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Introduction: Serum levels of interleukin-6 (IL-6) are increased in COVID-19 patients. IL-6 is an effective therapeutic target in inflammatory diseases and tocilizumab, a monoclonal antibody that blocks signaling via the IL-6 receptor (IL-6R), is used to treat patients with severe COVID-19. However, the IL-6R exists in membrane-bound and soluble forms (sIL-6R), and the sIL-6R in combination with soluble glycoprotein 130 (sgp130) forms an IL-6-neutralizing buffer system capable of neutralizing small amounts of IL-6. Methods: In this study, we analyzed serum levels of IL-6, sIL-6R and sgp130 in the serum of COVID-19 convalescent individuals with a history of mild COVID-19 disease and in acute severely ill COVID-19 patients compared to uninfected control subjects. Furthermore, we used single cell RNA sequencing data in order to determine which immune cell types are sources and targets of the individual cytokines and whether their expression is altered in severe COVID-19 patients. Results: We find that sIL-6R levels are not only increased in acute severely ill patients, but also in convalescents after a mild COVID-19 infection. We show that this increase in sIL-6R results in an enhanced capacity of the sIL-6R/sgp130 buffer system, but that significantly enhanced free IL-6 is still present due to an overload of the buffer. Further, we identify IL-6 serum levels, age and the number of known pre-existing medical conditions as crucial determinants of disease outcome for the patients. We also show that IL-11 has no major systemic role in COVID-19 patients and that sCD25 is only increased in acute severely ill COVID-19 patients, but not in mild convalescent individuals. Discussion: In conclusion, our study shows long-lasting alterations of the IL-6 system after COVID-19 disease, which might be relevant when applying anti-IL-6 or anti-IL-6R therapy. [ABSTRACT FROM AUTHOR]

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The significant increase in patients during the COVID-19 pandemic presented the healthcare system with a variety of challenges. The intensive care unit is one of the areas particularly affected in this context. Only through extensive infection control measures as well as an enormous logistical effort was it possible to treat all patients requiring intensive care in Germany even during peak phases of the pandemic, and to prevent triage even in regions with high patient pressure and simultaneously low capacities. Regarding pandemic preparedness, the German Parliament passed a law on triage that explicitly prohibits ex post (tertiary) triage. In ex post triage, patients who are already being treated are included in the triage decision and treatment capacities are allocated according to the individual likelihood of success. Legal, ethical, and social considerations for triage in pandemics can be found in the literature, but there is no quantitative assessment with respect to different patient groups in the intensive care unit. This study addressed this gap and applied a simulation-based evaluation of ex ante (primary) and ex post triage policies in consideration of survival probabilities, impairments, and pre-existing conditions. The results show that application of ex post triage based on survival probabilities leads to a reduction in mortality in the intensive care unit for all patient groups. In the scenario close to a real-world situation, considering different impaired and prediseased patient groups, a reduction in mortality of approximately 15% was already achieved by applying ex post triage on the first day. This mortality-reducing effect of ex post triage is further enhanced as the number of patients requiring intensive care increases. [ABSTRACT FROM AUTHOR]

Few studies have examined the impact of the initial school closures and stay-at-home orders on those vulnerable children and adolescents with preexisting psychiatric conditions. In our study, we explore the impact on this population and identify risk and resilience factors by looking both at those children who were impacted negatively as well as those who were impacted positively by this period. Questionnaires were administered by child and adolescent psychiatrists to 101 parents of child and adolescent outpatients in a mental health clinic as well as 75 of the adolescents, themselves, during the initial stay-at-home orders in Israel. Parents and their children were asked how the situation changed the symptoms for which the children are being treated at our clinic. Information regarding demographic, family, and individual factors was also gathered. The largest group of parents (44%) reported improvement in their child's symptoms during this period, whereas 33% reported no change and 25% reported worsening. Risk factors included parental stress and level of child preoccupation with Covid-19. The major protective factor was parental presence. Although home confinement during the Covid-19 pandemic can lead to worsening mental health status among children, it can also provide an opportunity for those with previous mental health conditions to improve and strive. For these children to improve during such a period, decreased social and academic demands and increased parental presence seem to be key factors. For those who deteriorate, identifying and targeting parental stress can be as important as targeting the child's stress during such times. [ABSTRACT FROM AUTHOR]

The novel coronavirus disease (COVID-19) has infected more than 10 million people globally, and it caused more than 500 thousand deaths. Researchers have highlighted the need for early detection and intervention for psychological ill effect of the pandemic on various population subgroups. Women may be more vulnerable in such a crisis phase. This review addresses the mental health needs of women and the kind of interventions needed to cater to their various psychological issues. All existing literature was searched using PubMed, Google Scholar, and Medline databases for articles published on mental health aspects of women during COVID-19 pandemic. Only English language articles published till June 15, 2020, were considered for the review. Data were extracted by the authors from the selected articles, and the findings were synthesized in a narrative format. From the available literature, following themes were identified for further discussion: sexual health and contraception, pregnancy, lactation, domestic abuse, female healthcare workers, women with pre-existing mental illness, women with substance use disorders, homeless women, refugees, and professional sex workers. Studies have reported a higher burden of mental health issues in females than male counterparts and an increase in domestic violence and crises for those at-risk (such as refugees and women with pre-existing illnesses). Women mental health is compromised in many aspects due to COVID-19 pandemic. Findings stress upon the increased need for early detection and prompt intervention for women in the community to alleviate the long-term psychological consequences of this pandemic. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to get an overview of barriers emerging across the globe from the pandemic that are likely to increase the level of pre-existing disability status of neurologically challenged populations. Database searches (PubMed/MEDLINE, CINAHL, ProQuest, Ovid, Scopus, and Web of Science) updated to December 2020 were conducted. Articles that identified challenges or barriers to neuro-rehabilitation, impact on disability status and health care services were included. Full-text articles limited to the English language with no restrictions on study design were included. Data was synthesized based on recurrent themes that were identified. Thirty-seven studies were included in this review. Neurological populations considered: stroke, multiple sclerosis, amyotrophic lateral sclerosis, parkinson's disease, autism, developmental disabilities, and those who required neurosurgical care. Barriers were grouped into categories as increased disease risk and complications, delayed or restricted access to neuro-rehabilitation, limited hospital access, telerehabilitation limitations, and shutdown of special centers of aid. COVID-19 pandemic has given rise to barriers that affect almost every aspect of healthcare and rehabilitation in neurologically challenged populations prompting an increase in their disability level. This can assist policymakers in designing mitigation strategies to minimize the detrimental effects on this vulnerable population. Pandemic has led to the worsening of existing motor and non-motor symptoms, which need to be monitored, assessed and managed medically, and through rehabilitation in neurologically challenged populations. Notable decline of cognition and physical activity in neurologically challenged populations needs to be assessed and efforts to reverse these outcomes should be attempted. Rehabilitation services, hospital care and centers of aid need to be made more accessible for neurologically challenged populations with COVID-19 precautionary measures. Telemedicine and telerehabilitation need to be upgraded to enhance further face to face like interactions and for tracking of progressive disease. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, South Africa implemented a strict stay-at-home order. The mental health effects of the pandemic and related containment measures are minimally documented in this region. This study examines the association between COVID-19 related stressors and mental health during a strict stay-at-home order in South Africa. A total of 860 self-selected participants residing in the Western Cape province completed an online survey from 20–31 May 2020. This sample consisted mainly of higher socioeconomic and higher educated segments of the population. Structural equation modelling was used to assess how sociodemographic factors, membership of vulnerable groups and COVID-19 related stressors were associated with PHQ-9 (depression) and GAD-7 (anxiety) scores. 46.0% and 47.2% of participants met the diagnostic threshold of anxiety and depressive disorder, respectively. Considerable daily life repercussions were linked to these scores. Among these participants, less than 20% consulted a formal practitioner and this was 12% for participants without a pre-existing mental health condition. Distress related to containment measures and distress about being infected were significantly associated with more anxiety and depressive symptoms. Having a pre-existing mental health condition was associated with poorer mental health, but being an active health worker was not. Younger age, being female, and living in a non-rural area were associated with poorer mental health. Our findings suggest a considerable mental health impact of this pandemic and related containment measures, but low attendance of mental health services. The accessibility to tailored mental health support is essential under these circumstances, especially for vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. Aim: To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. Methods: A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient (r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. Results: A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant – { r = 0.405, Sig. (two-tailed) = 0.001}. Conclusion: Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms. [ABSTRACT FROM AUTHOR]

Determining who is particularly vulnerable to mental health deterioration during the COVID-19 pandemic is essential when designing and targeting interventions to mitigate the adverse psychological impacts of the outbreak. Older people have appeared to be less exposed to mental health deterioration compared with younger individuals, but most exposed to the risk of severe illness and death from the virus, as well as less equipped to use technologies for coping with lockdown measures. Amongst the old population, we aim at determining how depressive symptoms have changed during the first wave of the COVID-19 pandemic and identifying individual risk factors associated with changes in reporting depression. We are particularly interested in exploring the role of pre-existing mental health problems and evaluating gender differences. Data come from the Survey of Health, Ageing and Retirement in Europe, in particular from the first COVID-19 survey administered in summer 2020. Logistic models are estimated and Average Marginal Effects computed to take the degree of individual unobserved heterogeneity into account comparing point estimates across samples. Multiple Imputation (implemented through Multivariate Imputation by Chained Equations) is used to replace missing data. Statistical power of the effect sizes is estimated by a simulation approach. Pre-existing mental health problems, a diagnosis of affective/emotional disorders, a recent diagnosis of a major illness, and (only for men) job loss during the first wave of the outbreak are the most important risk factors. Statistical differences between genders emerge, with women experiencing higher levels of depression and greater worsening of mental health than men. To identify people at greater risk of depression deterioration during an outbreak it is very important to consider their pre-existing mental and general health, distinguishing severity level. On population level, it is also crucial to evaluate depression disorders separately by gender. • We studied depression deterioration among adults 50+ after the first COVID-19 wave. • Women reported higher levels of increasing sadness/depression than men. • Pre-existing mental health disorders increase the risk of depression deterioration. • Job loss was meaningfully associated with depression deterioration only for men. • People were more worried about the chance than the fact of being infected. [ABSTRACT FROM AUTHOR]