key: cord-0722222-dz700ng7
authors: Han, Xiaohua; Xia, Nan; Chen, Zejian; Pan, Chu; Huang, Xiaolin
title: Inpatients with brain damage, impaired airways and severely restricted daily activities have an increased infection rate during the COVID-19 pandemic: a single-center retrospective analysis from Wuhan
date: 2020-07-28
journal: Am J Phys Med Rehabil
DOI: 10.1097/phm.0000000000001535
sha: dd8330166b43400621beda6292b1dffc604ca4b5
doc_id: 722222
cord_uid: dz700ng7

nan

Key words: COVID-19, brain damage, airway impairment, daily activity

Although there has been much coverage of the vulnerable populations and risk factors of coronavirus disease 2019 (COVID-19), attention to hospitalized populations with severe disabilities has been limited. We retrospectively analyzed the infection features of inpatients with brain damage (BD) in one rehabilitation ward of a large general hospital with natural exposure to COVID-19 at the beginning of the outbreak in Wuhan. This rehabilitation ward is responsible for improving the functional status of a large number of patients with severe neurological injuries in the subacute phase for reasonable transfer to other institutions. 1 We analyzed the demographic characteristics, major injuries, comorbidities, dysfunctions, and daily activity levels of COVID-19 patients with BD from this ward and further explored the differences between these patients and noninfected subjects with BD.

From December 30, 2019 to February 17, 2020, 38 patients with subacute neurological disorders (25 with BD and 13 with spinal cord injuries) were admitted to this rehabilitation ward. A series of strict measures related to COVID-19 were implemented for all personnel in this ward starting A C C E P T E D on January 22, 2020. In addition to daily environmental disinfection, hand hygiene and mask protection were also required for all members. Patients with fever were isolated immediately.

Blood tests, computed tomography (CT) and real-time polymerase chain reaction (PCR) were performed as soon as possible. Finally, four patients were diagnosed with COVID-19 infection by PCR assay and transferred to the designated medical institution during this period. There were no reports of COVID-19 in staff and caregivers.

The 4 male patients who were diagnosed with COVID-19 pneumonia all suffered from BD, accounting for 16% of all BD patients (21 male/4 female) in this ward. The median ages of the noninfected and infected BD patients were 50 (IQR, 37.5 -63) and 60.5 (IQR, 48.5 -68), respectively. COVID-19 patients with BD showed a higher prevalence rate of tracheotomy (75% vs 9.5%, P = 0.016) and underlying pulmonary infection (100% vs 38.1%, P = 0.039). Their modified Barthel Index (MBI) scores were significantly lower than those of noninfected subjects with BD (7.5 ± 9.6 vs 29.5 ± 26.4, P = 0.011). These four people were the only inpatients under double supervision with 2 caregivers in the ward. The detailed clinical characteristics of the infected and noninfected patients with BD, including demographics, primary diagnosis, invasive intervention history, underlying diseases, dysfunctions and activity levels, were compared and are presented in Table 1 .

All four patients developed fever first; 3 had cough, and 1 had dyspnea. One 65-year-old male (Case 1) experienced nausea, vomiting, diarrhea and chills but no dyspnea. The hemoglobin and A C C E P T E D albumin levels of these 4 patients were lower than or equal to the threshold value. Only Case 3 showed a significant increase in white blood cell count (13.49×10 9 /L) and neutrophil count (11.02×10 9 /L) simultaneously with fever and cough. No other symptoms were reported. In addition to treatment for BD, these patients received antiviral treatment, antibiotics, corticosteroids, intravenous immunoglobin and oxygen therapy. Unfortunately, the oldest of the four patients (Case 4) died within a week after diagnosis, two of the other three patients were classified as severely infected, and one was mildly infected. As of April 15, 2020, two patients were discharged home, and one patient still needed hospitalization. The detailed information of these patients is shown in Table 1 . The most notable features of these four patients were impaired airway, reduced activity, previous pulmonary infection and a variety of other underlying diseases and dysfunctions. The median MBI score of 5(full score 100) indicates extremely impaired daily activity levels. 2 Unlike the emergency diagnosis procedure for COVID-19, which advocated for CT at that time, the first symptom of these patients was fever, and the subsequent CT scan did not suggest typical changes. The blood tests also found no obvious reduction in lymphocyte count. Finally, these patients were quickly isolated as suspected cases after the appearance of clinical symptoms such as fever and cough and then confirmed by real-time PCR. The patients' underlying pulmonary infections may make the CT manifestation of COVID-19 pneumonia atypical, and the images of old and new lesions superimposed on each other increases the difficulty of imaging diagnosis. In In conclusion, BD inpatients with impaired airways and low activity levels are more susceptible to COVID-19 and can easily become severely ill or even die. We look forward to the results of this retrospective analysis, which can provide useful information for other institutions that care for high-risk populations such as patients with BD. IQR represents interquartile range. * represents p < 0.05

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