Social Distancing Alters the Clinical Course of COVID-19 in Young Adults: A Comparative Cohort Study.

BACKGROUND: Social distancing and stringent hygiene seem to be effective in reducing the number of transmitted virus particles, and therefore the infectivity, of coronavirus disease 2019 (COVID-19) and could alter the mode of transmission of the disease. However, it is not known if such practices can change the clinical course in infected individuals. METHODS: We prospectively studied an outbreak of COVID-19 in Switzerland among a population of 508 predominantly male soldiers with a median age of 21 years. We followed the number of infections in 2 spatially separated cohorts with almost identical baseline characteristics with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before and after implementation of stringent social distancing. RESULTS: Of the 354 soldiers infected prior to the implementation of social distancing, 30% fell ill from COVID-19, while no soldier in a group of 154, in which infections appeared after implementation of social distancing, developed COVID-19 despite the detection of viral RNA in the nasal and virus-specific antibodies within this group. CONCLUSIONS: Social distancing not only can slow the spread of SARS-CoV-2 in a cohort of young, healthy adults but it can also prevent the outbreak of COVID-19 while still inducing an immune response and colonizing nasal passages. Viral inoculum during infection or mode of transmission may be a key factor determining the clinical course of COVID-19.

Reduced maximal aerobic capacity after COVID-19 in young adult recruits, Switzerland, May 2020.

In March 2020, we observed an outbreak of COVID-19 among a relatively homogenous group of 199 young (median age 21 years; 87% men) Swiss recruits. By comparing physical endurance before and in median 45 days after the outbreak, we found a significant decrease in predicted maximal aerobic capacity in COVID-19 convalescent but not in asymptomatically infected and SARS-CoV-2 naive recruits. This finding might be indicative of lung injury after apparently mild COVID-19 in young adults.

Patients' Views on Regional Anesthesia for Elective Unilateral Carotid Endarterectomy--A Prospective Cohort Study.

BACKGROUND: Carotid endarterectomy (CEA) can be performed under general anesthesia (GA) or locoregional anesthesia (LA). However, the patients' views on the choice between GA and LA are currently poorly understood. We aimed at identifying the preoperative patient information needs, their role in decision-making, and influencing factors associated with LA and anxiety regarding surgery and anesthesia in CEA as a base for improving preoperative consultation and decision-making in the informed consent process. METHODS: Data were collected from consecutive patients undergoing unilateral elective CEA. Data on basic demographics, preoperative information needs, factors influencing decision-making concerning anesthesia technique, a Mini Mental State Examination (MMSE), a Visual Analog Scale (VAS), and the State-Trait Anxiety Inventory (STAI-T/S) were collected. RESULTS: A total of 59 patients were included in the study, 10 women and 49 men, with a median age of 71 years (interquartile range, 66-77 years). Fifty-four (92%) patients assessed the surgeons' given information as adequate. Older patients (>70 years, n = 31) had less self-conception of anxiety compared to younger patients (≤70 years, n = 28), 3% vs. 21%, P = 0.045. Males expressed less anxiety regarding "waking up during general anesthesia" compared to females (0% vs. 30%, P < 0.001). Anxiety about anesthesia and surgery as measured by VAS highly correlated with the STAI-S scores (Pearson correlation coefficient [CC], 0.45; 95% confidence interval [CI], 0.18-0.66, P < 0.001; CC, 0.47; 95% CI, 0.27-0.66, P < 0.001, respectively). Patients with a lower cognitive function (MMSE ≤27, n = 20) had lower needs for preoperative medical information compared to patients with MMSE >27 (n = 36), 0% vs. 15%, P = 0.042. Two (3%) patients received GA because of their previous bad experience with LA. CONCLUSIONS: Younger and female patients may benefit from a more detailed and reassuring informed consent process. All institutions should use procedure-specific informed consent forms as they appear to be very adequate for the patient information needs. Nearly all patients are willing to undergo LA with the exception of those having had previous bad experience with LA for CEA.