Justin Rosenheck DO 102320 Global Cases https coronavirusjhuedumaphtml accessed 102220 Short Term Recovery General Symptoms Tenforde Kim et al 2020 1421 days post dx ID: 931564
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Slide1
COVID-19: Recovery and Outcomes
Justin Rosenheck, DO
10/23/20
Slide2Global Cases
https://
coronavirus.jhu.edu/map.html
; accessed 10/22/20
Slide3Short Term Recovery – General Symptoms
|
Tenforde
, Kim, et al., 2020
*14-21 days post dx
Slide4Short Term Recovery – Pulmonary
1 month follow up – 51 patients with “common COVID”
Persistent lung lesions in 35.3%
|
Liu, Ye, et al., 2020
Slide5Short Term Recovery – Pulmonary
1 month follow up, 57 pts
Persistent lung lesions in 54.3%: 94% of severe cases, 37.5% of non-severe
Abnormal PFTs in 75%
6MWD shorter in severe patients (517m v. 573.5m)Sx: 10.5% cough, 7% SOB
|
Huang, Tan, et al., 2020
Slide6Short Term Recovery – Pulmonary
3
month follow up, 55 patients
47 moderate, 4 mild, 4 severe
Residual CT findings in 71%Abnormal PFTs in 25.5%GI sx in 31%, HA 18%, Fatigue 16%, Dyspnea 14.5%
|
Zhao, Shang, et al., 2020
Slide7Short Term Recovery – Cardiac
CMR in Competitive Athletes
26 athletes with no or mild symptoms, Median 23 days post dx
No hospitalizations, no specific therapy
All with normal ECGsCMR findings4 with active myocarditis8 with evidence of prior myocardial injury
|
Rajpal
, Tong, et al., 2020
Late Gadolinium Enhancement
Slide8Short Term Recovery – Cardiac
CMR in Patients Recovered from COVID
Prospective, observational cohort (n=100)
Median 71 days post dx
33 req’d hospitalization78 pts: evidence of cardiac involvement60 pts: ongoing myocardial inflammationSymptoms: 36 pts:ongoing fatigue and dyspnea17 pts: atypical chest pain20 pts: palpitations
|
Puntmann
,
Carerj
, et al., 2020
Slide9Short Term Outcomes – Renal
9657 patients – 13 metro NY hospitals
AKI incidence 38.4/1000 patient days
684 patients required renal replacement
tx33 pts req’d HD on dcNo outpatient follow up
|
Ng, Hirsch, et al., 2020
Slide10Long Term Recovery
|
Slide11SARS - MERS - COVID-19
|
SARS-CoV-1:
11/2003
07/2004
8098 confirmed cases. 774 deaths, 9.6% case fatality
MERS:
09/2012
2562 confirmed cases. 881 deaths, 34.4% case fatality
SARS-CoV-2:
12/2019
>41 million cases. 1.12 million deaths, 2.8% fatality
Slide12Long Term Sx
and HR-QOL
Ahmed
, Patel, et al.,
2020Carfi, Bernabei, et al., 2020
Slide13Long Term Recovery - Pulmonary
Lessons from SARS-1:
At 7 years, 11 SARS survivors
Impaired DLCO in 24%
Dyspnea (5), Cough (4), Sputum (2)At 15 years, 71 SARS survivorsImpaired DLCO in 35%Abnormal CT in 38%Femoral head osteonecrosis in 21%
|
Wu, Dong, et al., 2016
Zhang, Li, et al., 2019
Slide14Long Term Recovery - Pulmonary
MERS, SARS: Meta-Analysis 28 studies
At 6 months, decreased 6MWD
At 12 months, 24% with impaired DLCO
Impaired HRQOL at 6 months and beyond Anxiety, Depression, PTSD commonH7N9: 56 survivorsAt 12 months: 14.6% with normal CTsAt 24 months: Persistent impaired DLCOARDS patients: consistently lower PFTs
|
Chen, Wu,
et al., 2017
Ahmed, Patel, et al., 2020
Slide15Long Term Recovery – Cardiac
SARS-1:
At 12 years post recovery, 8 of 25 patients with persistent cardiovascular abnormalities
Viral Myocarditis:
502 bx proven patients: 6.6% rate of aborted or actual SCDArrhythmia burden similar between active or previous myocarditis1142 patients with prior myocarditis: 6-8% with HF hospitalization over 14 years of observation
|
Yancy
,
Fonarow
(2020)
Mitrani
,
Dabas
, et al. (2020)
Slide16Long Term Recovery – Hepatic, Renal
Hepatic
No long term follow up data from SARS-1 or MERS
Renal
No long term follow up data from SARS-1 or MERSNCT04353583: Enrolling to evaluate 3 month COVID outcomes
|
Leung,
et al., 2020
Slide17Assessing Long Term Outcomes
Dozens of planned long term follow up registries and studies
|
Ross, Seiler,
et al., 2020
Slide18wexnermedical.osu.edu