A COVID-19 Brazil Coalition — research alliance, formed by Hospital Israelita Albert Einstein, Hcor, Hospital Sírio-Libanês, Hospital Moinhos de Vento, Hospital Alemão Oswaldo Cruz, BP – Beneficência Portuguesa de São Paulo, the Brazilian Clinical Research Institute (BCRI) and Rede Brazilian Society of Intensive Care Research (BRICNet) — conducts clinical studies on treatments and the health impacts of the coronavirus. A new study has been published by Intensive Care Medicine, the official scientific journal of the European Society of Intensive Care Medicine. Coalition VII analyzed the association between the severity of COVID-19 in its acute phase and quality of life in the long term.
After a year of monitoring patients who were discharged after hospitalization for COVID-19 in Brazilian institutions, the researchers identified that more severe cases of the disease during hospitalization — defined by the need for mechanical ventilation, for example — are associated with greater impacts on quality of life and worse results in terms of mortality, major cardiovascular events, re-hospitalizations, new disabilities for daily activities, symptoms of anxiety and post-traumatic stress and difficulty returning to work or studies.
One of the main findings is the high percentage of patients who reported new disabilities, such as difficulty getting around, taking care of their own hygiene, shopping and managing their finances. Among those who required mechanical ventilation, this rate was 47%.
The study identified that one in four people intubated during treatment needed to be rehospitalized over the subsequent 12 months. In addition, 5.6% had a heart attack, stroke or died from cardiovascular disease, twice the rate among patients who did not require respiratory support during hospitalization.
The impacts on mental health are also of concern to researchers. The prevalence of post-traumatic stress disorder (PTSD) in patients who used mechanical ventilation was twice that of the Brazilian population in general. In addition, one in four experienced symptoms of anxiety. This mental health impairment, added to the reported physical disabilities, is associated with a significant reduction in quality of life.
The post-discharge mortality rate in patients intubated during treatment for COVID-19 was 8% over the 12 months, while among those who did not require ventilatory support it was 2%. mechanical ventilation is an important marker of disease severity and indicates a greater degree of lung and other organ involvement — it is not the technique that causes damage (on the contrary, it helps save lives), but it is an indication that that individual will need priority treatment in rehabilitation.
the patients
The researchers followed 1,508 patients, hospitalized in 84 hospitals in Brazil, and who participated in the other Coalizão studies. Volunteers were classified into four groups: those who did not need oxygen support; those who received oxygenation through a mask or nasal cannula; those requiring non-invasive ventilation or oxygen through a high-flow nasal catheter; and those who were intubated and required mechanical ventilation. Contacts for monitoring quality of life, persistent symptoms, health complications and other illnesses were carried out through telephone interviews at three, six, nine and 12 months after discharge.
The importance of Coalition VII
Many consequences of COVID-19 are still unknown and concern experts around the world. The World Health Organization (WHO) recommends three steps to face this challenge: recognize and find these patients, prioritize their rehabilitation and invest in research.
The study, by associating sequelae, impacts and damage to quality of life with the severity of cases, helps to identify populations at higher risk and who need to be given priority in treatment and rehabilitation. According to the Scientific Committee of the Coalizão COVID-19 Brasil, knowing who needed mechanical ventilation is a way of looking for these patients and including them in specific programs for their rehabilitation.
The survey also warns of the need for tracking post-discharge patients, as many die as a result of complications from the disease, but appear in surveys as recovered. Another important measure is to prepare professionals to act early in rehabilitation.
The other studies of the Coalizão COVID-19 Brazil that will be published
Coalition VIII — Evaluated whether anticoagulation with rivaroxaban prevents worsening of disease requiring hospitalization in outpatients with COVID-19. It has been finalized and will be submitted for publication.
Coalition IX — Evaluated whether antiviral drugs alone and/or in combination with each other are effective in treating hospitalized COVID-19 cases with moderate disease. The antivirals tested were atazanavir and daclatasvir associated with sofosbuvir. It was completed and submitted for publication.
A COVID-19 Brazil Coalition — research alliance, formed by Hospital Israelita Albert Einstein, Hcor, Hospital Sírio-Libanês, Hospital Moinhos de Vento, Hospital Alemão Oswaldo Cruz, BP – Beneficência Portuguesa de São Paulo, the Brazilian Clinical Research Institute (BCRI) and Rede Brazilian Society of Intensive Care Research (BRICNet) — conducts clinical studies on treatments and the health impacts of the coronavirus. A new study has been published by Intensive Care Medicine, the official scientific journal of the European Society of Intensive Care Medicine. Coalition VII analyzed the association between the severity of COVID-19 in its acute phase and quality of life in the long term.
After a year of monitoring patients who were discharged after hospitalization for COVID-19 in Brazilian institutions, the researchers identified that more severe cases of the disease during hospitalization — defined by the need for mechanical ventilation, for example — are associated with greater impacts on quality of life and worse results in terms of mortality, major cardiovascular events, re-hospitalizations, new disabilities for daily activities, symptoms of anxiety and post-traumatic stress and difficulty returning to work or studies.
One of the main findings is the high percentage of patients who reported new disabilities, such as difficulty getting around, taking care of their own hygiene, shopping and managing their finances. Among those who required mechanical ventilation, this rate was 47%.
The study identified that one in four people intubated during treatment needed to be rehospitalized over the subsequent 12 months. In addition, 5.6% had a heart attack, stroke or died from cardiovascular disease, twice the rate among patients who did not require respiratory support during hospitalization.
The impacts on mental health are also of concern to researchers. The prevalence of post-traumatic stress disorder (PTSD) in patients who used mechanical ventilation was twice that of the Brazilian population in general. In addition, one in four experienced symptoms of anxiety. This mental health impairment, added to the reported physical disabilities, is associated with a significant reduction in quality of life.
The post-discharge mortality rate in patients intubated during treatment for COVID-19 was 8% over the 12 months, while among those who did not require ventilatory support it was 2%. mechanical ventilation is an important marker of disease severity and indicates a greater degree of lung and other organ involvement — it is not the technique that causes damage (on the contrary, it helps save lives), but it is an indication that that individual will need priority treatment in rehabilitation.
the patients
The researchers followed 1,508 patients, hospitalized in 84 hospitals in Brazil, and who participated in the other Coalizão studies. Volunteers were classified into four groups: those who did not need oxygen support; those who received oxygenation through a mask or nasal cannula; those requiring non-invasive ventilation or oxygen through a high-flow nasal catheter; and those who were intubated and required mechanical ventilation. Contacts for monitoring quality of life, persistent symptoms, health complications and other illnesses were carried out through telephone interviews at three, six, nine and 12 months after discharge.
The importance of Coalition VII
Many consequences of COVID-19 are still unknown and concern experts around the world. The World Health Organization (WHO) recommends three steps to face this challenge: recognize and find these patients, prioritize their rehabilitation and invest in research.
The study, by associating sequelae, impacts and damage to quality of life with the severity of cases, helps to identify populations at higher risk and who need to be given priority in treatment and rehabilitation. According to the Scientific Committee of the Coalizão COVID-19 Brasil, knowing who needed mechanical ventilation is a way of looking for these patients and including them in specific programs for their rehabilitation.
The survey also warns of the need for tracking post-discharge patients, as many die as a result of complications from the disease, but appear in surveys as recovered. Another important measure is to prepare professionals to act early in rehabilitation.
The other studies of the Coalizão COVID-19 Brazil that will be published
Coalition VIII — Evaluated whether anticoagulation with rivaroxaban prevents worsening of disease requiring hospitalization in outpatients with COVID-19. It has been finalized and will be submitted for publication.
Coalition IX — Evaluated whether antiviral drugs alone and/or in combination with each other are effective in treating hospitalized COVID-19 cases with moderate disease. The antivirals tested were atazanavir and daclatasvir associated with sofosbuvir. It was completed and submitted for publication.
