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Yıldız Y, Öztürk Şahin B, Demir MC, Demir Ş, Çiftci B, Köktürk N, Ulukavak Çiftçi T, Yurdakul AS, Yılmaz Demirci N, Aydoğdu M, Dizbay M, Oğuzülgen İK. Risk factors for post-acute sequelae of COVID-19 in hospitalized patients: An observational study based on a survey in a tertiary care center in Türkiye. Tuberk Toraks 2023; 71:261-272. [PMID: 37740629 PMCID: PMC10854058 DOI: 10.5578/tt.20239707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Introduction Long COVID is a multisystem disease with various symptoms and risk factors. We aim to investigate the post-acute sequelae of COVID-19 and related risk factors in a tertiary care center. Materials and Methods In this observational study, based on a survey of 1.977 COVID-19 patients hospitalized from April 2020 to January 2021, a retrospective assessment was carried out on 1.050 individuals who were reachable via telephone to determine their eligibility for meeting the inclusion criteria. Results The data of 256 patients who reported at least one persistent symptom were analyzed. Long COVID prevalence was 24.3%. Among 256 patients (median age 52.8; 52.7% female; 56.63% had at least one comorbidity), dyspnea, fatigue, arthralgia-myalgia, cough, and back pain were the most common post-acute sequelae of COVID-19 (42.4%; 28.29%; 16.33%; 13.15% and 7.17%, respectively). The risk factors for the persistence of dyspnea included having lung diseases such as chronic obstructive pulmonary disease, a history of intensive care support, the requirement for long-term oxygen therapy, and a history of cytokine storm (p= 0.024, p= 0.026, p< 0.001, p= 0.036, p= 0.005, respectively). The correlation between lung involvement with post-discharge cough (p= 0.041) and dizziness (p= 0.038) was significant. No correlation between the symptoms with the severity of acute infection, age, and gender was found. When a multivariate regression analysis was conducted on the most common long COVID-related symptoms, several independent risk factors were identified. These included having lung disease for dyspnea (OR 5.81, 95% CI 1.08-31.07, p= 0.04); length of hospital stay for myalgia (OR 1.034, 95% CI 1.004-1.065, p= 0.024); and pulmonary involvement of over 50% during COVID-19 infection for cough (OR 3.793, 95% CI 1.184-12.147, p= 0.025). Conclusion COVID-19 survivors will require significant healthcare services due to their prolonged symptoms. We hope that our findings will guide the management of these patients in clinical settings towards best practices.
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Affiliation(s)
- Yeşim Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | | | - Mert Can Demir
- Department of Pulmonary, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Şerife Demir
- Department of Pulmonary, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Beyza Çiftci
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Nurdan Köktürk
- Department of Pulmonary, Gazi University Faculty of Medicine, Ankara, Türkiye
| | | | | | | | - Müge Aydoğdu
- Department of Pulmonary, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Murat Dizbay
- Department of Infectious Diseases and Clinical Microbiology, Gazi University Faculty of Medicine, Ankara, Türkiye
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Prashar J. Long Covid: conceptualizing the challenges for public health. J Public Health (Oxf) 2023; 45:771-779. [PMID: 37132023 PMCID: PMC10470368 DOI: 10.1093/pubmed/fdac153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Long Covid has caused significant disruption to public services, economies and population health worldwide, but no single public health approach has proven effective in its management. This essay was the winning entry for the Faculty of Public Health's Sir John Brotherston Prize 2022. METHODS In this essay, I synthesize existing literature on public health policy in long Covid, and discuss the challenges and opportunities posed by long Covid for the public health profession. The utility of specialist clinics and community care, in the UK and internationally, is examined, as well as key outstanding issues relating to evidence generation, health inequality and defining long Covid. I then use this information to inform a simple conceptual model. RESULTS The generated conceptual model integrates community- and population-level interventions; key areas of identified policy need at both levels include ensuring equitable access to long Covid care, developing screening programmes for high-risk populations, co-production of research and clinical services with patients, and using interventions to generate evidence. CONCLUSIONS Significant challenges remain in the management of long Covid from a public health policy perspective. Multidisciplinary community-level and population-level interventions should be employed with a view to achieving an equitable and scalable model of care.
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Affiliation(s)
- Jai Prashar
- University College London Medical School, 74 Huntley St, London, WC1E 6DE, UK
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Day S, Lury C, Ward H. Personalization: a new political arithmetic? DISTINKTION : SCANDINAVIAN JOURNAL OF SOCIAL THEORY 2023; 24:167-194. [PMID: 38013839 PMCID: PMC10503135 DOI: 10.1080/1600910x.2022.2098352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Scholarship on the history of political arithmetic highlights its significance for classical liberalism, a political philosophy in which subjects perceive themselves as autonomous individuals in an abstract system called society. This society and its component individuals became intelligible and governable in a deluge of printed numbers, assisted by the development of statistics, the emergence of a common space of measurement, and the calculation of probabilities. Our proposal is that the categories, numbers, and norms of this political arithmetic have changed in a ubiquitous culture of personalization. Today's political arithmetic, we suggest, produces a different kind of society, what Facebook CEO Mark Zuckerberg calls the 'default social'. We address this new social as a 'vague whole' and propose that it is characterized by a continuous present, the contemporary form of simultaneity or way of being together that Benedict Anderson argued is fundamental to any kind of imagined community. Like the society imagined in the earlier arithmetic, this vague whole is an abstraction that obscures forms of stratification and discrimination.
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Affiliation(s)
- Sophie Day
- Anthropology, Goldsmiths, University of London, London, UK
| | - Celia Lury
- Centre for Interdisciplinary Methodologies, University of Warwick, Warwick, UK
| | - Helen Ward
- School of Public Health, Imperial College London, London, UK
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Frailty and long-COVID: is COVID-19 responsible for a transition in frailty status among older adults who survived hospitalization for COVID-19? Aging Clin Exp Res 2023; 35:455-461. [PMID: 36445566 PMCID: PMC9707219 DOI: 10.1007/s40520-022-02308-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of knowledge about the effects of COronaVIrus Disease-19 (COVID-19) on long-term frailty development or progression over time. AIM This study aims to assess transitions in frailty status in older adults who survived hospitalization for COVID-19. METHODS This is a longitudinal panel study. A multidisciplinary outpatient follow-up service was established since summer 2020, for the evaluation of individuals discharged alive, after hospitalization due to COVID-19. Frailty status was assessed in-hospital and at follow-up using the clinical frailty scale (CFS). Main patients' characteristics, including health, functional, cognitive, and psychological status were collected. RESULTS A total of 177 patients aged 65 years and older were evaluated until June 2022. They were predominantly male, with a median age of 70 (Q1-Q3 67-75) years and a median body mass index of 27.5 (Q1-Q3 24.9-30.6) kg/m2 at hospital admission. The median follow-up time was 6.3 (Q1-Q3 3.7-10.9) months. Sixty-one patients (34.5%) scored worse at CFS follow-up compared to hospital admission, and twenty-two patients (12.4%) became frail. DISCUSSION AND CONCLUSION This study shows that one out of three older patients previously hospitalized for COVID-19 had an unfavorable transition in CFS score during a median follow-up of nearly 6 months. Specific interventions to prevent frailty development or progression should be considered for patients at risk. Further studies are required to confirm our findings.
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Long-COVID Symptoms in Individuals Infected with Different SARS-CoV-2 Variants of Concern: A Systematic Review of the Literature. Viruses 2022; 14:v14122629. [PMID: 36560633 PMCID: PMC9785120 DOI: 10.3390/v14122629] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
The association of SARS-CoV-2 variants with long-COVID symptoms is still scarce, but new data are appearing at a fast pace. This systematic review compares the prevalence of long-COVID symptoms according to relevant SARS-CoV-2 variants in COVID-19 survivors. The MEDLINE, CINAHL, PubMed, EMBASE and Web of Science databases, as well as the medRxiv and bioRxiv preprint servers, were searched up to 25 October 2022. Case-control and cohort studies analyzing the presence of post-COVID symptoms appearing after an acute SARS-CoV-2 infection by the Alpha (B.1.1.7), Delta (B.1.617.2) or Omicron (B.1.1.529/BA.1) variants were included. Methodological quality was assessed using the Newcastle-Ottawa Scale. From 430 studies identified, 5 peer-reviewed studies and 1 preprint met the inclusion criteria. The sample included 355 patients infected with the historical variant, 512 infected with the Alpha variant, 41,563 infected with the Delta variant, and 57,616 infected with the Omicron variant. The methodological quality of all studies was high. The prevalence of long-COVID was higher in individuals infected with the historical variant (50%) compared to those infected with the Alpha, Delta or Omicron variants. It seems that the prevalence of long-COVID in individuals infected with the Omicron variant is the smallest, but current data are heterogeneous, and long-term data have, at this stage, an obviously shorter follow-up compared with the earlier variants. Fatigue is the most prevalent long-COVID symptom in all SARS-CoV-2 variants, but pain is likewise prevalent. The available data suggest that the infection with the Omicron variant results in fewer long-COVID symptoms compared to previous variants; however, the small number of studies and the lack of the control of cofounders, e.g., reinfections or vaccine status, in some studies limit the generality of the results. It appears that individuals infected with the historical variant are more likely to develop long-COVID symptomatology.
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Hrzic R, Davidovitch N, Barros H, Lopes H, Moreno JMM, Mason-Jones AJ, McCallum A, Reid J, Reintjes R, Sheek-Hussein M, Simon J, Wong BLH, Leighton L, Otok R, Middleton J. ASPHER Statement: Facing the Fourth Winter of the COVID-19 Pandemic. Public Health Rev 2022; 43:1605395. [PMID: 36267593 PMCID: PMC9578432 DOI: 10.3389/phrs.2022.1605395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rok Hrzic
- Department of International Health, Care and Public Health Research Institute – CAPHRI, Maastricht University, Maastricht, Netherlands
| | - Nadav Davidovitch
- School of Public Health, Ben Gurion University of the Negev, Beersheba, Israel
- *Correspondence: Nadav Davidovitch,
| | - Henrique Barros
- Institute of Public Health, University of Porto, Porto, Portugal
| | - Henrique Lopes
- Unit of Public Health, Institute of Health Sciences, Catolica University, Lisbon, Portugal
| | - Jose M. Martin Moreno
- Department of Preventive Medicine and Public Health, Medical School and INCLIVA, University of Valencia, Valencia, Spain
| | | | - Alison McCallum
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - John Reid
- Department of Public Health and Wellbeing, University of Chester, Chester, United Kingdom
| | - Ralf Reintjes
- Department of Public Health, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Mohamud Sheek-Hussein
- Institute of Public Health — College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Brian Li Han Wong
- Department of International Health, Care and Public Health Research Institute – CAPHRI, Maastricht University, Maastricht, Netherlands
- The International Digital Health and AI Research Collaborative (I-DAIR), Geneva, Switzerland
| | - Lore Leighton
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Robert Otok
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - John Middleton
- Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
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Associated-Onset Symptoms and Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors Infected with Wuhan, Alpha or Delta SARS-CoV-2 Variant. Pathogens 2022; 11:pathogens11070725. [PMID: 35889971 PMCID: PMC9320021 DOI: 10.3390/pathogens11070725] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023] Open
Abstract
This study compared associated-symptoms at the acute phase of infection and post-COVID-19 symptoms between individuals hospitalized with the Wuhan, Alpha or Delta SARS-CoV-2 variant. Non-vaccinated individuals hospitalized because of SARS-CoV-2 infection in one hospital during three different waves of the pandemic (Wuhan, Alpha or Delta) were scheduled for a telephone interview. The presence of post-COVID-19 symptoms was systematically assessed. Hospitalization and clinical data were collected from medical records. A total of 201 patients infected with the Wuhan variant, 211 with the Alpha variant and 202 with Delta variant were assessed six months after hospitalization. Patients infected with the Wuhan variant had a greater number of symptoms at hospital admission (higher prevalence of fever, dyspnea or gastrointestinal problems) than those infected with Alpha or Delta variant (p < 0.01). A greater proportion of patients infected with the Delta variant reported headache, anosmia or ageusia as onset symptoms (p < 0.01). The mean number of post-COVID-19 symptoms was higher (p < 0.001) in individuals infected with the Wuhan variant (mean: 2.7 ± 1.3) than in those infected with the Alpha (mean: 1.8 ± 1.1) or Delta (mean: 2.1 ± 1.5) variant. Post-COVID-19 dyspnea was more prevalent (p < 0.001) in people infected with the Wuhan variant, whereas hair loss was higher in those infected with the Delta variant (p = 0.002). No differences in post-COVID-19 fatigue by SARS-CoV-2 variant were found (p = 0.594). Differences in COVID-19 associated onset symptoms and post-COVID-19 dyspnea were observed depending on the SARS-CoV-2 variant. The presence of fatigue was a common post-COVID-19 symptom to all SARS-CoV-2 variants.
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Holly JMP. Commentary: A Machine-Generated View of the Role of Blood Glucose Levels in the Severity of COVID-19. A Metabolic Endocrinology Perspective. Front Endocrinol (Lausanne) 2022; 13:877973. [PMID: 35574035 PMCID: PMC9097450 DOI: 10.3389/fendo.2022.877973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/22/2022] [Indexed: 01/08/2023] Open
Affiliation(s)
- Jeff M. P. Holly
- Faculty of Medicine, School of Translational Health Science, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, United Kingdom
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Whitaker M, Elliott J, Chadeau-Hyam M, Riley S, Darzi A, Cooke G, Ward H, Elliott P. Persistent COVID-19 symptoms in a community study of 606,434 people in England. Nat Commun 2022; 13:1957. [PMID: 35413949 PMCID: PMC9005552 DOI: 10.1038/s41467-022-29521-z] [Citation(s) in RCA: 151] [Impact Index Per Article: 75.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
Long COVID remains a broadly defined syndrome, with estimates of prevalence and duration varying widely. We use data from rounds 3-5 of the REACT-2 study (n = 508,707; September 2020 - February 2021), a representative community survey of adults in England, and replication data from round 6 (n = 97,717; May 2021) to estimate the prevalence and identify predictors of persistent symptoms lasting 12 weeks or more; and unsupervised learning to cluster individuals by reported symptoms. At 12 weeks in rounds 3-5, 37.7% experienced at least one symptom, falling to 21.6% in round 6. Female sex, increasing age, obesity, smoking, vaping, hospitalisation with COVID-19, deprivation, and being a healthcare worker are associated with higher probability of persistent symptoms in rounds 3-5, and Asian ethnicity with lower probability. Clustering analysis identifies a subset of participants with predominantly respiratory symptoms. Managing the long-term sequelae of COVID-19 will remain a major challenge for affected individuals and their families and for health services.
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Affiliation(s)
- Matthew Whitaker
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Joshua Elliott
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Marc Chadeau-Hyam
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Environment and Health, Imperial College London, London, UK
| | - Steven Riley
- School of Public Health, Imperial College London, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- Abdul Latif Jameel Institute for Disease & Emergency Analytics, Imperial College London, London, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, London, UK
- Institute of Global Health Innovation at Imperial College London, London, UK
| | - Graham Cooke
- Imperial College Healthcare NHS Trust, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Helen Ward
- Imperial College Healthcare NHS Trust, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, UK
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK
| | - Paul Elliott
- School of Public Health, Imperial College London, London, UK.
- MRC Centre for Environment and Health, Imperial College London, London, UK.
- Imperial College Healthcare NHS Trust, London, UK.
- National Institute for Health Research Imperial Biomedical Research Centre, London, UK.
- Health Data Research (HDR) UK London at Imperial College, London, UK.
- UK Dementia Research Institute at Imperial College, London, UK.
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Madden PJ, Thomas Y, Blair RV, Samer S, Doyle M, Midkiff CC, Doyle-Meyers LA, Becker ME, Arif MS, McRaven MD, Simons LM, Carias AM, Martinelli E, Lorenzo-Redondo R, Hultquist JF, Villinger FJ, Veazey RS, Hope TJ. An immunoPET probe to SARS-CoV-2 reveals early infection of the male genital tract in rhesus macaques. RESEARCH SQUARE 2022:rs.3.rs-1479315. [PMID: 35411346 PMCID: PMC8996619 DOI: 10.21203/rs.3.rs-1479315/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The systemic nature of SARS-CoV-2 infection is highly recognized, but poorly characterized. A non-invasive and unbiased method is needed to clarify whole body spatiotemporal dynamics of SARS-CoV-2 infection after transmission. We recently developed a probe based on the anti-SARS-CoV-2 spike antibody CR3022 to study SARS-CoV-2 pathogenesis in vivo. Herein, we describe its use in immunoPET to investigate SARS-CoV-2 infection of three rhesus macaques. Using PET/CT imaging of macaques at different times post-SARS-CoV-2 inoculation, we track the 64Cu-labelled CR3022-F(ab')2 probe targeting the spike protein of SARS-CoV-2 to study the dynamics of infection within the respiratory tract and uncover novel sites of infection. Using this method, we uncovered differences in lung pathology between infection with the WA1 isolate and the delta variant, which were readily corroborated through computed tomography scans. The 64Cu-CR3022-probe also demonstrated dynamic changes occurring between 1- and 2-weeks post-infection. Remarkably, a robust signal was seen in the male genital tract (MGT) of all three animals studied. Infection of the MGT was validated by immunofluorescence imaging of infected cells in the testicular and penile tissue and severe pathology was observed in the testes of one animal at 2-weeks post-infection. The results presented here underscore the utility of using immunoPET to study the dynamics of SARS-CoV-2 infection to understand its pathogenicity and discover new anatomical sites of viral replication. We provide direct evidence for SARS-CoV-2 infection of the MGT in rhesus macaques revealing the possible pathologic outcomes of viral replication at these sites.
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Affiliation(s)
- Patrick J Madden
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Yanique Thomas
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert V Blair
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Sadia Samer
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark Doyle
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Cecily C Midkiff
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | | | - Mark E Becker
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Muhammad S Arif
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael D McRaven
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lacy M Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ann M Carias
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elena Martinelli
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Judd F Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francois J Villinger
- New Iberia Research Center, University of Louisiana-Lafayette, New Iberia, Louisiana, USA
| | - Ronald S Veazey
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Thomas J Hope
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Philip KEJ, Owles H, McVey S, Pagnuco T, Bruce K, Brunjes H, Banya W, Mollica J, Lound A, Zumpe S, Abrahams AM, Padmanaban V, Hardy TH, Lewis A, Lalvani A, Elkin S, Hopkinson NS. An online breathing and wellbeing programme (ENO Breathe) for people with persistent symptoms following COVID-19: a parallel-group, single-blind, randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2022; 10:851-862. [PMID: 35489367 PMCID: PMC9045747 DOI: 10.1016/s2213-2600(22)00125-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 12/20/2022]
Abstract
Background There are few evidence-based interventions for long COVID; however, holistic approaches supporting recovery are advocated. We assessed whether an online breathing and wellbeing programme improves health related quality-of-life (HRQoL) in people with persisting breathlessness following COVID-19. Methods We conducted a parallel-group, single-blind, randomised controlled trial in patients who had been referred from one of 51 UK-based collaborating long COVID clinics. Eligible participants were aged 18 years or older; were recovering from COVID-19 with ongoing breathlessness, with or without anxiety, at least 4 weeks after symptom onset; had internet access with an appropriate device; and were deemed clinically suitable for participation by one of the collaborating COVID-19 clinics. Following clinical assessment, potential participants were given a unique online portal code. Participants were randomly assigned (1:1) to either immediate participation in the English National Opera (ENO) Breathe programme or to usual care. Randomisation was done by the research team using computer-generated block randomisation lists, with block size 10. The researcher responsible for randomisation was masked to responses. Participants in the ENO Breathe group participated in a 6-week online breathing and wellbeing programme, developed for people with long COVID experiencing breathlessness, focusing on breathing retraining using singing techniques. Those in the deferred group received usual care until they exited the trial. The primary outcome, assessed in the intention-to-treat population, was change in HRQoL, assessed using the RAND 36-item short form survey instrument mental health composite (MHC) and physical health composite (PHC) scores. Secondary outcome measures were the chronic obstructive pulmonary disease assessment test score, visual analogue scales (VAS) for breathlessness, and scores on the dyspnoea-12, the generalised anxiety disorder 7-item scale, and the short form-6D. A thematic analysis exploring participant experience was also conducted using qualitative data from focus groups, survey responses, and email correspondence. This trial is registered with ClinicalTrials.gov, NCT04830033. Findings Between April 22 and May 25, 2021, 158 participants were recruited and randomly assigned. Of these, eight (5%) individuals were excluded and 150 participants were allocated to a treatment group (74 in the ENO Breathe group and 76 in the usual care group). Compared with usual care, ENO Breathe was associated with an improvement in MHC score (regression coefficient 2·42 [95% CI 0·03 to 4·80]; p=0·047), but not PHC score (0·60 [–1·33 to 2·52]; p=0·54). VAS for breathlessness (running) favoured ENO Breathe participation (−10·48 [–17·23 to –3·73]; p=0·0026). No other statistically significant between-group differences in secondary outcomes were observed. One minor self-limiting adverse event was reported by a participant in the ENO Breathe group who felt dizzy using a computer for extended periods. Thematic analysis of ENO Breathe participant experience identified three key themes: (1) improvements in symptoms; (2) feeling that the programme was complementary to standard care; and (3) the particular suitability of singing and music to address their needs. Interpretation Our findings suggest that an online breathing and wellbeing programme can improve the mental component of HRQoL and elements of breathlessness in people with persisting symptoms after COVID-19. Mind–body and music-based approaches, including practical, enjoyable, symptom-management techniques might have a role supporting recovery. Funding Imperial College London.
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Affiliation(s)
- Keir E J Philip
- National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK.
| | - Harriet Owles
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Stephanie McVey
- Learning and Participation, English National Opera, London, UK
| | - Tanja Pagnuco
- Learning and Participation, English National Opera, London, UK
| | - Katie Bruce
- Learning and Participation, English National Opera, London, UK
| | - Harry Brunjes
- Learning and Participation, English National Opera, London, UK
| | - Winston Banya
- National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
| | - Jenny Mollica
- Learning and Participation, English National Opera, London, UK
| | - Adam Lound
- Patient Experience Research Centre, Imperial College London, London, UK
| | - Suzi Zumpe
- Learning and Participation, English National Opera, London, UK
| | - Amiad M Abrahams
- Clinical Health Psychology, Imperial College Healthcare NHS Trust, London, UK
| | - Vijay Padmanaban
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Thomas H Hardy
- Learning and Participation, English National Opera, London, UK
| | - Adam Lewis
- Department of Health Sciences, Brunel University London, London, UK
| | - Ajit Lalvani
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Sarah Elkin
- National Heart and Lung Institute, Imperial College London, London, UK; Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK; National Institute for Health Research Imperial Biomedical Research Centre, Imperial College London, London, UK
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12
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Madden PJ, Thomas Y, Blair RV, Samer S, Doyle M, Midkiff CC, Doyle-Meyers LA, Becker ME, Arif MS, McRaven MD, Simons LM, Carias AM, Martinelli E, Lorenzo-Redondo R, Hultquist JF, Villinger FJ, Veazey RS, Hope TJ. An immunoPET probe to SARS-CoV-2 reveals early infection of the male genital tract in rhesus macaques. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2022:2022.02.25.481974. [PMID: 35262081 PMCID: PMC8902882 DOI: 10.1101/2022.02.25.481974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The systemic nature of SARS-CoV-2 infection is highly recognized, but poorly characterized. A non-invasive and unbiased method is needed to clarify whole body spatiotemporal dynamics of SARS-CoV-2 infection after transmission. We recently developed a probe based on the anti-SARS-CoV-2 spike antibody CR3022 to study SARS-CoV-2 pathogenesis in vivo. Herein, we describe its use in immunoPET to investigate SARS-CoV-2 infection of three rhesus macaques. Using PET/CT imaging of macaques at different times post-SARS-CoV-2 inoculation, we track the 64Cu-labelled CR3022-F(ab')2 probe targeting the spike protein of SARS-CoV-2 to study the dynamics of infection within the respiratory tract and uncover novel sites of infection. Using this method, we uncovered differences in lung pathology between infection with the WA1 isolate and the delta variant, which were readily corroborated through computed tomography scans. The 64Cu-CR3022-probe also demonstrated dynamic changes occurring between 1- and 2-weeks post-infection. Remarkably, a robust signal was seen in the male genital tract (MGT) of all three animals studied. Infection of the MGT was validated by immunofluorescence imaging of infected cells in the testicular and penile tissue and severe pathology was observed in the testes of one animal at 2-weeks post-infection. The results presented here underscore the utility of using immunoPET to study the dynamics of SARS-CoV-2 infection to understand its pathogenicity and discover new anatomical sites of viral replication. We provide direct evidence for SARS-CoV-2 infection of the MGT in rhesus macaques revealing the possible pathologic outcomes of viral replication at these sites.
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Affiliation(s)
- Patrick J Madden
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Yanique Thomas
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Robert V Blair
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Sadia Samer
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark Doyle
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Cecily C Midkiff
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | | | - Mark E Becker
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Muhammad S Arif
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Michael D McRaven
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lacy M Simons
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ann M Carias
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elena Martinelli
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ramon Lorenzo-Redondo
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Judd F Hultquist
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Pathogen Genomics and Microbial Evolution, Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francois J Villinger
- New Iberia Research Center, University of Louisiana-Lafayette, New Iberia, Louisiana, USA
| | - Ronald S Veazey
- Tulane National Primate Research Center, Covington, Louisiana, USA
| | - Thomas J Hope
- Department of Cell and Developmental Biology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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13
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Global Trends and Research Hotspots in Long COVID: A Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063742. [PMID: 35329428 PMCID: PMC8955790 DOI: 10.3390/ijerph19063742] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 12/18/2022]
Abstract
Long COVID is a condition distinguished by long-term sequelae that occur or persist after the convalescence period of COVID-19. During the COVID-19 pandemic, more and more people who tested positive for SARS-CoV-2 experienced long COVID, which attracted the attention of researchers. This study aims to assess the pattern of long COVID research literature, analyze the research topics, and provide insights on long COVID. In this study, we extracted 784 publications from Scopus in the field of long COVID. According to bibliometric analysis, it is found that: developed countries in Europe and America were in leading positions in terms of paper productivity and citations. The International Journal of Environmental Research and Public Health and the Journal of Clinical Medicine were leading journals in the perspective of publications count, and Nature Medicine had the highest number of citations. Author Greenhalgh T has the highest number of papers and citations. The main research topics were: pathophysiology, symptoms, treatment, and epidemiology. The causes of long COVID may be related to organ injury, inflammation, maladaptation of the angiotensin-converting enzyme 2 (ACE2) pathway, and mental factors. The symptoms are varied, including physical and psychological symptoms. Treatment options vary from person to person. Most patients developed at least one long-term symptom. Finally, we presented some possible research opportunities.
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Edwards AM, Baric RS, Saphire EO, Ulmer JB. Stopping pandemics before they start: Lessons learned from SARS-CoV-2. Science 2022; 375:1133-1139. [PMID: 35271333 DOI: 10.1126/science.abn1900] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The vaccine and drug discovery responses to COVID-19 have worked far better than could have been imagined. Yet by the end of 2021, more than 5 million people had died, and the pandemic continues to evolve and rage globally. This Review will describe how each of the vaccines, antibody therapies, and antiviral drugs that have been approved to date were built on decades of investment in technology and basic science. We will caution that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has so far proven a straightforward test of our pandemic preparedness, and we will recommend steps we should undertake now to prepare for, to minimize the effects of, and ideally to prevent future pandemics. Other Reviews in this series describe the interactions of SARS-CoV-2 with the immune system and those therapies that target the host response to infection.
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Affiliation(s)
- Aled M Edwards
- Structural Genomics Consortium, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Ralph S Baric
- Rapidly Emerging Antiviral Drug Development Initiative (READDI), Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Erica Ollmann Saphire
- Center for Infectious Disease and Vaccine Research, La Jolla Institute for Immunology, 9420 Athena Circle, La Jolla, CA 92037, USA.,Department of Medicine, University of California, San Diego, La Jolla, CA 92037, USA
| | - Jeffrey B Ulmer
- TechImmune, Newport Beach, CA 92660, USA.,Immorna Biotherapeutics, Durham, NC 27703, USA
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15
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Lackermair K, Wilhelm K, William F, Grzanna N, Lehmann E, Sams L, Fichtner S, Kellnar A, Estner H. The Prevalence of Persistent Symptoms After COVID-19 Disease. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:175-176. [PMID: 35583039 DOI: 10.3238/arztebl.m2022.0125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/08/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
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16
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Legrand M, Fong N, Laouénan C, Ghosn J, Thill B, Faure K, Garot D, Goujard C, Curlier E, Resche-Rigon M, Rossignol P, Pirracchio R. Risk factors of long term symptoms and outcomes among patients discharged after covid-19: prospective, multicentre observational study. BMJ MEDICINE 2022; 1:e000093. [PMID: 36936553 PMCID: PMC9951375 DOI: 10.1136/bmjmed-2021-000093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/10/2022] [Indexed: 12/17/2022]
Abstract
Objective To investigate risk factors and subphenotypes associated with long term symptoms and outcomes after hospital admission for covid-19. Design Prospective, multicentre observational study. Setting 93 hospitals in France. Participants Data from 2187 adults admitted to hospital with covid-19 in France between 1 February 2020 and 30 June 2021. Main outcome measures Primary endpoint was the total number of persistent symptoms at six months after hospital admission that were not present before admission. Outcomes examined at six months were persistent symptoms, Hospital Anxiety and Depression Scale, six minute walk test distances, 36-Item Short Form Health Survey scores, and ability to resume previous professional activities and self-care. Secondary endpoints included vital status at six months, and results of standardised quality-of-life scores. Additionally, an unsupervised consensus clustering algorithm was used to identify subphenotypes based on the severity of hospital course received by patients. Results 1109 (50.7%) of 2187 participants had at least one persistent symptom. Factors associated with an increased number of persistent symptoms were in-hospital supplemental oxygen (odds ratio 1.12, 95% confidence interval 1 to 1.24), no intensive care unit admission (1.15, 1.01 to 1.32), female sex (1.33, 1.22 to 1.45), gastrointestinal haemorrhage (1.51, 1.02 to 2.23), a thromboembolic event (1.66, 1.17 to 2.34), and congestive heart failure (1.76, 1.27 to 2.43). Three subphenotypes were identified: including patients with the least severe hospital course (based on ventilatory support requirements). Although Hospital Anxiety and Depression Scale scores were within normal values for all groups, patients of intermediate severity and more comorbidities had a higher median Hospital Anxiety and Depression Scale score than did the other subphenotypes. Patients in the subphenotype with most severe hospital course had worse short form-36 scores and were less able to resume their professional activity or care for themselves as before compared with other subphenotypes. Conclusions Persistent symptoms after hospital admission were frequent, regardless of acute covid-19 severity. However, patients in more severe subphenotypes had a significantly worse functional status and were less likely to resume their professional activity or able to take care of themselves as before. Trial registration NCT04262921.
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Affiliation(s)
- Matthieu Legrand
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Nicholas Fong
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
- School of Medicine, University of California, San Francisco, California, USA
| | - Cédric Laouénan
- UMR_S 1137, Sorbonne Universités, Univ Paris Diderot, Paris, France
| | - Jade Ghosn
- APHP.Nord-Université de Paris, Paris, France
- INSERM, Paris, Île-de-France, France
| | - Benoit Thill
- CH Beziers, Beziers, Languedoc-Roussillon, France
| | - Karine Faure
- Department of Infectious Diseases, Univ Lille, CHU Lille, France
| | | | - Cécile Goujard
- Internal Medecine Unit, Le Kremlin-Bicêtre Hospital, APHP, Le Kremlin-Bicêtre, France
| | | | | | | | - Romain Pirracchio
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
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