covid-19 roundup

COVID-19 Linked to Increase Use of Outpatient Care, Cognition Deficits Among Those With Long COVID, and More

Anthony Calabro, MA

Veterans Experience Increase in Outpatient Care Following COVID-19 Infection1
Among a large cohort of veterans, COVID-19 infection was associated with an increased use of outpatient services for up to 12 months after infection compared with uninfected veterans.

In a retrospective cohort study of Veterans Affairs primary care patients, researchers matched veterans with COVID-19 infection (n = 202,803) with veterans without infection (n = 202,803) and then compared the groups based on six categories of care: primary care, specialty care, surgery care, mental health, emergency care, and diagnostic and/or other care. Researchers obtained the study data from the Veterans Affairs Corporate Data Warehouse and the CMS Fee-for-Service Carrier/Physician Supplier file from January 2019 through December 2022.

Researchers found higher outpatient use in all categories but one (surgical care) during the peri-infection period for veterans with COVID-19 infection compared with the uninfected cohort. The results showed an overall increase of 5.12 visits per 30 days for veterans with COVID-19 infection. Although the differences in outpatient use lessened over time, there was still a statistically significant change from 184 to 365 days after infection.

“This study found that outpatient use increased significantly in the month after infection, then attenuated but remained greater than the uninfected cohorts’ use through 12 months, which suggests that there are sustained impacts of COVID-19 infection,” the authors concluded.

Cognition, Memory Impairment Among Those Recovering From COVID-19 Infection2
Results from a large, observational study showed that those who recovered from COVID-19 with symptom resolution at either less than 4 weeks or no later than 12 weeks post-infection had small, but measurable deficits in cognition compared with those with no infection. Larger deficits were found in those with unresolved COVID-19 symptoms compared with those with no infection.

The researchers set out to determine whether objectively measurable cognitive deficits could be found among those who had a COVID-19 infection. To do this, researchers invited 800,000 adults from a large community sample of more than 3 million people from the Real-Time Assessment of Community Transmission study in England to take an online assessment of cognitive function. Of those who were invited, 141,583 participants started the online assessment, and 112,964 completed the assessment, which featured eight total tasks.

Those who recovered from a COVID-19 infection in less than 4 weeks or at least 12 weeks each had small deficits in global cognition as compared with those without a known infection group. Those with “long COVID” (unresolved, persistent symptoms) had larger deficits as compared with the no–COVID-19 group. Larger cognitive deficits were found in those who had an infection during periods in which the original virus or the B.1.1.7 variant was predominant compared with later variants.

Additionally, those who had been hospitalized for their COVID-19 infection had larger cognitive deficits compared with those who had not been hospitalized. Among the “long COVID” group, memory, reasoning, and executive function tasks were associated with the largest deficits compared with the uninfected group.

“Participants with resolved persistent symptoms after COVID-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration COVID-19 was still associated with small cognitive deficits after recovery,” the authors concluded. “Longer-term persistence of cognitive deficits and any clinical implications remain uncertain.”

Study: No Link Between COVID-19, Asthma Development in Children3
A positive SARS-CoV-2 polymerase chain reaction (PCR) test is not associated with the development of asthma among children, according to retrospective cohort study.

Although respiratory viral infections are risk factors for the onset of pediatric asthma, little is known about whether SARS-CoV-2 infection influences its development. Researchers set out to determine whether infection with SARS-CoV-2 affected the risk of asthma among children.

The study assessed children aged 1 to 16 years from the Children’s Hospital of Philadelphia Care Network who received PCR testing for SARS-CoV-2 between March 1, 2020 and February 28, 2021 (n = 27,423).

The study participants were divided into two groups: the SARS-CoV-2 positive group (n = 3147) and the SARS-CoV-2 negative group (n = 24,276). A total of 573 patients received an asthma diagnosis during the study period. Of those, 1.81% (n = 57) were from the SARS-CoV-2 positive group compared with 2.13% (n = 516) in the SARS-CoV-2 negative group.

Black race, food allergies, and allergic rhinitis increased the risk of a new asthma diagnosis, while pre-term birth and BMI increased the risk among those aged younger than 5 years.

“Taken altogether, we find a consistent finding across all pediatric age groups that SARS-CoV-2 PCR positivity does not confer an additional risk for asthma diagnosis, at least within the first 18 months after PCR test,” the authors concluded. “This information may be useful for families and providers alike in the prognostication of the long-term respiratory effects after SARS-CoV-2 infection in children.”

Antidepressant Dispensing to Adolescents, Young Adults Accelerates Following Pandemic4
Antidepressant dispensing to adolescents sharply increased following the pandemic, and this increase was even more profound among female adolescents, the results from a recent database study showed.

Previous studies have shown that the prevalence of depression and anxiety among adolescents was rising prior to the pandemic in March 2020. After the pandemic, these disorders continued to rise. But researchers wanted to know whether there was a change in antidepressant dispensing to adolescents following the pandemic.

To make this determination, researchers used an all-payer database (IQVIA Longitudinal Prescription Database) to identify antidepressant prescriptions dispensed to US adolescents aged 12 to 25 years from 2016 to 2022. Based on the data, researchers developed the monthly antidepressant dispensing rate, defined as the “monthly number of individuals with [greater than or equal to] 1 dispensed antidepressant prescription per 100,000 people.”

The results showed that overall, the monthly antidepressant dispensing rate increased 66.3% (from 2575.9 to 4284.8) from January 2016 to March 2022. Before March 2020, the dispensing rate increased by 17 points per month. After March 2020, the monthly antidepressant dispensing rate increased to 27.8 per month, a 63.5% higher rate of change than before March 2020.

In subgroup analyses, researchers looked at sex differences. Among female adolescents, the monthly antidepressant dispensing rate increased by 17.9 points per month before March 2020. But from March 2020 on, among females aged 12 to 17 years, the monthly antidepressant dispensing rate increased by 41.1 points per month—a 129.6% higher rate of change than before March 2020. Among females 18 to 25 years of age, the rate of change was 56.5% higher compared to before March 2020.

“Antidepressant dispensing to adolescents and young adults was rising before the COVID-19 outbreak and rose 63.5% faster afterward,” the authors concluded. “This change was driven by increased antidepressant dispensing to females and occurred despite decreased dispensing to male adolescents.”

 

References:

  1. Hebert PL, Kumbier KE, Smith VA, et al. Changes in outpatient health care use after COVID-19 infection among veterans. JAMA Netw Open. 2024;7(2):e2355387. doi:10.1001/jamanetworkopen.2023.55387
  2. Hampshire A, Azor A, Atchison C, et al. Cognition and memory after COVID-19 in a large community sample. N Engl J Med. 2024;390(9):806-818. doi:10.1056/NEJMoa2311330
  3. Senter JP, Aisenberg LK, Dudley JW, et al. COVID-19 and asthma onset in children. Pediatrics. 2024;153(5):e2023064615. doi:10.1542/peds.2023-064615
  4. Chua KP, Volerman A, Zhang J, Hua J, Conti RM. Antidepressant dispensing to US adolescents and young adults: 2016-2022. Pediatrics. 2024;153(3):e2023064245. doi:10.1542/peds.2023-064245