Does "Flattening the Curve" Affect Critical Care Services Delivery for COVID-19? A Global Health Perspective
INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
Authors: Gilardino, Ramiro E.
During this coronavirus disease 2019 (COVID-19) global pandemic, nations are taking bold measures to mitigate the spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in order to avoid the overwhelming its critical care facilities. While these "flattening the curve" initiatives are showing signs of impeding the potential surge in COVID-19 cases, it is not known whether these measures alleviate the burden placed on intensive care units. Much has been made of the desperate need for critical care beds and medical supplies, especially personal protective equipment (PPE). But while these initiatives may provide health systems time to bolster their critical care infrastructure, they do little to protect the most essential element - the critical care providers. This article examines bolder initiatives that may be needed to both protect crucial health systems and the essential yet vulnerable providers during this global pandemic.
Headache: A striking prodromal and persistent symptom, predictive of COVID-19 clinical evolution
Authors: Caronna, Edoardo; Ballve, Alejandro; Llaurado, Arnau; Jose Gallardo, Victor; Maria Ariton, Diana; Lallana, Sofia; Lopez Maza, Samuel; Olive Gadea, Marta; Quibus, Laura; Restrepo, Juan Luis; Rodrigo-Gisbert, Marc; Vilaseca, Andreu; Hernandez Gonzalez, Manuel; Martinez Gallo, Monica; Alpuente, Alicia; Torres-Ferrus, Marta; Pujol Borrell, Ricard; Alvarez-Sabin, Jose; Pozo-Rosich, Patricia
Objective To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. Methods This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. Results Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 +/- 11.6 vs. 31.2 +/- 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). Conclusions Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.