients’ fear of contracting COVID in various hospital settings, as well as a shift toward telemedicine and outpatient COPD management during the pandemic.

To understand what may have occurred to reduce COPD admissions, the researchers compared weekly hospital admissions for COPD in the pre-COVID-19 years of 2018 and 2019, with admissions after the COVID-19 public health measures were instituted. At UMMS, those measures were implemented before April 1, 2020, so the investigators chose the same five-month period in each year for their comparison, April 1 to Sept. 30.

Co-lead author Jennifer Y. So, MD, UMSOM Assistant Professor of Medicine and COPD specialist at UMMC, said electronic medical records from multiple hospitals across a range of communities in the UMMS database facilitated a granular evaluation of changes over time. “We assessed a variety of possible causes that could affect COPD admissions including the presence of multiple diseases or medical conditions and the frequency of COPD exacerbations.”

The database findings were correlated with data on respiratory viral trends from the U.S. Centers for Disease Control and Prevention for the period of Jan. 1, 2018, through Oct. 1, 2020.

“We found a 53 percent drop in COPD admissions throughout UMMS during COVID-19. That is substantial, but equally significant, the drop in weekly COPD admissions was 36 percent lower than the declines seen in other serious medical conditions, including congestive heart failure, diabetes and heart attack,” said Dr. So.

As more and more people are vaccinated against COVID-19 and many of the public health measures of the past year are relaxed, the researchers warn that a full return to normal may again expose COPD patients to the familiar seasonal triggers.

“Our study did not assess which public health components worked to tame seasonal respiratory viruses, but a simple thing like wearing a mask while riding on public transit or working from home when you’re sick with a cold could go a long way to reduce virus exposure,” said Dr. Reed.

Dr. So, who is from South Korea, said it is a cultural norm to wear masks during the winter in her native country. “The COVID-19 pandemic has helped a lot of people around the world become more aware of the role of masking and social distancing to reduce the spread of disease,” she said.

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Delta COVID-19 variant 'probably going to become' dominant strain in US, Gottlieb says

Doctors urge COVID vaccinations as Delta variant spreads

Fox News medical contributor Dr. Marty Makary discusses the COVID-19 Delta variant and vaccine side-effects in adolescents

The former head of the FDA said that while the Delta variant currently accounts for about 10% of coronavirus infections in the U.S., it’s doubling at a rate of every two weeks meaning “it’s probably going to become the dominant strain.” 

However, Dr. Scott Gottlieb, who was appearing on CBS’s “Face the Nation,” said, that doesn’t necessarily mean there will be a sharp rise in infections over the coming weeks. 

“Right now in the U.S., it’s about 10% of infections doubling every two weeks, so it’s probably going to become the dominant strain here in the U.S.,” he said. “That doesn’t mean we’re going to see a sharp uptick in infections but it does mean that this is going to take over and I think the risk is really to the fall that this could spike a new epidemic heading into the fall.” 

One of the concerns, he noted, is that people who are infected with the Delta variant appear to carry higher viral loads for longer periods of time, meaning they shed more virus. He said early data indicates that it may be 60% more transmissible than the Alpha variant, which was the first strain to overtake the wild type in the U.S. 

The good news, Gottlieb said, is that the vaccines appear to work well against the Delta variant with the mRNA jabs showing about 88% effectiveness and the viral vector products showing 60% effectiveness. The risk is especially high in parts of the country where vaccination rates are lagging.

“We have the tools to control this and defeat it, we just need to use those tools,” he said. 

The Delta variant, which first emerged in India, is currently classified as a variant of interest by the Centers for Disease Control and Prevention (CDC), which unlike the World Health Organization (WHO) has yet to elevate its status to a variant of concern. The CDC lists the Alpha, Beta, Epsilon and Gamma as variants of concern, while the Eta, Iota, Kappa, Delta and Zeta remain variants of interest. 

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As COVID-19 cases wane, vaccine-lagging areas still see risk

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JACKSON, Miss. – New COVID-19 cases are declining across most of the country, even in some states with vaccine-hesitant populations. But almost all states bucking that trend have lower-than-average vaccination rates, and experts warn that relief from the pandemic could be fleeting in regions where few people get inoculated.

Case totals nationally have declined in a week from a seven-day average of nearly 21,000 on May 29 to 14,315 on Saturday, according to data from Johns Hopkins University. For weeks, states and cities have been dropping virus restrictions and mask mandates, even indoors.

Experts said some states are seeing increased immunity because there were high rates of natural spread of the disease, which has so far killed nearly 600,000 Americans.

“We certainly are getting some population benefit from our previous cases, but we paid for it,” said Mississippi State Health Officer Dr. Thomas Dobbs. “We paid for it with deaths.”

More than 7,300 Mississippians have died in the pandemic, and the state has the sixth-highest per capita death rate.

Dobbs estimated that about 60% of the state’s residents have “some underlying immunity.”

“So we’re now sort of seeing that effect, most likely, because we have a combination of natural and vaccine-induced immunity,” Dobbs said.

Just eight states — Alabama, Arkansas, Hawaii, Missouri, Nevada, Texas, Utah and Wyoming — have seen their seven-day rolling averages for infection rates rise from two weeks earlier, according to data compiled by Johns Hopkins University. All of them except Hawaii have recorded vaccination rates that are lower than the US average of 43% fully vaccinated, according to the U.S Centers for Disease Control and Prevention.

The 10 states with the fewest new cases per capita over that time frame all have fully vaccinated rates above the national average.

Medical experts said a host of factors is playing into the drop in case counts across the country, including vaccines, natural immunity from exposure to the virus, warmer weather and people spending less time indoors.

But Dr. Leana Wen, a public health professor at George Washington University, said she is concerned that the natural immunity of those who have been exposed to coronavirus may soon wane. And she’s worried that states with low vaccination rates could become hot spots.

“Just because we’re lucky in June doesn’t mean we’ll continue to be lucky come the late fall and winter,” said Wen, the former health commissioner for the city of Baltimore. “We could well have variants here that are more transmissible, more virulent and those who do not have immunity or have waning immunity could be susceptible once again.”

In Mississippi, about 835,000 people have been fully vaccinated, or 28% of the population. But despite the lagging vaccination rate, the state’s rolling average of daily new cases over the past two weeks has decreased by about 18%, according to Johns Hopkins.

May 3, 2021: Workers at a mostly empty COVID-19 vaccination clinic located at Cathedral of the Cross A.O.H. Church of God in Birmingham, Ala., are shown in file photo. 
(AP Photo/Jay Reeves, File)

Dr. Albert Ko, who chairs Department of Epidemiology of Microbial Diseases at Yale, said there is no accurate data to show what percentage of the population in “high burden” states such as Alabama or Texas have been exposed to the virus, but he said estimates have put it as high as 50%.

“I think it doesn’t deny the importance of vaccination, particularly because the levels of antibodies that you get that are induced by natural infection are lower than that of what we have for our best vaccine,” Ko said.

Ko said it is important that even those exposed to the disease get vaccinated because natural immunity does not last as long as vaccine immunity and the levels of antibodies are lower.

Wen said research strongly suggests that vaccinations provide a benefit to those who already have some antibodies due to infection.

“I think it is a fallacy that many people have that recovery means they no longer need to be vaccinated,” she said.

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Noninvasive Ventilation Tied to Higher Mortality Than CPAP in COVID-19 Pneumonia

NEW YORK (Reuters Health) – Compared with continuous positive airway pressure (CPAP), use of non-invasive ventilation (NIV) to treat acute respiratory failure secondary to COVID-19 pneumonia is tied to higher mortality, according to a new review.

However, as Dr. Davide Alberto Chiumello of the University of Milan, Italy, and colleagues point out, “due to the heterogeneity of data reporting and patients’ baseline characteristics, it was difficult to assess if treatment with NIV was dedicated to patients with more severe disease.”

The researchers examined data from 23 studies published between December 2019 and November 2020. These included 4,776 patients and contained data on in-hospital mortality in COVID-19 patients treated with NIV or CPAP.

Hospital stay on average ranged from 6.2 to 21 days, and 1956 patients (40.9%) died in hospital, the team reports in the Journal of Critical Care.

Complications were under-reported, say the researchers, but mostly were unrelated to CPAP/NIV treatment. The most common complications, described in five reports, included pulmonary embolisms, renal failure, cerebrovascular accident, heart failure, septic shock, as well as ventilator-associated pneumonia.

Forty-six percent of the patients (2,192) received non-invasive respiratory support. Of these, 48.4% received CPAP, 46% had NIV, and 4% had either CPAP or NIV. This support failed in 47.7% of patients, of whom 582 (26.5%) were intubated.

Among reasons for intubation were decreased level of consciousness, refractory hypoxemia, sepsis and hemodynamic instability.

Twenty-nine percent of patients treated with CPAP or NIV died while on non-invasive respiratory support, including 22.2% of CPAP recipients, 35.1% of NIV recipients and 49% of CPAP/NIV recipients.

Of the 582 patients who were intubated after CAP/NIV failure, 59.8% died on invasive mechanical ventilation.

“Both CPAP and NIV have been demonstrated to reduce work of breathing, increase oxygenation and reduce intubation rates in patients with acute hypoxic respiratory failure,” the researchers say. “However, the indication for starting a non-invasive respiratory support in COVID-related acute respiratory distress syndrome is still debated.”

They conclude that both approaches “appear equally and frequently applied in patients with COVID-19 pneumonia, but associated with high mortality. Robust evidence is urgently needed to confirm the clinical efficacy of non-invasive respiratory support in COVID-19-related ARDS.”

Dr. Chiumello did not respond to requests for comments.

SOURCE: https://bit.ly/3zcprEr Journal of Critical Care, online May 21, 2021.

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Heatstroke or COVID-19? Similar Symptoms Could Confuse at Olympics

TOKYO (Reuters) – Emergency medicine experts warn first responders at the Tokyo Olympics could easily confuse heatstroke and coronavirus patients because the illnesses bear similar symptoms.

While Games organisers have moved the marathon and race-walk events to the cooler northern city of Sapporo, most events are taking place in Tokyo between July 23 and Aug. 8, the peak of the city’s hot and humid summer.

“Medical resources in the hot summer are so limited, even in the normal summer without the Olympic Games,” said Shoji Yokobori, chair of the Nippon Medical School Hospital’s department of emergency and critical care medicine in Tokyo.

Shinji Nakahara, a public health expert at Kanagawa University of Human Services, said medical teams could mistake a COVID-19 patient for somebody suffering from heatstroke as both illnesses have symptoms of high temperature, dehydration and fatigue.

“It can cause a messy situation in medical care stations at each venue,” said Nakahara.

Tokyo’s emergency health system has already had a taste of the combination of heatstroke and COVID-19. So-called difficult-to-transfer cases – where a patient being transported by ambulance is turned down by multiple hospitals – more than doubled last summer from a year earlier.

Toshiro Muto, CEO of the Tokyo 2020 Organising Committee, has said officials are working on plans to deal with heatstroke, considered a major health concern alongside COVID-19.

In a study of heatstroke management during the pandemic, Yokobori found that around four people diagnosed with severe heatstroke among 1,000 cases later tested positive for COVID-19.

While the ratio was nominal, the result was a “shock”, Yokobori said, due to risks over hospital-acquired infections.

Compounding the problem, wearing masks, a key prevention measure against the coronavirus, can raise body temperatures in the heat of the summer.

That puts not only spectators but emergency responders at risk, Yokobori said, calling for organisers to bar spectators from the Games.

Tokyo 2020 have already blocked spectators from overseas but are yet to announce whether locals will be able to attend.

“When we take care of heatstroke patients, we also have to protect ourselves with heavy protective gear, because we cannot separate COVID-19 with heatstroke,” Yokobori said. “That makes us so stressed.”

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