September 2020

In This Issue: How Research Helps Combat COVID-19
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COVID-19 Sequelae among Veterans Treated in VA: Planning for What Comes Next

Feature Article

Takeaway: Study results will inform planning for Veterans’ long-term health outcomes related to COVID-19. Understanding the longer-term health impacts on Veterans will better position VA to address their future health needs, as well as assist public health authorities as they deal with what might be life-long effects of the pandemic on the general public.

While much attention is appropriately focused on the acute phase of minimizing further spread of the COVID-19 virus, treating those who contract the illness, and protecting frontline clinicians, it also is important to plan for surveillance and monitoring sequelae of COVID-19 illness and treatment. Recent clinical reports have revealed that COVID-19 disease is associated with a high inflammatory response that can result in viral pneumonia, cardiac and neurological symptoms, and complications. The severity, extent, and short-term versus long-term respiratory, cardiovascular, and neurological effects of COVID-19, along with the effect of specific COVID-19 treatments (e.g. steroids, unlabeled drug use, new drugs and therapies) are not yet known. Additional concerns remain about the long-term mental health impacts on those who recover, especially among those with pre-existing mental health conditions. Severity of symptoms and mortality have been highest among the elderly, males, and those with comorbidities including chronic lung disease, hypertension, diabetes mellitus, cardiovascular diseases, and cerebrovascular diseases. The health impacts on vulnerable populations also are coming to light. With knowledge that Veterans in VA care tend to have more comorbidities compared to the general population, for those who contract COVID-19 and ultimately recover, they may experience exacerbation of pre-existing respiratory, cardiac, and mental health conditions, as well as develop new conditions.

This ongoing HSR&D funded study (August 2020 – April 2021) will identify VA primary care patients who were treated for COVID-19 at three or more VA sites that faced significant surges in early FY20 and follow their trajectory through December 2020. Among these patients, study investigators also will:

• Describe the patient-level health impacts through December 2020, including hospital readmissions, exacerbation of existing conditions, development of new COVID-related chronic conditions, and vital status; and
• Explore and examine factors (i.e., ICU treatment or not, medications, comorbidities, urban residence, medications used during acute and recovery phase) associated with patient outcomes (i.e., readmissions, new-related conditions, mental health status, mortality) during the first six to nine months after diagnosis.

Further, investigators expect to identify and develop methods for monitoring the sequelae of COVID-19 disease and treatment.

Methods

With input from clinical and epidemiology experts, investigators will leverage an existing data set of VA primary care patients from an ongoing research project to identify and examine the impact of COVID-19 illness on Veterans. Using this database and additional information available through VA’s COVID-19 Shared Data Resource, investigators will track VA patients treated for COVID-19 at the selected sites and will follow their trajectory through December 2020. A Clinical & Epidemiology Advisory Committee (CEAC) will be convened virtually for three meetings to review initial criteria for identifying COVID-19 cases, criteria for identifying and classifying subsequent health conditions, and preliminary analyses. These meetings also will assist in identifying information gaps that may require new routinely collected data (i.e., ventilator days) or new patient reported data (i.e., symptoms after recovery) that could be a focus in a subsequent study.

Findings

None at this time.

Anticipated Impact

This work is foundational to ensuring a coordinated approach to planning for Veterans’ long-term health outcomes related to COVID-19. Understanding the longer-term health impacts on Veterans will better position VA and public health authorities to address their future health needs.

Principal Investigator: Denise Hynes, PhD, MPH, RN, is part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC) in Portland, OR.

View study abstract