Survey finds large increase in psychological distress reported among US adults during the COVID-19 pandemic

June 3, 2020

Science Daily/Johns Hopkins University Bloomberg School of Public Health

A new survey conducted by researchers at the Johns Hopkins Bloomberg School of Public Health during the COVID-19 pandemic found a more-than-threefold increase in the percentage of U.S. adults who reported symptoms of psychological distress -- from 3.9 percent in 2018 to 13.6 percent in April 2020. The percentage of adults ages 18-29 in the U.S. who reported psychological distress increased from 3.7 percent in 2018 to 24 percent in 2020.

The survey, fielded online April 7 to April 13, found that 19.3 percent of adults with annual household incomes less than $35,000 reported psychological distress in 2020 compared to 7.9 percent in 2018, an increase of 11.4 percentage points. Nearly one-fifth, or 18.3 percent, of Hispanic adults reported psychological distress in 2020 compared to 4.4 percent in 2018, a more than four-fold increase of 13.9 percentage points. The researchers also found that psychological distress in adults age 55 and older almost doubled from 3.8 percent in 2018 to 7.3 percent in 2020.

The survey found only a slight increase in feelings of loneliness, from 11 percent in 2018 to 13.8 percent in 2020, suggesting that loneliness is not driving increased psychological distress.

The findings were published online June 3 in a research letter in JAMA.

The disruptions of the COVID-19 pandemic -- social distancing, fear of contracting the disease, economic uncertainty, including high unemployment -- have negatively affected mental health. The pandemic has also disrupted access to mental health services.

"We need to prepare for higher rates of mental illness among U.S .adults post-COVID," says McGinty. "It is especially important to identify mental illness treatment needs and connect people to services, with a focus on groups with high psychological distress including young adults, adults in low-income households, and Hispanics."

The survey used a scale to assess feelings of emotional suffering and symptoms of anxiety and depression in the past 30 days. The survey questions included in this analysis did not ask specifically about COVID-19. The scale, a validated measure of psychological distress, has been shown to accurately predict clinical diagnoses of serious mental illness.

Using NORC AmeriSpeak, a nationally representative online survey panel, the researchers analyzed survey responses of 1,468 adults ages 18 and older. They compared the measure of psychological distress in this survey sample from April 2020 to an identical measure from the 2018 National Health Interview Survey.

"The study suggests that the distress experienced during COVID-19 may transfer to longer-term psychiatric disorders requiring clinical care," says McGinty. "Health care providers, educators, social workers, and other front-line providers can help promote mental wellness and support."

https://www.sciencedaily.com/releases/2020/06/200603132550.htm

How Americans are coping with COVID-19 stress

June 1, 2020

Science Daily/University of Connecticut

Almost overnight, the rapid emergence of the COVID-19 pandemic in the United States and subsequent state and federal prevention measures dramatically altered daily behavior. A new study provides the first snapshot of the immediate impact of COVID-19 on Americans' stress levels, coping strategies, and adherence to public health guidelin

Several months into the pandemic, most Americans are familiar with the physical toll COVID-19 takes on those who contract it. But what about the mental and emotional implications of stress caused by the pandemic itself?

A new study by researchers from the University of Connecticut provides the first snapshot of the immediate impact of COVID-19 on Americans' stress levels, coping strategies, and adherence to public health guidelines.

For the study, which was published in the Journal of General Internal Medicine, the team surveyed over 1,000 English-speaking individuals, 18 years of age or older, living in the United States. Responses were collected in early April 2020, giving the researchers a unique view of how Americans are handling their new reality.

"Almost overnight, the rapid emergence of the COVID-19 pandemic in the United States and subsequent state and federal prevention measures dramatically altered daily behavior," says Crystal Park, professor of in the Department of Psychological Sciences. "This unique, early study and our planned future work will let us see how Americans navigate all of these changes, and how their response to this stress evolves over time."

In the study, the UConn researchers present baseline data on COVID-19-related stressors in three categories: stress related to the virus itself, stress related to changes in daily routines caused by the pandemic, and financial or resource-related stress. These measures allowed them to examine the circumstance-specific stressors of COVID-19 rather than global stress that could have other causes.

Based on previous work during SARS outbreaks and the early months of the COVID-19 pandemic, the researchers created an assessment of 23 COVID-19 stressors and their degree of stressfulness. The survey showed that Americans have high stress exposure from COVID-19, and that some demographic groups appear particularly vulnerable to stress effects. Reading or hearing about the severity and contagiousness of COVID-19 was the most common stressor, with almost 97% of survey respondents experiencing it. Uncertainty about the duration of social distancing requirements and changes to social and daily personal care routines also ranked high on the list of stressors with between 80% and 88% of those surveyed experiencing them.

While fears related to the virus itself were the most common, the survey showed that respondents were more acutely concerned about the financial consequences caused by the pandemic. Of the stressors experienced, respondents ranked loss of job security or income as the most stressful, followed by risk of a loved one's illness.

The researchers also looked at the methods Americans reported using to cope with these stressors. Distraction, seeking emotional social support, and active coping were the most commonly reported strategies. Younger participants, sexual minorities, and those with greater financial instability generally reported greater use of less helpful strategies, including substance use, behavioral disengagement, and humor.

Because of the unprecedented nature of the COVID-19 pandemic, the researchers say it's hard to determine which strategies will be healthy for managing stress over the weeks and months ahead.

"Distraction or avoidance is usually considered to be an unproductive coping strategy for most challenging situations and can lead to negative outcomes," says Beth Russell, associate professor of Human Development and Family Sciences and director of the Center for Applied Research in Human Development (CARHD). "But in this instance where people don't have much control over making the disease itself better, we can do small things to help ourselves and others -- seek connections through telemediated emotional support, for example -- and find ways to let the time pass. We'll see in the long run how those strategies help people's mental health."

The survey also showed very high rates of compliance with social distancing and federal Centers for Disease Control and Prevention (CDC) guidelines. Approximately 95% of respondents avoided eating out at bars or restaurants and visiting nursing homes, although these behaviors are likely impacted by policies enacted at the state and municipal levels. Almost 90% of respondents had stopped discretionary travel and were keeping the recommended six-feet distance from others. Approximately 75% of respondents reported adhering to CDC guidelines related to hygiene, like avoiding touching their faces and regularly cleaning and disinfecting surfaces. Some of the reported behaviors showed a potentially worrisome lack of adherence to critical CDC guidelines though, particularly for men and younger adults.

The role demographics play in stress, coping, and adherence to guidelines will be the focus of future studies by the team. Those results will be important for clinicians and policymakers as they develop the most effective health interventions to stem the anticipated long-term mental health impacts, they say.

"As we focus on developing treatments and vaccines, it is critical that we also understand the social aspects of this virus," says Michael Fendrich, associate dean for research in UConn's School of Social Work and co-author of the paper. "Understanding how Americans experience and respond to COVID-19 stressors and how this varies by socio-demographic characteristics can help to more effectively target prevention measures across various groups."

The team is continuing to monitor Americans' response to stress from the COVID-19 pandemic in future longitudinal waves of this study, which they hope will inform effective health behavior interventions to stop its spread.

https://www.sciencedaily.com/releases/2020/06/200601134607.htm

Older men worry less than others about COVID-19

May 29, 2020

Science Daily/Georgia State University

Older men may be at greater risk of contracting COVID-19 because they worry less about catching or dying from it than women their age or than younger people of both sexes, according to a new study by Sarah Barber, a gerontology and psychology researcher at Georgia State University.

This is a concern because older men are already more at risk of severe or fatal COVID-19 infections. Data from the CDC show the fatality rate of COVID-19 steadily rises with age, and that men are more at risk than women.

To test levels of worry and protective behaviors, Barber teamed with Hyunji Kim, a Georgia State doctoral student in psychology, and administered an online questionnaire assessing COVID-19 perceptions and behavior changes. The results were published by the Journals of Gerontology.

It is well established that worry is a key motivator of behavioral health changes, said Barber, including motivating people to engage in preventive health care activities such as healthy eating, exercise and timely screenings. In general, worry begins to ease with age, and is also lower among men than women.

"Not only do older adults exhibit less negative emotions in their daily lives," she said, "they also exhibit less worry and fewer PTSD symptoms following natural disasters and terrorist attacks."

She said that this may be because older adults have better coping strategies, perhaps gained through experience, and thus are able to regulate their emotional responses better.

Knowing that older adults tend to worry less, Barber conducted a study to see how this affected responses to the global pandemic.

"In normal circumstances," said Barber, "not worrying as much is a good thing. Everyday life is probably happier if we worry less. However, where COVID-19 is concerned, we expected that lower amounts of worry would translate into fewer protective COVID-19 behavior changes."

COVID-19 was declared a pandemic on March 11, and the questionnaire took place from March 23-31. Widespread behavioral changes were taking place, including the beginning of sheltering at home and social distancing.

All participants lived in the United States, and were primarily Caucasian with at least some college education. Participants were either aged 18-35 or aged 65-81, with 146 younger adults and 156 older adults studied.

The questionnaire assessed the perceived severity of COVID-19, such as whether respondents thought people were over-reacting to the threat of COVID-19 and whether it was similar in risk to flu. It also assessed worries about COVID-19, including how worried participants were about catching the virus themselves, dying as a result of it, a family member catching it, lifestyle disruptions, hospitals being overwhelmed, an economic recession, personal or family income declining and stores running out of food or medicine.

The questionnaire assessed behavioral changes that can reduce infection risk, from washing hands more often, to wearing a mask, avoiding socializing, avoiding public places, observing a complete quarantine or taking more care with a balanced diet and purchasing extra food or medications.

Not surprisingly, said Barber, most participants were at least moderately concerned about COVID-19, and only one individual, an older male, had "absolutely no worry at all." Also as expected, worry translated to protective behavior: more than 80 percent of participants reported washing their hands more frequently, taking more care about cleanliness, no longer shaking hands and avoiding public places. More than 60 percent of participants also reported no longer socializing with others. The participants who were most worried about COVID-19 were also the most likely to have implemented these behavior changes.

The catch was older men: compared to all other participants, older men were less worried about COVID-19, and had adopted the fewest number of behavior changes. They were relatively less likely to have worn a mask, to report having stopped touching their faces or to have purchased extra food.

Barber does not think the answer is to try to incite worry in older men. She thinks a better answer is to help them understand their risk accurately.

"Our study showed that for older men, accurate perception of risk worked as well as worry to predict preventive behaviors," she said.

If older men can be better educated about the virus, they may adopt protective behaviors even if they don't feel worried. She also notes that the survey took place "right after the pandemic was declared, and we all hope that a more accurate perception of risk has evolved over the last two months."

Either way, said Barber, older men may need a little extra coaching and attention to risk assessment and protective behaviors, both from concerned family members as well as their healthcare practitioners.

https://www.sciencedaily.com/releases/2020/05/200529150712.htm

Clues to COVID-19 in the brain uncovered

Researchers review neuroimaging for patients and show altered mental state and stroke dominate

May 27, 2020

Science Daily/University of Cincinnati

A study by University of Cincinnati researchers and four Italian institutions reviewing neuroimaging and neurological symptoms in patients with COVID-19 may shed light on the virus's impact on the central nervous system.

The findings, published in the journal Radiology, reveal that altered mental status and stroke are the most common neurological symptoms in COVID-19 patients, which authors say could help physicians notice "red flags" earlier.

"Studies have described the spectrum of chest imaging features of COVID-19, but only a few case reports have described COVID-19 associated neuroimaging findings," says lead author Abdelkader Mahammedi, MD, assistant professor of radiology at UC and a UC Health neuroradiologist. "To date, this is the largest and first study in literature that characterizes the neurological symptoms and neuroimaging features in COVID-19 patients. These newly discovered patterns could help doctors better and sooner recognize associations with COVID-19 and possibly provide earlier interventions."

Researchers in this study investigated neurological symptoms and imaging findings in patients from three major institutions in Italy: University of Brescia, Brescia; University of Eastern Piedmont, Novara; and University of Sassari, Sassari. Italy was the second epicenter of the spread of COVID-19, resulting in over 30,000 deaths.

The study included images from 725 hospitalized patients with confirmed COVID-19 infection between Feb. 29 and April 4. Of these, 108 (15%) had serious neurological symptoms and underwent brain or spine imaging. Most patients (99%) had brain CT scans, while 16% had head and neck CT imaging and 18% had brain MRI.

Investigators found that 59% of patients reported an altered mental state and 31% experienced stroke, which were the most common neurological symptoms. Patients also experienced headache (12%), seizure (9%) and dizziness (4%), among other symptoms.

"Of these 108 patients, 31, or 29%, had no known past medical history. Of these, aged 16 to 62 years, 10 experienced stroke and two had brain bleeds," Mahammedi says. "Seventy-one, or 66%, of these patients had no findings on a brain CT, out of which 7 of them (35%) brain MRI showed abnormalities."

He adds that altered mental status was more common in older adults.

While results show that the neuroimaging features of patients with COVID-19 vary, and an altered mental status and stroke are the most prevalent in patients, Mahammedi says this study reveals that there are other conditions to be on the lookout for.

"This topic definitely needs more research," he says. "Currently, we have a poor understanding of the neurological symptoms in COVID-19 patients, whether these are arising from critical illness or from direct central nervous system invasion of SARS-CoV-2. We hope further study on this subject will help in uncovering clues and providing better interventions for patients."

https://www.sciencedaily.com/releases/2020/05/200527105049.htm

Dementia gene raises risk of severe COVID-19

May 26, 2020

Science Daily/University of Exeter

Having a faulty gene linked to dementia doubles the risk of developing severe COVID-19, according to a large-scale study.

Researchers at the University of Exeter Medical School and the University of Connecticut School of Medicine analysed data from the UK Biobank, and found high risk of severe COVID-19 infection among European ancestry participants who carry two faulty copies of the APOE gene (termed e4e4). One in 36 people of European ancestry have two faulty copies of this gene, and this is known to increase risks of Alzheimer's disease up to 14-fold and also increases risks of heart disease.

Now, the research team has found that carrying these gene mutations doubles the risks of COVID-19 -- even in people who had not developed these diseases.

The team has previously found that people with dementia are three times more likely to get severe COVID-19, yet they are not one of the groups advertised to shield -- or shelter in place -- on health grounds. Part of the increased risk effect may have been exposure to the high prevalence of the virus in care homes. However, the new study, published in the Journal of Gerontology: Medical Sciences, indicates that a genetic component may also be at play. The team found that people with the APOE e4e4 genotype were at double the risk of developing severe COVID-19, compared to those with the common e3e3 form of the APOE gene. The team used data from the UK Biobank study, which collects health and genetic data on 500,000 people.

The majority of people in the population and in the sample size have not yet been exposed to the virus. In this analysis, 2.36% (n=9,022) of participants with European ancestries (n=382,188) had the ApoE e4e4 faulty gene, but 5.13% (n=37) of those who tested positive for COVID-19 (n=721) had this gene variant, suggesting the risk is doubled compared to e3e3 (410 per 100,000 versus 179 per 100,000).

Co-author Dr. Chia-Ling Kuo, of the UConn School of Medicine, said: "This is an exciting result because we might now be able to pinpoint how this faulty gene causes vulnerability to COVID-19. This could lead to new ideas for treatments. It's also important because it shows again that increasing disease risks that appear inevitable with ageing might actually be due to specific biological differences, which could help us understand why some people stay active to age 100 and beyond, while others become disabled and die in their sixties."

Professor David Melzer, who led the team, said: "Several studies have now shown that people with dementia are at high risk of developing severe COVID-19. This study suggests that this high risk may not simply be due to the effects of dementia, advancing age or frailty, or exposure to the virus in care homes."

Melzer stresses: "The effect could be partly due to this underlying genetic change, which puts them at risk for both COVID-19 and dementia."

https://www.sciencedaily.com/releases/2020/05/200526091412.htm

Child's play 'lost' in pandemic fear

Safe interactions are important to wellbeing: Experts

May 22, 2020

Science Daily/Flinders University

Social and community disruptions caused by the COVID-19 restrictions could have a lasting effect on child wellbeing, Flinders University researchers warn.

While health, safety and education responses are the focus of restrictions, the needs of childhood independence, self-determination and play are less acknowledged, Flinders University experts explain in a new publication.

"Play is a key aspect of children's wellbeing from their perspectives," says lead author Jennifer Fane. "The closure of playgrounds, schools and the fear and worry associated with being in public spaces has likely had significant impacts on children during this time.

"As children return to school, and life starts to resume as it did pre-COVID-19, focus and attention to children's opportunities for play -- and their ability to exercise reasonable 'agency' during this time of significant transition -- are two key aspects that can support their wellbeing during this difficult time."

While everyone's freedoms have been impacted by COVID-19 pandemic, children's agency, or ability to make choices and decisions within adult-imposed constraints, has never been more apparent.

"Young children interviewed in the study told us of the importance to their lives of trying new things and having a say about play," says Flinders Professor of Public Health Colin MacDougall, a co-author on the Child Indicators Research paper.

"As the world takes baby steps to ease these life-saving restrictions, and move into an uncertain future, we must take the time to think about very young children.

"This research can be used to help chart a course for the multiple transitions these children are undergoing."

Ms Fane, whose PhD at Flinders focused on communicating with preschoolers, says these perspectives can support child wellbeing in future, including as government restrictions on people's boundaries affects where children play and how much they can have a say.

https://www.sciencedaily.com/releases/2020/05/200512134437.htm

High stress related to coronavirus is the new normal for many parents, says new APA survey

Online learning, basic needs, missing milestones contribute to parental stress

May 21, 2020

Science Daily/American Psychological Association

Nearly half of parents of children under age 18 say their stress levels related to the coronavirus pandemic are high, with managing their kids' online learning a significant source of stress for many, according to a new survey by the American Psychological Association.

As the global pandemic continues and parents juggle child care, work and schooling demands, the mental health toll on parents is growing, warns APA. At the same time, the proportion of Americans saying that the economy or work is a significant source of stress in their life has risen significantly.

"For many parents, it can feel overwhelming to face competing demands at home and work along with possible financial challenges during this unprecedented crisis," said Arthur C. Evans Jr., PhD, APA's chief executive officer. "Children are keen observers and often notice and react to stress or anxiety in their parents, caregivers, peers and community. Parents should prioritize their self-care and try their best to model healthy ways of coping with stress and anxiety."

Stress in America 2020 Stress in the Time of Coronavirus, Volume 1, was conducted by The Harris Poll from April 24 to May 4, 2020, and surveyed online 3,013 adults age 18+ who reside in the United States. This is the first of at least three monthly surveys APA and The Harris Poll plan to gauge the impact of the pandemic on stress.

The survey found that 46% of parents say their average stress level related to the coronavirus pandemic is high (between 8 and 10 on a 10-point scale where 1 means "little or no stress" and 10 means "a great deal of stress"). Only 28% of adults who don't have children under the age of 18 report similar levels of stress.

With schools closed and many parents working from home while coordinating their children's schedules, 71% of parents say managing distance/online learning for their children is a significant source of stress.

Parents are more likely than those without children to say basic needs -- such as access to food and housing -- are a significant source of stress (70% compared with 44%). Other significant stressors for parents include access to health care services (66% vs. 44%) and missing major milestones, such as weddings and graduation ceremonies (63% vs. 43%).

As unemployment numbers have reached record highs, the economy and work have increased as stressors for Americans. The current survey found that the economy is a significant source of stress for 70% of adults, compared with 46% in APA's 2019 Stress in America poll. Current stress levels are similar to the levels seen in the 2008 Stress in America poll during the Great Recession. Similarly, 7 in 10 employed adults say work is a significant source of stress in their lives, compared with 64% in the 2019 survey.

Pandemic-related stress is having a disproportionate impact on communities of color. People of color are more likely than white adults to report significant stressors in their life as a result of the coronavirus pandemic, namely getting coronavirus (71% vs. 59%, respectively), basic needs (61% vs. 47%), and access to health care services (59% vs. 46%). Slightly more than 2 in 5 Hispanic adults (41%) say their average level of stress related to the coronavirus pandemic during the past month was between 8 and 10. Hispanic adults are also most likely to say they constantly or often feel stress as a result of the pandemic (37%), as compared with white (32%), black (32%), Native American (31%), and Asian (28%) adults.

"The mental health ramifications of the coronavirus pandemic are immense and growing," Evans warned. "We need to prepare for the long-term implications of the collective trauma facing the population. On an individual level, this means looking out for one another, staying connected, keeping active and seeking help when necessary."

To read Stress in America 2020 Stress in the Time of Coronavirus, Volume 1 in full or to download graphics, visit the Stress in America Press Room webpage (https://www.apa.org/news/press/releases/stress). APA also offers resources for the public on mental health during the time of COVID-19 (https://www.apa.org/topics/covid-19), including resources specially for parents and on racial equity and health disparities.

https://www.sciencedaily.com/releases/2020/05/200521151919.htm

Stroke rates among COVID-19 patients are low, but cases are more severe

Overall stroke hospital admissions are down globally

May 21, 2020

Science Daily/American Heart Association

The rate of strokes in COVID-19 patients appears relatively low, but a higher proportion of those strokes are presenting in younger people and are often more severe compared to strokes in people who do not have the novel coronavirus, while globally rates for stroke hospitalizations and treatments are significantly lower than for the first part of 2019, according to four separate research papers published this week in Stroke, a journal of the American Stroke Association, a division of the American Heart Association.

In "SARS2-CoV-2 and Stroke in a New York Healthcare System," researchers reported key demographic and clinical characteristics of patients who developed ischemic stroke associated with the COVID-19 infection and received care within one hospital system serving all 5 boroughs of New York City.

During the study period of March 15 through April 19, 2020, out of 3,556 hospitalized patients with diagnosis of COVID-19 infection, 32 patients (0.9%) had imaging-proven ischemic stroke. They compared those 32 patients admitted with stroke and COVID-19 to those admitted only with stroke (46 patients) and found that the patients with COVID-19:

• tended to be younger, average age of 63 years vs. 70 years for non-COVID stroke patients;

• had more severe strokes, average score of 19 vs. 8 on the National Institutes of Health Stroke Scale;

• had higher D-dimer levels, 10,000 vs. 525, which can indicate significant blood clotting;

• were more likely to be treated with blood thinners, 75% vs. 23.9%;

• were more likely to have a cryptogenic stroke in which the cause is unknown, 65.6% vs. 30.4%; and

• were more likely to be dead at hospital discharge, 63.6% vs. 9.3%.

Conversely, COVID-19 stroke patients were less likely than those stroke patients without the novel coronavirus to have high blood pressure (56.3% vs. 76.1%) or to have a prior history of stroke (3.1% vs. 13%).

The researchers observed that the rate of imaging-confirmed acute ischemic stroke in hospitalized patients with COVID-19 in their New York City hospital system was lower compared to prior reports in COVID-19 studies from China. One reason for the difference might be related to variations in race/ethnicity between the two study populations. In addition, the low rate of ischemic stroke with COVID-19 infection may be an underestimate because "the diagnosis of ischemic stroke can be challenging in those critically ill with COVID-19 infection who are intubated and sedated," said lead study author Shadi Yaghi, M.D., FAHA, of the department of neurology at NYU Grossman School of Medicine in Manhattan.

Yaghi said, "It was difficult to determine the exact cause of the strokes of the COVID-19 patients, however, most patients appeared to experience abnormal blood clotting. Additional research is needed to determine if therapeutic anticoagulation for stroke is useful in patients with COVID-19." The researchers noted that at least one clinical trial is already underway to investigate the safety and efficacy of treatment for active clotting vs. preventive treatment in certain patients with COVID-19 infection presenting with possible clotting indicators.

Yaghi and his coauthors also noted the number of stroke cases with COVID-19 seems to have peaked and is now decreasing. This finding may be related to the overall reduction in COVID-19 hospital admissions, which may be due to social distancing and guidance for people to stay at home. In addition, the number of stroke patients hospitalized during the study period was significantly lower than the same time frame in 2019.

Similar trends are reported in several other studies also published this week in Stroke, reflecting a global disruption of emergency health care services including delayed care and a lower-than-usual volume of stroke emergencies during the COVID-19 pandemic crisis.

In a Hong Kong study, "Delays in Stroke Onset to Hospital Arrival Time during COVID-19," by lead author Kay Cheong Teo, M.B.B.S., researchers compared the stroke onset time to hospital arrival time for stroke and transient ischemic attack (TIA) patients from Jan. 23 to March 24, 2020 (the first 60 days from the first diagnosed COVID-19 case in Hong Kong) to the same time period in 2019. In 2020, 73 stroke patients presented to Queen Mary Hospital compared to 83 in 2019. However, the time from stroke onset-to-arrival time was about an hour longer in 2020 compared with last year (154 minutes vs. 95 minutes). In addition, the number of patients arriving within the critical 4.5-hour treatment window dropped from 72% in 2019 to 55% in 2020.

Also from China, "The impact of the COVID-19 epidemic on stroke care and potential solutions," by lead author Jing Zhao, M.D., Ph.D., detailed survey results from more than 200 stroke centers through the Big Data Observatory Platform for Stroke of China, which consists of 280 hospitals across China. They found that in February 2020, hospital admissions related to stroke dropped nearly 40%, while clot-busting treatment and mechanical clot-removal cases also decreased by 25%, compared to the same time period in 2019. The researchers cited several factors likely contributed to the reduced admissions and prehospital delays during the COVID-19 pandemic, such as lack of stroke knowledge and proper transportation. They also noted that another key factor was patients not coming to the hospital for fear of virus infection.

In a fourth study, "Mechanical Thrombectomy for Acute Ischemic Stroke Amid the COVID-19 Outbreak," by lead author Basile Kerleroux, M.D., researchers in France compared patient data from stroke centers across the country from February 15 through March 30, 2020 to data of patients treated during the same time period in 2019. They found a 21% decrease (844 in 2019 vs. 668 in 2020) in overall volume of ischemic patients receiving mechanical thrombectomy during the pandemic compared to the previous year.

Additionally, there was a significant increase in the amount of time from imaging to treatment overall -- 145 minutes in 2020 compared to 126 minutes in 2019, and that delay increased by nearly 30 minutes in patients transferred to other facilities for treatment after imaging. The researchers said delays may have been due to unprecedented stress on emergency medical system services, as well as primary care stroke centers lacking transfer resources needed to send eligible patients to thrombectomy capable stroke centers within the therapeutic window. They noted stricter applications of guidelines during the pandemic period could also have meant some patients may have not been referred or accepted for mechanical thrombectomy treatment during that time.

https://www.sciencedaily.com/releases/2020/05/200521124648.htm

Coronavirus infections may lead to delirium and potentially PTSD

May 19, 2020

Science Daily/University College London

People taken ill by coronavirus infections may experience psychiatric problems while hospitalised and potentially after they recover, suggests an analysis of past research led by the UCL Institute of Mental Health with King's College London collaborators.

The systematic review paper, published in The Lancet Psychiatry, compiled results from short- and long-term studies of people hospitalised by recent coronaviruses, namely SARS (Severe acute respiratory syndrome) in 2002-2004, MERS (Middle East respiratory syndrome) in 2012, as well as COVID-19 this year.

COVID-19 is caused by the SARS-CoV-2 virus, a type of coronavirus. Some coronaviruses only cause mild symptoms of the common cold, but SARS-CoV-2 can cause severe respiratory illness, as did SARS-CoV-1 (the virus implicated in the 2002-2004 SARS epidemic) and MERS-CoV, which caused MERS in 2012.

The analysis found that one in four people hospitalised with COVID-19 may experience delirium during their illness, a known problem among hospital patients, which can increase risk of death or extend time in hospital.

The post-recovery effects of COVID-19 are not yet known, so long-term risks such as post-traumatic stress disorder (PTSD), chronic fatigue, depression, and anxiety are based on SARS and MERS studies, which may or may not apply to COVID-19 as well.

Co-lead author Dr Jonathan Rogers (UCL Psychiatry and South London and Maudsley NHS Foundation Trust) said: "Most people with COVID-19 will not develop any mental health problems, even among those with severe cases requiring hospitalisation, but given the huge numbers of people getting sick, the global impact on mental health could be considerable.

"Our analysis focuses on potential mental health risks of being hospitalised with a coronavirus infection, and how psychiatric conditions could worsen the prognosis or hold people back from returning to their normal lives after recovering."

The authors of the new paper analysed 65 peer-reviewed studies and seven recent pre-prints that are awaiting peer review, which included data from over 3,500 people who have had one of the three related illnesses. The review only included results from people who were hospitalised, and not people with more mild cases. The findings cover both acute symptoms during the illness, and long-term outcomes from two months to 12 years.

Almost one in three people hospitalised with SARS or MERS went on to develop PTSD, at an average follow-up time of almost three years, especially if they had ongoing physical health problems. Rates of depression and anxiety were also high, at roughly 15% one year or longer after the illness, with a further 15% also experiencing some symptoms of depression and anxiety without a clinical diagnosis. More than 15% also experienced chronic fatigue, mood swings, sleep disorder or impaired concentration and memory.

While in hospital, a significant minority of people with coronavirus infections experienced delirium symptoms such as confusion, agitation and altered consciousness. Almost 28% of people hospitalised for SARS and MERS experienced confusion, and early evidence from the ongoing pandemic suggests that delirium could be similarly common in COVID-19 patients. The authors found some preliminary evidence that delirium may have been associated with raised mortality during the MERS outbreak.

Co-lead author Dr Edward Chesney (Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust) said: "We need more research on how to prevent mental health problems in the long term. One possibility might be to reduce social isolation by allowing patients to communicate with their loved ones by using video links."

The body of research also identified some of the risk factors associated with worse mental health outcomes. Researchers found that worrying a lot about the illness was associated with worse mental health in the long run, and healthcare workers had worse long-term mental health outcomes than other groups, while making a good physical recovery predicted better long-term mental health.

Senior author Professor Anthony David (UCL Institute of Mental Health) said: "To avoid a large-scale mental health crisis, we hope that people who have been hospitalised with COVID-19 will be offered support, and monitored after they recover to ensure they do not develop mental illnesses, and are able to access treatment if needed.

"While most people with COVID-19 will recover without experiencing mental illness, we need to research which factors may contribute to enduring mental health problems, and develop interventions to prevent and treat them."

https://www.sciencedaily.com/releases/2020/05/200518184914.htm

Call for broad changes in stroke care during COVID-19

New guidelines needed to preserve health care resources, limit disease spread and ensure optimal care

May 14, 2020

Science Daily/Loyola University Health System

Broad modifications to current standards for treating acute stroke patients during the COVID-19 pandemic may be needed to preserve health care resources, limit disease spread and ensure optimal care, according to a Loyola Medicine neurologist.

"Doctors are seeing a rise in COVID-19 patients of all ages suffering from stroke and other vascular complications, as the COVID-19 virus overwhelms the health care system," said Jose Biller, MD, chairperson of neurology at Loyola University Medical Center, and professor, Loyola University Chicago Stritch School of Medicine, and co-author of a new editorial, "Acute Stroke Care in the Coronavirus 2019 Pandemic."

"COVID-19 may increase the risk of stroke as a result of several mechanisms, including enhanced inflammatory response, increased blood clotting tendencies, and damage of the inner layers of the blood vessels (endothelial damage)," said Dr. Biller. In general, the majority of stroke patients are older and have underlying medical conditions associated not only with risk for acute ischemic stroke (AIS), but also poor outcomes associated with COVID-19.

Dr. Biller says new guidelines are needed to safely manage stroke patients, both with and without COVID-19, within the limitations of strained health systems during this "ferocious novel pandemic."

"We believe that it is crucial for the stroke community to relax guidelines and stroke pathways while continuously providing high quality of care, including treatment algorithms, post intravenous thrombolysis monitoring, diagnostic work up, disposition planning, prevention measures, in order to optimally care for stroke patients while minimizing the chances of contributing to the rapid spread of COVID-19," according to the editorial, co-authored by Rima M. Dafer, MD, MPH, and Nicholas D. Osteraas, MD, MS, both of Rush University Medical Center, and appearing in the Journal of Stroke and Cerebrovascular Diseases.

The recommendations pertain to all aspects and stages of care, and include the following highlights:

• Prehospitalization. Patients or loved ones should continue to call 911 to report a stroke. In addition to standard triage, emergency medical system (EMS) personnel should screen patients over the phone for COVID-19 symptoms. Telemedicine should be considered for patients with low suspicion of stroke, or mild symptoms with no potential indication for intervention. All patients with acute stroke symptoms should be treated as suspected or possible COVID-19 patients.

• Emergency Room Evaluation. In the emergency room, patients should be screened for COVID-19 prior to evaluation by the stroke team. All patients should wear a mask.

• Hospitalization. Hospitals should designate isolated units for stroke care. Patients receiving intravenous chemical thrombolysis (a common stroke treatment involving an intravenous injection of drugs directly to the blood clot) may be monitored virtually with two-way video conferencing to minimize staff infection.

• Rehabilitation Planning. Rehabilitation for stroke patients can include physical, occupational, and speech therapy, along with other rehabilitation. All therapists and health care workers caring for COVID-19 patients should wear appropriate protective gear. Whenever appropriate, therapy services should emphasize patient exercises that can used at home.

• Family Members. As many hospitals have restricted visitors during COVID-19, extra effort will need to be made to reach families by phone to discuss a patient's condition, treatment options and discharge planning. Exceptions to the visitor policy, such as discussions regarding end-of-life care, should be made when appropriate.

• Transfers. Stroke care often involves networks of hospitals; commonly a comprehensive "hub" with multiple smaller hospitals or "spoke" sites which transfer stroke patients to the "hub" for emergency treatment or Intensive Care Unit (ICU) care. Tele-stroke should be encouraged to evaluate patients and to prevent unnecessary transfers. For AIS patients, neuroimaging and COVID-19 screening should be obtained at the smaller, spoke site hospital before a patient is transferred to a larger medical center.

• Discharge Planning. Discharges to acute rehabilitation institutions and long-term facilities have been delayed due to concerns about the spread of COVID-19 infections in long-term care facilities and nursing homes. Hospitals may need to designate rehabilitation beds for patients who do not qualify for transfer to acute inpatient facilities, as well as discussing possible discharge to home when medically stable and appropriate until the pandemic is under control.

Finally, the article recommends establishing stroke networks within cities, as well as collaboration between institutions "as the surge of COVID-19 worsens." This should include "collaborations among stroke networks to establish a rotating weekly coverage for acute stroke care in a specified geographic area; thus, both freeing hospital resources and releasing stroke call responsibilities, and allowing these physicians to help in caring for patients on the COVID-19 units."

https://www.sciencedaily.com/releases/2020/05/200507150514.htm