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Objectives: COVID-19 studies report on hospital admission outcomes across SARS-CoV-2 waves of infection but knowledge of the impact of SARS-CoV-2 variants on the development of Long COVID in hospital survivors is limited. We sought to investigate Long COVID outcomes, aiming to compare outcomes in adult hospitalised survivors with known variants of concern during our first and second UK COVID-19 waves, prior to widespread vaccination., Design: Prospective observational cross-sectional study., Setting: Secondary care tertiary hospital in the UK., Participants: This study investigated Long COVID in 673 adults with laboratory-positive SARS-CoV-2 infection or clinically suspected COVID-19, 6 weeks after hospital discharge. We compared adults with wave 1 (wildtype variant, admitted from February to April 2020) and wave 2 patients (confirmed Alpha variant on viral sequencing (B.1.1.7), admitted from December 2020 to February 2021)., Outcome Measures: Associations of Long COVID presence (one or more of 14 symptoms) and total number of Long COVID symptoms with SARS-CoV-2 variant were analysed using multiple logistic and Poisson regression, respectively., Results: 322/400 (wave 1) and 248/273 (wave 2) patients completed follow-up. Predictors of increased total number of Long COVID symptoms included: pre-existing lung disease (adjusted count ratio (aCR)=1.26, 95% CI 1.07, 1.48) and more COVID-19 admission symptoms (aCR=1.07, 95% CI 1.02, 1.12). Weaker associations included increased length of inpatient stay (aCR=1.02, 95% CI 1.00, 1.03) and later review after discharge (aCR=1.00, 95% CI 1.00, 1.01). SARS-CoV-2 variant was not associated with Long COVID presence (OR=0.99, 95% CI 0.24, 4.20) or total number of symptoms (aCR=1.09, 95% CI 0.82, 1.44)., Conclusions: Patients with chronic lung disease or greater COVID-19 admission symptoms have higher Long COVID risk. SARS-CoV-2 variant was not predictive of Long COVID though in wave 2 we identified fewer admission symptoms, improved clinical trajectory and outcomes. Addressing modifiable factors such as length of stay and timepoint of clinical review following discharge may enable clinicians to move from Long COVID risk stratification towards improving its outcome., Competing Interests: Competing interests: JRH, SM and AS report personal fees, and JRH, SM, AS and AJS report non-financial support from pharmaceutical companies that make medicines and medical devices to treat respiratory disease, outside the submitted work., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The COVID-19 pandemic has caused major disruption to healthcare services globally. We present the findings of a national survey of home mechanical ventilation (HMV) services in England and Wales. 30 HMV services (60%) responded. There was a significant reduction in outpatient services with 93% of services not offering routine face-to-face appointments, although most centres were able to offer emergency appointments for ventilation review and set-up. HMV inpatient capacity was reassigned, and HMV service staff re-deployed in the majority of centres (97%). The initial wave of the COVID-19 pandemic left a service backlog of a median of 87 outpatient appointments [range 0-1500] and a median of 4 patients (range 0-100) awaiting NIV set-up., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: Pneumothorax and pneumomediastinum have both been noted to complicate cases of coronavirus disease 2019 (COVID-19) requiring hospital admission. We report the largest case series yet described of patients with both these pathologies (including nonventilated patients)., Methods: Cases were collected retrospectively from UK hospitals with inclusion criteria limited to a diagnosis of COVID-19 and the presence of either pneumothorax or pneumomediastinum. Patients included in the study presented between March and June 2020. Details obtained from the medical record included demographics, radiology, laboratory investigations, clinical management and survival., Results: 71 patients from 16 centres were included in the study, of whom 60 had pneumothoraces (six with pneumomediastinum in addition) and 11 had pneumomediastinum alone. Two of these patients had two distinct episodes of pneumothorax, occurring bilaterally in sequential fashion, bringing the total number of pneumothoraces included to 62. Clinical scenarios included patients who had presented to hospital with pneumothorax, patients who had developed pneumothorax or pneumomediastinum during their inpatient admission with COVID-19 and patients who developed their complication while intubated and ventilated, either with or without concurrent extracorporeal membrane oxygenation. Survival at 28 days was not significantly different following pneumothorax (63.1±6.5%) or isolated pneumomediastinum (53.0±18.7%; p=0.854). The incidence of pneumothorax was higher in males. 28-day survival was not different between the sexes (males 62.5±7.7% versus females 68.4±10.7%; p=0.619). Patients aged ≥70 years had a significantly lower 28-day survival than younger individuals (≥70 years 41.7±13.5% survival versus <70 years 70.9±6.8% survival; p=0.018 log-rank)., Conclusion: These cases suggest that pneumothorax is a complication of COVID-19. Pneumothorax does not seem to be an independent marker of poor prognosis and we encourage continuation of active treatment where clinically possible., Competing Interests: Conflict of interest: A.W. Martinelli has nothing to disclose. Conflict of interest: T. Ingle has nothing to disclose. Conflict of interest: J. Newman has nothing to disclose. Conflict of interest: I. Nadeem has nothing to disclose. Conflict of interest: K. Jackson has nothing to disclose. Conflict of interest: N.D. Lane reports non-financial support from Chiesi, outside the submitted work. Conflict of interest: J. Melhorn has nothing to disclose. Conflict of interest: H.E. Davies has nothing to disclose. Conflict of interest: A.J. Rostron has nothing to disclose. Conflict of interest: A. Adeni has nothing to disclose. Conflict of interest: K. Conroy has nothing to disclose. Conflict of interest: N. Woznitza reports grants from Cancer Research UK and Roy Castle Lung Cancer Foundation, and personal fees from InHealth, outside the submitted work. Conflict of interest: M. Matson has nothing to disclose. Conflict of interest: S.E. Brill has nothing to disclose. Conflict of interest: J. Murray has nothing to disclose. Conflict of interest: A. Shah has nothing to disclose. Conflict of interest: R. Naran has nothing to disclose. Conflict of interest: S.S. Hare has nothing to disclose. Conflict of interest: O. Collas has nothing to disclose. Conflict of interest: S. Bigham has nothing to disclose. Conflict of interest: M. Spiro has nothing to disclose. Conflict of interest: M.M. Huang has nothing to disclose. Conflict of interest: B. Iqbal has nothing to disclose. Conflict of interest: S. Trenfield has nothing to disclose. Conflict of interest: S. Ledot has nothing to disclose. Conflict of interest: S. Desai has nothing to disclose. Conflict of interest: L. Standing has nothing to disclose. Conflict of interest: J. Babar has nothing to disclose. Conflict of interest: R. Mahroof has nothing to disclose. Conflict of interest: I. Smith has nothing to disclose. Conflict of interest: K. Lee has nothing to disclose. Conflict of interest: N. Tchrakain Nothing to declare. Conflict of interest: S. Uys has nothing to disclose. Conflict of interest: W. Ricketts has nothing to disclose. Conflict of interest: A.R.C. Patel has nothing to disclose. Conflict of interest: A. Aujayeb has nothing to disclose. Conflict of interest: M. Kokosi has nothing to disclose. Conflict of interest: A.J.K. Wilkinson has nothing to disclose. Conflict of interest: S.J. Marciniak has nothing to disclose., (Copyright ©ERS 2020.)

Aim: Due to the fact that patients with COVID--19 can have a bacterial co-infection, physicians should be careful when prescribing antibiotics, with rather considering the sensitivity and resistance of these drugs than various bacteria. Therefore, the main purpose of the present study was to evaluate bacterial coinfections and antibiotic resistance in positive COVID-19 patients. Method: This descriptive cross-sectional study was performed on 450 hospitalized COVID-19 patients who were selected by simple random sampling. Blood culture (BC) and endotracheal aspirate (ETA) were performed for all COVID-19 patients participating in the study. Antibacterial susceptibility was assessed using the standard Kirby-Bauer disk diffusion method on Mueller Hinton agar for all isolated strains in accordance with the Institute of Clinical and Laboratory Standards guidelines. Finally, susceptibility of all identified bacteria to 10 types of antibiotics was assessed. Results: Based on the results of endotracheal aspirate (ETA) culture, we found that 79 (17.5%) patients had COVID-19 and bacterial co-infection. Among COVID-19 patients with bacterial co-infection, Klebsiella species had the highest frequency (21.6%), followed by Methicillin-sensitive Staphylococcus aureus (MSSA) (19%), Escherichia coli (17.7%), Methicillin-resistant Staphylococcus aureus (MRSA) (15.2%), Enterobacter species (13.9%) and Pseudomonas aeruginosa (12.6%), respectively. Based on the results of the present study, it was found that the level of antibiotic resistance for different bacteria varied from 0-100%. Conclusion: The results of the present study indicate that patients with COVID-19 are susceptible to bacterial co-infection, which leads to the conclusion that excessive use of antibiotics is an important factor in the development of antimicrobial resistance. Therefore, caution is needed in prescribing different antibiotics to patients with COVID-19. In addition, considering the SARS-CoV-2 co-infection with other pathogens, it is necessary to use an optimal treatment method for this purpose. [ABSTRACT FROM AUTHOR]