Progress and limitations on vaccines, strokes and readmissions in COVID-19

A study published in the CDC's Emerging Infectious Diseases on Feb. 1 described 22 cases of COVID-19 in health care workers who had just been vaccinated. These cases represented 0.54% of 4,081 workers vaccinated within a week at one hospital in Israel. Eleven of the workers who tested positive reported COVID-19 symptoms, at a median of 3.5 days after their first vaccine dose (range, 0 to 10 days). Based on the findings, the authors said that “almost every physical complaint after vaccination poses a true diagnostic dilemma as to whether an adverse reaction or a new COVID-19 infection is the cause” and suggested clinicians maintain “a high level of suspicion of reported symptoms and avoid dismissing complaints as vaccine-related until true infection is ruled out and vaccinees are tested.”

Two MMWR articles, posted on Feb. 1, reported on vaccination progress in the U.S. One looked at the 11,460 skilled nursing facilities that held vaccination clinics as part of the CDC Pharmacy Partnership for Long-Term Care Program. It found that a median of 77.8% of the residents and 37.5% of staff members received at least one vaccine dose. Those rates varied by state, with the median percentages ranging from 65.7% to 100% of residents and from 19.4% to 67.4% of staff. The authors called for “focused communication and outreach strategies to improve vaccination coverage” among staff at these facilities. The other article reported on overall vaccinations from Dec. 14 to Jan. 14. Almost 13 million people were vaccinated; 63.0% were women and 55.0% were age 50 years or older. Race/ethnicity data were only available for about half of vaccinees and indicated that 60.4% were non-Hispanic White. The observed characteristics likely reflect the makeup of the phase 1a priority vaccination group, but the findings “underscore the need for more complete reporting of race and ethnicity data,” the authors said.

Acute ischemic strokes were relatively rare among patients with COVID-19, according to a study published by Stroke on Feb. 4. Among 8,163 patients from 54 hospitals who were treated in the ED or admitted for COVID-19, 1.3% had an acute ischemic stroke, compared to 1.0% of 19,513 studied patients without COVID-19. Patients who had strokes had higher prevalence of hypertension, diabetes, hyperlipidemia, atrial fibrillation, and congestive heart failure than other COVID-19 patients. Dying or being discharged to a destination other than home was significantly more common among patients with both COVID-19 and a stroke than those with only one of those conditions. The authors noted that COVID-19 and stroke were mostly diagnosed during the same encounter so “an acute ischemic stroke patient with suspected COVID-19 has to be evaluated under the assumption that the patient has COVID-19.”

Another recent study, published by the Journal of General Internal Medicine on Feb. 2, tried to identify markers to predict readmissions of patients with COVID-19. A chart review of 99 patients discharged from a medicine service early in the pandemic found that within 30 days, five patients were treated in an ED and another five required readmission. However, none of the studied characteristics from the patients' inpatient stays, including fever in the 24 hours before discharge, oxygen requirement, and laboratory abnormalities, predicted return to the hospital. The authors noted that many have taken a conservative approach to discharging COVID-19 patients, but that carries numerous downsides. “In hopes of foregoing these avoidable consequences, we offer this single-center experience as the first case series of its kind supporting reliance on clinical improvement rather than fixation over laboratory abnormalities, persistent oxygen requirement, or continued fever in the absence of other causes,” they wrote.