1 in 3 COVID survivors develop neurologic, psychological conditions
One in three COVID-19 survivors were diagnosed as having a neurologic or psychological condition within 6 months after their coronavirus diagnosis, according to a study yesterday in The Lancet Psychiatry. The researchers noted that disease severity was linked to higher risk.
Among 236,379 US COVID-19 patients, the researchers found that 33.6% of survivors developed a neurologic or psychological condition within 6 months after testing positive for coronavirus and that for 12.8%, it was their first such condition.
The most common psychiatric conditions were anxiety (17.4%) and mood disorders (13.7%), while neurologic conditions included ischemic stroke (2.1%), and dementia (0.7%). No significant association was found between COVID-19 and increased risk of parkinsonism or Guillain-Barre syndrome.
Severe COVID-19 was also associated with a higher prevalence of neurologic or psychological disorders. For instance, 38.7% of those who were hospitalized had a neurologic or psychological diagnosis, compared with 46.4% admitted to the intensive care unit (ICU) and 62.3% who had delirium at some point during their infection.
Similarly, less common conditions also occurred more often, with intracranial hemorrhage in 2.7% of ICU patients and 3.6% of patients with delirium (compared with 0.3% of nonhospitalized patients) and development of a psychotic disorder in 2.8% in ICU patients and 7.0% in patients with delirium (compared with 0.9% of nonhospitalized patients).
“Although almost all neurological and psychiatric outcomes were more frequent in patients with more severe COVID-19 than in those with mild disease, these psychiatric disorders might be more driven by general effects, including psychosocial aspects of infection, rather than a direct effect of COVID-19 on the brain,” notes a commentary by Jonathan P. Rogers, MRCPsych, and Anthony S. David, MD, of University College London.
Compared with a matched cohort of people who had the flu or any respiratory infection, those who had COVID-19 were associated with a 44% and 16% increased risk, respectively (95% confidence interval, 1.40 to 1.47 and 1.14 to 1.17).
Overall, 80.4% of the cohort was not hospitalized, 19.6% was, 3.8% needed ICU treatment, and 2.6% developed encephalopathy. Patients were included if they were older than 10 years, infected with COVID-19 after Jan 20, 2020, and still alive on Dec 13, 2020.
Apr 6 Lancet Psychiatry study and commentary
Moderna COVID-19 vaccine antibodies persist for at least 6 months
Moderna’s COVID vaccine (mRNA-1273) showed coronavirus antibody persistence 6 months after administration of the second 100-microgram dose, according to a letter to the editor in the New England Journal of Medicine yesterday.
Among 33 healthy adults who received the Moderna vaccine, antibody activity “remained high,” ranging from 49,373 geometric mean end-point titers (GMTs) in those 71 years and older to 92,451 in those aged 18 to 55. Nearly all had detectable activity in pseudovirus neutralization assay tests, and in a more sensitive live-virus neutralization test, 50% inhibitory dilution GMTs were 406, 171, and 131 across age-groups 18 to 55, 56 to 70, and 71 and older, respectively.
The researchers estimated half-life for binding and neutralizing antibodies with models that assumed either a steady rate of decay or an exponential rate. For binding antibodies, the half-life 43 days after vaccination was 52 assuming steady decay or 109 days assuming an exponential rate, respectively. For neutralizing antibodies, the half-life for pseudovirus neutralization was 69 or 173 days, respectively, and, for live-virus neutralization, 68 or 202 days.
These results are in line with results from convalescent COVID-19 patients through 8 months after symptom onset, the authors note.
“Although the antibody titers and assays that best correlate with vaccine efficacy are not currently known,” they continue, “antibodies that were elicited by mRNA-1273 persisted through 6 months after the second dose, as detected by three distinct serologic assays.”
Apr 6 N Eng J Med letter
Final leafy greens E coli probe finds recurring issues related to cattle
The Food and Drug Administration (FDA) yesterday released its final investigation report into a 2020 Escherichia coli O157:H7 outbreak linked to leafy greens, which said cattle in the area was probably a contributing factor and persistent source of the pathogen.
The source of the outbreak was never linked to a specific farm or type of greens, and the Centers for Disease Control and Prevention (CDC) on Dec 22 concluded its probe, with 40 cases reported in 19 states. Half of the patients were hospitalized, but no deaths were reported.
In a statement, Frank Yiannas, MPH, the FDA’s deputy commissioner for food policy and response, said the investigation sheds light on understanding E coli outbreaks tied to California’s Central Coast growing region, especially those in the Salinas Valley and Santa Maria areas since 2017. He noted the preliminary findings released in January described the detection of the outbreak strain in a sample of cattle feces collected from a roadside about a mile uphill from a produce farm.
“This finding drew our attention once again to the role that cattle grazing on agricultural lands near leafy greens fields could have on increasing the risk of produce contamination, where contamination could be spread by water, wind or other means,” he said.
An examination of outbreaks that seem to occur each fall since 2017 found three key recurring trends: the same E coli strain, the same region, and issues with activities on adjacent lands.
The FDA recommends that growers in the Central Coast consider the recurring E coli strain a reasonably foreseeable hazard, especially in the South Monterey County portion of the Salinas Valley. The agency also urged growers to identify where the recurring strain persists and how it’s likely contaminating leafy greens.
Apr 6 FDA statement
Apr 6 FDA final inspection report
Dec 23, 2020, CIDRAP News scan