How the Covid-19 epidemic is challenging our practice in clinical nutrition—feedback from the field

Abstract

The viral epidemic caused by the new Coronavirus SARS-CoV-2 is responsible for the new Coronavirus disease-2019 (Covid-19). Fifteen percent of the Covid-19 patients will require hospital stay, and 10% of them will need urgent respiratory and hemodynamic support in the intensive care unit (ICU). Covid-19 is an infectious disease characterized by inflammatory syndrome, itself leading to reduced food intake and increased muscle catabolism. Therefore Covid-19 patients are at high risk of being malnourished, making the prevention of malnutrition and the nutritional management key aspects of care. Urgent, brutal and massive arrivals of patients needing urgent respiratory care and artificial ventilation lead to the necessity to reorganize hospital care, wards and staff. In that context, nutritional screening and care may not be considered a priority. Moreover, at the start of the epidemic, due to mask and other protecting material shortage, the risk of healthcare givers contamination have led to not using enteral nutrition, although indicated, because nasogastric tube insertion is an aerosolgenerating procedure. Clinical nutrition practice based on the international guidelines should therefore adapt and the use of degraded procedures could unfortunately be the only way. Based on the experience from the first weeks of the epidemic in France, we emphasize ten challenges for clinical nutrition practice. The objective is to bring objective answers to the most frequently met issues to help the clinical nutrition caregivers to promote nutritional care in the hospitalized Covid-19 patient. We propose a flow chart for optimizing the nutrition management of the Covid-19 patients in the non-ICU wards.

Simultaneously complete but not partial taste and smell losses were associated with SARS-CoV-2 infection

“…This study showed that SARS-CoV-2 infection was associated with more severe appetite loss when compared to the control group. This finding may help explain the malnutrition in COVID-19 patients reported in previous studies ( Thibault et al, 2020 , Li et al, 2020 ). Oral hygiene, especially tongue coat, could reduce the sense of taste ( Solemdal et al, 2012 ).…”

Nutritional determinants and COVID-19 outcomes of older patients with COVID-19: A systematic review

“…First, COVID-19 inflamatory responses lead to reduced food intake of patients. Secondly, it increases the muscle catabolism resulting in patients at high risk of being malnoursihed ( Thibault, Coëffier, et al, 2020 ). Therefore, a implementing a nutritional assessment for all patients with COVID-19 is essential.…”

COVID-19 and Dentistry in 72 Questions: An Overview of the Literature

“…SARS-CoV-2 infection is characterized by inflammatory syndrome leading to increased muscle catabolism and increased protein-energy needs. There is a vicious circle, because dyspnea, oxygen therapy and isolation hinder food intake [ 283 ]. In a study involving 403 patients hospitalized for COVID-19, 70% of them left the hospital with malnutrition and an average loss of 6.5 kg [ 284 ].…”