Hospital Epidemiology and Infection Control in the Era of the COVID-19 Pandemic

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Infectious Disease".

Deadline for manuscript submissions: closed (28 February 2022) | Viewed by 35905

Special Issue Editors


E-Mail Website1 Website2
Guest Editor
1. School of Medicine, University of Crete, Crete, Greece
2. School of Health and Related Research, University of Sheffield, Sheffield, UK
Interests: medical statistics; epidemiological methods; healthcare epidemiology; infection control; antimicrobial resistance; surveillance; public health
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
School of Medicine, University of Crete, 715 00 Giofirakia, Greece
Interests: infectious diseases; infection control; clinical microbiology; healthcare-associated infections; antimicrobial resistance; antibiotic stewardship; surveillance; public health

Special Issue Information

Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic has had major operational and organizational impacts on healthcare systems globally. Traditional infection prevention resources at the hospital level (both infrastructure and personnel) have been largely diverted to help manage COVID-19 outbreaks at the health system level. Although this shift of resources has understandably taken immediate priority, it may have disrupted or even compromised conventional infection prevention duties (e.g., surveillance), especially in areas of high severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) activity and/or low resource settings. We are beginning to see reports, for example, of high and inappropriate use of broad-spectrum antibiotics, shortages of staff, shortages of personal protective equipment, and overcrowded facilities due to the rapid increase of hospital admissions of COVID-19 patients. Of concern, the pandemic is occurring in parallel with an antimicrobial resistance crisis of alarming pace worldwide. Severe COVID-19, which particularly affects multi-morbid elderly patients, may be an important factor in increasing the spread of multi-drug-resistant bacteria in the hospital setting. On the other hand, infection prevention and control are playing a crucial role in the management of COVID-19, and a unique opportunity is arising to reevaluate and strengthen areas that may have been previously overlooked, as well as implement innovative approaches necessitated by the pandemic.

This Special Issue of Medicina seeks to collate original research papers, systematic reviews, and meta-analyses investigating potential implications or impacts (either negative or positive) of the COVID-19 pandemic on healthcare epidemiology and infection control, including changes in the epidemiology of healthcare-associated infections and antimicrobial resistance in hospital settings.

Prof. Evangelos I. Kritsotakis
Prof. Achilleas Gikas
Guest Editor

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Keywords

  • infection prevention
  • infection control
  • antimicrobial resistance
  • antimicrobial stewardship
  • healthcare epidemiology
  • hospital
  • covid-19
  • sars-cov-2
  • pandemic

Published Papers (10 papers)

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Research

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10 pages, 1037 KiB  
Article
Adverse Events and Immunogenicity of mRNA-Based COVID-19 Vaccine among Healthcare Workers: A Single-Centre Experience
by Jolanta Sauserienė, Ida Liseckienė, Vitalija Neverauskė, Eglė Šepetauskienė, Danielius Serapinas, Šarūnas Mačinskas, Brigita Šitkauskienė, Ieva Bajoriūnienė, Rūta Vaičiūnienė and Leonas Valius
Medicina 2022, 58(3), 441; https://doi.org/10.3390/medicina58030441 - 17 Mar 2022
Cited by 3 | Viewed by 2214
Abstract
Background and Objectives: The safety and effectiveness of vaccines are among the key priorities in COVID-19 pandemic management. Moreover, evidence-based data regarding vaccine safety and immunogenicity can play an important role in building the trust of the community regarding vaccination. The aim [...] Read more.
Background and Objectives: The safety and effectiveness of vaccines are among the key priorities in COVID-19 pandemic management. Moreover, evidence-based data regarding vaccine safety and immunogenicity can play an important role in building the trust of the community regarding vaccination. The aim of this study was to investigate the safety and immunogenicity of Pfizer-BioNTech vaccine among healthcare workers in one hospital, 21 days after first dose. Materials and Methods: This study was conducted in the Hospital of the Lithuanian University of Health Sciences between February and March 2021. Hospital employees who arrived to receive the second dose of the Pfizer-BioNTech vaccine 21 days after the first one were invited to participate in the study: they were asked to complete an anonymous adverse events questionnaire and were offered a SARS-CoV-2 IgG/IgM rapid test. The study was performed at a single point, 21 days after the first dose of the vaccine. Results: Data of 4181 vaccine recipients were analysed. The first vaccine dose was associated with a 53.6% incidence of adverse events, mainly local reactions. Adverse events occurred more frequently in younger participants and women. Moderate adverse events were experienced by 1.4% of the vaccine recipients; 6.2% were incapacitated. Of the 3439 participants who performed a rapid IgG test, 94.5% were positive for IgG antibodies after the first vaccine dose. Seroconversion rates were lower in participants older than 47 years. Conclusions: Despite 1.4% moderate adverse events, no safety concerns or anaphylaxis were identified. The Pfizer-BioNTech vaccine induced an immune response in the overwhelming majority of recipients after a single dose. Younger participants experienced adverse events and were positive for IgG antibodies more frequently than older counterparts. It is important to mention that this study specifically considered short-term safety and reactions following vaccination and that long-term adverse effects were not investigated in the study. Thus, future research into both long-term adverse reactions and immune system programming is essential. Full article
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9 pages, 1251 KiB  
Article
Towards an Accurate Estimation of COVID-19 Cases in Kazakhstan: Back-Casting and Capture–Recapture Approaches
by Antonio Sarría-Santamera, Nurlan Abdukadyrov, Natalya Glushkova, David Russell Peck, Paolo Colet, Alua Yeskendir, Angel Asúnsolo and Miguel A. Ortega
Medicina 2022, 58(2), 253; https://doi.org/10.3390/medicina58020253 - 8 Feb 2022
Cited by 7 | Viewed by 1975
Abstract
Background and Objectives: Coronavirus disease 19 (COVID-19) has emerged as the most devastating syndemic of the 21st century, with worrisome and sustained consequences for the entire society. Despite the relative success of vaccination programs, the global threat of the novel coronavirus SARS-CoV-2 is [...] Read more.
Background and Objectives: Coronavirus disease 19 (COVID-19) has emerged as the most devastating syndemic of the 21st century, with worrisome and sustained consequences for the entire society. Despite the relative success of vaccination programs, the global threat of the novel coronavirus SARS-CoV-2 is still present and further efforts are needed for its containment and control. Essential for its control and containment is getting closer to understanding the actual extent of SARS-CoV-2 infections. Material and Methods: We present a model based on the mortality data of Kazakhstan for the estimation of the underlying epidemic dynamic—with both the lag time from infection to death and the infection fatality rate. For the estimation of the actual number of infected individuals in Kazakhstan, we used both back-casting and capture–recapture methods. Results: Our results suggest that despite the increased testing capabilities in Kazakhstan, official case reporting undercounts the number of infections by at least 60%. Even though our count of deaths may be either over or underestimated, our methodology could be a more accurate approach for the following: the estimation of the actual magnitude of the pandemic; aiding the identification of different epidemiological values; and reducing data bias. Conclusions: For optimal epidemiological surveillance and control efforts, our study may lead to an increased awareness of the effect of COVID-19 in this region and globally, and aid in the implementation of more effective screening and diagnostic measures. Full article
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11 pages, 306 KiB  
Article
Risk Factors for Therapeutic Intervention of Remdesivir in Mild to Moderate COVID-19—A Single-Center Retrospective Study of the COVID-19 Fourth Pandemic Period in Wakayama, Japan
by Shinobu Tamura, Takahiro Kaki, Mayako Niwa, Yukiko Yamano, Shintaro Kawai, Yusuke Yamashita, Harumi Tanaka, Yoshinobu Saito, Yoshinori Kajimoto, Yusuke Koizumi, Hiroki Yamaue, Naoyuki Nakao, Takako Nojiri and Masaya Hironishi
Medicina 2022, 58(1), 118; https://doi.org/10.3390/medicina58010118 - 13 Jan 2022
Cited by 2 | Viewed by 2077
Abstract
Background and Objectives: The incidence of coronavirus disease 2019 (COVID-19) has increased in Wakayama, Japan, due to the spread of the highly infectious B.1.1.7 variant. Before this event, the medical systems were almost unaffected. We aimed to assess the clinical characteristics of patients [...] Read more.
Background and Objectives: The incidence of coronavirus disease 2019 (COVID-19) has increased in Wakayama, Japan, due to the spread of the highly infectious B.1.1.7 variant. Before this event, the medical systems were almost unaffected. We aimed to assess the clinical characteristics of patients hospitalized with COVID-19 and the risk factors for therapeutic intervention of remdesivir during the fourth pandemic period in Wakayama, Japan. Materials and Methods: This single-center retrospective study enrolled 185 patients with mild to moderate COVID-19 hospitalized in our hospital without intensive care between 14 March and 31 May 2021. Results: In this period, 125 (67.6%) of the 185 patients had the B.1.1.7 variant. Sixty-three patients (34.1%) required remdesivir treatment. Age upon admission and length of hospitalization were significantly different between remdesivir treatment and careful observation groups (mean (standard deviation); 59.6 (14.7) versus 45.3 (20.6) years; p < 0.001 and median (interquartile range); 10 (9–12) versus 9 (8–10) years; p < 0.001). One patient was transferred to another hospital because of disease progression. At hospital admission, age ≥60 years (odds ratio (OR) 6.90, p < 0.001), a previous history of diabetes mellitus (OR 20.9, p = 0.002), B.1.1.7 variant (OR 5.30; p = 0.005), lower respiratory symptoms (OR 3.13, p = 0.011), headache (OR 3.82, p = 0.011), and fever ≥37.5 °C (OR 4.55, p = 0.001) were independent risk factors to require remdesivir treatment during the admission. Conclusions: Many patients with mild to moderate COVID-19 required the therapeutic intervention of remdesivir during the fourth pandemic period in Wakayama, Japan. From the clinical data obtained at admission, these risk factors could contribute to a prediction regarding the requirement of remdesivir treatment in cases of mild to moderate COVID-19. Full article
13 pages, 1867 KiB  
Article
Can Deep Learning-Based Volumetric Analysis Predict Oxygen Demand Increase in Patients with COVID-19 Pneumonia?
by Marie Takahashi, Tomoyuki Fujioka, Toshihiro Horii, Koichiro Kimura, Mizuki Kimura, Yurika Hashimoto, Yoshio Kitazume, Mitsuhiro Kishino and Ukihide Tateishi
Medicina 2021, 57(11), 1148; https://doi.org/10.3390/medicina57111148 - 22 Oct 2021
Cited by 2 | Viewed by 1775
Abstract
Background and Objectives: This study aimed to investigate whether predictive indicators for the deterioration of respiratory status can be derived from the deep learning data analysis of initial chest computed tomography (CT) scans of patients with coronavirus disease 2019 (COVID-19). Materials and [...] Read more.
Background and Objectives: This study aimed to investigate whether predictive indicators for the deterioration of respiratory status can be derived from the deep learning data analysis of initial chest computed tomography (CT) scans of patients with coronavirus disease 2019 (COVID-19). Materials and Methods: Out of 117 CT scans of 75 patients with COVID-19 admitted to our hospital between April and June 2020, we retrospectively analyzed 79 CT scans that had a definite time of onset and were performed prior to any medication intervention. Patients were grouped according to the presence or absence of increased oxygen demand after CT scan. Quantitative volume data of lung opacity were measured automatically using a deep learning-based image analysis system. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of the opacity volume data were calculated to evaluate the accuracy of the system in predicting the deterioration of respiratory status. Results: All 79 CT scans were included (median age, 62 years (interquartile range, 46–77 years); 56 (70.9%) were male. The volume of opacity was significantly higher for the increased oxygen demand group than for the nonincreased oxygen demand group (585.3 vs. 132.8 mL, p < 0.001). The sensitivity, specificity, and AUC were 76.5%, 68.2%, and 0.737, respectively, in the prediction of increased oxygen demand. Conclusion: Deep learning-based quantitative analysis of the affected lung volume in the initial CT scans of patients with COVID-19 can predict the deterioration of respiratory status to improve treatment and resource management. Full article
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4 pages, 272 KiB  
Article
Performance of Antigen-Based Testing as Frontline Diagnosis of Symptomatic COVID-19
by Efrén Murillo-Zamora, Xóchitl Trujillo, Miguel Huerta, Mónica Ríos-Silva and Oliver Mendoza-Cano
Medicina 2021, 57(8), 852; https://doi.org/10.3390/medicina57080852 - 21 Aug 2021
Cited by 3 | Viewed by 2723
Abstract
Background and Objectives: To evaluate the performance of antigen-based detection tests as the frontline diagnosis of coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a nationwide retrospective cohort study in Mexico. A cross-sectional analysis of a cohort study was conducted [...] Read more.
Background and Objectives: To evaluate the performance of antigen-based detection tests as the frontline diagnosis of coronavirus disease 2019 (COVID-19). Materials and Methods: We conducted a nationwide retrospective cohort study in Mexico. A cross-sectional analysis of a cohort study was conducted in Mexico and data from 15,408 suspected (all of them symptomatic) cases of COVID-19 were analyzed. The results of antigen-based tests were compared with those obtained by molecular (polymerase chain reaction-based) assays. Results: The antigen-based tests showed sensitivity below 50% and high specificity in all the analyzed age groups. The highest Youden index (J) was observed among adults aged 25–44 years old (45.5, 95% CI 43.7–47.3). Conclusions: We documented the poor performance of serologic techniques as frontline diagnosis of symptomatic COVID-19 and inaccurate results may impact negatively on pandemic progression. Full article
14 pages, 1319 KiB  
Article
The Prospect of Lactoferrin Use as Adjunctive Agent in Management of SARS-CoV-2 Patients: A Randomized Pilot Study
by Fahad Dhafer Algahtani, Mohamed Tharwat Elabbasy, Mai A. Samak, Adeniyi A. Adeboye, Rafeek A. Yusuf and Mohamed E. Ghoniem
Medicina 2021, 57(8), 842; https://doi.org/10.3390/medicina57080842 - 19 Aug 2021
Cited by 18 | Viewed by 5359
Abstract
Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently [...] Read more.
Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently no widely approved treatment for SARS-CoV-2 (COVID-19). Strict adherence to infection prevention and control procedures, as well as vaccines, can, however, prevent the spread of SARS-CoV-2. This study aimed to evaluate the efficacy of lactoferrin treatment in improving clinical symptoms and laboratory indices among individuals with mild to moderate coronavirus disease-19 (COVID-19). Materials and Method: A randomized, prospective, interventional pilot study conducted between 8 July and 18 September 2020 used a hospital-based sample of 54 laboratory-confirmed participants with mild to moderate symptoms of COVID-19. Randomization into a control and two treatment groups ensured all groups received the approved Egyptian COVID-19 management protocol; only treatment group participants received lactoferrin at different doses for seven days. Clinical symptoms and laboratory indices were assessed on Days 0, 2 and 7 after starting treatments. Mean values with standard deviation and one-way analysis of variance with least significant difference of demographic and laboratory data between control and treatment groups were calculated. Results: Our study showed no statistically significant difference among studied groups regarding recovery of symptoms or laboratory improvement. Conclusions: Further research into therapeutic properties particularly related to dosage, duration and follow-up after treatment with lactoferrin in individuals with COVID-19 is required. Full article
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4 pages, 573 KiB  
Communication
Effectiveness of BNT162b2 COVID-19 Vaccine in Preventing Severe Symptomatic Infection among Healthcare Workers
by Efrén Murillo-Zamora, Xóchitl Trujillo, Miguel Huerta, Mónica Riós-Silva and Oliver Mendoza-Cano
Medicina 2021, 57(8), 746; https://doi.org/10.3390/medicina57080746 - 23 Jul 2021
Cited by 8 | Viewed by 2919
Abstract
Background and Objectives: This study aims to evaluate the effectiveness of the BNT162b2 COVID-19 (coronavirus disease 2019) in preventing severe symptomatic laboratory-confirmed infection among healthcare workers in a real-world scenario. Materials and Methods: A cross-sectional analysis of a prospective cohort study was conducted. [...] Read more.
Background and Objectives: This study aims to evaluate the effectiveness of the BNT162b2 COVID-19 (coronavirus disease 2019) in preventing severe symptomatic laboratory-confirmed infection among healthcare workers in a real-world scenario. Materials and Methods: A cross-sectional analysis of a prospective cohort study was conducted. Subjects with onset illness from January to February 2021 were eligible and classified according to the number of vaccine doses received (single-shot, n = 8; two-shot, n = 12; unvaccinated, n = 290). Results: The vaccine effectiveness against severe illness was 100% in the single and two-shot group. The presented results suggest that vaccination reduces the frequency of severe symptomatic COVID-19 in working-age adults. Conclusions: Efforts focusing on maximizing the number of immunized subjects in the study population may reduce associated economic and social burdens. Full article
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9 pages, 513 KiB  
Article
Evaluation of Mortality and Morbidity According to Initial Symptoms in COVID-19 Patients Using Clinical Epidemiologic Data from the Korea Centers for Disease Control & Prevention
by So Young Kim, Dae Myoung Yoo, Chanyang Min, Joo-Hee Kim and Hyo Geun Choi
Medicina 2021, 57(7), 688; https://doi.org/10.3390/medicina57070688 - 6 Jul 2021
Cited by 2 | Viewed by 1775
Abstract
Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum [...] Read more.
Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum level of morbidity during hospital admission was classified as mild or severe, and patient mortality was recorded. Clinical symptoms were categorized as respiratory, gastrointestinal, general, and neurologic symptoms. The hazard ratios (HRs) for clinical symptoms associated with mortality were analyzed using the Cox proportional hazards model. The odds ratios (ORs) for clinical symptoms associated with morbidity were analyzed using the logistic regression model. Results: Of the included COVID-19 patients, 15.4% (808/5253) were classified as having severe morbidity. Morbidity was related to the clinical symptoms of cough, sputum, shortness of breath, vomiting/nausea, diarrhea, fever, and altered mental status or confusion. According to the symptom categories, respiratory and general symptoms were related to high morbidity (OR = 1.41, 95% CI = 1.30–1.53, p < 0.001 for respiratory symptom and OR = 1.37, 95% CI = 1.18–1.59, p < 0.001 for general symptom). Mortality was associated with the clinical symptoms of shortness of breath, fever, and altered mental status or confusion. Among the symptom categories, respiratory symptoms were associated with a 1.17-fold increased HR for mortality (95% CI = 1.04–1.32, p = 0.008). Conclusions: Initial respiratory symptoms were related to high morbidity and mortality in COVID-19 patients. Full article
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8 pages, 369 KiB  
Article
Stroke Patients’ Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study
by Hong Chuan Loh, Kar Keong Neoh, Angelina Siing Ngi Tang, Chen Joo Chin, Purnima Devi Suppiah, Irene Looi, Khang Wen Goh, Ching Siang Tan and Long Chiau Ming
Medicina 2021, 57(5), 507; https://doi.org/10.3390/medicina57050507 - 19 May 2021
Cited by 3 | Viewed by 3777
Abstract
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given [...] Read more.
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services. Full article
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Review

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8 pages, 5003 KiB  
Review
Skeletal Muscle Damage in COVID-19: A Call for Action
by Amira Mohammed Ali and Hiroshi Kunugi
Medicina 2021, 57(4), 372; https://doi.org/10.3390/medicina57040372 - 12 Apr 2021
Cited by 71 | Viewed by 9013
Abstract
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as [...] Read more.
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary. Full article
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