NEWS & PERSPECTIVE
Long-term neurologic symptoms emerge in 1 out of 3 patients hospitalized with COVID-19
With confirmed cases of the 2019 coronavirus disease (COVID-19) on the rise, neurological symptoms and syndromes have been reported by a significant proportion of patients in addition to the predominant respiratory symptoms.1-3 A recent study from Italy further demonstrated that long-term neurologic manifestations were seen in more than a third of previously hospitalized COVID-19 patients who had no prior neurological disease.4 The study also noted that multiple neurological abnormalities, including mild cognitive impairment, are associated with the severity of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.4
Shortly after the first case was reported in Wuhan, China, COVID-19 has rapidly developed into pandemic.4 Clinical findings on previously hospitalized and non-hospitalized patients with COVID-19 reported the persistence of multiple symptoms, particularly fatigue and dyspnea.5 Accordingly, some authors have suggested the so-called, but not yet defined, “post-COVID-19 syndrome” based on the symptoms reported after three months of SARS-CoV-2 infection.6 Few follow-up studies, however, have investigated COVID-19 patients discharged from hospitals after recovery, but with no data published on the persistent neurological manifestations in such patients.4
Dr. Padovani and his colleagues, thus developed a longitudinal study to evaluate the neurological manifestations of SARS-CoV-2 after 6 months of follow-up and the potential relationship between pre-morbid conditions and the severity of SARS-CoV-2 infection.4 COVID-19 survivors without pre-morbid neurologic disease and discharged from the Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili Hospital in Italy between February and April 2020 were recruited in a follow-up study which included a standardized neurologic symptoms checklist and a neurologic exam at 6 months.4 The neurological checklist included symptoms related to central, peripheral, myopathic and cognitive manifestations, whereas the neurological examination assessed cranial nerves, motor, sensory, cerebellar, basal ganglia-related function, deep tendon reflexes, pyramidal signs and global cognitive function using the Montreal Cognitive Assessment (MoCA).4 Premorbid conditions were recorded at hospital admission using the Cumulative Illness Rating Scale (CIRS).4,7 Hospitalization data included the severity of the COVID-19 disease which was classified according to the Brescia COVID Respiratory Severity Scale (BCRSS).4,8
At 6 months of follow-up, the most common symptoms reported were fatigue (34.0%), memory complaints (30.8%), sleep disorders (30.8%) and myalgias (29.6%), followed by depression or anxiety symptoms (26.0%), loss of dependency in instrumental activities of daily living (IADL), blurring or other visual disturbances (19.5%), numbness or tingling (18.3%) and hyposmia or hypogeusia (16.5%).4 Patients with higher BCRSS scores reported a higher number of symptoms at follow-up (p=0.004), memory complaints (p=0.015) and visual disturbances (p=0.006) after correction for age and CIRS.4
105 patients were further evaluated with a neurologic exam and cognitive screening. Among them, 42 patients were identified with neurologic abnormalities consisting of dysgeusia/hyposmia (n=19), enhanced physiological tremor (n=15), low-limb hypoesthesia (n=6), low-limb motor deficits (n=3) and cognitive deficits (n=17) according to the Italian validated version of MoCA.4,9 Neurologic abnormalities at examination were associated with older age (p=0.005), higher premorbid comorbidity index (p=0.001), worse BCRSS (p=0.05), longer hospitalization duration (p=0.002), and higher number of neurologic symptoms reported (p=0.007).4 Length of hospitalization (p=0.02) and premorbid comorbidity index (p=0.03) were also predictors of neurologic abnormalities.4
In summary, findings from this study demonstrated that previously hospitalized COVID-19 patients reported a wide array of neurological symptoms at 6 months after SAR-CoV-2 infections which could be predicted by the combination of age, premorbid conditions and severity of COVID-19.4 These findings supported the observation of a high prevalence of post-COVID-19 clinical manifestations and the claim that long-term consequences of COVID-19 involve both central and peripheral nervous systems.4 Dr. Padovoni concluded, “[These results] suggest the importance of long-term follow-up programs to properly care for patients and to evaluate the real impact of SARS-CoV-2 infection on brain health status which is still uncertain.”4
Safeguard children’s health from Omicron-associated complications with BNT162b2
The fifth wave of Coronavirus disease 2019 (COVID-19) has caused more than a million people being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Omicron BA.2, predominant) and over 9,000 COVID-19-associated deaths in Hong Kong.1 Children, a subgroup of the population who had experienced more favorable outcomes vs. the older adults during the first 4 waves of the pandemic, were reported to have disproportionately higher hospitalization rates under the Omicron era.2 Some studies revealed that seizure and laryngotracheobronchitis, or croup, were common severe complications which led to pediatric hospitalization.2 The findings highlighted the importance of COVID-19 vaccination among children, but those aged <5 years were still not eligible for this mitigation measure. In an interview with Omnihealth Practice, Dr. Leung, Sze-Yin Agnes presented the latest safety and efficacy data of BNT162b2 among children aged ≥6 months and encouraged parents to arrange COVID-19 vaccination for their children to reduce the negative impact of this pandemic in young children.
Addition of molnupiravir in the evolving SARS-CoV-2 treatment landscape
At a symposium organized by the Hong Kong Society for Infectious Diseases, Dr. Marissa Grifasi Williams kicked off the symposium by sharing how the evolution of virus has changed the management of SARS-CoV-2, highlighting the current guidelines to recommend molnupiravir as an oral therapy for the coronavirus disease 2019 (COVID-19). She further discussed the MOVe-OUT trial, which demonstrated that molnupiravir reduced the risk of hospitalization or death in at-risk and unvaccinated COVID-19 adults. Concluding her presentation, Dr. Williams featured the additional data of molnupiravir from the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2022, validating that molnupiravir was effective in clearing the virus as early as 3 days, as well as improving symptoms. Then, Dr. Yap, Yat-Hin Desmond shared his experience in managing COVID-19 patients with renal failure in Hong Kong.
Multi-peptide CoVac-1 vaccine induces T-cell immunity in immunoglobulin-deficient cancer patients
In the American Association for Cancer Research (AACR) annual meeting 2022, Dr. Claudia Tandler from the University of Tübingen, Germany, discussed the safety and immunogenicity of a novel multi-peptide vaccine, CoVac-1, for the induction of a (SARS-CoV-2) T-cell immunity in cancer patients with dis
BNT162b2 boosters and beyond: Strategies to overcome waning immune responses against omicron variant
During the fifth wave of Coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [B.1.1.529 (Omicron), predominant] infected over a million people and claimed more than 9,000 lives in Hong Kong.1 Elderly people aged ≥60 years were the most vulnerable population and accounted for ≥95% of the total death cases.1 Among the deceased, most were unvaccinated (>70%), or had received only 1 dose of COVID-19 vaccine, and/or were with known chronic diseases.1 Even for people who have received 2 doses of vaccines, increasing evidence showed that protection against severe COVID-19 would be reduced due to the waning immune responses against the Omicron variant.2 As such, in an interview with Omnihealth Practice, Professor HUNG, Fan-Ngai Ivan, addressed the rising concern about Omicron and presented the latest data showing that BNT162b2 boosters are still highly effective against the new threat. He also provided some updates on the development of new Omicron-adapted vaccines for conferring better protection to people.
Emerging from covid-19 predicament: An update on its management and vaccination
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has afflicted more than 200 million people, with a death toll of more than 4 million people worldwide.1 As of September 29, 2021, Hong Kong has recorded 12,210 COVID-19 cases with 213 deaths.2 Although the situation in Hong Kong has been stabilized since the end of the fourth wave of epidemic in May 2021, the emergence of variants, especially the Delta variants, could be another threat to our society.3,4 In a lecture held by the Macau Association of Health Service Executives (MAHSE), Professor Hung, Fan-Ngai Ivan addressed the concerns over the emergence of the Delta variant and provided an update on the COVID-19 management and vaccination.
Latest updates: Six-month safety and efficacy of BNT162b2 mRNA COVID-19 vaccine
In brief With up to 6 months of follow-up in an ongoing, placebo-controlled, observer-blinded, multinational, pivotal efficacy study, the 6-month safety and efficacy data of BNT162b2 mRNA COVID-19 have been updated and summarized in this report.1 Background The current outbreak of the novel coron
The myths and facts of COVID-19 vaccination and boosters: Current strategies and foresight
Since launching the COVID-19 Vaccination Program in Hong Kong, over 50% of the total population has received the 1st vaccine dose.1 Currently, some studies point out that the immunogenicity varies greatly across the COVID-19 vaccines locally available, sparking controversy on the pro
Breaking the myths: Consensus statements from local rheumatologists recommend covid-19 vaccination in patients with autoimmune rheumatic diseases
In brief The Hong Kong Society of Rheumatology (HKSR) published a set of consensus statements for Coronavirus Disease 2019 (COVID-19) vaccination in adult patients with autoimmune rheumatic diseases (ARDs). This statement serves as a guide to local rheumatologists and other specialists, nurses, he