Characterizing post-covid conditions in a Turkish cohort: A prospective study

Abstract Background Investigating the people who suffer from post-COVID health conditions is necessary to accommodate the demand for accessing healthcare. This study aims to describe post-COVID health conditions within six months after diagnosis. Methods This study was conducted at Dokuz Eylul University Hospital, a tertiary care hospital in Ä°zmir-Turkey. Participants aged ≥18 years who were diagnosed as SARS-CoV-2 RNA positive in the hospital from November 1st, 2020 to May 31st were interviewed by phone at one, three and six months after diagnosis. Symptom frequencies were stratified by demographic and clinical characteristics. The dependent variable was having post-COVID condition according to World Health Organization's definition. We estimated logistic regression models to identify associated factors for post-COVID condition in the patients who had symptoms at baseline. Results A total of 5083 people completed the third month's interview. The prevalence of post-COVID condition was 21.8% (n = 1108). Tiredness/fatigue (10.2%), muscle or body aches (7.3%) and dyspnea/difficulty breathing (4.8%) were the most common symptoms. Older age (65-74 aged groups versus 18-24 aged group, odds ratio-OR:1.57, 95% confidence interval: 1.10-2.25), female gender (OR: 1.97, 1.71-2.28), bad economic status (OR: 1.44, 1.13-1.84), having more health conditions (≥3 conditions, OR: 1.82, 1.28-2.55), having more symptoms (>5 symptoms, OR: 2.59, 2.20-3.07) and hospitalization (intensive care unit, OR: 1.98, 1.13-3.37) were found to be associated with reporting of post-COVID condition. Conclusions This study identifies the prevalence and risk factors for post-COVID conditions in a large cohort of patients. The results of the study would guide the healthcare organizations in the planning of post-COVID management strategies. Key messages • The prevalence of post-COVID conditions was 21.8%. Older age, female gender, having more health conditions, disease severity in the acute phase and bad economic status were risk factors. • Clinical management strategies and country-specific healthcare planning should be devised for the post-COVID condition burden.


Introduction:
The COVID-19 pandemic has changed the patterns of access to the Emergency Department (ED), but it is unclear whether this change was due to COVID-19 incidence or the lockdown imposed by law. Aim: To evaluate the association between trends of ED accesses and COVID-19 incidence in the period 1 January -31 December 2020.

Material and methods:
The data of accesses to the ED per month and severity triage code of 14 hospitals in the Southeast Tuscany (Italy, Provinces of Siena, Arezzo, Grosseto) were obtained from hospitals data warehouses. Data on new cases of COVID-19 infection (obtained by the Ministry of Health) for the 3 provinces were used to calculate the incidence of infection. Hospitals were classified in 4 categories based on beds number, medical specialties offered, services provided. Differences in ED accesses by month, triage code and hospital type were investigated by a Kruskal-Wallis analysis of variance. Association between ED accesses and COVID-19 incidence was evaluated using a random effect panel data analysis adjusting for hospital type and triage code.

Results:
A total of 268,072 ED accesses have been studied. Their trends saw a strong decrease in correspondence of the first pandemic peak, subsequently they are increased and then decreased again until the minimum peak in November 2020. COVID-19 incidence appeared to overlap, but in the reverse direction, with ED admissions trends. Monthly differences of the ED accesses were significant (p < 0.01) except for most severity code. There is a statistically significant inverse association between ED accesses and COVID-19 incidence (Coef. = -0.074, p < 0.001) except for most severe cases (triage code 1: Coef. = -0.028, p = 0.154). Conclusions: ED admissions trends followed the COVID-19 incidence independently from the period of lockdown except for the most severe cases. The fear to contract the infection seemed to discourage patients to access ED for diseases that were perceived as not serious.

Key messages:
The pandemic has changed the lifestyle of people worldwide, modifying even the perception that the patient has of own state of health and their access to Emergency Department. The decrease in accesses involved less severe cases. Reflect on both the adequacy of accesses in the pre-pandemic period and on what is the best setting to manage these cases in the pandemic period.

Background:
Investigating the people who suffer from post-COVID health conditions is necessary to accommodate the demand for accessing healthcare. This study aims to describe post-COVID health conditions within six months after diagnosis.

Methods:
This study was conducted at Dokuz Eylul University Hospital, a tertiary care hospital in Ä zmir-Turkey. Participants aged 18 years who were diagnosed as SARS-CoV-2 RNA positive in the hospital from November 1st, 2020 to May 31st were interviewed by phone at one, three and six months after diagnosis. Symptom frequencies were stratified by demographic and clinical characteristics. The dependent variable was having post-COVID condition according to World Health Organization's definition. We estimated logistic regression models to identify associated factors for post-COVID condition in the patients who had symptoms at baseline.

Conclusions:
This study identifies the prevalence and risk factors for post-COVID conditions in a large cohort of patients. The results of the study would guide the healthcare organizations in the planning of post-COVID management strategies.

Key messages:
The prevalence of post-COVID conditions was 21.8%. Older age, female gender, having more health conditions, disease severity in the acute phase and bad economic status were risk factors. Clinical management strategies and country-specific healthcare planning should be devised for the post-COVID condition burden. analysis of comprehensive strategy documents to guide policy makers in implementing new or decrease existing measures to protect against COVID-19 in Germany. WICID 1.0 was validated by coding the framework against an updated set of the key strategy documents, and key strategy documents addressing non-pharmacological measures in long-term care facilities. In total, 12 key strategy documents were analysed to develop WICID 1.0, and 18 + 23 documents were analyzed for its refinement towards WICID 2.0. The revised framework consists of 11 + 1 criteria and includes implications for the health of individuals and populations due to and beyond COVID-19, infringement on liberties and fundamental human rights, acceptability and equity considerations, societal, environmental and economic implications, as well as implementation, resource and feasibility considerations. Validation found high consistency with minor revisions between WICID 1.0 and 2.0. WICID can be a tool to support researchers, practitioners, and policy makers to systematically integrate evidence and ethics and to balance of health, societal and other considerations when reflecting on PH interventions targeting COVID-19. Key messages: Due to the rapidly developing pandemic, decision-making process often did not include the views of all affected stakeholders and did not adequately include all criteria and considerations of relevance.
The WICID Framework can serve as a tool to support decision-makers in accounting for relevant considerations and criteria, even when not all stakeholders could be included.

Background:
During the COVID-19 pandemic, several public health challenges were faced, requiring worldwide leaders able to direct, guide, and establish appropriate strategies. The aim of this review was to summarize evidence on public health leadership during the COVID-19 era.

Methods:
The systematic literature review was conducted according to the PRISMA 2020 checklist. A search of relevant articles was performed in the PubMed, Scopus, and Web of Science databases. Eligible articles were any type of publication, published between 2020 and 2022, that outlined one or more characteristics of effective public health leadership during the COVID-19 pandemic We excluded all articles that did not explicitly address the COVID-19 pandemic or had a different setting.

Results:
A total of 2499 records were screened, and 45 articles were included. We identified 93 characteristics, clustered in six groups, that were reported as fundamental to be an effective leader in public health crises worldwide. Emotional intelligence and human traits (reported by 46.67% of the articles) were considered essential to build trust in the population and ensure cooperation with working groups. Communication skills (47%) are considered necessary to enable people to understand and accept measures. A supportive, multidisciplinary team and accountability mechanisms (33,33%) were highlighted as central elements, especially in the international field, to ensure reliability and consistency in action. Management skills (35,56%), adaptability (44,44%), and evidence-based approach (33,33%) were reported as key capabilities to ensure a prompt and rapid response to the challenges created by the pandemic.

Conclusions:
The identification of the attributes of an effective public health leader conducted in this study is useful in choosing the key personalities who must lead public health today and in the training of tomorrow's European and worldwide leaders to be ready to face future threats. Key messages: Effective public health leaders in crisis are empathetic and trustworthy people, who have developed management and communication skills, and are able to make timely and evidence-based decisions.
In order to create leaders capable of facing future threats, more emphasis in the training of public health workforce on