New research on PASC, COVID-19 infection and vaccination during pregnancy

The aftereffects of COVID-19 were the focus of two recent studies. The first, an analysis of Medicare beneficiaries published by The BMJ on Feb. 9, found that 32% of 87,337 COVID-19 survivors ages 65 years or older sought medical attention for one or more new or persistent symptoms in the 120 days after diagnosis, a higher rate than in comparison groups of patients without COVID-19. However, compared to a group of patients who were treated for viral lower respiratory tract illnesses before the pandemic, the only significantly more common sequelae were respiratory failure, dementia, and postviral fatigue, which increased by rates of 2.39, 0.71, and 0.18 per 100 patients, respectively. “These findings further highlight the wide range of important sequelae after acute infection with the SARS-CoV-2 virus,” the authors concluded. The other study, published by Critical Care Medicine on Feb. 8, reported on neurologic consultations in 41 French patients who had been treated for COVID-19 in an ICU. At a median of 3.8 months after discharge, about half of the patients had mild cognitive impairment; ICU-acquired weakness, depression or anxiety, and post-traumatic stress disorder were reported by 16%, 26%, and 7%, respectively.

Multiple recent studies made the case for vaccination against COVID-19 during pregnancy. A retrospective study of 14,104 patients admitted to 17 U.S. hospitals for delivery in 2020 found that the 586 patients who had a moderate or worse SARS-CoV-2 infection had a significantly higher risk of a composite outcome of maternal death or serious morbidity related to hypertensive disorders of pregnancy, postpartum hemorrhage, or infection besides COVID-19 than uninfected patients (26.1% vs. 9.2%; adjusted rate ratio, 2.06 [95% CI, 1.73 to 2.46]). Mild or asymptomatic COVID-19 was not associated with increased risk. All five maternal deaths were in the SARS-CoV-2-positive group, according to results published by JAMA on Feb. 7. The second study, published by JAMA Pediatrics on Feb. 10, looked at 24,288 newborns, of whom 16,697 were exposed to the Pfizer-BioNTech COVID-19 vaccine in utero, and found no evident differences in their health based on maternal vaccination.

Another study of infants, published by JAMA on Feb. 7, found that those whose mothers had been vaccinated were more likely to have detectable antibodies against SARS-CoV-2 at six months than those whose mothers had been infected with COVID-19 (57% [16 of 28] vs. 8% [1 of 12]).

In other COVID-19 news, ACP and Annals of Internal Medicine presented “COVID-19 Forum VIII: Outpatient Evaluation and Management of Patients with COVID-19” on Wednesday, Feb. 9. The eighth edition of the forum series featured expert panelists discussing appropriate testing, quarantine and isolation periods, management of symptoms, and recommended treatments. The forum was moderated by Rebecca Andrews, MD, FACP, associate program director of categorical internal medicine at the University of Connecticut in Farmington and Chair of ACP's Board of Governors. The panelists included Jason Gallagher, PharmD, clinical professor at Temple University School of Pharmacy in Philadelphia; Roy M. Gulick, MD, MPH, Rochelle Belfer Professor in Medicine and chief of the division of infectious diseases at Weill Medical College of Cornell University in New York City; Megan L. Ranney, MD, MPH, Warren Alpert Endowed Professor of Emergency Medicine and academic dean at Brown University School of Public Health in Providence, R.I.; and Paul E. Sax, MD, professor of medicine at Harvard Medical School and clinical director of the division of infectious diseases at Brigham and Women's Hospital in Boston. The full recording of the forum is available for replay and was published in Annals of Internal Medicine along with commentary by Christine Laine, MD, MPH, FACP, ACP Senior Vice President and Editor-in-Chief of Annals of Internal Medicine.

Also, on Feb. 11, the FDA issued an emergency use authorization (EUA) for outpatient use of a new monoclonal antibody. Bebtelovimab is authorized for treatment of mild to moderate COVID-19 in adults and children 12 years of age and older weighing at least 40 kg who have a positive COVID-19 test result; who are at high risk for progression to severe COVID-19, including hospitalization or death; and for whom alternative approved or authorized COVID-19 treatment options are not accessible or clinically appropriate, the agency said. Bebtelovimab is not authorized for patients hospitalized for COVID-19 or those who require oxygen therapy due to COVID-19.