Determining the Impact of Swallowing Impairment in People recovering from Severe COVID-19 Infection

Project Summary/AbstractThe recent spread of COVID-19 has led to an international pandemic, with >4 million confirmed cases to dateworldwide, of which >1.3 million confirmed cases and >80,000 deaths have been reported in the USA. Infectedindividuals commonly experience severe respiratory difficulties and pneumonia, leading to hospital admissionand the need for intensive care and mechanical ventilation. Emerging evidence suggests that impaired tasteand smell may be early markers of the disease, and that in severe cases, there may be neurological damage inin the medulla, an important brainstem control site for both respiration and swallowing. Given theoverlapping neuroanatomical regulation of breathing and swallowing, we hypothesize that dysphagia(swallowing impairment) will be common in People recovering from Severe COVID-19 (PrSC-19) andassociated with poorer outcomes. Through this grant supplement, we propose to extend our existing workcharacterizing dysphagia profiles in different clinical populations to study dysphagia and its impact in PrSC-19. To understand the prevalence and pathophysiology of dysphagia in PrSC-19, we will conduct detailedanalyses of videofluoroscopies performed during the standard of care, post-discharge from intensive care toregular medical care units within the acute care setting. Given the current limitations in performingswallowing assessments for inpatients who test positive for COVID-19, we will also establish 3 regionalresearch clinics that will offer comprehensive swallowing assessments to PrSC-19 after discharge from acutecare to rehabilitation or the community. These assessments will include the collection of case historyinformation, videofluoroscopy, use of a novel digital stethoscope to measure respiratory-swallowcoordination, measures of other risk factors for dysphagia (e.g. bulbar muscle strength) and patient-reportedoutcomes. Detailed analyses of the videofluoroscopies will identify specific measures of swallowing that falloutside the range of normal variation based on comparison to healthy reference values established throughour research program exploring swallowing physiology on liquids of different consistencies.