Peer Reviewed

Risk Management

COVID-19 Roundup: NSAID Use, Rehabilitation, Pregnancy

Non-Steroidal Anti-Inflammatory Medications1

Pre-existing use of non-steroidal anti-inflammatory medications (NSAIDs) does not result in increased disease severity or worse outcomes for patients with COVID-19, according to the results of a recent study. 

Included in this prospective, multicenter cohort study were patients who were hospitalized in 1 of 255 health care facilities in England, Scotland, and Wales between January to August 2020. Two cohorts of 4205 patients each were included in the study, of which one group reported taking NSAIDs within the 2 weeks prior to hospital admission. 

There were no significant differences in disease severity between NSAID users and NSAID non-users. Worse in-hospital mortality, critical care admission, requirement for invasive ventilation, non-invasive ventilation and oxygen, and occurrence of acute kidney injury were not significantly associated with NSAID use. 

 

COVID Rehabilitation2

Recovery programs may improve lasting COVID-19 symptoms that impact quality of life, such as exercise capacity, respiratory symptoms such as breathlessness, fatigue, and cognition. 

A total of 30 individuals completed the twice weekly rehabilitation program that lasted 6 weeks. Included in the program was supervised aerobic exercise, strength training of upper and lower limbs, and educational handouts on symptom management. 

Following the recovery program, participants had improved scores for the incremental and endurance shuttle walking tests, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the COPD Assessment Test, among other clinical tools. 

“To conclude, a rehabilitation program to support individuals with symptoms of long-COVID is safe and demonstrates improvements in exercise capacity and symptoms of breathlessness, fatigue, and cognition,” the researchers wrote. 

 

In-Hospital Mortality for Pregnant Patients with COVID-193

Pregnant patients who are hospitalized with COVID-19 are not at an increased risk of death.

Symptomatic patients with COVID-19 and a viral pneumonia diagnosis who were hospitalized from April to November 2020 were examined to better understand the relationship between pregnancy and COVID-19 mortality risk. 

Among the 1062 pregnant patients included in this retrospective cohort study, 9 (0.8%) in-hospital deaths occurred. Of the 9815 nonpregnant patients, 340 (3.5%) in-hospital deaths occurred. 

The median time from admission to death for pregnant patients was 18 days, and the median time for nonpregnant patients was 12 days.

Further, among those admitted to an intensive care unit, the mortality rate increased to 3.5% (9 of 255) in pregnant patients and 14.9% (283 to 937) of nonpregnant patients. For pregnant patients who received mechanical ventilation, the mortality rate was 8.6% (9 of 105), while the morality rate for nonpregnant patients was 31.4% (294 of 937). 

“Overall and within multiple subgroups, we found a substantially lower rate of in-hospital mortality in pregnant patients than nonpregnant patients hospitalized with COVID-19 and viral pneumonia,” the researchers concluded. 

 

COVID-19 and Placenta in Pregnancy4

Placentas from patients who were vaccinated against COVID-19 during pregnancy do not show any evidence of injury, according to the results of a recent study.

A total of 84 vaccinated women and 114 nonvaccinated women were included in the study. Vaccinated women were more likely to deliver vaginally and displayed strong antibody responses whereas the nonvaccinated did not. There was no increased incidence of decidual arteriopathy, fetal vascular malperfusion, low-grade chronic villitis, or chronic histiocytic intervillositis in the vaccinated group when compared to the control. 

“In our cohort of vaccinated pregnant patients, there was no observed increase in the incidence of findings characteristic of SARS-CoV-2 infection in pregnancy and no evidence of vaccine-triggered breakdown in maternal immunologic tolerance of the feus,” the researchers concluded. “Although limited by population differences between vaccinated and unvaccinated patients, these findings add to the growing literature supporting the safety of SARS-CoV-2 vaccination in pregnancy. 

 

—Leigh Precopio

 

Reference: 

  1. Drake TM, Farifield CJ, Pius R, et al. Non-steroidal anti-inflammatory drug use and outcomes of COVID-19 in the ISARIC clinical characterization protocol UK cohort: a matched, prospective cohort study. The Lancet. Published online May 7, 2021. doi: 10.1016/S2665-9913(21)00104-1
  2. Daynes E, Gerlis C, Chaplin E, Gardiner N, Singh SJ. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition – a cohort study. Chronic Respiratory Disease. Published online May 6, 2021. doi: 10.1177/14799731211015691
  3. Pineles BL, Goodman KE, Pineles L, et al. In-hospital mortality in a cohort of hospitalized pregnant and nonpregnant patients with COVID-19. Annals Intern Med. Published online May 11, 2021. doi: 10.7326/M21-0974
  4. Shanes ED, Otero S, Mithal LB, Mupanomunda CA, Miller ES, Goldstein JA. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) vaccination in pregnancy. Obstetrics & Gynecology. Published online May 11, 2021. doi: 10.1097/AOG.0000000000004457