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Thomas C, Faghy MA, Chidley C, Phillips BE, Bewick T, Ashton RE. Blood Biomarkers of Long COVID: A Systematic Review. Mol Diagn Ther 2024; 28:537-574. [PMID: 39103645 DOI: 10.1007/s40291-024-00731-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Long coronavirus disease (COVID; LC) affects millions of people worldwide. The exact mechanisms which result in a broad, undulating and detrimental symptom profile remain unknown. Blood biomarkers associated with LC have been described; however, consensus on these remains elusive, in part due to a lack of continuity between studies on a universally accepted definition of LC. This systematic review aimed to consolidate current knowledge of blood biomarkers associated with the prevalence of LC on the basis of the World Health Organisation (WHO) clinical definition of this condition. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational, cross-sectional, and randomised control studies published in the English language that studied blood biomarkers associated with the WHO definition of LC. All studies included participants who were ≥ 18 years old and group sizes ≥ 10 participants, and were compared against a control group without any known co-morbidities. METHODS A systematic literature search was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines and prospectively registered on Prospero (ID: CRD42022373121). The Cochrane, Embase, PubMed and Web of Science databases were searched from inception to January 2024. Search results were gathered using Rayyan software and data extracted using Microsoft Excel. The reporting recommendations for tumour markers prognostic studies (REMARK) questionnaire was used to assess the quality of the included studies. RESULTS A total of 45 observational and one interventional study comprising 4415 participants were included in this review which identified 525 blood biomarkers thought to be associated with LC. Three blood biomarker subtypes were associated with the development of LC: (1) immunological and inflammatory dysfunction, (2) endothelial/vascular dysfunction and (3) metabolic and clotting abnormalities. DISCUSSION AND CONCLUSIONS Our data are consistent with previous findings; however, no single biomarker was sufficiently associated with LC prevalence and instead a profile of biomarkers across various physiological systems may be more clinically useful. In all, 196 studies were excluded due to a lack of an adequately healthy comparator group and/or failure to meet the WHO LC definition. This demonstrates a need for further research incorporating a universal LC definition across all disease severity groups and symptom profiles, and longitudinal data reflecting the relapsing and remitting nature of this condition. Further investigation into blood biomarkers of LC, including clear reporting of healthy comparator groups and the investigation of acute and chronic biomarker changes, within the context of medical practice, may support the development of curative/restorative approaches.
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Affiliation(s)
- Callum Thomas
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK.
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.
| | - Mark A Faghy
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Department of Physical Therapy, College of Applied Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Corinna Chidley
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Bethan E Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, UK
| | - Thomas Bewick
- Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Ruth E Ashton
- Biomedical and Clinical Science Research Theme, School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
- Research Centre for Physical Activity, Sport and Exercise Sciences, Coventry University, Coventry, UK
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Saxena A, Mautner J. A Disease Hidden in Plain Sight: Pathways and Mechanisms of Neurological Complications of Post-acute Sequelae of COVID-19 (NC-PASC). Mol Neurobiol 2024:10.1007/s12035-024-04421-z. [PMID: 39133434 DOI: 10.1007/s12035-024-04421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
The global impact of coronavirus disease 2019 (COVID-19) marked by numerous pandemic peaks is attributed to its high variability and infectious nature, transforming it into a persistent global public health concern. With hundreds of millions of cases reported globally, the illness is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite its initial classification as an acute respiratory illness, recent evidence indicates that lingering effects on various bodily systems, such as cardiovascular, pulmonary, nervous, gastrointestinal (GI), and musculoskeletal, may endure well beyond the acute phase. These persistent manifestations following COVID-19, commonly known as long COVID, have the potential to affect individuals across the entire range of illness severity, with a tendency to be more prevalent in mild to moderate cases. At present, there are no established criteria for diagnosing long COVID. Nonetheless, it is conceptualized as a multi-organ disorder encompassing a diverse array of clinical manifestations. The most common, persistent, and debilitating symptoms of long COVID may be neurological, known as neurological complications of post-acute sequelae of COVID-19 (NC-PASC). More than one-third of individuals with a prior SARS-CoV-2 infection show involvement of both the central nervous system (CNS) and peripheral nervous system (PNS), as evidenced by an approximately threefold higher incidence of neurological symptoms in observational studies. The persistent neurological symptoms of long COVID encompass fatigue, headache, cognitive decline, "brain fog", dysautonomia, neuropsychiatric issues, loss of smell (anosmia), loss of taste (ageusia), and peripheral nerve problems (peripheral neuropathy). Reported pathogenic mechanisms encompass viral persistence and neuro-invasion by SARS-CoV-2, neuroinflammation, autoimmunity, coagulopathy, and endotheliopathy. Raising awareness of potential complications is crucial for preventing and alleviating the long-term effects of long COVID and enhancing the prognosis for affected patients. This review explores the hypothetical pathophysiological mechanisms and pathways of NC-PASC with a sole aim to increase awareness about this crippling disease.
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Affiliation(s)
- Apoorva Saxena
- Department of Biology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Josef Mautner
- Institute of Virology, Helmholtz Zentrum München, Munich, Germany
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Greenhalgh T, Darbyshire J, Ladds E, Van Dael J, Rayner C. Working knowledge, uncertainty and ontological politics: An ethnography of UK long covid clinics. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 39031491 DOI: 10.1111/1467-9566.13819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/27/2024] [Indexed: 07/22/2024]
Abstract
Long covid (persistent COVID-19) is a new disease with contested aetiology and variable prognosis. We report a 2-year ethnography of UK long covid clinics. Using a preformative lens, we show that multidisciplinary teams (MDTs) built working knowledge based on shared practices, mutual trust, distributed cognition (e.g. emails, record entries), relational knowledge of what was at stake for the patient, and harnessing uncertainty to open new discursive spaces. Most long covid MDTs performed the working knowledge of 'rehabilitation', a linked set of practices oriented to ensuring that the patient understood and strove to 'correct' maladaptive physiological responses (e.g. through breathing exercises) and pursued recovery goals, supported by physiotherapists, psychologists and generalist clinicians. Some MDTs with a higher proportion of doctors (e.g. cardiologists, neurologists, immunologists) enacted the working knowledge of 'microscopic damage', seeking to elucidate and rectify long covid's underlying molecular and cellular pathology. They justified non-standard investigations and medication in selected patients by co-constructing an evidentiary narrative based on biological mechanisms. Working knowledge was ontologically concordant within MDTs but sometimes discordant between MDTs. Overt ontological conflict occurred mostly when patients attending 'rehabilitation' clinics invoked the working knowledge of microscopic damage that had been generated and circulated in online support communities.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Julie Darbyshire
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jackie Van Dael
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Rayner
- Independent Occupational Physician, Manchester, UK
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Müllenmeister C, El-Sayed I, Heinemann S, Schröder D, Müller F, Hummers E, Stölting A, Happle C, Dopfer-Jablonka A, Marotzki U, Schmachtenberg T. Navigating uncertainty: occupational therapists' experiences of Long COVID management in Germany, Austria and Switzerland. Disabil Rehabil 2024:1-10. [PMID: 38958213 DOI: 10.1080/09638288.2024.2367603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Long COVID presents global challenges for healthcare professionals. Occupational therapists responded by seeking effective treatment strategies. The approaches of occupational therapists supporting long-haulers in German-speaking countries remain under-explored. The purpose of this study is to explore how occupational therapists in Germany, Austria and Switzerland navigate and apply profession-specific strategies in the new clinical landscape of Long COVID care. MATERIALS AND METHODS This study used qualitative-descriptive design and content analysis to extract insights from seven semi-structured interviews with occupational therapists in inpatient and outpatient settings from three countries. RESULTS Four overarching themes emerged: how Long COVID was encountered within the scope of occupational therapy, the multifaceted repertoire experts used to support long haulers, triumphs and challenges that emerged in Long COVID treatment, and recommendations and opportunities for occupational therapy practice. The results underscore the complex support needed for long-haulers, achieved through a multifaceted occupational therapy repertoire, incorporating client-centred, occupation-focused, and context-referencing strategies with shared decision-making and collaborative therapy planning. CONCLUSIONS Occupational therapy concepts, with their focus on human occupation, may offer new treatment options and strategies for managing emerging conditions such as Long COVID.
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Affiliation(s)
| | - Iman El-Sayed
- Department of General Practice, University Medical Center, Goettingen, Germany
| | | | - Dominik Schröder
- Department of General Practice, University Medical Center, Goettingen, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center, Goettingen, Germany
- Department of Family Medicine, MI State University, Grand Rapids, MI, USA
| | - Eva Hummers
- Department of General Practice, University Medical Center, Goettingen, Germany
| | - Andrea Stölting
- Department of Rheumatology and Immunology, Hannover Medical School, Germany
| | - Christine Happle
- Department of Rheumatology and Immunology, Hannover Medical School, Germany
- Department of Pediatric Pulmonology, Allergology and Neonatology, Hannover, Germany
- Biomedical Research in End-Stage and Obstructive Lung Disease Hannover (BREATH), Germany
| | | | - Ulrike Marotzki
- Faculty of Social Work and Health, University of Applied Sciences and Arts Hildesheim, Germany
| | - Tim Schmachtenberg
- Department of General Practice, University Medical Center, Goettingen, Germany
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Coste J, Delpierre C, Richard JB, Alleaume C, Gallay A, Tebeka S, Lemogne C, Robineau O, Steichen O, Makovski TT. Prevalence of long COVID in the general adult population according to different definitions and sociodemographic and infection characteristics. A nationwide random sampling survey in France in autumn 2022. Clin Microbiol Infect 2024; 30:924-929. [PMID: 38527615 DOI: 10.1016/j.cmi.2024.03.020] [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: 12/18/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES Long COVID has been recognized since early 2020, but its definition is not unanimous, which complicates epidemiological assessments. This study estimated the prevalence of long COVID based on several definitions and severity thresholds in the adult population of mainland France and examined variations according to sociodemographic and infection characteristics. METHODS A cross-sectional survey using random sampling was conducted in August-November 2022. Participants declaring SARS-CoV-2 infection were assessed for infection dates and context, post-COVID symptoms (from a list of 31, with onset time, daily functioning impact, and alternative diagnosis), and perceived long COVID. Long COVID prevalence was estimated according to the WHO, National Institute for Health and Care Excellence, United States National Centre for Health Statistics, and United Kingdom Office for National Statistics definitions. RESULTS Of 10 615 participants, 5781 (54.5%) reported SARS-CoV-2 infection, with 123-759 (1.2-13.4%) having long COVID, depending on the definition. The prevalence of WHO post-COVID condition (PCC) was 4.0% (95% CI: 3.6-4.5) in the overall population and 8.0% (95% CI: 7.0-8.9) among infected individuals. Among the latter, the prevalence varied from 5.3% (men) to 14.9% (unemployed) and 18.6% (history of hospitalization for COVID-19). WHO-PCC overlapped poorly with other definitions (kappa ranging from 0.18 to 0.59) and perceived long COVID (reported in only 43% of WHO-PCC). DISCUSSION Regardless of its definition, long COVID remains a significant burden in the French adult population that deserves surveillance, notably for forms that strongly impact daily activities. More standardized definitions will improve integrated surveillance of, and better research on, long COVID.
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Affiliation(s)
- Joël Coste
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France.
| | | | - Jean-Baptiste Richard
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Caroline Alleaume
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Anne Gallay
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
| | - Sarah Tebeka
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France; Université Paris Cité, INSERM UMR1266, Institute of Psychiatry and Neurosciences, Team 1, Paris, France; Department of Psychiatry, AP-HP, Louis Mourier Hospital, Colombes, France
| | - Cédric Lemogne
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), Service de Psychiatrie de l'adulte, AP-HP, Hôpital Hôtel-Dieu, Paris, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses, Centre Hospitalier Gustave Dron, Tourcoing, France; Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMR-S 1136, Paris, France
| | - Olivier Steichen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, IPLESP, UMR-S 1136, Paris, France; AP-HP, Hôpital Tenon, Service de Médecine Interne, Paris, France
| | - Tatjana T Makovski
- Department of Non-Communicable Diseases and Injuries, French Public Health Agency (Santé Publique France), Saint-Maurice, France
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Donnelly SC. Effective early strategy to prevent persistent olfactory and gustatory dysfunction in the long COVID syndrome: a randomized controlled trial. QJM 2024; 117:311-312. [PMID: 38834017 DOI: 10.1093/qjmed/hcae079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
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Kaplan K, Mendenhall E. Framing Long Covid through Patient activism in the United States: Patient, Provider, Academic, and Policymaker Views. Soc Sci Med 2024; 350:116901. [PMID: 38688088 DOI: 10.1016/j.socscimed.2024.116901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024]
Abstract
In 2020, when COVID-19 patients first recognized their complex and progressive symptoms, patient activists defined "Long Covid" on social media. While patient support groups are by no means new, the predominance of online support groups and those leveraging the power of social media has become a defining characteristic of Long Covid. In this article, we argue that naming Long Covid served as a powerful conduit of legitimacy for patient activists in media, medicine, and policy. We conducted 57 in-depth qualitative interviews with patients (n = 22), clinicians (n = 20), and policy and academic experts (n = 15). We found naming was not a primary area of contention. In contrast, patients found pride and a sense of identity within the terms. Many clinicians struggled with diagnostics because Long Covid lacks clear biological tests, while patients were consistently disappointed by the lack of positive tests and clarity around their symptomatology. The heterogeneity of the Long Covid experience, as well as the diversity of symptoms, further provides opportunities for contestation and disbelief among clinicians and policymakers not only in diagnostics but also in disability rights. Thus, the power of patient activism has transformed how the condition is perceived among and between patients, clinicians, policymakers, and the media in unprecedented ways that will likely have longstanding impacts on how IACCs are viewed in medicine and the public alike.
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Affiliation(s)
- Kenton Kaplan
- Walsh School of Foreign Service, Georgetown University, Washington D.C, USA
| | - Emily Mendenhall
- Walsh School of Foreign Service, Georgetown University, Washington D.C, USA.
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Greenhalgh T, Darbyshire JL, Lee C, Ladds E, Ceolta-Smith J. What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography. BMC Med 2024; 22:159. [PMID: 38616276 PMCID: PMC11017565 DOI: 10.1186/s12916-024-03371-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/26/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards to reduce a so-called "postcode lottery" of care. The original aim of this study-to examine the nature of quality in long covid care and reduce unwarranted variation in services-evolved to focus on examining the reasons why standardizing care was so challenging in this condition. METHODS In 2021-2023, we ran a quality improvement collaborative across 10 UK sites. The dataset reported here was mostly but not entirely qualitative. It included data on the origins and current context of each clinic, interviews with staff and patients, and ethnographic observations at 13 clinics (50 consultations) and 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection and analysis were informed by relevant lenses from clinical care (e.g. evidence-based guidelines), improvement science (e.g. quality improvement cycles) and philosophy of knowledge. RESULTS Participating clinics made progress towards standardizing assessment and management in some topics; some variation remained but this could usually be explained. Clinics had different histories and path dependencies, occupied a different place in their healthcare ecosystem and served a varied caseload including a high proportion of patients with comorbidities. A key mechanism for achieving high-quality long covid care was when local MDTs deliberated on unusual, complex or challenging cases for which evidence-based guidelines provided no easy answers. In such cases, collective learning occurred through idiographic (case-based) reasoning, in which practitioners build lessons from the particular to the general. This contrasts with the nomothetic reasoning implicit in evidence-based guidelines, in which reasoning is assumed to go from the general (e.g. findings of clinical trials) to the particular (management of individual patients). CONCLUSION Not all variation in long covid services is unwarranted. Largely because long covid's manifestations are so varied and comorbidities common, generic "evidence-based" standards require much individual adaptation. In this complex condition, quality improvement resources may be productively spent supporting MDTs to optimise their case-based learning through interdisciplinary discussion. Quality assessment of a long covid service should include review of a sample of individual cases to assess how guidelines have been interpreted and personalized to meet patients' unique needs. STUDY REGISTRATION NCT05057260, ISRCTN15022307.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK.
| | - Julie L Darbyshire
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Cassie Lee
- Imperial College Healthcare NHS Trust, London, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford, OX2 6GG, UK
| | - Jenny Ceolta-Smith
- LOCOMOTION Patient Advisory Group and Lived Experience Representative, London, UK
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Azargoonjahromi A. Role of the SARS-CoV-2 Virus in Brain Cells. Viral Immunol 2024; 37:61-78. [PMID: 38315740 DOI: 10.1089/vim.2023.0116] [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] [Indexed: 02/07/2024] Open
Abstract
COVID-19, caused by the SARS-CoV-2 virus, can have neurological effects, including cognitive symptoms like brain fog and memory problems. Research on the neurological effects of COVID-19 is ongoing, and factors such as inflammation, disrupted blood flow, and damage to blood vessels may contribute to cognitive symptoms. Notably, some authors and existing evidence suggest that the SARS-CoV-2 virus can enter the central nervous system through different routes, including the olfactory nerve and the bloodstream. COVID-19 infection has been associated with neurological symptoms such as altered consciousness, headaches, dizziness, and mental disorders. The exact mechanisms and impact on memory formation and brain shrinkage are still being studied. This review will focus on pathways such as the olfactory nerve and blood-brain barrier disruption, and it will then highlight the interactions of the virus with different cell types in the brain, namely neurons, astrocytes, oligodendrocytes, and microglia.
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Affiliation(s)
- Ali Azargoonjahromi
- Researcher in Neuroscience, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Al‐Jabr H, Thompson DR, Castle DJ, Ski CF. Experiences of people with long COVID: Symptoms, support strategies and the Long COVID Optimal Health Programme (LC-OHP). Health Expect 2024; 27:e13879. [PMID: 37751413 PMCID: PMC10726154 DOI: 10.1111/hex.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Long COVID (LC) is a multisystem illness, with fluctuating symptoms that affect the daily activities of patients. There are still no standardised diagnostic criteria or treatment approaches for managing LC. The LC-Optimal Health Programme (LC-OHP) was designed to support the mental wellbeing and physical health of people with LC. Gaining an in-depth understanding of patients' experiences and support strategies is imperative to identifying appropriate supports to guide them through their recovery. This study aimed to elicit the experiences and perceptions of adults with LC regarding symptoms, support strategies and the LC-OHP. METHODS As part of a wider randomised controlled trial of the LC-OHP, participants in the intervention group had their sessions audio-recorded. Transcripts were thematically analysed to identify common emergent themes. FINDINGS The LC-OHP was delivered to 26 participants. Data were collected between January 2022 and February 2023. Four main themes emerged: 'Symptoms and impact of LC'; 'Other sources of support and perceived challenges'; 'Strategies to support LC' and 'Perceptions of the LC-OHP'. CONCLUSION LC experiences were mostly described as fluctuating and burdensome that significantly impacted daily activities, and physical and mental health. The LC-OHP was perceived as beneficial. Access and experiences of other sources of support were varied. Increasing LC awareness amongst health practitioners and the wider community has the potential to improve the experiences of those affected by LC. PATIENT OR PUBLIC CONTRIBUTION The LC-OHP was derived from the OHP. It was adapted to people with LC following consultation with practitioners at an LC clinic. Additionally, the mode and timing of delivering the programme to this population were taken into account for its delivery at the convenience of participating patients. While considering that fatigue and brain fog are amongst the most reported complaints of people with LC, public members with LC were not involved directly in this study; however, feedback obtained from practitioners working with this population was implemented in amending the programme and its delivery. Additionally, feedback from patients with other chronic health conditions who used the OHP in previous studies has been implemented to make the programme more user-friendly. Moreover, feedback obtained from participants receiving this programme in this study was implanted immediately and shared with other participants. Finally, this study was overviewed by a data management committee that included two public members with LC, who contributed and provided guidance to support this study.
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Affiliation(s)
- Hiyam Al‐Jabr
- Primary Community and Social CareFaculty of Medicine and Health SciencesUniversity of KeeleKeeleUK
| | | | - David J. Castle
- Department of PsychiatryUniversity of TasmaniaHobartTasmaniaAustralia
- Centre for Mental Health Service InnovationHobartTasmaniaAustralia
| | - Chantal F. Ski
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
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Zaidi AK, Dehgani-Mobaraki P. Long Covid. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2024; 202:113-125. [PMID: 38237983 DOI: 10.1016/bs.pmbts.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), refers to a constellation of persistent symptoms and health issues that continue beyond the acute phase of COVID-19. This chapter provides an overview of the pathogenesis, risk factors, manifestations, major findings, and diagnosis and treatment strategies associated with Long COVID. Hypotheses regarding the pathogenesis of Long COVID are discussed, encompassing various factors such as persistent viral reservoirs, immune dysregulation with or without reactivation of herpesviruses (e.g., Epstein-Barr Virus and human herpesvirus), dysbiosis, autoimmunity triggered by infection, endothelial dysfunction, microvessel blood clotting, and dysfunctional brainstem and/or vagal signaling. The chapter also highlights the risk factors associated with Long COVID and its occurrence in children. The major findings of Long COVID, including immune dysregulation, vessel and tissue damage, neurological and cognitive pathology, eye symptoms, endocrinal issues, myalgic encephalomyelitis and chronic fatigue syndrome, reproductive system involvement, respiratory and gastrointestinal symptoms, and the chronology of symptoms, are thoroughly explored. Lastly, the chapter discusses the challenges and current approaches in the diagnosis and treatment of Long COVID, emphasizing the need for multidisciplinary care and individualized management strategies.
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Affiliation(s)
| | - Puya Dehgani-Mobaraki
- Founder and President, Associazione Naso Sano, Ringgold Institution ID 567754, San Mariano, Italy
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Affiliation(s)
| | - Christina Pagel
- Clinical Operational Research Unit, University College London
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13
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Ailioaie LM, Ailioaie C, Litscher G. Gut Microbiota and Mitochondria: Health and Pathophysiological Aspects of Long COVID. Int J Mol Sci 2023; 24:17198. [PMID: 38139027 PMCID: PMC10743487 DOI: 10.3390/ijms242417198] [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: 10/31/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
The current understanding of long COVID (LC) is still limited. This review highlights key findings regarding the role of gut microbiota, mitochondria, and the main pathophysiological aspects of LC revealed by clinical studies, related to the complex interplay between infection, intestinal dysbiosis, dysfunctional mitochondria, and systemic inflammation generated in a vicious circle, reflecting the molecular and cellular processes from the "leaky gut" to the "leaky electron transport chain (ETC)" into a quantum leap. The heterogeneity of LC has hindered progress in deciphering all the pathophysiological mechanisms, and therefore, the approach must be multidisciplinary, with a special focus not only on symptomatic management but also on addressing the underlying health problems of the patients. It is imperative to further assess and validate the effects of COVID-19 and LC on the gut microbiome and their relationship to infections with other viral agents or pathogens. Further studies are needed to better understand LC and expand the interdisciplinary points of view that are required to accurately diagnose and effectively treat this heterogeneous condition. Given the ability of SARS-CoV-2 to induce autoimmunity in susceptible patients, they should be monitored for symptoms of autoimmune disease after contracting the viral infection. One question remains open, namely, whether the various vaccines developed to end the pandemic will also induce autoimmunity. Recent data highlighted in this review have revealed that the persistence of SARS-CoV-2 and dysfunctional mitochondria in organs such as the heart and, to a lesser extent, the kidneys, liver, and lymph nodes, long after the organism has been able to clear the virus from the lungs, could be an explanation for LC.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Gerhard Litscher
- President of the International Society for Medical Laser Applications (ISLA Transcontinental), German Vice President of the German-Chinese Research Foundation (DCFG) for TCM, Honorary President of the European Federation of Acupuncture and Moxibustion Societies, Honorary Professor of China Beijing International Acupuncture Training Center, China Academy of Chinese Medical Sciences, Former Head of Two Research Units and the TCM Research Center at the Medical University of Graz, Auenbruggerplatz, 8036 Graz, Austria
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14
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Zimmermann P, Sourij H, Aberer F, Rilstone S, Schierbauer J, Moser O. SGLT2 Inhibitors in Long COVID Syndrome: Is There a Potential Role? J Cardiovasc Dev Dis 2023; 10:478. [PMID: 38132646 PMCID: PMC10744331 DOI: 10.3390/jcdd10120478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
The coronavirus disease (COVID)-19 has turned into a pandemic causing a global public health crisis. While acute COVID-19 mainly affects the respiratory system and can cause acute respiratory distress syndrome, an association with persistent inflammatory stress affecting different organ systems has been elucidated in long COVID syndrome (LCS). Increased severity and mortality rates have been reported due to cardiophysiological and metabolic systemic disorders as well as multiorgan failure in COVID-19, additionally accompanied by chronic dyspnea and fatigue in LCS. Hence, novel therapies have been tested to improve the outcomes of LCS of which one potential candidate might be sodium-glucose cotransporter 2 (SGLT2) inhibitors. The aim of this narrative review was to discuss rationales for investigating SGLT2 inhibitor therapy in people suffering from LCS. In this regard, we discuss their potential positive effects-next to the well described "cardio-renal-metabolic" conditions-with a focus on potential anti-inflammatory and beneficial systemic effects in LCS. However, potential beneficial as well as potential disadvantageous effects of SGLT2 inhibitors on the prevalence and long-term outcomes of COVID-19 will need to be established in ongoing research.
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Affiliation(s)
- Paul Zimmermann
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
- Interdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, Germany
- Department of Cardiology, Klinikum Bamberg, 96049 Bamberg, Germany
| | - Harald Sourij
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
| | - Felix Aberer
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
| | - Sian Rilstone
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London SW7 2AZ, UK
| | - Janis Schierbauer
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
| | - Othmar Moser
- Division of Exercise Physiology and Metabolism, BaySpo—Bayreuth Center of Sport Science, University of Bayreuth, 95440 Bayreuth, Germany; (P.Z.); (S.R.); (J.S.)
- Interdisciplinary Metabolic Medicine Research Group, Division of Endocrinology and Diabetology, Medical University of Graz, 8036 Graz, Austria; (H.S.); (F.A.)
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15
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Cegolon L, Mauro M, Sansone D, Tassinari A, Gobba FM, Modenese A, Casolari L, Liviero F, Pavanello S, Scapellato ML, Taus F, Carta A, Spiteri G, Monaco MGL, Porru S, Larese Filon F. A Multi-Center Study Investigating Long COVID-19 in Healthcare Workers from North-Eastern Italy: Prevalence, Risk Factors and the Impact of Pre-Existing Humoral Immunity-ORCHESTRA Project. Vaccines (Basel) 2023; 11:1769. [PMID: 38140174 PMCID: PMC10747427 DOI: 10.3390/vaccines11121769] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Introduction: The impact of long-COVID-19 syndrome is rather variable, since it is influenced by several residual confounders. This study aimed to investigate the prevalence of long COVID-19 in healthcare workers (HCWs) from four university hospitals in north-eastern Italy: Trieste, Padua, Verona, and Modena-Reggio Emilia. Methods: During the period June 2022-August 2022, HCWs were surveyed for past COVID-19 infections, medical history, and any acute as well as post-COVID-19 symptoms. The prevalence of long COVID-19 was estimated at 30-60 days or 61+ days since first negative swab following first and second COVID-19 episode. Furthermore, the risk of long COVID-19 was investigated by multivariable logistic regression. Results were expressed as the adjusted odds ratio (aOR) with a 95% confidence interval (95%CI). Results: 5432 HCWs returned a usable questionnaire: 2401 were infected with SARS-CoV-2 at least once, 230 were infected at least twice, and 8 were infected three times. The prevalence of long COVID-19 after a primary COVID-19 infection was 24.0% at 30-60 days versus 16.3% at 61+ days, and 10.5% against 5.5% after the second SARS-CoV-2 event. The most frequent symptoms after a first COVID-19 event were asthenia (30.3%), followed by myalgia (13.7%), cough (12.4%), dyspnea (10.2%), concentration deficit (8.1%), headache (7.3%), and anosmia (6.5%), in decreasing order of prevalence. The risk of long COVID-19 at 30-60 days was significantly higher in HCWs hospitalized for COVID-19 (aOR = 3.34; 95%CI: 1.62; 6.89), those infected with SARS-CoV-2 during the early pandemic waves-namely the Wuhan (aOR = 2.16; 95%CI: 1.14; 4.09) or Alpha (aOR= 2.05; 95%CI: 1.25; 3.38) transmission periods-and progressively increasing with viral shedding time (VST), especially 15+ days (aOR = 3.20; 95%CI: 2.07; 4.94). Further determinants of long COVID-19 at 30-60 days since primary COVID-19 event were female sex (aOR = 1.91; 95%CI: 1.30; 2.80), age >40 years, abnormal BMI, or administrative services (reference category). In contrast, HCWs vaccinated with two doses before their primary infection (aOR = 0.57; 95%CI: 0.34; 0.94), undergraduate students, or postgraduate medical trainees were less likely to experience long COVID-19 at 30-60 days. Apart from pandemic waves, the main determinants of long COVID-19 at 30-60 days were confirmed at 61+ days. Conclusions: The risk of long COVID-19 following primary infection increased with the severity of acute disease and VST, especially during the initial pandemic waves, when more virulent viral strains were circulating, and susceptibility to SARS-CoV-2 was higher since most HCWs had not been infected yet, COVID-19 vaccines were still not available, and/or vaccination coverage was still building up. The risk of long COVID-19 therefore decreased inversely with humoral immunity at the individual level. Nevertheless, the prevalence of long COVID-19 was remarkably lower after SARS-CoV-2 reinfections regardless of vaccination status, suggesting that hybrid humoral immunity did not increase protection against the syndrome compared to immunity mounted by either natural infection or vaccination separately. Since the risk of long COVID-19 is currently low with Omicron and patients who developed the syndrome following SARS-CoV-2 infection in the early pandemic waves tend to return to a state of full health with time, a cost-effective approach to screen post-COVID-19 symptoms during the Omicron time could be restricted to vulnerable individuals developing severe disease and/or with prolonged VST.
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Affiliation(s)
- Luca Cegolon
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
| | - Marcella Mauro
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
| | - Donatella Sansone
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
| | - Alice Tassinari
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
| | - Fabrizio Maria Gobba
- Department of Biomedical, Metabolic and Neurological Sciences, University of Modena and Reggio-Emilia, 41125 Modena, Italy; (F.M.G.); (A.M.)
| | - Alberto Modenese
- Department of Biomedical, Metabolic and Neurological Sciences, University of Modena and Reggio-Emilia, 41125 Modena, Italy; (F.M.G.); (A.M.)
| | - Loretta Casolari
- Health Surveillance Service, Modena University Hospital, 41125 Modena, Italy;
| | - Filippo Liviero
- Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy; (F.L.); (S.P.)
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Sofia Pavanello
- Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy; (F.L.); (S.P.)
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Maria Luisa Scapellato
- Occupational Medicine Unit, Padua University Hospital, 35128 Padua, Italy; (F.L.); (S.P.)
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, 35128 Padua, Italy
| | - Francesco Taus
- Department of Diagnostics and Public Health, Section of Medical Statistics, University of Verona, 37134 Verona, Italy;
| | - Angela Carta
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Medicine, University of Verona, 37134 Verona, Italy
| | - Gianluca Spiteri
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
| | - Maria Grazia Lourdes Monaco
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
| | - Stefano Porru
- Occupational Medicine Unit, Verona University Hospital, 37134 Verona, Italy; (A.C.); (G.S.); (M.G.L.M.); (S.P.)
- Department of Diagnostics and Public Health, Section of Occupational Medicine, University of Verona, 37134 Verona, Italy
| | - Francesca Larese Filon
- Occupational Medicine Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (M.M.); (D.S.); (A.T.); (F.L.F.)
- Occupational Medicine Unit, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
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16
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Kostka K, Roel E, Trinh NTH, Mercadé-Besora N, Delmestri A, Mateu L, Paredes R, Duarte-Salles T, Prieto-Alhambra D, Català M, Jödicke AM. "The burden of post-acute COVID-19 symptoms in a multinational network cohort analysis". Nat Commun 2023; 14:7449. [PMID: 37978296 PMCID: PMC10656441 DOI: 10.1038/s41467-023-42726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 10/19/2023] [Indexed: 11/19/2023] Open
Abstract
Persistent symptoms following the acute phase of COVID-19 present a major burden to both the affected and the wider community. We conducted a cohort study including over 856,840 first COVID-19 cases, 72,422 re-infections and more than 3.1 million first negative-test controls from primary care electronic health records from Spain and the UK (Sept 2020 to Jan 2022 (UK)/March 2022 (Spain)). We characterised post-acute COVID-19 symptoms and identified key symptoms associated with persistent disease. We estimated incidence rates of persisting symptoms in the general population and among COVID-19 patients over time. Subsequently, we investigated which WHO-listed symptoms were particularly differential by comparing their frequency in COVID-19 cases vs. matched test-negative controls. Lastly, we compared persistent symptoms after first infections vs. reinfections.Our study shows that the proportion of COVID-19 cases affected by persistent post-acute COVID-19 symptoms declined over the study period. Risk for altered smell/taste was consistently higher in patients with COVID-19 vs test-negative controls. Persistent symptoms were more common after reinfection than following a first infection. More research is needed into the definition of long COVID, and the effect of interventions to minimise the risk and impact of persistent symptoms.
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Affiliation(s)
- Kristin Kostka
- Pharmaco- and Device Epidemiology Group, CSM, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Elena Roel
- I Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Nhung T H Trinh
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Núria Mercadé-Besora
- I Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Antonella Delmestri
- Pharmaco- and Device Epidemiology Group, CSM, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Lourdes Mateu
- Department of Infectious Diseases, Hospital Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita contra les Infeccions, Badalona, Spain
| | - Roger Paredes
- Department of Infectious Diseases, Hospital Germans Trias i Pujol, Badalona, Spain
- Fundació Lluita contra les Infeccions, Badalona, Spain
- irsiCaixa AIDS Research Institute, Badalona, Spain
- Center for Global Health and Diseases, Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Talita Duarte-Salles
- I Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Prieto-Alhambra
- Pharmaco- and Device Epidemiology Group, CSM, NDORMS, University of Oxford, Oxford, United Kingdom.
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Martí Català
- Pharmaco- and Device Epidemiology Group, CSM, NDORMS, University of Oxford, Oxford, United Kingdom
| | - Annika M Jödicke
- Pharmaco- and Device Epidemiology Group, CSM, NDORMS, University of Oxford, Oxford, United Kingdom
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17
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Fundora MP, Kamidani S, Oster ME. COVID Vaccination as a Strategy for Cardiovascular Disease Prevention. Curr Cardiol Rep 2023; 25:1327-1335. [PMID: 37688764 DOI: 10.1007/s11886-023-01950-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE OF REVIEW Cardiovascular (CV) disease is a known complication of SARS-CoV-2 infection. A clear benefit of COVID-19 vaccination is a reduction mortality; however, COVID-19 vaccination may also prevent cardiovascular disease (CVD). We aim to describe CV pathology associated with SARS-CoV-2 infection and describe how COVID-19 vaccination is a strategy for CVD prevention. RECENT FINDINGS The risks and benefits of COVID-19 vaccination have been widely studied. Analysis of individuals with and without pre-existing CVD has shown that COVID-19 vaccination can prevent morbidity associated with SARS-CoV-2 infection and reduce mortality. COVID-19 vaccination is effective in preventing myocardial infarction, cerebrovascular events, myopericarditis, and long COVID, all associated with CVD risk factors. Vaccination reduces mortality in patients with pre-existing CVD. Further study investigating ideal vaccination schedules for individuals with CVD should be undertaken to protect this vulnerable group and address new risks from variants of concern.
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Affiliation(s)
- Michael P Fundora
- Children's Healthcare of Atlanta Cardiology, Department of Pediatrics, Emory University, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Satoshi Kamidani
- The Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew E Oster
- Children's Healthcare of Atlanta Cardiology, Department of Pediatrics, Emory University, 1405 Clifton Rd NE, Atlanta, GA, 30322, USA.
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18
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Ailioaie LM, Ailioaie C, Litscher G. Infection, Dysbiosis and Inflammation Interplay in the COVID Era in Children. Int J Mol Sci 2023; 24:10874. [PMID: 37446047 DOI: 10.3390/ijms241310874] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
For over three years, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children and adolescents has generated repercussions, especially a few weeks after infection, for symptomatic patients who tested positive, for asymptomatic ones, or even just the contacts of an infected person, and evolved from severe forms such as multisystem inflammatory syndrome in children (MIS-C) to multifarious clinical manifestations in long COVID (LC). Referred to under the umbrella term LC, the onset of persistent and highly heterogeneous symptoms such as fatigue, post-exertion malaise, cognitive dysfunction, and others have a major impact on the child's daily quality of life for months. The first aim of this review was to highlight the circumstances of the pathophysiological changes produced by COVID-19 in children and to better understand the hyperinflammation in COVID-19 and how MIS-C, as a life-threatening condition, could have been avoided in some patients. Another goal was to better identify the interplay between infection, dysbiosis, and inflammation at a molecular and cellular level, to better guide scientists, physicians, and pediatricians to advance new lines of medical action to avoid the post-acute sequelae of SARS-CoV-2 infection. The third objective was to identify symptoms and their connection to molecular pathways to recognize LC more easily. The fourth purpose was to connect the triggering factors of LC with related sequelae following acute SARS-CoV-2 injuries to systems and organs, the persistence of the virus, and some of its components in hidden reservoirs, including the gut and the central nervous system. The reactivation of other latent infectious agents in the host's immune environments, the interaction of this virus with the microbiome, immune hyperactivation, and autoimmunity generated by molecular mimicry between viral agents and host proteins, could initiate a targeted and individualized management. New high-tech solutions, molecules, probiotics, and others should be discovered to innovatively solve the interplay between RNA persistent viruses, microbiota, and our immune system.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania
| | - Gerhard Litscher
- President of the International Society for Medical Laser Applications (ISLA Transcontinental), German Vice President of the German-Chinese Research Foundation (DCFG) for TCM, Honorary President of the European Federation of Acupuncture and Moxibustion Societies, 8053 Graz, Austria
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19
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Scholkmann F, May CA. COVID-19, post-acute COVID-19 syndrome (PACS, "long COVID") and post-COVID-19 vaccination syndrome (PCVS, "post-COVIDvac-syndrome"): Similarities and differences. Pathol Res Pract 2023; 246:154497. [PMID: 37192595 DOI: 10.1016/j.prp.2023.154497] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
Worldwide there have been over 760 million confirmed coronavirus disease 2019 (COVID-19) cases, and over 13 billion COVID-19 vaccine doses have been administered as of April 2023, according to the World Health Organization. An infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to an acute disease, i.e. COVID-19, but also to a post-acute COVID-19 syndrome (PACS, "long COVID"). Currently, the side effects of COVID-19 vaccines are increasingly being noted and studied. Here, we summarise the currently available indications and discuss our conclusions that (i) these side effects have specific similarities and differences to acute COVID-19 and PACS, that (ii) a new term should be used to refer to these side effects (post-COVID-19 vaccination syndrome, PCVS, colloquially "post-COVIDvac-syndrome"), and that (iii) there is a need to distinguish between acute COVID-19 vaccination syndrome (ACVS) and post-acute COVID-19 vaccination syndrome (PACVS) - in analogy to acute COVID-19 and PACS ("long COVID"). Moreover, we address mixed forms of disease caused by natural SARS-CoV-2 infection and COVID-19 vaccination. We explain why it is important for medical diagnosis, care and research to use the new terms (PCVS, ACVS and PACVS) in order to avoid confusion and misinterpretation of the underlying causes of disease and to enable optimal medical therapy. We do not recommend to use the term "Post-Vac-Syndrome" as it is imprecise. The article also serves to address the current problem of "medical gaslighting" in relation to PACS and PCVS by raising awareness among the medical professionals and supplying appropriate terminology for disease.
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Affiliation(s)
- Felix Scholkmann
- University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.
| | - Christian-Albrecht May
- Department of Anatomy, Faculty of Medicine Carl Gustav Carus, TU Dresden, 01307 Dresden, Germany
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20
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Thomas C, Faghy MA, Owen R, Yates J, Ferraro F, Bewick T, Haggan K, Ashton REM. Lived experience of patients with Long COVID: a qualitative study in the UK. BMJ Open 2023; 13:e068481. [PMID: 37185640 PMCID: PMC10151237 DOI: 10.1136/bmjopen-2022-068481] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Long COVID is a rapidly evolving global health crisis requiring interdisciplinary support strategies that incorporate the lived experience of patients. Currently, there is a paucity of research documenting the day-to-day experiences of patients living with Long COVID. OBJECTIVE To explore the lived experience of Long COVID patients. STUDY DESIGN Longitudinal, observation study. SETTING An inductive, data-driven, qualitative approach was used to evaluate hand-written diaries obtained from individuals who had been referred to a Derbyshire Long COVID clinic. PARTICIPANTS 12 participants (11 females, age 49±10 years, 11 Caucasians) were recruited. Participants were included if they had a previous confirmed or suspected COVID-19 infection with ongoing recovery, >18 years old, understood the study requirements and provided informed consent. METHOD Participants were directed to complete self-report diaries over 16 weeks. Responses were transcribed verbatim and analysed using thematic analysis. RESULTS Three key themes were highlighted: (1) understanding who helps patients manage symptoms, (2) daily activities and the impact on quality of life and health status and (3) the effect of turbulent and episodic symptom profiles on personal identity and recovery. CONCLUSIONS The novel challenges presented by Long COVID are complex with varying inter-related factors that are broadly impacting functional status and quality of life. Support mechanisms must incorporate the lived experiences and foster true collaborations between health professionals, patients and researchers to improve patient outcomes. TRIAL REGISTRATION NUMBER NCT04649957.
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Affiliation(s)
- Callum Thomas
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA
| | - Mark A Faghy
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA
| | - Rebecca Owen
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA
| | - James Yates
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA
| | - Francesco Ferraro
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA
| | - Tom Bewick
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Kate Haggan
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Ruth E M Ashton
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, Illinois, USA
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21
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Chandan JS, Brown KR, Simms-Williams N, Bashir NZ, Camaradou J, Heining D, Turner GM, Rivera SC, Hotham R, Minhas S, Nirantharakumar K, Sivan M, Khunti K, Raindi D, Marwaha S, Hughes SE, McMullan C, Marshall T, Calvert MJ, Haroon S, Aiyegbusi OL. Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3477. [PMID: 36834176 PMCID: PMC9967466 DOI: 10.3390/ijerph20043477] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS. METHODS We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively. FINDINGS Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients. INTERPRETATION In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS. REGISTRATION The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022.
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Affiliation(s)
- Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Kirsty R. Brown
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nikita Simms-Williams
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Nasir Z. Bashir
- School of Oral and Dental Sciences, University of Bristol, Bristol BS8 1TH, UK
| | - Jenny Camaradou
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - Dominic Heining
- Department of Microbiology, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK
| | - Grace M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Samantha Cruz Rivera
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
| | - Richard Hotham
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Sonica Minhas
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Midlands Health Data Research UK, Birmingham B15 2TT, UK
| | - Manoj Sivan
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester LE1 7RH, UK
| | - Devan Raindi
- School of Dentistry, Institute of Clinical Sciences, University of Birmingham, Birmingham B5 7EG, UK
| | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham and Solihull Mental Health NHS Foundation Trust, Unit 1, B1, 50 Summer Hill Road, Birmingham B1 3RB, UK
| | - Sarah E. Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Melanie J. Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham, Birmingham B15 2TT, UK
- Health Data Research UK, London WC1E 6BT, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham B15 2TT, UK
- National Institute for Health Research (NIHR), Applied Research Collaboration, Birmingham B15 2TT, UK
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22
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Müller D, Stengel S, Roesler M, Schillinger G, Dräther H, Günster C, Tillmanns H, Erhart M, Szecsenyi J, Merle U. Treated post-acute sequelae after COVID-19 in a German matched cohort study using routine data from 230,256 adults. FRONTIERS IN EPIDEMIOLOGY 2023; 2:1089076. [PMID: 38455320 PMCID: PMC10911009 DOI: 10.3389/fepid.2022.1089076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/09/2022] [Indexed: 03/09/2024]
Abstract
Background Post-acute sequelae after COVID-19 are still associated with knowledge gaps and uncertainties at the end of 2022, e.g., prevalence, pathogenesis, treatment, and long-term outcomes, and pose challenges for health providers in medical management. The aim of this study was to contribute to the understanding of the multi-faceted condition of long-/ post-COVID. It was designed to evaluate whether a prior SARS-CoV-2 infection during the first COVID-19 wave in Germany increases the rate of disease, as measured via a record of insurance data on diagnoses, symptoms, and treatment, in the subsequent 12 months compared with matched control groups without recorded SARS-CoV-2 infection. Method 50 outcome variables at disease, symptom and treatment levels (14 main categories and 36 sub-categories; new diagnoses) were defined from health insurance data. Logistic regression was carried out for two groups of patients tested positive in a PCR test in March/April 2020 for SARS-CoV-2, compared to the respective risk-adjusted (age, administrative region, 1:5 propensity-score matching), contemporaneous control group without prior documented SARS-CoV-2 infection (CG): First, individuals with outpatient treatment of acute COVID-19, indicating a not severe course (COV-OUT), and second, individuals with inpatient treatment of acute COVID-19, indicating a severe course (COV-IN) were compared with their respective control group. Results The mortality rate in COV-OUT (n = 32,378) and COV-IN (n = 5,998) groups is higher compared to their control groups with odds ratio (OR) 1.5 [95%CI (1.3, 1.6)] and 1.7 [95%CI (1.5, 1.8)] respectively. Both groups were more likely to have experienced at least one outcome compared to their CG [OR = 1.4, 95%CI (1.4, 1.4)]; OR = 2.5, 95%CI [2.4, 2.6]). 42/37 (COV-IN/COV-OUT) outcome variables showed increased ORs. COV-OUT: Loss of taste and smell [OR = 5.8, 95%CI (5.1, 6.6)], interstitial respiratory diseases [OR = 2.8, 95%CI (2.0, 4.1)] and breathing disorders [OR = 3.2, 95%CI (2.2, 4.7)] showed the highest ORs. COV-IN: Interstitial respiratory diseases [OR = 12.2, 95%CI (8.5, 17.5)], oxygen therapy [OR = 8.1, 95%CI (6.4, 10.2)] and pulmonary embolism/anticoagulation [OR = 5.9, 95%CI (4.4, 7.9)] were the most pronounced. Conclusion Following a SARS-CoV-2 infection during the first wave of the COVID-19 pandemic in Germany, 8.4 [COV-OUT, 95%CI (7.7, 9.1)] respectively 25.5 [COV-IN, 95%CI (23.6, 27.4)] percentage points more subjects showed at least one new diagnosis/symptom/treatment compared to their matched CG (COV-OUT: 44.9%, CG: 36.5%; COV-IN: 72.0%, CG: 46.5%). Because the symptoms and diagnoses are so varied, interdisciplinary and interprofessional cooperation among those providing management is necessary.
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Affiliation(s)
| | - Sandra Stengel
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arkaden, Turm West, Heidelberg, Germany
| | | | | | | | | | | | - Michael Erhart
- Department for Health and Rehabilitation Sciences, Alice-Salomon-Hochschule Berlin, Berlin, Germany
- Psychology Department, Apollon Hochschule der Gesundheitswirtschaft, Bremen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arkaden, Turm West, Heidelberg, Germany
| | - Uta Merle
- Clinic for Gastroenterology, Infectious Diseases, Toxicology, Heidelberg University Hospital, Heidelberg, Germany
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23
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Ora J, Calzetta L, Frugoni C, Puxeddu E, Rogliani P. Expert guidance on the management and challenges of long-COVID syndrome: a systematic review. Expert Opin Pharmacother 2023; 24:315-330. [PMID: 36542805 DOI: 10.1080/14656566.2022.2161365] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Long-COVID is a condition characterized by the permanence of symptoms beyond 4 weeks after an initial infection. It affects 1 out of 5 people and is loosely related to the severity of acute infection and pathological mechanisms, which are yet to be understood. AREAS COVERED This article looks at currently available and under-studied therapies for long-COVID syndrome. It particularly gives focus to ongoing trials and reviews the underlying mechanisms. A comprehensive literature search was performed on PubMed and clincaltrial.gov of clinical trials concerning the management of long-COVID syndrome. EXPERT OPINION 'Long-COVID' syndrome is a new emergency characterized by several symptoms such as fatigue, dyspnea, cognitive and attention disorders, sleep disorders, post-traumatic stress disorder, muscle pain, and concentration problems. Despite the many guidelines available to date, there are no established treatments of long-COVID. Pharmacological research is studying known drugs that act on the reduction or modulation of systemic inflammation, or innovative drugs used in similar pathologies. Rehabilitation now seems to be the safest treatment to offer, whereas we will have to wait for the pharmacological research trials in progress as well as plan new trials based on a better understanding of the pathogenic mechanisms.
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Affiliation(s)
- Josuel Ora
- Unit of Respiratory Medicine, Division of Emergency Medicine, University Hospital Tor Vergata, 00133, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Luigino Calzetta
- Respiratory Disease and Lung Function Unit, Department of Medicine and Surgery, University of Parma, 43126, Parma, Italy
| | - Chiara Frugoni
- Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Ermanno Puxeddu
- Unit of Respiratory Medicine, Division of Emergency Medicine, University Hospital Tor Vergata, 00133, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Paola Rogliani
- Unit of Respiratory Medicine, Division of Emergency Medicine, University Hospital Tor Vergata, 00133, Rome, Italy.,Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome "Tor Vergata", 00133, Rome, Italy
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24
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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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25
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Craparo G, La Rosa VL, Commodari E, Marino G, Vezzoli M, Faraci P, Vicario CM, Cinà GS, Colombi M, Arcoleo G, Severino M, Costanzo G, Gori A, Mangiapane E. What Is the Role of Psychological Factors in Long COVID Syndrome? Latent Class Analysis in a Sample of Patients Recovered from COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010494. [PMID: 36612816 PMCID: PMC9819212 DOI: 10.3390/ijerph20010494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 05/24/2023]
Abstract
Background: This study aimed to identify clusters of long COVID-19 symptoms using latent class analysis and investigate the psychological factors involved in the onset of this syndrome. Method: Five hundred and six subjects recovering from COVID-19 completed a series of standardized questionnaires to evaluate the personality traits, alexithymia, and post-traumatic stress. Results: Five classes were identified: Brain fog (31.82%), No symptoms (20.95%), Sensory disorders (18.77%), Breath impairment (17.59%), and Multiple disorders (10.87%). Women reported post-COVID-19 respiratory symptoms and multiple disorders to a greater extent than men. Hospitalized subjects were more likely to report persistent symptoms after COVID-19 than asymptomatic or home-treated subjects. Antagonism, hyperarousal, and difficulty identifying emotions significantly predicted post COVID-19 symptoms. Conclusions: These findings open new questions for research on long COVID-19 and how states of emotional dysregulation can alter the physiological processes of the body and contribute to the onset of organic pathologies.
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Affiliation(s)
- Giuseppe Craparo
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy
| | | | - Elena Commodari
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
| | - Graziella Marino
- IRCCS—Referral Cancer Center of Basilicata (CROB), 85028 Rionero in Vulture, Italy
| | - Michela Vezzoli
- Department of Psychology, University of Milano-Bicocca, 20126 Milan, Italy
| | - Palmira Faraci
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy
| | - Carmelo Mario Vicario
- Department of Cognitive Sciences, Psychology, Education and Cultural Studies, University of Messina, 98122 Messina, Italy
| | - Gabriella Serena Cinà
- Department of Psychology, U.O.C., Azienda Sanitaria Provinciale Trapani, 91100 Trapani, Italy
| | | | | | | | - Giulia Costanzo
- Faculty of Human and Social Sciences, Kore University of Enna, 94100 Enna, Italy
| | - Alessio Gori
- Department of Health Sciences, University of Florence, 50121 Florence, Italy
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26
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Hunt J, Blease C, Geraghty KJ. Long Covid at the crossroads: Comparisons and lessons from the treatment of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J Health Psychol 2022; 27:3106-3120. [PMID: 35341334 DOI: 10.1177/13591053221084494] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Whilst parallels have been drawn between Long Covid and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), there is a well-documented history of negative stereotyping and marginalisation of patients with ME/CFS. A socio-politically oriented comparison of scientific, clinical and societal responses to Long Covid and ME/CFS is thus important to prevent similar harms arising among Long Covid patients. We identify four reasons for injustices in the treatment of ME/CFS patients, and discuss the risk of Long Covid following a similar trajectory. We conclude with policy and practice recommendations to help prevent such injustices arising again, including consideration of critical reflexivity in medical education.
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27
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Sheppard CL, Szigeti Z, Simpson R, Minezes J, Hitzig SL, Mayo A, Robinson LR, Lung M, Wasilewski MB. Implementation considerations for delivering inpatient COVID rehabilitation: A qualitative study. J Eval Clin Pract 2022; 28:971-985. [PMID: 36070223 PMCID: PMC9537784 DOI: 10.1111/jep.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 12/01/2022]
Abstract
RATIONALE Patients recovering from significant COVID-19 infections benefit from rehabilitation; however, aspects of rehabilitative care can be difficult to implement amidst COVID infection control measures. AIMS AND OBJECTIVES We used the Consolidated Framework for Implementation Research (CFIR) to evaluate the rapid implementation of a COVID zone in an in-patient rehabilitation hospital at the onset of the first wave of the pandemic. METHODS Semistructured interviews were conducted with health care providers (n = 12) supporting the COVID zone, as well as with patients (n = 10) who were discharged from the COVID zone and their family caregivers (n = 5). The interviews explored the successes and challenges of working on the unit and the quality of care that was delivered to patients recovering from COVID. RESULTS Rapid implementation of the COVID zone was supported by champions at the middle-management level but challenged by a number of factors, including: conflicting expert opinions on best infection control practices (outer setting), limited flow of information from senior leaders to frontline staff (inner setting), lack of rehabilitation equipment and understanding of how to provide high quality rehabilitative care in this context (intervention characteristics), willingness and self-efficacy of staff working in the COVID zone (individual characteristics) and lack of time to reflect on and assess effectiveness (process). CONCLUSIONS While there was an apparent need for rapid implementation of a COVID rehabilitation zone, senior leadership, middle management and frontline staff faced several challenges. Future evaluations should focus on how to adapt COVID rehabilitation services during fluctuating pandemic restrictions, and to account for rehabilitative needs of people recovering from significant COVID infections.
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Affiliation(s)
- Christine L. Sheppard
- St. John's Rehab Research Program, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
| | - Zara Szigeti
- St. John's Rehab Research Program, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
| | - Robert Simpson
- Department of Physical Medicine and Rehabilitation & Rehabilitation Sciences Institute, Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Jacqueline Minezes
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John's RehabSunnybrook Health Sciences CentreTorontoCanada
| | - Sander L. Hitzig
- St. John's Rehab Research Program, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Amanda Mayo
- St. John's Rehab Research Program, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
- Department of Physical Medicine and Rehabilitation, Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Lawrence R. Robinson
- St. John's Rehab Research Program, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
- Department of Physical Medicine and Rehabilitation, Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Maria Lung
- Musculoskeletal/STAR Rehab and Restorative Transitional Unit, St. John's RehabSunnybrook Health Sciences CentreTorontoCanada
| | - Marina B. Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research InstituteSunnybrook Health Sciences CentreTorontoCanada
- Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
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28
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Nouraeinejad A. Brain fog as a Long-term Sequela of COVID-19. SN COMPREHENSIVE CLINICAL MEDICINE 2022; 5:9. [PMID: 36466122 PMCID: PMC9685075 DOI: 10.1007/s42399-022-01352-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 05/31/2023]
Abstract
Increasing data indicate that people infected with COVID-19 are at high risk for developing long-term neurological complications, such as "brain fog" or cognitive impairment. However, little is known about the long-term outcomes of COVID-19 survivors. This also applies to the prevalence, risk factors, and pathobiological findings associated with these consequences. Although cognitive complications are anticipated in patients who require a long-lasting hospital stay or intubation, milder cases of COVID-19 with no record of hospitalization have also been shown to experience assessable cognitive challenges. Cognitive impairment can have a devastating impact on daily functioning. Understanding the long-term effect of COVID-19 on cognitive function is vital for applying specific schemes to those who wish to return to their jobs productively.
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Affiliation(s)
- Ali Nouraeinejad
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London (UCL), London, UK
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29
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Khandker S, Akther A, Syed BH, Shafiullah R, Ahmed K, Chowdhury AA, Khan S. Post-COVID-19 complications in home and hospital-based care: A study from Dhaka city, Bangladesh. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1037649. [PMID: 36504697 PMCID: PMC9731105 DOI: 10.3389/fresc.2022.1037649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/21/2022] [Indexed: 11/25/2022]
Abstract
A cross-sectional survey was undertaken to understand the management patterns and post-COVID-19 complications among hospital and home-treated participants. Retrospective information was collected from four COVID-19 dedicated hospitals and four selected community settings. Using probability proportional sampling, 925 participants were selected. Data were collected using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis and the exact chi-square tests were utilized to analyze the association between the studied variables. A total of 659 participants responded (response rate 70.93%); 375 from hospitals and 284 from communities. About 80% of participants were mild cases, 75% were treated at home, and 65% of hospital-treated participants were referred after home treatment. Participants treated at home-to hospital and directly in the hospital had 1.64 and 3.38 times longer recovery time respectively than what home-based participants had. A significant increasing trend (p < 0.001) of co-morbidities was found among referred and hospital treated participants. Age, level of education, physical exercise, practicing preventive measures, exposure to sunlight, and intake of carbohydrate, additional liquid, food supplements, and avoidance of junk foods were significantly associated with place of treatment. Post-COVID-19 difficulties of all factors were statistically significant for home treatment participants, whilst only depression (p = 0.026), chest pain (p = 0.017), and digestive disorders (p = 0.047) were significant (p < 0.05) for hospital treated participants. The outcomes from this study provide insight into a range of post-COVID-19 difficulties relating to at home and in hospital treatment participants. There are clear differences in the complications experienced, many of which are statistically significant. The health care professionals, the community people and COVID-19 survivors will be benefitted from the study findings, and the policy level people may use the information for designing health education program on post COVID-19 complications.
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Affiliation(s)
- Salamat Khandker
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh,Correspondence: Salamat Khandker
| | - Aivee Akther
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Billal H. Syed
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Rezoun Shafiullah
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Kawsar Ahmed
- School of Mathematics & Statistics, Central South University, Changsha, China
| | | | - Salim Khan
- Head, Department of Public Health, Birmingham City University, Birmingham, United Kingdom
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30
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Porter N, Jason LA. Mindfulness Meditation Interventions for Long COVID: Biobehavioral Gene Expression and Neuroimmune Functioning. Neuropsychiatr Dis Treat 2022; 18:2599-2626. [PMID: 36387947 PMCID: PMC9653042 DOI: 10.2147/ndt.s379653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Some individuals infected with SARS CoV-2 have developed Post-Acute Sequelae of SARS CoV-2 infection (PASC) or what has been referred to as Long COVID. Efforts are underway to find effective treatment strategies for those with Long COVID. One possible approach involves alternative medical interventions, which have been widely used to treat and manage symptoms of a variety of medical problems including post-viral infections. Meditation has been found to reduce fatigue and unrefreshing sleep, and for those with post-viral infections, it has enhanced immunity, and reduced inflammatory-driven pathogenesis. Our article summarizes the literature on what is known about mindfulness meditation interventions, and reviews evidence on how it may apply to those with Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Evidence is reviewed suggesting effective and sustainable outcomes may be achieved for symptomatology and underlying pathology of post-viral fatigue (PASC and ME/CFS).
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Affiliation(s)
- Nicole Porter
- Center for Community Research, DePaul University, Chicago, IL, USA
| | - Leonard A Jason
- Center for Community Research, DePaul University, Chicago, IL, USA
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31
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Bschir K, Lohse S. Pandemics, policy, and pluralism: A Feyerabend-inspired perspective on COVID-19. SYNTHESE 2022; 200:441. [PMID: 36320863 PMCID: PMC9607765 DOI: 10.1007/s11229-022-03923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
We analyse insufficient epistemic pluralism and associated problems in science-based policy advice during the COVID-19 pandemic drawing on specific arguments in Paul Feyerabend's philosophy. Our goal is twofold: to deepen our understanding of the epistemic shortcomings in science-based policy during the pandemic, and to assess the merits and problems of Feyerabend's arguments for epistemic pluralism as well as their relevance for policy-making. We discuss opportunities and challenges of integrating a plurality of viewpoints from within and outside science into policy advice thus contributing to discussions about normative issues concerning evidence and expertise in policy-making.
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Affiliation(s)
- Karim Bschir
- University of St. Gallen, St. Gallen, Switzerland
| | - Simon Lohse
- Institute for Science in Society, Radboud University, Nijmegen, The Netherlands
- Centre for Ethics and Law in the Life Sciences, Leibniz University Hannover, Hannover, Germany
- African Centre for Epistemology and Philosophy of Science, University of Johannesburg, Johannesburg, South Africa
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32
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Alkwai HM, Khalifa AM, Ahmed AM, Alnajib AM, Alshammari KA, Alrashidi MM, Ahmed HG. Persistence of COVID-19 symptoms beyond 3 months and the delayed return to the usual state of health in Saudi Arabia: A cross-sectional study. SAGE Open Med 2022; 10:20503121221129918. [PMID: 36226231 PMCID: PMC9548451 DOI: 10.1177/20503121221129918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
A substantial number of COVID-19 survivors describe ongoing symptoms long after
the acute phase. This so-called post-COVID-19 syndrome or long COVID occurs
irrespective of initial disease severity.
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Affiliation(s)
- Hend M Alkwai
- Department of Pediatrics, College of
Medicine, University of Ha’il, Ha’il, Saudi Arabia,Hend M Alkwai, Department of Pediatrics,
College of Medicine, University of Ha’il, 2440 Ha’il, Saudi Arabia.
| | - Amany M Khalifa
- Department of Pathology, College of
Medicine, University of Ha’il, Ha’il, Saudi Arabia
| | - Ahmed M Ahmed
- Department of Surgery, College of
Medicine, University of Ha’il, Ha’il, Saudi Arabia
| | - Alfatih M Alnajib
- Department of Surgery, College of
Medicine, University of Ha’il, Ha’il, Saudi Arabia
| | | | | | - Hussain G Ahmed
- Department of Pathology, College of
Medicine, University of Ha’il, Ha’il, Saudi Arabia
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33
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Muacevic A, Adler JR. Acute COVID-19 Syndrome Predicts Severe Long COVID-19: An Observational Study. Cureus 2022; 14:e29826. [PMID: 36204261 PMCID: PMC9527039 DOI: 10.7759/cureus.29826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Tissue damage, chronic dysfunction, and symptoms that last more than 12 weeks are hallmarks of long-term chronic opportunistic viral infection (COVID-19), and the disease may have a permanent, relapsing/remitting, or gradually improving course. This study aimed to determine the risk factors of severe long COVID-19. Methods In October 2021, primary care clinics enrolled consenting 18- to 89-year-olds to complete an online questionnaire on self-diagnosis, clinician diagnosis, testing, symptom presence, and duration of COVID-19. Long COVID-19 was identified if symptoms were beyond 12 weeks. Patients with long-lasting COVID-19 symptoms were assessed using multivariable regression to identify potential predictors of severe long COVID-19. Results Of the 220 respondents, 108 (49%) patients were self- or clinician-diagnosed with COVID-19 or had a confirmed positive laboratory test result. Patients aged >45 years and with at least 15 COVID-19 symptoms were 5.55 and 6.02 times, respectively, more likely to acquire severe long COVID-19. Most patients with severe and moderate post-acute COVID-19 syndrome had no relevant comorbidities (p=0.0402; odds ratio [OR]=0.4; 95% confidence interval [CI]=0.18-0.98). Obesity was a significant predictor (p=0.0307; OR=6.2; 95% CI=1.1-33.2). Conclusion The simultaneous presence of 15 or more COVID-19 symptoms, age >45 years, and obesity were related to a higher probability of severe long COVID-19.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Brendan Delaney
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Rachael Evans
- Institute for Lung Health, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Ruairidh Milne
- School of Healthcare Enterprise and Innovation, University of Southampton, Southampton, UK
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Affiliation(s)
| | - Paul Tubig
- Georgia Southern University, Statesboro, USA
| | | | | | - Kelly Hills
- University of Massachusetts Lowell, Lowell, USA
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Hunt J. Making space for disability studies within a structurally competent medical curriculum: reflections on long Covid. MEDICAL HUMANITIES 2022; 49:medhum-2022-012415. [PMID: 35853689 DOI: 10.1136/medhum-2022-012415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
While critically informed approaches to medical education are increasingly advocated in literature, discussion of the potential role of disability studies in informing pedagogy and practice is largely lacking. The emergence of long Covid, alongside the strong possibility of a wave of covid-related disability, underlines an urgent need for medicine to develop more contextualised, nuanced and structurally competent understandings of chronic illness and disability. This article argues that the integration of thinking from disability studies into medical curricula offers a pathway to such understanding, informing a more equitable, holistic and patient-centred approach to practice. Further, a structurally competent, antiableist approach positions clinicians and patients as allies, working together within a structural context that constrains both parties. Such positioning may mitigate tensions within the clinical encounter, tensions that are well documented in the realm of marginalised chronic illness and disability. While the possibilities arising from a partnership between disability studies and medicine are numerous, the foci here are the social relational model of disability and the concept of psycho-emotional disablism, within a broader framework of critical disability studies. It is argued that inadequate healthcare provision and policy in the realm of long Covid can be understood as a form of structural and psycho-emotional disablism, arising from and reinforcing an ableist psychosocial imaginary permeated with neoliberal assumptions, and carrying a risk of furthering both disability and impairment. After considering long Covid through these particular lenses, the article concludes with a discussion of how a partnership between disability studies and a structurally competent approach to medical education might translate into practice.
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Affiliation(s)
- Joanne Hunt
- Independent disabled researcher, Stroud, Gloucestershire, UK
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Awoyemi T, Ebili U, Olusanya A, Ogunniyi KE, Adejumo AV. Twitter Sentiment Analysis of Long COVID Syndrome. Cureus 2022; 14:e25901. [PMID: 35844354 PMCID: PMC9278796 DOI: 10.7759/cureus.25901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Long COVID syndrome originated as a patient phrased terminology which was initially used to describe a group of vague symptoms that persisted after recovering from COVID-19. However, it has moved from a patient lingo to a recognized pathological entity which refers to a group of symptoms that lasts weeks or months after the COVID-19 illness. The novelty of this condition, the inadequacy of research on long COVID syndrome, and its origin as a patient-coined terminology necessitated exploring the disease's sentiments and conversations by analyzing publicly available tweets. Method Tweets were extracted using the Twarc2 tool for tweets in the English language with the keywords (long COVID syndrome, long COVID, post-COVID syndrome, post-acute sequelae of SARS-CoV-2, long-term COVID, long haulers, and chronic COVID syndrome) between March 25, 2022, and April 1, 2022. The analyses included frequency of the keywords, sentiment analysis, and topic modeling to identify and explore discussion topics over time. A natural language approach and the latent Dirichlet allocation algorithm were used to determine the most shared tweet topics, categorize clusters, and identify themes based on keyword analysis. Results The search yielded 62,232 tweets. The tweets were reduced to 10,670 tweets after removing the duplicates. The vast majority of the tweets originated from the United States of America (38%), United Kingdom (30%), and Canada (13%), with the most common hashtags being #longcovid (36%) and #covid (6.36%), and the most frequently used word being people (1.05%). The top three emotions detected by our analysis were trust (11.68%), fear (11.26%), and sadness (9.76%). The sentiment analysis results showed that people have comparable levels of positivity (19.90%) and negativity (18.39%) towards long COVID. Conclusions Our analysis revealed comparable sentiments about long COVID syndrome, albeit slightly positive. Most tweets connoted trust (positive), fear (negative), and sadness (negative). These emotions were linked with concerns about the infection, pandemic, chronic disability, and governmental policies. We believe this study would be important in guiding information dissemination and governmental policy implementation necessary in tackling long COVID syndrome.
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Töpfner N, Alberer M, Ankermann T, Bender S, Berner R, de Laffolie J, Dingemann J, Heinicke D, Haas JP, Hufnagel M, Hummel T, Huppertz HI, Knuf M, Kobbe R, Lücke T, Riedel J, Rosenecker J, Wölfle J, Schneider B, Schneider D, Schriever V, Schroeder A, Stojanov S, Tenenbaum T, Trapp S, Vilser D, Brinkmann F, Behrends U. [Recommendation for standardized medical care for children and adolescents with long COVID]. Monatsschr Kinderheilkd 2022; 170:539-547. [PMID: 35637934 PMCID: PMC9131710 DOI: 10.1007/s00112-021-01408-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/03/2022]
Abstract
This current consensus paper for long COVID complements the existing AWMF S1 guidelines for long COVID with a detailed overview on the various clinical aspects of long COVID in children and adolescents. Members of 19 different pediatric societies of the DGKJ convent and collaborating societies together provide expert-based recommendations for the clinical management of long COVID based on the currently available but limited academic evidence for long COVID in children and adolescents. It contains screening questions for long COVID and suggestions for a structured, standardized pediatric medical history and diagnostic evaluation for patients with suspected long COVID. A time and resource-saving questionnaire, which takes the clinical complexity of long COVID into account, is offered via the DGKJ and DGPI websites as well as additional questionnaires suggested for an advanced screening of specific neurocognitive and/or psychiatric symptoms including post-exertional malaise (PEM) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). According to the individual medical history as well as clinical signs and symptoms a step by step diagnostic procedure and a multidisciplinary therapeutic approach are recommended.
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Affiliation(s)
| | - Deutsche Gesellschaft für Pädiatrische Infektiologie e. V. (DGPI)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | - Martin Alberer
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
| | | | - Gesellschaft für Pädiatrische Pneumologie e. V. (GPP)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | | | - Gesellschaft für Pädiatrische Gastroenterologie und Ernährung e. V. (GPGE)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Kinderchirurgie e. V. (DGKCH)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Bündnis Kinder- und Jugendreha e. V. (BKJR)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Gesellschaft für Kinder- und Jugendrheumatologie (GKJR)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | | | - Deutsche Akademie für Kinder- und Jugendmedizin (DAKJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Gesellschaft für Neuropädiatrie e. V. (GNP)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (DGSPJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Deutsche Gesellschaft für Kinderendokrinologie und -diabetologie e. V. (DGKED)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Schlafforschung und Schlafmedizin e. V. (DGSM)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | - Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V. (DGKJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Gesellschaft für Neuropsychologie (GNP)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | | | - Berufsverband der Kinder- und Jugendärzte e. V. (BVKJ)
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Klinikum Rechts der Isar (AöR) der Technischen Universität München und München Klinik gGmbH, München, Deutschland
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
| | | | | | - Folke Brinkmann
- Klinik für Kinder- und Jugendmedizin, Katholisches Klinikum Bochum gGmbH, Standort St. Josef-Hospital, Alexandrinenstr. 5, 44791 Bochum, Deutschland
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Kuodi P, Gorelik Y, Edelstein M. Characterisation of the long-term physical and mental health consequences of SARS-CoV-2 infection: A systematic review and meta-analysis protocol. PLoS One 2022; 17:e0266232. [PMID: 35381027 PMCID: PMC8982872 DOI: 10.1371/journal.pone.0266232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background As of July 2021, there has been more than 185 million documented cases of the novel coronavirus (SARS-CoV-2) infections and more than 4 million deaths globally. Despite more than 90% of documented cases being classified as “recovered” from SARS-CoV-2 infection, a proportion of patients reported a wide variety of persisting symptoms after the initial onset or acute phase of the infection, often referred to as “Long Covid”. As data on the symptomatology of post-acute SARS-CoV-2 infection gradually becomes available, there is an urgent need to organise and synthesise the data in order to define what constitutes Long Covid and assist with its management in clinical and community settings. Methods This protocol follows the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines. A comprehensive literature search strategy will be developed in accordance with the Cochrane highly sensitive search guidelines. The following electronic databases will be searched for studies to include in the systematic review and meta-analysis: MEDLINE (via PubMed), Scopus, Google Scholar, Web of Science (Web of Knowledge), Science direct, EMBASE, Mednar, Psych INFO, and EBSCOhost. Dual screening will be applied at every screening stage. Two reviewers will independently screen titles, abstracts and full text of potentially eligible studies following the predefined inclusion and exclusion criteria in order to select studies to include in the review. As heterogeneity is anticipated between the included studies, data will be pooled in a meta-analysis using a random effects model. A clustering analytic approach will be applied to identify symptoms groupings and assign the symptoms into clusters. R statistical software will be used for the meta-analysis. Highly heterogenous data will be synthesised narratively. The studies will be assessed, for quality using quality assessment tools appropriate for each study design. Two reviewers will independently undertake the quality of studies assessments. Dissemination plans Findings of the systematic review will be disseminated through a peer-reviewed publication and presentation of findings at conferences, workshops and government and private sector stakeholder engagement meetings. Clinical trial registration PROSPERO registration number: CRD4202126589. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202126589.
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Affiliation(s)
- Paul Kuodi
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- * E-mail:
| | - Yanay Gorelik
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Neurological and Mental Health Symptoms Associated with Post-COVID-19 Disability in a Sample of Patients Discharged from a COVID-19 Ward: A Secondary Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074242. [PMID: 35409924 PMCID: PMC8998950 DOI: 10.3390/ijerph19074242] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022]
Abstract
Recent studies suggest that COVID-19 survivors may experience long-term health consequences: in particular, neurological and mental health symptoms might be associated with long-term negative outcomes. This study is a secondary analysis of a larger cohort study and aims to determine the extent to which neurological and mental health sequelae are associated with survivors’ disability. Participants include COVID-19 survivors, with no pre-morbid brain conditions, who were discharged from the COVID-19 Unit of the ASST Spedali Civili Hospital between February and April 2020. At an average of 3.5 months after discharge, they were submitted to a neurological examination and completed the WHO Disability Assessment Schedule (WHODAS-12), the Hospital Anxiety and Depression Score, the Pittsburgh Sleep Quality Index and the Montreal Cognitive Assessment. Multivariable regression analysis was carried out to analyze variables that explain WHODAS-12 variation. In total, 83 patients (63 males, average age 66.9, 95% CI: 64.2–69.7) were enrolled; average WHODAS-12 was 13.2 (95% CI: 9.7–16.6). Cognitive dysfunction, anxiety, fatigue, and hyposmia/hypogeusia explained 28.8% of WHODAS-12 variation. These findings underline the importance and need for longitudinal follow-up assessments after recovery from COVID-19 and suggest the need for early rehabilitation of residual symptoms to enhance patients’ functioning.
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Ziauddeen N, Gurdasani D, O’Hara ME, Hastie C, Roderick P, Yao G, Alwan NA. Characteristics and impact of Long Covid: Findings from an online survey. PLoS One 2022; 17:e0264331. [PMID: 35259179 PMCID: PMC8903286 DOI: 10.1371/journal.pone.0264331] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/06/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Long Covid is a public health concern that needs defining, quantifying, and describing. We aimed to explore the initial and ongoing symptoms of Long Covid following SARS-CoV-2 infection and describe its impact on daily life. METHODS We collected self-reported data through an online survey using convenience non-probability sampling. The survey enrolled adults who reported lab-confirmed (PCR or antibody) or suspected COVID-19 who were not hospitalised in the first two weeks of illness. This analysis was restricted to those with self-reported Long Covid. Univariate comparisons between those with and without confirmed COVID-19 infection were carried out and agglomerative hierarchical clustering was used to identify specific symptom clusters, and their demographic and functional correlates. RESULTS We analysed data from 2550 participants with a median duration of illness of 7.6 months (interquartile range (IQR) 7.1-7.9). 26.5% reported lab-confirmation of infection. The mean age was 46.5 years (standard deviation 11 years) with 82.8% females and 79.9% of participants based in the UK. 89.5% described their health as good, very good or excellent before COVID-19. The most common initial symptoms that persisted were exhaustion, chest pressure/tightness, shortness of breath and headache. Cognitive dysfunction and palpitations became more prevalent later in the illness. Most participants described fluctuating (57.7%) or relapsing symptoms (17.6%). Physical activity, stress, and sleep disturbance commonly triggered symptoms. A third (32%) reported they were unable to live alone without any assistance at six weeks from start of illness. 16.9% reported being unable to work solely due to COVID-19 illness. 37.0% reported loss of income due to illness, and 64.4% said they were unable to perform usual activities/duties. Acute systems clustered broadly into two groups: a majority cluster (n = 2235, 88%) with cardiopulmonary predominant symptoms, and a minority cluster (n = 305, 12%) with multisystem symptoms. Similarly, ongoing symptoms broadly clustered in two groups; a majority cluster (n = 2243, 88.8%) exhibiting mainly cardiopulmonary, cognitive symptoms and exhaustion, and a minority cluster (n = 283, 11.2%) exhibiting more multisystem symptoms. Belonging to the more severe multisystem cluster was associated with more severe functional impact, lower income, younger age, being female, worse baseline health, and inadequate rest in the first two weeks of the illness, with no major differences in the cluster patterns when restricting analysis to the lab-confirmed subgroup. CONCLUSION This is an exploratory survey of Long Covid characteristics. Whilst this is a non-representative population sample, it highlights the heterogeneity of persistent symptoms, and the significant functional impact of prolonged illness following confirmed or suspected SARS-CoV-2 infection. To study prevalence, predictors and prognosis, research is needed in a representative population sample using standardised case definitions.
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Affiliation(s)
- Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | - Deepti Gurdasani
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Margaret E. O’Hara
- Patient contributor, Long Covid Support: www.longcovid.org, London, United Kingdom
| | - Claire Hastie
- Patient contributor, Long Covid Support: www.longcovid.org, London, United Kingdom
| | - Paul Roderick
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Guiqing Yao
- Department of Health Science, University of Leicester, Leicester, United Kingdom
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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Thyagaraj V, Rao A, Kulkarni A, Shankar T, R N, Unnikrishnan H, Kalaiah K, E I, Veluswamy SK, Kumar B S N, Ravindra S, Shetty N. Clinical and Laboratory Profile of Patients Visiting the Post-COVID-19 Clinic at a Tertiary Care Hospital: A Cross-Sectional Study. Cureus 2022; 14:e22888. [PMID: 35273894 PMCID: PMC8901080 DOI: 10.7759/cureus.22888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) survivors may continue experiencing diverse symptoms. This study portrays the clinical and laboratory profile of patients with post-acute sequelae of COVID-19'(PASC) at a tertiary care hospital in India. Methodology: This cross-sectional study enrolled patients visiting the post-COVID-19 clinic three weeks after their acute COVID-19 illness. Their clinical, serological, and radiological characteristics were collected and analyzed. RESULTS Of the 259 participants (age: 48.02±15.27 years; 62.25% men), 168 had PASC manifestations. The most frequently reported symptoms were fatigue (n=71(42.26%)), breathlessness (n=38(22.61%)), and cough (n=35(20.83%)). Patients with PASC had higher body mass index (28.24±5.02 vs. 26.26±3.65; p=0.002), history of hypertension (52 (30.95%) vs. 17 (18.6%); p=0.039), uncontrolled systolic blood pressure (37 (22.03) vs. 14 (15.38); p=0.042), and persistent chest x-ray abnormalities (34 (20.23) vs. 10 (10.98); p=0.048). CONCLUSION Fatigue, breathlessness, and cough are common PASC symptoms. Hypertension, obesity, and abnormal chest x-ray findings at follow-up are potential risk factors for developing PASC.
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Affiliation(s)
| | - Akshay Rao
- Internal Medicine, Ramaiah Medical College, Bengaluru, IND
| | | | | | - Nithin R
- Internal Medicine, Ramaiah Medical College, Bengaluru, IND
| | | | | | - Iniya E
- Internal Medicine, Ramaiah Medical College, Bengaluru, IND
| | - Sundar K Veluswamy
- Physical Medicine and Rehabilitation, Ramaiah Medical College, Bengaluru, IND
| | | | - Savita Ravindra
- Physical Medicine and Rehabilitation, Ramaiah Medical College, Bengaluru, IND
| | - Naresh Shetty
- Orthopaedics, Ramaiah Medical College, Bengaluru, IND
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Fowler Davis S, Choppin S, Kelly S. Towards an Understanding of Population Health Data in a Single NHS Trust during COVID-19. Healthcare (Basel) 2022; 10:healthcare10030447. [PMID: 35326925 PMCID: PMC8953481 DOI: 10.3390/healthcare10030447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
The objective of this study was to determine the further care needs of people discharged from the hospital following a COVID-19 illness from April–September 2020. Methods: In partnership with an NHS trust in the UK, data analysis was undertaken by linking data from the Trust, to facilitated a triage process. The intention was to provide information in a format that enabled an examination of the population data and highlight any inequality in provision. Data were mapped onto the indices of multiple deprivation, and a range of text and graphical methods were used to represent the population data to the hospital leadership. The visual representation of the demographics and deprivation of people discharged during a critical period of the pandemic was intended to support planning for community services. The results demonstrated that just under half of those discharged were from the poorest fifth of the English population and that just under half were aged 75 or older. This reflected the disproportional effect of COVID-19 on those who were poorer, older or had pre-existing multiple morbidities. Referral to community or outpatient services was informed by the analysis, and further understanding of the diversity of the population health was established in the Trust. Conclusion: By identifying the population and mapping to the IMD, it was possible to show that over half of discharged patients were from deprived communities, and there was significant organisational learning bout using data to identify inequalities.. The challenge of planning services that target underserved communities remains an important issue following the pandemic, and lessons learnt from one health system are being shared.
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Behnood SA, Shafran R, Bennett SD, Zhang AXD, O'Mahoney LL, Stephenson TJ, Ladhani SN, De Stavola BL, Viner RM, Swann OV. Persistent symptoms following SARS-CoV-2 infection amongst children and young people: A meta-analysis of controlled and uncontrolled studies. J Infect 2022; 84:158-170. [PMID: 34813820 PMCID: PMC8604800 DOI: 10.1016/j.jinf.2021.11.011] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Data on the long-term impact of SARS-CoV-2 infection in children and young people (CYP) are conflicting. We assessed evidence on long-term post-COVID symptoms in CYP examining prevalence, risk factors, type and duration. METHODS Systematic search of published and unpublished literature using 13 online databases between 01/12/2019 and 31/07/2021. Eligible studies reported CYP ≤19 years with confirmed or probable SARS-CoV-2 with any symptoms persisting beyond acute illness. Random effects meta-analyses estimated pooled risk difference in symptom prevalence (controlled studies only) and pooled prevalence (uncontrolled studies also included). Meta-regression examined study characteristics hypothesised to be associated with symptom prevalence. Prospectively registered: CRD42021233153. FINDINGS Twenty two of 3357 unique studies were eligible, including 23,141 CYP. Median duration of follow-up was 125 days (IQR 99-231). Pooled risk difference in post-COVID cases compared to controls (5 studies) were significantly higher for cognitive difficulties (3% (95% CI 1, 4)), headache (5% (1, 8)), loss of smell (8%, (2, 15)), sore throat (2% (1, 2)) and sore eyes (2% (1, 3)) but not abdominal pain, cough, fatigue, myalgia, insomnia, diarrhoea, fever, dizziness or dyspnoea. Pooled prevalence of symptoms in post-COVID participants in 17 studies ranged from 15% (diarrhoea) to 47% (fatigue). Age was associated with higher prevalence of all symptoms except cough. Higher study quality was associated with lower prevalence of all symptoms, except loss of smell and cognitive symptoms. INTERPRETATION The frequency of the majority of reported persistent symptoms was similar in SARS-CoV-2 positive cases and controls. This systematic review and meta-analysis highlights the critical importance of a control group in studies on CYP post SARS-CoV-2 infection.
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Affiliation(s)
- S A Behnood
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, United Kingdom
| | - R Shafran
- UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - S D Bennett
- UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - A X D Zhang
- UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - L L O'Mahoney
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - T J Stephenson
- UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - S N Ladhani
- Immunisation and Countermeasures Division, Public Health England Colindale, United Kingdom; Paediatric Infectious Disease, St. George's Hospital London, United Kingdom
| | - B L De Stavola
- UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - R M Viner
- UCL Great Ormond Street Institute of Child Health, United Kingdom
| | - O V Swann
- Department of Child Life and Health, University of Edinburgh, United Kingdom; Royal Hospital for Children, Glasgow, United Kingdom.
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Reviewing fair subject selection considerations for the unique case of post sequelae COVID-19 translational studies. J Clin Transl Sci 2022; 6:e91. [PMID: 36003210 PMCID: PMC9389279 DOI: 10.1017/cts.2022.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/20/2022] Open
Abstract
Fair inclusion of research subjects is necessary to ensure that post-acute sequelae COVID-19 (PASC) research results benefit all members of society. Scientists should conduct research on a broad sample of individuals who represent clinically relevant factors influencing a disease. Without demographic diversity and sociological and environmental variability, research outputs are less likely to apply to different populations and would thus increase health disparities. The goal of this narrative literature review and ethical analysis is to apply fair selection criteria to PASC research studies. We briefly highlight the importance of fair subject selection in translational research and then identify features of PASC, as well as PASC research, that hinder fair inclusion of research participants. We will demonstrate that determining an adequate and representative sample is not simply a matter of ensuring greater diversity; rather, fairness requires a broader evaluation of risks, burdens, and benefits specific to underrepresented populations. We provide recommendations to ensure fair subject selection in PASC research and promote translation toward positive health outcomes for all individuals, including the most vulnerable.
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Bobdey S, Mookkiah I, Kaur M, Yadav A, Teli P, Faujdar D, Bhaskar SV, Adhya S, Kaushik SK. An evaluation of persistence of postdischarge symptoms in survivors of COVID-19 infection. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_729_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Hossain MA, Hossain KMA, Saunders K, Uddin Z, Walton LM, Raigangar V, Sakel M, Shafin R, Hossain MS, Kabir MF, Faruqui R, Rana MS, Ahmed MS, Chakrovorty SK, Hossain MA, Jahid IK. Prevalence of Long COVID symptoms in Bangladesh: a prospective Inception Cohort Study of COVID-19 survivors. BMJ Glob Health 2021; 6:bmjgh-2021-006838. [PMID: 34906986 PMCID: PMC8671853 DOI: 10.1136/bmjgh-2021-006838] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The objective of this study was to identify the prevalence of long COVID symptoms in a large cohort of people living with and affected by long COVID and identify any potential associated risk factors. METHODS A prospective survey was undertaken of an inception cohort of confirmed people living with and affected by long COVID (aged 18-87 years). 14392 participants were recruited from 24 testing facilities across Bangladesh between June and November 2020. All participants had a previously confirmed positive COVID-19 diagnosis, and reported persistent symptoms and difficulties in performing daily activities. Participants who consented were contacted by face-to-face interview, and were interviewed regarding long COVID, and restriction of activities of daily living using post COVID-19 functional status scale. Cardiorespiratory parameters measured at rest (heart rate, systolic blood pressure, diastolic blood pressure, oxygen saturation levels, maximal oxygen consumption, inspiratory and expiratory lung volume) were also measured. RESULTS Among 2198 participants, the prevalence of long COVID symptoms at 12 weeks was 16.1%. Overall, eight long COVID symptoms were identified and in descending order of prominence are: fatigue, pain, dyspnoea, cough, anosmia, appetite loss, headache and chest pain. People living with and affected by long COVID experienced between 1 and 8 long COVID symptoms with an overall duration period of 21.8±5.2 weeks. Structural equation modelling predicted the length of long COVID to be related to younger age, female gender, rural residence, prior functional limitation and smoking. CONCLUSION In this cohort, at 31 weeks post diagnosis, the prevalence of long COVID symptoms was 16.1%. The risk factors identified for presence and longer length of long COVID symptoms warrant further research and consideration to support public health initiatives.
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Affiliation(s)
- Mohammad Anwar Hossain
- Department of Microbiology, Jashore University of Science and Technology, Jashore, Bangladesh.,Department of Physiotherapy, Centre for Rehabilitation of the Paralysed, Dhaka, Bangladesh
| | - K M Amran Hossain
- Department of Physiotherapy, Bangladesh Health Professions Institute, Savar, Dhaka, Bangladesh
| | - Karen Saunders
- School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK
| | - Zakir Uddin
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Lori Maria Walton
- Department of Physical Therapy, School of Health Sciences, University of Scranton, Scranton, Pennsylvania, USA
| | - Veena Raigangar
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mohamed Sakel
- East Kent Neurorehabilation Department, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Rubayet Shafin
- Department of Physiotherapy, Centre for Rehabilitation of the Paralysed, Dhaka, Bangladesh
| | - Mohammad Sohrab Hossain
- Department of Physiotherapy, Bangladesh Health Professions Institute, Savar, Dhaka, Bangladesh
| | - Md Feroz Kabir
- Department of Physiotherapy & Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Rafey Faruqui
- Department of Neuropsychiatry, Kent and Medway NHS and Social Care Partnership Trust, Maidstone, Kent, UK
| | - Md Shohag Rana
- Department of Physiotherapy, Bangladesh Health Professions Institute, Savar, Dhaka, Bangladesh
| | - Md Shahoriar Ahmed
- Department of Physiotherapy, Centre for Rehabilitation of the Paralysed, Dhaka, Bangladesh
| | | | - Md Anwar Hossain
- Department of Microbiology, University of Dhaka, Dhaka, Bangladesh.,Vice-Chancellor, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Iqbal Kabir Jahid
- Department of Microbiology, Jashore University of Science and Technology, Jashore, Bangladesh
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Fowler-Davis S, Young R, Maden-Wilkinson T, Hameed W, Dracas E, Hurrell E, Bahl R, Kilcourse E, Robinson R, Copeland R. Assessing the Acceptability of a Co-Produced Long COVID Intervention in an Underserved Community in the UK. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13191. [PMID: 34948798 PMCID: PMC8701839 DOI: 10.3390/ijerph182413191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The COVID-19 pandemic has disproportionately affected people from more deprived communities. The experience of Long COVID is similarly distributed but very few investigations have concentrated on the needs of this population. The aim of this project was to co-produce an acceptable intervention for people with Long COVID living in communities recognised as more deprived. METHODS The intervention was based on a multi-disciplinary team using approaches from sport and exercise medicine and functional rehabilitation. The co-production process was undertaken with a stakeholder advisory group and patient public involvement representation. This study identified participants by postcode and the indices of multiple deprivation (IMD); recruitment and engagement were supported by an existing health and wellbeing service. A virtual 'clinic' was offered with a team of professional practitioners who met participants three times each; to directly consider their needs and offer structured advice. The acceptability of the intervention was based on the individual's participation and their completion of the intervention. RESULTS Ten participants were recruited with eight completing the intervention. The partnership with an existing community health and wellbeing service was deemed to be an important way of reaching participants. Two men and six women ages ranging from 38 to 73 were involved and their needs were commonly associated with fatigue, anxiety and depression with overall de-conditioning. None reported serious hardship associated with the pandemic although most were in self-employment/part-time employment or were not working due to retirement or ill-health. Two older participants lived alone, and others were single parents and had considerable challenges associated with managing a household alongside their Long COVID difficulties. CONCLUSIONS This paper presents the needs and perspectives of eight individuals involved in the process and discusses the needs and preferences of the group in relation to their support for self- managed recovery from Long COVID.
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Affiliation(s)
- Sally Fowler-Davis
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK; (S.F.-D.); (T.M.-W.); (R.C.)
| | - Rachel Young
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK; (S.F.-D.); (T.M.-W.); (R.C.)
| | - Tom Maden-Wilkinson
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK; (S.F.-D.); (T.M.-W.); (R.C.)
| | - Waqas Hameed
- Community Wellbeing Service (Specific Identity Withheld);
| | - Elizabeth Dracas
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S5 7AU, UK;
| | - Eleanor Hurrell
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK;
| | - Romila Bahl
- Faculty of Sport and Exercise Medicine, Virtual Institution, Edinburgh EH8 9DR, UK; (R.B.); (E.K.); (R.R.)
| | - Elisabeth Kilcourse
- Faculty of Sport and Exercise Medicine, Virtual Institution, Edinburgh EH8 9DR, UK; (R.B.); (E.K.); (R.R.)
| | - Rebecca Robinson
- Faculty of Sport and Exercise Medicine, Virtual Institution, Edinburgh EH8 9DR, UK; (R.B.); (E.K.); (R.R.)
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield S9 3TU, UK; (S.F.-D.); (T.M.-W.); (R.C.)
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Akbarialiabad H, Taghrir MH, Abdollahi A, Ghahramani N, Kumar M, Paydar S, Razani B, Mwangi J, Asadi-Pooya AA, Malekmakan L, Bastani B. Long COVID, a comprehensive systematic scoping review. Infection 2021; 49:1163-1186. [PMID: 34319569 PMCID: PMC8317481 DOI: 10.1007/s15010-021-01666-x] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/10/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To find out what is known from literature about Long COVID until January 30, 2021. METHODS We undertook a four-step search with no language restriction. A preliminary search was made to identify the keywords. A search strategy of all electronic databases resulted in 66 eligible studies. A forward and backward search of the references and citations resulted in additional 54 publications. Non-English language articles were translated using Google Translate. We conducted our scoping review based on the PRISMA-ScR Checklist. RESULTS Of 120 papers, we found only one randomized clinical trial. Of the 67 original studies, 22 were cohort, and 28 were cross-sectional studies. Of the total 120 publications, 49.1% focused on signs and symptoms, 23.3% on management, and 10.8% on pathophysiology. Ten publications focused on imaging studies. The results are also presented extensively in a narrative synthesis in separated sections (nomenclature, diagnosis, pathophysiology, risk factors, signs/symptoms, management). CONCLUSIONS The controversies in its definition have impaired proper recognition and management. The predominant symptoms were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness.
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Affiliation(s)
- Hossein Akbarialiabad
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Taghrir
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ashkan Abdollahi
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA, 17033, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Shahram Paydar
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Razani
- Cardiology Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
- John Cochran Division, Veterans Affairs St. Louis Healthcare System, St. Louis, MO, 63106, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - John Mwangi
- Pulmonary and Critical Care Medicine, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurology, Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahar Bastani
- Professor of Medicine-Nephrology, Saint Louis University School of Medicine, Saint Louis, MO, USA.
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Roth PH, Gadebusch-Bondio M. The contested meaning of "long COVID" - Patients, doctors, and the politics of subjective evidence. Soc Sci Med 2021; 292:114619. [PMID: 34906823 PMCID: PMC8629766 DOI: 10.1016/j.socscimed.2021.114619] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/22/2021] [Accepted: 11/28/2021] [Indexed: 10/25/2022]
Abstract
In our article, we reconstruct how the patient-made term "long COVID" was able to become a widely accepted concept in public discourses. While the condition was initially invisible to the public eye, we show how the mobilization of subjective evidence online, i.e., the dissemination of reports on the different experiences of lasting symptoms, was able to transform the condition into a crucial feature of the coronavirus pandemic. We explore how stakeholders used the term "long COVID" in online media and in other channels to create their illness and group identity, but also to demarcate the personal experience and experiential knowledge of long COVID from that of other sources. Our exploratory study addresses two questions. Firstly, how the mobilization of subjective evidence leads to the recognition of long COVID and the development of treatment interventions in medicine; and secondly, what distinguishes these developments from other examples of subjective evidence mobilization. We argue that the long COVID movement was able to fill crucial knowledge gaps in the pandemic discourses, making long COVID a legitimate concern of official measures to counter the pandemic. By first showing how illness experiences were gathered that defied official classifications of COVID-19, we show how patients made the "long COVID" term. Then we compare the clinical and social identity of long COVID to that of chronic fatigue syndrome (ME/CFS), before we examine the social and epistemic processes at work in the digital and medial discourses that have transformed how the pandemic is perceived through the lens of long COVID. Building on this, we finally demonstrate how the alignment of medical professionals as patients with the movement has challenged the normative role of clinical evidence, leading to new forms of medical action to tackle the pandemic.
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Affiliation(s)
- Phillip H Roth
- RWTH Aachen University, Käte Hamburger Kolleg: Cultures of Research, Theaterstr. 75, 52062, Aachen, Germany.
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