H5N1

Long COVID is associated with severe cognitive slowing: A multicentre cross-sectional study

Via eClinical Medicine: Long COVID is associated with severe cognitive slowing: a multicentre cross-sectional study. The summary:

Background  

COVID-19 survivors may experience a wide range of chronic cognitive symptoms for months or years as part of post-COVID-19 conditions (PCC). To date, there is no definitive objective cognitive marker for PCC. We hypothesised that a key common deficit in people with PCC might be generalised cognitive slowing.  

Methods  

To examine cognitive slowing, patients with PCC completed two short web-based cognitive tasks, Simple Reaction Time (SRT) and Number Vigilance Test (NVT). 270 patients diagnosed with PCC at two different clinics in UK and Germany were compared to two control groups: individuals who contracted COVID-19 before but did not experience PCC after recovery (No-PCC group) and uninfected individuals (No-COVID group). All patients with PCC completed the study between May 18, 2021 and July 4, 2023 in Jena University Hospital, Jena, Germany and Long COVID clinic, Oxford, UK.  

Findings  

We identified pronounced cognitive slowing in patients with PCC, which distinguished them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. Cognitive slowing was evident even on a 30-s task measuring simple reaction time (SRT), with patients with PCC responding to stimuli ∼3 standard deviations slower than healthy controls. 53.5% of patients with PCC's response speed was slower than 2 standard deviations from the control mean, indicating a high prevalence of cognitive slowing in PCC. This finding was replicated across two clinic samples in Germany and the UK. Comorbidities such as fatigue, depression, anxiety, sleep disturbance, and post-traumatic stress disorder did not account for the extent of cognitive slowing in patients with PCC. Furthermore, cognitive slowing on the SRT was highly correlated with the poor performance of patients with PCC on the NVT measure of sustained attention.  

Interpretation  

Together, these results robustly demonstrate pronounced cognitive slowing in people with PCC, which distinguishes them from age-matched healthy individuals who previously had symptomatic COVID-19 but did not manifest PCC. This might be an important factor contributing to some of the cognitive impairments reported in patients with PCC.

One in three COVID-19 patients in US developed a neurological or psychiatric condition, study finds

Via The Globe and Mail; One in three COVID-19 patients in U.S. developed a neurological or psychiatric condition, study finds. Excerpt:

A study of more than 236,000 people in the United States who contracted COVID-19 last year has found that one in three developed a neurological or psychiatric condition and one in 50 of those who became seriously ill received their first diagnosis of dementia within six months. 

The most common conditions were anxiety and mood disorders, which occurred in 17 per cent and 14 per cent respectively of those studied. Among patients admitted to intensive care, the researchers found that 7 per cent suffered a stroke and almost 2 per cent developed dementia – which could have been present before COVID-19 but went undiagnosed. They added that more study is needed to fully establish the link between COVID-19 and dementia. 

“I think we can have more confidence that there is an increased risk of stroke and an increasing risk of at least uncovering dementia with COVID, and that that really goes along with the severity of the illness,” said Masud Husain, a professor of neurology and cognitive neuroscience at the University of Oxford who co-authored the study.

The research, published Tuesday in The Lancet Psychiatry, also compared people who had contracted COVID-19 to those who had the flu or another respiratory illness, such as pneumonia or acute bronchitis. The researchers found a 44-per-cent greater risk of neurological and mental health diagnoses after infection with COVID-19 than with the flu and a 16-per-cent greater risk than with other respiratory diseases. 

The study is the largest of its kind, and the researchers said the results could have a profound effect on the demand for mental health services and other medical care once the pandemic eases. “What we hope is our data can provide some of the best findings upon which people can begin to model the implications for public health and the health services generally,” said Paul Harrison, a professor of psychiatry at Oxford who was also among the co-authors.

Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62,354 COVID-19 cases in the USA

Via The Lancet Psychiatry, still more bad news about this wretched virus: Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA.

Background 

Adverse mental health consequences of COVID-19, including anxiety and depression, have been widely predicted but not yet accurately measured. There are a range of physical health risk factors for COVID-19, but it is not known if there are also psychiatric risk factors. In this electronic health record network cohort study using data from 69 million individuals, 62 354 of whom had a diagnosis of COVID-19, we assessed whether a diagnosis of COVID-19 (compared with other health events) was associated with increased rates of subsequent psychiatric diagnoses, and whether patients with a history of psychiatric illness are at a higher risk of being diagnosed with COVID-19. 

Methods 

We used the TriNetX Analytics Network, a global federated network that captures anonymised data from electronic health records in 54 health-care organisations in the USA, totalling 69·8 million patients. TriNetX included 62 354 patients diagnosed with COVID-19 between Jan 20, and Aug 1, 2020. We created cohorts of patients who had been diagnosed with COVID-19 or a range of other health events. We used propensity score matching to control for confounding by risk factors for COVID-19 and for severity of illness. We measured the incidence of and hazard ratios (HRs) for psychiatric disorders, dementia, and insomnia, during the first 14 to 90 days after a diagnosis of COVID-19. 

Findings 

In patients with no previous psychiatric history, a diagnosis of COVID-19 was associated with increased incidence of a first psychiatric diagnosis in the following 14 to 90 days compared with six other health events (HR 2·1, 95% CI 1·8–2·5 vs influenza; 1·7, 1·5–1·9 vs other respiratory tract infections; 1·6, 1·4–1·9 vs skin infection; 1·6, 1·3–1·9 vs cholelithiasis; 2·2, 1·9–2·6 vs urolithiasis, and 2·1, 1·9–2·5 vs fracture of a large bone; all p<0·0001). The HR was greatest for anxiety disorders, insomnia, and dementia. We observed similar findings, although with smaller HRs, when relapses and new diagnoses were measured. 

The incidence of any psychiatric diagnosis in the 14 to 90 days after COVID-19 diagnosis was 18·1% (95% CI 17·6–18·6), including 5·8% (5·2–6·4) that were a first diagnosis. The incidence of a first diagnosis of dementia in the 14 to 90 days after COVID-19 diagnosis was 1·6% (95% CI 1·2–2·1) in people older than 65 years. A psychiatric diagnosis in the previous year was associated with a higher incidence of COVID-19 diagnosis (relative risk 1·65, 95% CI 1·59–1·71; p<0·0001). This risk was independent of known physical health risk factors for COVID-19, but we cannot exclude possible residual confounding by socioeconomic factors. 

Interpretation 

Survivors of COVID-19 appear to be at increased risk of psychiatric sequelae, and a psychiatric diagnosis might be an independent risk factor for COVID-19. Although preliminary, our findings have implications for clinical services, and prospective cohort studies are warranted.

See also this Reuters report on the study.

Infestations, sedation and neglect: Military report details ‘horrific’ living conditions in seniors’ homes

This is the ugliest scandal Canada has seen in many years. Via The Globe and Mail: Infestations, sedation and neglect: Military report details ‘horrific’ living conditions in seniors’ homes. Excerpt:

A Canadian military report released on Tuesday chronicles horrific conditions at five long-term care homes in Ontario, ranging from poor infection control practices to the neglect and abuse of residents.  

The Ontario government said Tuesday it would send inspectors from the Ministry of Long-Term Care into the seniors’ residences to investigate the military’s allegations. But critics said members of Premier Doug Ford’s government should have been aware of long-standing problems at the homes well before the military stepped in. 

In their report, the Canadian Armed Forces describe one home using narcotics to sedate residents who are “agitated and difficult” over being confined to their rooms during the pandemic lockdown. “But when you talk to them,” the report says, “they just say they’re ‘scared and feel alone like they’re in jail.’ ”  

Two seniors’ residences are infested with cockroaches and leave residents in soiled diapers, the report says. Staff in one of the homes take up to two hours to respond to their cries for help. And a third home is force-feeding residents, causing audible choking. 

Mr. Ford told reporters he didn’t know the “full extent” of what was happening in the homes until he read the military’s report on Monday. Mr. Ford said the results of an investigation by the coroner will be shared with police to “look into any possible criminal charges.” 

“It’s shocking that this can happen here in Canada” Mr. Ford said. “It’s gut wrenching."  

The federal government deployed the military to homes in Ontario and Quebec in late April to provide humanitarian relief and medical support at the request of the two provinces. The military is also expected to produce a report detailing the problems witnessed at 28 Quebec elder-care centres. 

The five homes in Ontario have been hit hard by the coronavirus: To date, a total of 217 residents have died of COVID-19, the respiratory disease caused by the virus. All but one of the homes are owned by private, for-profit companies.  

The military says it wrote the 15-page report to ensure that its observations do not go unnoticed. “It is with a heavy heart that I bring this to your attention on behalf of the government of Canada,” Public Safety Minister Bill Blair says in a letter attached to the report. 

Mr. Ford said he asked the Canadian military to extend its mission in the homes for another 30 days. Asked why it took the Canadian Armed Forces to shine a light on the practices that compromised the frail elderly, Mr. Ford cited the military’s 24/7 presence, saying they were able to detect things that inspectors could not by spending a few days in a home.

 “You need someone very transparent, like the military, to go in there and say, here are the goods, as ugly and as heartbreaking as it is, here it is. That’s where you get the real answers,” he said.

BC seniors’ homes problems aren’t new. COVID-19 showed they could be deadly

Via The Tyee, my colleague Andrew MacLeod writes: BC Seniors’ Homes Problems Aren’t New. The Virus Showed They Could Be Deadly. Excerpt:

Across Canada and around the world, the pandemic has taken a major toll in homes where elderly people live in groups. There are 19 facilities with ongoing outbreaks in B.C. Another 10 have made it through outbreaks that have been declared over. 

About half the deaths from COVID-19 in B.C. and Canada have been in long-term care homes. The pandemic has highlighted staffing issues and the government has ended the widespread practice of allowing people to work part-time in multiple homes, which increased the risk illness would spread.  

In B.C., the government is topping up wages so workers get the standard amount for unionized staff and is re-organizing schedules so people working at a single site can get full-time hours. 

Some advocates are now calling for an end to the involvement of private businesses in the sector. In B.C., they are finding support from Premier John Horgan. Others see the call as a political attack on a sector that has more pressing needs than changes to the ownership model. 

The laws and regulations governing B.C.’s long-term care homes are detailed and complex and operators have to show they meet more than 200 conditions.  

Licensing and inspections are a key part of a system that sees large amounts of public money transferred to private and non-profit providers to care for people who, in many cases, are elderly, vulnerable and unable to self-advocate.  

While it’s not unusual for inspections to find violations at care homes, the reports are a window into what was happening before the pandemic at care homes that have since had COVID-19 outbreaks. 

The Amica Edgemont Village in North Vancouver, for example, had five infractions in June. A 2018 inspection found it had failed to meet the requirement that “All persons admitted comply with the Province’s immunization and TB control programs.”  

The Windermere Care Centre was found out of compliance with that same requirement in January 2018. 

Haro Park Residential Care in Vancouver was cited in 2017 for not meeting the requirements of the immunization and tuberculosis programs and in both 2018 and 2019 for failing to regularly review employee performance to make sure they met requirements and demonstrated the competence required for their duties. 

The Lynn Valley Care Centre in North Vancouver has a history of multiple violations, including issues with keeping rooms clean. At least 20 deaths have been linked to the outbreak in the care home.

COVID-19 in Canada: Police investigating after 31 die inside Quebec long-term care home

Via CBC News, a grim story: Police investigating after 31 die inside Quebec long-term care home. Excerpt:

Police are investigating the owners of a privately run Montreal-area nursing home after news that 31 patients died at the facility since mid-March.  

At least five of the deceased residents had contracted COVID-19, Quebec Premier François Legault revealed on Saturday.  

He promised a thorough public investigation into Résidence Herron in Dorval, where nurses spoke out on Saturday about conditions inside the home.   

They said residents were left in unsanitary conditions, many unfed and without water for more than 24 hours, because staff were failing to show up. 

"It's going to be a long-term investigation" with a review of camera footage, said Montreal police spokesperson Jean-Pierre Brabant. ​​​​​​

The news came at a time when care homes have been in the spotlight because of troubling reports in both Quebec and Ontario about elderly residents contracting COVID-19 in long-term care homes. 

These outbreaks are a "sad shame, occurring in homes with the "most vulnerable individuals in our society" who need expert care, said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health Network in Toronto. 

COVID-19 can get into long-term care homes and spread partly because of staff who can't always get a full-time position and have to work at more than one facility, he told CBC News on Sunday.  

It's asking a lot of these workers to be at risk for COVID-19 themselves, he said. 

"When you're working for minimum wage, when you don't have sick benefits, to a certain extent you can appreciate why some workers didn't want to put themselves in the line of fire." 

Families say they can't get information 

Moira Davis, who lives in northern Saskatchewan, says her father is among the 31 people who died at the home in Dorval, either Tuesday night or Wednesday morning. 

Herron emailed her on March 27 to report its first confirmed COVID-19 case and to inform her that residents were now to be quarantined in their rooms. But from that point on, she says she was not able to get any more information, and the guilt she feels now is "beyond overwhelming." 

"I had no info, no nothing on what was going on," said Barbara Schneider, whose mother died at Herron on Friday after contracting the novel coronavirus. She said she visited her mother regularly until the residence was closed to visitors. After that, she says no receptionists answered the phone, emails did not receive replies and voicemail inboxes were always full.

Canada: 3 more people die of COVID-19 in BC as number of cases in province tops 100

Via CBC News: 3 more people die of COVID-19 in B.C. as number of cases in province tops 100. Excerpt:

Three more people have died of COVID-19 in B.C. in recent days, provincial officials said Monday, all of them linked to the same North Vancouver care home that reported the first coronavirus-related death in Canada.  

Dr. Bonnie Henry confirmed the fatalities on Monday, bringing the country's total number of deaths linked to the pandemic to four. All of the deaths stem from an outbreak at the Lynn Valley Care Centre home in North Vancouver, B.C., which first sickened a cluster of residents and staff earlier this month.  

Henry, the provincial health officer, also said 30 additional cases of COVID-19 have been confirmed in B.C. since Saturday. The new cases bring B.C.'s total to 103.  

"It has been a challenging weekend and a weekend of change as we watch what is happening," Henry said, speaking from Victoria on Monday. "The situation is escalating around us, and here in British Columbia as well." 

Henry said six patients are in hospital in acute care, while the others are in stable condition and isolating at home. Five people have fully recovered, although Henry said there are "many more" whose symptoms have been resolved. Test results are needed to positively confirm full recoveries.  

The new cases were found in the Fraser Health, Vancouver Coastal Health, Interior Health and Island Health regions. 

The province's top doctor said at least four of the latest cases are connected to a dental conference that was held in Vancouver March 6-7, which had nearly 15,000 people in attendance. One case was already confirmed with a conference attendee last week. 

The health officer said anyone who attended that conference "needs to self-isolate immediately." 

Meanwhile, Vancouver Coastal Health has alerted the public that someone who worked at the Showcase restaurant at the Vancouver Marriott Pinnacle hotel on March 10, 11 and 13 has tested positive for the novel coronavirus.  

Health officials say that the risk to people dining at the restaurant on those dates in low, but anyone who was at the restaurant between the hours of 10:30 a.m. and 6 p.m. on the dates in question should monitor themselves for symptoms.  

'I'm worried about people dying alone' 

At Lynn Valley Care Centre, residents' families say they've been pitching in to help look after residents because the outbreak has left the facility short-staffed.  

Kelly Shellard is currently living in isolation after spending a few days in the care home with her 81-year-old father, delivering meals to residents and generally helping out.

She told CBC her father is feeling anxious, depressed and frustrated from being trapped in his room, but she's most concerned about residents who don't have family looking out for them.  

"I've been kept up so many nights. I'm just really worried about all of those people in that home and I'm worried about them not getting the care that they need," Shellard said.  

"I'm worried about people dying alone."

Update on new and existing COVID-19 cases in British Columbia

Via the Ministry of Health: Update on new and existing COVID-19 cases in British Columbia. The update and then a comment:

Adrian Dix, Minister of Health, and Dr. Bonnie Henry, B.C.'s provincial health officer, have issued the following joint statement regarding updates on the novel coronavirus (COVID-19) response in British Columbia: 

"We are announcing six new cases of COVID-19, for a total of 27 cases in British Columbia. The individuals are in the Vancouver Coastal and Fraser Health regions, and were confirmed positive based on testing by the BC Centre for Disease Control.  

“Case 22 is a man is his 50s, who recently returned from travel in Iran. Case 25 is a woman in her 50s and a close household contact of case 22. Both individuals reside in the Fraser Health region. 

“Cases 23 and 24 were passengers on the Grand Princess cruise ship from Feb. 11 to 21. They are a man and woman, both in their 60s, and are receiving care in hospital in the Fraser Health region. 

“Cases 26 and 27 are residents of a long-term care facility, the Lynn Valley Care Centre in North Vancouver. These cases were identified as part of an outbreak assessment at the facility in response to a staff member testing positive for COVID-19. The staff member is Case 21, a woman in her 50s, who has no recent travel history. 

“All residents of this facility have now been screened and Vancouver Coastal teams are on site to support the families and continue to investigate in detail. Public health teams have notified facility staff and residents, and are meeting with their families.  

“Case 13, a woman in her 80s, continues to receive care at Vancouver General Hospital. She is now in stable condition. All precautions have been taken to ensure the safety of other patients and health-care workers, while providing her with the care she needs.  

“All other individuals with COVID-19 are stable and in isolation at home with support and monitoring from public health teams. So far, four of B.C.’s 21 individuals who tested positive for COVID-19 have fully recovered.  

“There has been a notable transmission of COVID-19 at events, such as religious gatherings. As a result, we recommend social distancing and forgoing usual greetings. As an alternative, we recommend considering virtual online gatherings.  

“Cruise ships continue to be a high-risk environment for transmission. As result, we recommend reconsidering any cruise-ship travel at this time.  

“We continue widespread testing by screening British Columbians and travellers with symptoms, along with their close contacts, to identify cases of COVID-19 and take immediate action as we have seen today. As of March 6, 2020, 2,803 samples have been tested. 

“The British Columbia Pandemic Provincial Co-ordination Plan details the preparations and comprehensive toolkit to respond to the evolving outbreak. This will be an ongoing resource for the province."

The Lynn Valley Care Center is not far from me, and in January I visited it a couple of times; I was serving as a chauffeur and translator for a woman from Cuba who had come to visit her husband—a resident of LVCC. She hadn't seen him in months and was worried that he wouldn't recognize her. But he did, and I witnessed a very happy and touching reunion.

So the LVCC cases made this outbreak very personal for me, and I worry for both of them.

Washington state sees 1st COVID-19 death in US, declares emergency

Thanks to Helen Branswell for tweeting about this situation. Via seattlepi.com: Wash. state sees 1st virus death in US, declares emergency. Excerpt and then a comment:

The governor of Washington declared a state of emergency Saturday after a man died there of COVID-19, the first such reported death in the United States. More than 50 people in a nursing facility are sick and being tested for the virus.  

Gov. Jay Inslee directed state agencies to use “all resources necessary” to prepare for and respond to the coronavirus outbreak. The declaration also allows the use of the Washington National Guard, if necessary.  

“We will continue to work toward a day where no one dies from this virus," the governor vowed.  

Health officials in California, Oregon and Washington state are worried about the novel coronavirus spreading through West Coast communities because a growing number of people are being infected despite not having visited an area where there was an outbreak, nor apparently been in contact with anyone who had. 

The man who died was in his 50s, had underlying health conditions and no history of travel or contact with a known COVID-19 case, health officials in Washington state said at a news conference. A spokesperson for EvergreenHealth Medical Center, Kayse Dahl, said the person died in the facility in the Seattle suburb of Kirkland. 

 Dr. Frank Riedo, medical director of Infection Control at Evergreen, said local hospitals are seeing people with severe coronavirus symptoms but it’s probable that there are more cases in the community. 

“This is the tip of the iceberg,” he said.  

The health officials reported two cases of COVID-19 virus connected to a long-term care facility in the same suburb, Life Care Center of Kirkland. One is a Life Care worker, a woman in her 40s who is in satisfactory condition at a hospital, and the other is a woman in her 70s and a resident at Life Care who is hospitalized in serious condition. Neither had traveled abroad.  

“In addition, over 50 individuals associated with Life Care are reportedly ill with respiratory symptoms or hospitalized with pneumonia or other respiratory conditions of unknown cause and are being tested for COVID-19,” Seattle and King County officials said. “Additional positive cases are expected.” 

Amy Reynolds of the Washington state health department said in a brief telephone interview: “We are dealing with an emergency evolving situation.”

This is precisely the situation that worries me the most: COVID-19 breaking out in hospitals and care facilities full of older people with pre-existing conditions, and hitting both them and their caregivers. How do you explain to care-home residents with dementia why people are running around in white coveralls, spraying disinfectant everywhere?

From seniors’ care to opioids, eight critical public health issues for 2020

The Tyee has published my article From Seniors’ Care to Opioids, Eight Critical Public Health Issues for 2020. Excerpt:

Canada has plenty of domestic public health problems, and an infectious disease outbreak anywhere in the world is just one airline passenger away from Toronto or Vancouver.

As the year winds down, here are eight incredibly pressing public health problems — and some solutions — we’re likely to deal with in 2020. 

The slow end of the Ebola outbreak. Time and again, extremist political violence and distrust of the Kinshasa government in the northeast Democratic Republic of Congo have halted the response to the Ebola crisis that has killed more than 2,200 people. We now have two effective Ebola vaccines, but getting them to people at risk will be a problem well into the new year.  

The outbreak won’t be considered over until 42 days have passed since the last confirmed case. Given the violence, we won’t likely experience those 42 days for months. 

Continued spread of measles. The World Health Organization estimates that 144,000 people died of measles in 2018. It’s killed more people in the DR Congo than Ebola. Encouragingly, Samoa recently shut down the country for two days to vaccinate 90 per cent of the population — and hit that target.

Social media attacks on measles vaccine have helped keep immunization rates low in countries that should know better, like the U.S. and Canada. We should learn from the Samoans.  

Opioids and their collateral damage. It’s been over three years since Dr. Perry Kendall declared a public health emergency in B.C. over opioid overdoses and deaths. Deaths are trending down, but overdoses seem to have stabilized at an intolerable 22,000 a year. 

It’s intolerable partly because survivors of multiple overdoses may end up with lifelong brain damage, and partly because first responders — fire and rescue and paramedics — must deal with the stress and mental health problems caused by saving the same people again and again. In 2020, we may start thinking about why people get on opioids in the first place.