Long-term Health Consequences of COVID-19

Working Conditions, Musculoskeletal Pain and Wellbeing Among Hospital Surgeons: A Cross-Sectional Study

Background/Objectives: Patient safety is directly linked with health and wellbeing of healthcare workers. In the UK, COVID-19 severely disrupted healthcare, with surgeons tackling prolonged waiting lists and working longer hours under high stress. This study explored the biomechanical and psychosocial demands on hospital surgeons, as well as their experience of pain and work-life balance post-pandemic. Methods: A questionnaire was developed combining validated tools assessing physical demands; modified job demand, control, and support; the WHO-5 wellbeing index; work-life balance from the Copenhagen Psychosocial Questionnaire; musculoskeletal pain; job satisfaction and retirement intentions. An online survey was developed using the Qualtrics© (Provo, UT, USA) platform and circulated through surgical networks using snowball sampling. Poisson regression modelling with robust confidence intervals was used to explore relationships between work-related factors and musculoskeletal pain, and associations with retirement intentions. Results: In total, 242 replies were received. Surgeons frequently reported strenuous occupational activities and work-life imbalance, and one in six reported job dissatisfaction. Only 17% reported no pain; the one-month prevalence of pain ranged from 46% at the lower back to 12% at the ankle, and pain was frequently disruptive. Better work-life balance had a protective effect for pain (PRR = 0.92, 95% CI = 0.85-0.99), while risk of pain increased with increasingly physically demanding activities at work (PRR = 1.04, 95% CI = 1.01-1.07) in the age- and sex-adjusted models. Job dissatisfaction was associated with intention to retire early (PRR = 1.83, 95% CI = 1.02-3.27). Conclusions: This study demonstrated high physical and mental demands among surgeons and poor work-life balance. Physical and emotional links to pain were identified. Fit surgeons ensure safe patient care. Our findings suggest that surgeons were facing health issues and work-life conflict post-pandemic, potentially limiting their job satisfaction and career span. A follow-up study is recommended.

Clinical Phenotyping of Long COVID Patients Evaluated in a Specialized Neuro-COVID Clinic

OBJECTIVE

To report Long COVID characteristics and longitudinal courses of patients evaluated between 4/14/21-4/14/22 at the University of Pennsylvania Neurological COVID Clinic (PNCC), including clinical symptoms, neurological examination findings, and neurocognitive screening tests from a standardized PNCC neurological evaluation approach.

METHODS

This is a retrospective cross-sectional and longitudinal study in a single-center tertiary care academic center. Participants include 240 patients with documented evidence of a positive SARS-CoV-2 PCR or antibody test who underwent initial evaluation and 182 patients with longitudinal follow-up. Main outcomes evaluated are patient demographics, duration of illness prior to self-reported improvement, and cognitive testing results-including the Montreal Cognitive Assessment (version 8.2) (MoCA) and Oral Trail Making Test-B (OTMT-B).

RESULTS

The majority (73%) of patients did not require hospitalization for their acute COVID-19 symptoms. Frequent Long COVID complaints included headache (60%), dizziness/vertigo (40%), and disturbance of taste/smell (40%). Almost all (94%) patients reported cognitive symptoms, and over 30% of patients had abnormal scores on cognitive testing. Severe infection, fewer years of education level, and non-White race were found to be statistically associated with an increased likelihood of having abnormal scores on cognitive testing. Neuroimaging and clinical laboratory testing were largely not informative for patient care. Sixty-two percent of patients with follow-up visits self-reported improvement in their primary neurological complaint within 1 year of evaluation.

INTERPRETATION

Performance on standardized cognitive screening tests may not be consistent with frequently reported cognitive complaints in Long COVID patients. The most common clinical trajectory was self-reported improvement in the primary neurological symptom.

The COVID Pandemic Worsened Physical Activity Disproportionately in Frailer Adults: A Canadian Longitudinal Study on Aging

INTRODUCTION

Frailty is associated with increased hospitalization and mortality and may be exacerbated with physical inactivity. The COVID-19 pandemic has heterogeneously impacted peoples' physical activity level, but the impact on the frail population is unclear.

OBJECTIVE

The objective of this study is to test the hypothesis that higher frailty levels were associated with worse changes in physical activity, ability to move around the home, and do housework during the pandemic.

METHODS

We included 23,303 Canadians (age: 69.1 ± 9.5 years, 53% females) who participated in the Canadian Longitudinal Study on Aging COVID-19 Questionnaire study. Frailty prior to the pandemic (follow-up 1: 2015-2018) was measured via 52-item frailty index and grouped into 0.00-0.05, 0.05-0.10, 0.10-0.20, and >0.20 scores. Participants were asked whether they changed their levels of physical activity, ability to move at home, and ability to do housework during the pandemic.

RESULTS

The average frailty level was 0.09 ± 0.06. Compared with the lowest frailty group, participants with frailty levels >0.20 reported worse physical activity (17% vs. 45%), worse ability to move at home (3% vs. 26%), and perform housework (3% vs. 27%). Covariate-adjusted logistic regression models demonstrated that higher frailty level was associated with a greater odds of reporting worse physical activity (reference: 0.00-0.05; odds ratio for frailty index >0.20:4.03, 95% confidence interval [3.33, 4.87]), worse ability to move in home (odds ratio = 11.16, 95% confidence interval [8.28, 15.03]), and worse ability doing housework (odds ratio = 12.58, 95% confidence interval [9.24, 17.13]).

CONCLUSIONS

The adverse changes in physical activity levels and ability to move at home among frail older adults during the pandemic document the need for strategies to help vulnerable populations move more.

Long-term health consequences of COVID-19 in young adults: a focus on respiratory and cardiovascular endurance

INTRODUCTION

The COVID-19 pandemic has significantly impacted health, extending beyond the acute phase of illness. Among young adults, "long COVID" has raised concerns regarding respiratory and cardiovascular endurance. This study evaluates pulmonary function test (PFT), distance travelled in the 6-min walk test (6MWT), and changes in SpO2 and respiratory rate before and after 6MWT in COVID-19 convalescent patients compared to healthy controls.

METHODS

This case-control study included 45 controls and 45 COVID-19 convalescent patients confirmed by RT-PCR. Data on PFT, distance travelled in 6MWT, SpO2, and respiratory rate were collected. The associations were analyzed using the Student t-test and ANOVA, with p < 0.05 considered significant.

RESULTS

Significant reductions were observed in FVC (p = 0.02), FEV1 (p = 0.007), FEF25% (p = 0.0001), FEF50% (p = 0.003), FEF25-75% (p = 0.02), and PEFR (p = 0.0001), with an increased lung age (p = 0.01) in COVID-19 convalescent patients compared to controls. No significant difference was observed in FEV1/FVC ratio, FEV3, FEV3/FVC ratio, or FEF75%. While percentage saturation of oxygen, respiratory rate, and distance travelled in 6MWT showed no significant differences between groups, respiratory rate (p = 0.0001) and pulse rate (p = 0.001) differed significantly before and after 6MWT.

CONCLUSIONS

COVID-19 convalescent patients exhibited significant declines in FVC, FEV1, FEF25%, FEF50%, and FEF25-75%, indicating potential restrictive or obstructive lung defects. Increased lung age also suggests long-term impacts of SARS-CoV-2 on respiratory performance.

Changes in long-term employment and income following COVID-19 (SARS-CoV-2) infection among Jewish and Arab populations in Israel

BACKGROUND

The impact of Coronavirus disease-2019 (COVID-19) extends beyond health, potentially affecting long-term income and employment dynamics. In Israel, disparities exist between Jewish and Arab populations across many dimensions, including socioeconomic. The study's primary aim was to compare changes in employment and income among COVID-19-infected and non-infected participants among Jews and Arabs, the two main population groups comprising the population of Israel.

METHODS

We conducted a cross-sectional study between March 2021 and June 2022 among adults employed prior to the pandemic, whose SARS-CoV-2 polymerase chain reaction test was processed in three hospitals in Israel's Northern District. Using a validated online survey, we collected information about socio-demographics, SARS-CoV-2 infection, vaccination, employment (full-time, part-time, unemployed, retired), and income status by income bracket. Multivariate binary logistic regression models were used to estimate the associations between SARS-CoV-2 infection and (1) changes in employment status and (2) income decreases among Jewish and Arab participants.

RESULTS

Of the 7741 respondents, 1468 met our inclusion criteria (fully answered employment questions, employed pre-pandemic). Of these, 19% were Arabs, and 36% (n = 523) reported SARS-CoV-2 infection. High-income earners were less likely to experience employment and income changes than low-income earners (OR = 0.4 for both, p < 0.01). After adjusting for age, gender, vaccination, income level, and other socio-economic factors, Arab participants who reported SARS-CoV-2 infection were more likely to report employment change and income loss (OR = 7.0 and 4.2 respectively, p < 0.01). No association between infection and changes in employment or income was found among Jewish participants.

CONCLUSIONS

After adjusting for potential socio-economic confounders, SARS-CoV-2 Infection was a significant determinant of employment changes and income loss among Arabs, but not Jews, in Israel. This finding suggests the pandemic has exacerbated pre-existing inequalities and highlights the need for economic recovery policies specifically targeting vulnerable groups.

The Global Health Security Index and Its Role in Shaping National COVID‑19 Response Capacities: A Scoping Review

Introduction: Following the introduction of the Global Health Security Index (GHSI), the coronavirus disease 2019 (COVID‑19) pandemic emerged as an unprecedented global health crisis, underscoring the need for robust health security frameworks and preparedness measures. This study conducts a scoping review to analyze the existing literature on the GHSI and assess national COVID‑19 responses across different countries. Method: A comprehensive search of electronic databases (EBSCO, EMBASE, PubMed, Scopus, and Web of Science) was conducted for articles published from 2020 to 2024. Search terms included "Global Health Security Index" and terms related to COVID‑19. The study followed the Preferred Reporting Items for Systematic Reviews and Meta‑analyses for Scoping Reviews (PRISMA‑ScR) guidelines. The Newcastle-Ottawa Scale (NOS), adjusted for cross‑sectional studies, was used for quality assessment. Results: A total of 3,243 studies were identified, of which 20 were finalized for data synthesis. Specific COVID‑19 parameters were analyzed to provide a comprehensive overview of each country's pandemic response capacity. Among the selected studies, 17 (85%) had a low risk of bias, while 3 (15%) had a medium risk. Countries' response capacities were categorized into five key parameters: detection, mortality, transmission, fatality, and recovery. Findings revealed significant discrepancies between GHSI scores and actual national responses, with some high‑scoring countries struggling to control the pandemic. This raises concerns about the GHSI's predictive reliability. Conclusion: The study highlights that the GHSI does not fully capture a country's capacity to respond effectively to COVID‑19. However, it remains a valuable tool for identifying gaps in pandemic preparedness. To enhance its relevance, the index should integrate a wider range of factors, including political leadership, governance, public health infrastructure, and socio‑cultural elements, which are crucial in managing public health emergencies.

Long-term outcomes of post-acute sequelae of SARS-CoV-2 infection: a cohort study protocol

Introduction

Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) presents a multifaceted interplay of demographic, clinical, environmental, and socioeconomic factors. Quantification at the individual level of these factors remains underexplored. Our study aims to address this knowledge gap by analyzing the long-term health implications of PASC, utilizing a comprehensive integration of spatiotemporal, clinical, environmental, and socioeconomic data.

Methods and analysis

The study will enroll over 4,000 confirmed COVID-19 patients from Gansu Provincial Hospital, treated from December 2022 to May 2023, as the baseline. These patients are spread across 14 cities in Gansu Province, with geographic coordinates ranging from 92°13'E to 108°46'E and 32°31'N to 42°57'N. Follow-ups will be conducted via structured telephone interviews at 24, 36, and 48 months post-discharge, from 2024 to 2027, to assess PASC and long-term health outcomes. Participants will be categorized into three age groups: children and teenagers (birth to 18 years), adults (18-65 years), and the older adult (over 65 years). Environmental and socioeconomic data corresponding to each case are also integrated. The primary objective is to assess the persistence and long-term health outcomes of PASC symptoms. Secondary objectives focus on evaluating the acute infection phase, its progression, and the efficacy of medical management strategies in influencing PASC trajectories. Mixed-effects models will be utilized to evaluate the impact of various factors on PASC, while spatiotemporal analyses will explore the correlations between environmental and socioeconomic conditions and the diagnosis and recovery trajectories of PASC.

Ethics and dissemination

The Gansu Provincial Hospital's research ethics committee has approved this study protocol. Participation will be voluntary, with informed consent obtained from all participants. Study results will be published in peer-reviewed journals.

Clinical trial registration

ChiCTR2400091805.

Impact of COVID-19 pandemic on elective care backlog trends, recovery efforts, and capacity needs to address backlogs in Scotland (2013-2023): a descriptive analysis and modelling study

Background

Prioritisation of COVID-19 care led to widespread cancellations of elective care, creating a substantial backlog for healthcare systems worldwide. While the pandemic's impacts on elective hospital waiting lists during the early phase of the pandemic have been described in multiple countries, there is limited research on longer-term impacts and recovery efforts.

Methods

We conducted a country-wide analysis of Scotland's healthcare system over an 11-year period (January 1, 2013-December 31, 2023) to assess the pandemic's impact on the elective care backlog, evaluate recovery efforts, and estimate the capacity increase required to clear the backlog. Our analysis involved assessments at national, elective type, regional, and specialty levels. We used descriptive statistics to compare trends and a statistical modelling approach (Vector Autoregressive model with exogenous variables) to estimate capacity increases needed.

Findings

Waiting lists gradually increased before the pandemic (2013: n = 285,149; 2019: n = 385,859; 35.3% increase over six years) and then rose rapidly during the pandemic (2023: n = 667,749; 73.1% increase over four years). Capacity for elective care dropped substantially during the initial lockdown period (April-June 2020) and had not fully recovered by the end of 2023. These patterns were broadly consistent across Scotland and similar trends were observed when stratified by elective type, region, and specialty. The number of referrals waiting over a year increased from 3056 on December 31, 2019, to 78,243 (>2400% increase) by December 31, 2023. To eliminate the backlog created during the pandemic, a gradual increase in capacity, accumulating to 20% over three years is required. This corresponds to an annual increase of approximately 6.67%, translating to an additional 32,302 cases per year.

Interpretation

Scotland's healthcare system struggled to meet elective care demand pre-pandemic, and the pandemic has worsened an already difficult situation. Pre-pandemic elective care capacity had not been restored by the end of 2023. While substantial additional capacity is necessary, it is crucial to adopt broader system-level strategies to effectively address waiting list backlogs.

Funding

University of Edinburgh's Chancellor Fellowship; Health Data Research UK.

Epidemiological Transitions in Influenza Dynamics in the United States: Insights from Recent Pandemic Challenges

The SARS-CoV-2 pandemic has reshaped the epidemiological landscape of respiratory diseases, with profound implications for seasonal influenza. Nonpharmaceutical interventions implemented globally during the pandemic significantly altered human behavior and reduced the prevalence of respiratory pathogens, including influenza. However, the post-pandemic resurgence of influenza activity to pre-pandemic levels highlights the persistent challenges posed by this virus. During the 2023-2024 influenza season in the United States, an estimated 40 million individuals contracted influenza, resulting in 470,000 hospitalizations and 28,000 deaths, with the elderly disproportionately affected. Pediatric mortality was also notable, with 724 deaths reported among children. This study examines trends in influenza incidence, vaccination rates, and mortality in the United States from the 2018-2019 through to the 2023-2024 influenza seasons. Additionally, it evaluates the interplay between influenza and SARS-CoV-2 during the pandemic, considering the impact of disrupted air travel, public health measures, and altered virus circulation dynamics. By integrating these insights, the study underscores the critical need for sustained vaccination campaigns and innovative public health strategies to mitigate the dual burden of respiratory diseases. Findings from this analysis highlight the urgency of strengthening prevention and surveillance systems to enhance pandemic preparedness and reduce the impact of respiratory pathogens in an evolving epidemiological landscape.

Navigating neurologic post-COVID-19 conditions in adults: Management strategies for cognitive dysfunction, headaches and neuropathies

This review aims to describe the neurologic post-COVID-19 conditions (PCC, also known as "long COVID"), a complex array of diagnoses that can occur following recovery from acute COVID-19. The review also includes clinical considerations for the recognition, diagnosis and management of neurologic manifestations of PCC. Cognitive impairment ("Brain Fog"), headaches, and neuropathies are specifically reviewed.

Targeting Cytokines: Evaluating the Potential of Mesenchymal Stem Cell Derived Extracellular Vesicles in the Management of COVID-19

The Coronavirus Disease 2019 (COVID-19), caused by virus SARS-CoV-2, is characterized by massive inflammation and immune system imbalance. Despite the implementation of vaccination protocols, the accessibility of treatment remains uneven. Furthermore, the persistent threat of new variants underscores the urgent need for expanded research into therapeutic options for SARS-CoV-2. Mesenchymal stem cells (MSCs) are known for their immunomodulatory potential through the release of molecules into the extracellular space, either as soluble elements or carried by extracellular vesicles (EVs). The aim of this study was to evaluate the anti-inflammatory potential of EVs obtained from human adipose tissue (ASC-EVs) against SARS-CoV-2 infection. ASC-EVs were purified by size-exclusion chromatography, and co-culture assays confirmed that ASC-EVs were internalized by human lung cells and could colocalize with SARS-CoV-2 into early and late endosomes. To determine the functionality of ASC-EVs, lung cells were infected with SARS-CoV-2 in the presence of increasing concentrations of ASC-EVs, and the release of cytokines, chemokines and viruses were measured. While SARS-CoV-2 replication was significantly reduced only at the highest concentrations tested, multiplex analysis highlighted that lower concentrations of ASC-EV sufficed to prevent the production of immune modulators. Importantly, ASC-EVs did not contain detectable inflammatory cytokines, nor did they trigger inflammatory mediators, nor affect cellular viability. In conclusion, this work suggests that ASC-EVs have the potential to attenuate inflammation by decreasing the production of pro-inflammatory cytokines in lung cells following SARS-CoV-2 infection.

Ceramides and Skin Health: New Insights

Ceramide has transitioned from an incidental discovery to a vital element in skincare, becoming a thoroughly studied compound in the quest to treat skin conditions. Creating a moisture barrier, preserving hydration, regulating pH, controlling inflammation, and enhancing skin functions and appearance are among its established benefits. It is often used medically to repair skin barrier defects, as observed in inflammatory skin conditions like atopic dermatitis (AD) and dry skin types. Furthermore, ceramide and its metabolites are commonly used as predictors before disease manifestation and for prognostication processes, thus can be used as biomarker for clinical diagnosis as well. In the last couple of decades, momentum was also seen in the pre-clinical studies involving anti-cancer and nanotechnology field, whereby ceramide was also used as a drug, a carrier, or even adjunct formulation to increase efficacy of treatment such as chemotherapy. Approaches to increase ceramide levels include directly replenishing lost ceramides with natural extracts, synthetic pseudo-ceramides, or ceramide-like analogues, as well as using supplements that stimulate the body's natural ceramide production. Although ceramide is a well-known treatment in skincare and for common skin conditions like AD and psoriasis, its development and related pharmacology for severe skin conditions, such as skin cancer, remain in pre-clinical stages. Hence, the purpose of this research is to explore the role of ceramide in skin health and its application in common skin diseases.

Delay discounting predicts COVID-19 vaccine booster willingness

Developing ways to predict and encourage vaccine booster uptake are necessary for durable immunity responses. In a multi-nation sample, recruited in June-August 2021, we assessed delay discounting (one's tendency to choose smaller immediate rewards over larger future rewards), COVID-19 vaccination status, demographics, and distress level. Participants who reported being vaccinated were invited back one year later (n = 2547) to report their willingness to receive a booster dose, along with reasons for their decision. After controlling for demographic variables and distress level, a greater tendency to discount future rewards was associated with reduced willingness to receive a booster dose. Thematic coding revealed that the most common reason for booster willingness was protection against COVID-19, and for unwillingness was non-necessity. The results identify delay discounting as a behavioral predictor of booster willingness that may be used to inform tailored approaches to increase booster uptake (e.g., trust in science vs. vaccine mandates).

Diagnostic value of lung function tests in long COVID: analysis of positive bronchial provocation test outcomes

Background

Long COVID patients are prone to bronchial hyperresponsiveness and respiratory symptoms like coughing and breathing difficulties, often with positive bronchial provocation test (BPT) results.

Objective

This study aims to evaluate the diagnostic value of various lung function tests in patients with long-term COVID-19, explicitly focusing on positive BPT outcomes.

Methods

Our study analyzed the BPT outcomes and various pulmonary function parameters of all 9,406 COVID-19 patients who met the inclusion criteria and visited our hospital between February 24, 2022, and April 28, 2024. Key indicators included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow (PEF), and single-breath diffusing capacity for carbon monoxide (DLCOc SB). A logistic regression model was employed to identify factors influencing positive BPT results, while the receiver operating characteristic (ROC) curve was used to assess the diagnostic efficacy of these indicators.

Results

A total of 4211 valid samples were analyzed, with 3388 patients (80.46%) testing positive for BPT. Significant differences were observed between positive and negative groups regarding age, gender, smoking status (all P < 0.05), and specific lung function indicators, including FVC, FEV1/FVC ratio, maximum of vital capacity (VC max), and DLCOc SB (all P < 0.001). Logistic regression identified age, MEF50, and DLCOc SB as independent factors influencing positive BPT results. The area under the ROC curve for all assessed factors was <0.700, indicating limited diagnostic value.

Conclusion

Age, the small airway function indicator MEF50, and the pulmonary diffusion function indicator DLCOc SB are independent influencing factors for BPT positivity in long-term COVID patients. However, baseline data and lung function indicators have limited utility for diagnosing positive BPT in this population, highlighting the complex nature of post-COVID respiratory symptoms.

Multidisciplinary Center Care for Long COVID Syndrome-A Retrospective Cohort Study

BACKGROUND

Persistent multi-organ symptoms after coronavirus disease 2019 (COVID-19) have been termed "long COVID" or "post-acute sequelae of SARS-CoV-2 infection." The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.

METHODS

We performed a retrospective cohort study of patients evaluated at our multidisciplinary comprehensive COVID-19 center in Chicago, Ill, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.

RESULTS

We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among the patients tested, 742/916 (81%) reported decreased quality of life, 284/553 (51%) had cognitive impairment, 195/434 (44.9%) had alteration of lung function, 249/299 (83.3%) had abnormal computed tomography chest scans, and 14/116 (12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had findings similar to those with negative or no test results.

CONCLUSIONS

The experience at our multidisciplinary comprehensive COVID-19 center shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.

Self-efficacy and healthy lifestyle behaviors as mediators between COVID-19 care knowledge and health status

The COVID-19 epidemic has affected the psychological well-being and daily life of college students, leading to a decrease in their quality of life. Health status can be influenced by a variety of factors. This study aims to assess the current health status of university students and explore the relationships among COVID-19 care knowledge, self-efficacy, healthy lifestyle behaviors, and health status and how these factors are influenced. Among the 1694 participants, 49.4% were male, 50.6% were female, and 82.2% were freshmen. The results revealed that health status across all dimensions decreased to some extent. COVID-19 care knowledge affected both physical and mental component summaries. The results suggest that improving COVID-19 care knowledge, strengthening self-efficacy, and promoting the development of healthy lifestyle behaviors can positively impact their health status. Here, we explore the health status of college students with COVID-19 infection and the factors and mechanisms that influence it to guide health interventions to better meet the challenges posed by future outbreaks.

Omics-based analysis of mitochondrial dysfunction and BBB integrity in post-COVID-19 sequelae

The SARS-CoV-2 virus that resulted in the COVID-19 pandemic has been implicated in a range of neurological issues, such as encephalopathy, stroke, and cognitive decline. Although the precise mechanism causing these issues is unknown, mounting evidence shows that blood-brain barrier (BBB) disruption is probable2 a major factor. The integrity of the blood-brain barrier (BBB), a highly selective barrier that divides the brain from the systemic circulation, is crucial for preserving normal brain function. By analysing the multi-transcriptome data, this work explores the neurological impacts of the SARS-CoV-2 virus and provides insight into the molecular mechanisms behind BBB breakdown and neurological symptoms in COVID-19 patients. The endothelial cells of BBB expresses inflammatory genes in response to the systemic inflammation induced due to SARS-CoV-2 remnants in the body. This raises the possibility that systemic inflammation brought on by SARS-CoV-2 and BBB integrity are correlated. Furthermore, the study highlights the pathways involved in oxidative stress and endothelial cell activation, revealing their role in COVID-19 passage through BBB and induction of systemic inflammation and advancement toward neurological disorders. The article showcases the evidence that mitochondrial dysfunction is a major aftermath associated with SARS-CoV-2 infection as the impaired Mitochondria leads to an accumulation of reactive oxygen species (ROS), triggering endothelial dysfunction, and leading to the passage of harmful molecules across the BBB. This study offers insightful information that may open up the possibilities for new treatment plans by targeting biomarkers specifically associated with inflammation and BBB dysfunctioning conditions.

"To Be Vaccinated or Not to Be Vaccinated": Factors Influencing COVID-19 Vaccine Hesitancy and Future Vaccination Willingness Amongst US Women of Reproductive Age

Background & Objectives

Growing data on the impact of herd immunity and susceptibility of unvaccinated persons to chronic COVID sequelae requires deeper understanding of vaccine stigma and hesitancy to facilitate population needs. Reproductive-aged women (18-45 years) were at a "vaccine paradox" during COVID-19 - hesitant to receive the vaccine, yet at increased risk for COVID infection. In this study, we sought to: identify demographic predictors, reasons, geographic location of vaccine hesitancy, and COVID-specific attributes that predict future vaccination willingness. We hypothesized that high COVID risk perception and high COVID stress would be predictors of willingness.

Methods

Study Design: Cross-sectional survey of women across the United States. Main Outcomes and Measures: Vaccine hesitancy was defined as responding "No/Not Sure" to the question "Have you received any of the COVID-19 vaccines?" The COVID-Risk scale evaluate perceived COVID Risk, and the COVID-19 Perceived Stress Scale (PSS-10-c) evaluated COVID stress. Open ended questions inquired about participants' vaccine concerns.

Results

Of the 1,037 women who accessed the survey, 948 (91%) consented and completed. Predictors of vaccine hesitancy included younger aged parents (p=0.005), non-white race (p=0.003), and having high school or lower educational attainment (p<0.0001). Using smoking as a proxy measure of "health behavior", we found long-term smokers or quitters were more hesitant than those who never smoked (p=0.03). Geographic analyses showed the most vaccine hesitant women resided in Southeast and Midwest US. Hesitancy reasons included side effects (21%) and fertility/pregnancy concerns (4%). High COVID risk perception (p=0.0004) and high COVID stress (p=0.01) significantly predicted future willingness to get vaccinated.

Conclusions and Relevance

This research provides insights for managing the "vaccine paradox" in reproductive age women, and identifying factors that influence COVID-19 vaccine hesitancy and future vaccination willingness. Public health and policy advocates could target messaging around COVID risk and stress in Southeastern and Midwestern regions; as well as address women's concerns around fertility and other side effects.

Alterations in Circadian Rhythms, Sleep, and Physical Activity in COVID-19: Mechanisms, Interventions, and Lessons for the Future

Although the world is acquitting from the throes of COVID-19 and returning to the regularity of life, its effects on physical and mental health are prominently evident in the post-pandemic era. The pandemic subjected us to inadequate sleep and physical activities, stress, irregular eating patterns, and work hours beyond the regular rest-activity cycle. Thus, perturbing the synchrony of the regular circadian clock functions led to chronic psychiatric and neurological disorders and poor immunological response in several COVID-19 survivors. Understanding the links between the host immune system and viral replication machinery from a clock-infection biology perspective promises novel avenues of intervention. Behavioral improvements in our daily lifestyle can reduce the severity and expedite the convalescent stage of COVID-19 by maintaining consistent eating, sleep, and physical activity schedules. Including dietary supplements and nutraceuticals with prophylactic value aids in combating COVID-19, as their deficiency can lead to a higher risk of infection, vulnerability, and severity of COVID-19. Thus, besides developing therapeutic measures, perpetual healthy practices could also contribute to combating the upcoming pandemics. This review highlights the impact of the COVID-19 pandemic on biological rhythms, sleep-wake cycles, physical activities, and eating patterns and how those disruptions possibly contribute to the response, severity, and outcome of SARS-CoV-2 infection.

A risk science perspective on vaccines

Vaccines can be seen as one of the greatest successes in modern medicine. Good examples are the vaccines against smallpox, polio, and measles. Unfortunately, vaccines can have side effects, but the risks are considered by the health authorities and experts to be small compared to their benefits. Nevertheless, there are many who are skeptical of vaccination, something which has been very clearly demonstrated in relation to the COVID-19 disease. Risk is the key concept when evaluating a vaccine, in relation to both its ability to protect against the disease and its side effects. However, risk is a challenging concept to measure, which makes communication about vaccines' performance and side effects difficult. The present article aims at providing new insights into vaccine risks-the understanding, perception, communication, and handling of them-by adopting what is here referred to as a contemporary risk science perspective. This perspective clarifies the relationships between the risk concept and terms like uncertainty, knowledge, and probability. The skepticism toward vaccines is multifaceted, and influenced by concerns that extend beyond the effectiveness and safety of the vaccines. However, by clarifying the relationships between key concepts of risk, particularly how uncertainty affects risk and its characterization, we can improve our understanding of this issue.

All eyes on PCS: analysis of the retinal microvasculature in patients with post-COVID syndrome-study protocol of a 1 year prospective case-control study

Since widespread vaccination against COVID-19, the development of effective antiviral drugs, and the decreasing number of patients with COVID-19 in intensive care, the risk from SARS-CoV-2 infection appears less threatening. However, studies show that a significant number of patients suffer from long-term sequelae, even months after SARS-CoV-2 infection. The so-called post-COVID syndrome (PCS) often presents a diagnostic and treatment challenge for physicians. This study protocol describes the "All Eyes on PCS" study, which aims to investigate the retinal microvasculature in PCS patients and COVID-19-recovered patients to provide new insights into the pathophysiology of PCS. "All Eyes on PCS" is a prospective, case-control study with the primary objective of detecting endothelial dysfunction (ED) in patients with PCS. Therefore, we intend to recruit patients with PCS, fully SARS-CoV-2-infection-recovered (CR) participants, and SARS-CoV-2-infection-naïve (CN) participants. Baseline measurements will include: (1) patient-specific characteristics, (2) biochemistry, (3) retinal vessel analysis (RVA), (4) survey questionnaires as patient-reported outcomes measurements (PROMs), (5) optical coherence tomography (OCT), OCT angiography (OCTA), and adaptive optics (AO), (6) blood pressure recordings, (7) handgrip strength test. After 6 months, baseline measurements will be repeated in the PCS cohort, and after 1 year, a telephone query will be conducted to assess residual symptoms and treatment needs. The aim of this study is to gain insight into the pathophysiology of PCS and to provide an objective biomarker for diagnosis and treatment, while also creating a comprehensive clinical database of PCS patients.ClinicalTrials.gov Identifier: NCT05635552; Date: 2.12.2022.

Psychosocial and socioeconomic changes among low-income people with HIV during the COVID-19 pandemic in Miami-Dade County, Florida: racial/ethnic and gender differences

BACKGROUND

COVID-19 profoundly and uniquely impacted people with HIV. People with HIV experienced significant psychosocial and socioeconomic impacts, yet a limited amount of research has explored potential differences across gender and racial/ethnic groups of people with HIV.

OBJECTIVE

The objective of this study was to examine psychosocial and socioeconomic stressors related to the COVID-19 pandemic among a diverse sample of people with HIV in South Florida and to determine if the types of stressors varied across gender and racial/ethnic groups.

METHODS

We analyzed data from a cross-sectional survey with Miami-Dade County, Ryan White Program recipients. Outcomes included mental health, socioeconomic, drug/alcohol, and care responsibility/social support changes. Weighted descriptive analyses provided an overview of stressors by gender and racial/ethnic group and logistic regressions estimated associations between demographics and stressors.

RESULTS

Among 291 participants, 39% were Non-Hispanic Black, 18% were Haitian, and 43% were Hispanic. Adjusting for age, sex, language, and foreign-born status, Hispanics were more likely to report several worsened mental health (i.e. increased loneliness, anxiety) and socioeconomic stressors (i.e. decreased income). Spanish speakers were more likely to report not getting the social support they needed. Women were more likely to report spending more time caring for children.

CONCLUSIONS

Findings highlight ways in which cultural and gender expectations impacted experiences across people with HIV and suggest strategies to inform interventions and resources during lingering and future public health emergencies. Results suggest that public health emergencies have different impacts on different communities. Without acknowledging and responding to differences, we risk losing strides towards progress in health equity.

Machine learning predicts pulmonary Long Covid sequelae using clinical data

Long COVID is a multi-systemic disease characterized by the persistence or occurrence of many symptoms that in many cases affect the pulmonary system. These, in turn, may deteriorate the patient's quality of life making it easier to develop severe complications. Being able to predict this syndrome is therefore important as this enables early treatment. In this work, we investigated three machine learning approaches that use clinical data collected at the time of hospitalization to this goal. The first works with all the descriptors feeding a traditional shallow learner, the second exploits the benefits of an ensemble of classifiers, and the third is driven by the intrinsic multimodality of the data so that different models learn complementary information. The experiments on a new cohort of data from 152 patients show that it is possible to predict pulmonary Long Covid sequelae with an accuracy of up to 94 % . As a further contribution, this work also publicly discloses the related data repository to foster research in this field.

The Tinetti Balance Test Is an Effective Predictor of Functional Decline in Non-Hospitalized Post-COVID-19 Individuals: A Cross-Sectional Study

Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. Methods: This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). Results: Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = -0.584), FRT (r = -0.542), MBT (r = -0.530), BBS (r = -0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted R2 = 0.318, p < 0.001). Conclusions: Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation.

Bone Mineral Density, Bone Biomarkers, and Joints in Acute, Post, and Long COVID-19: A Systematic Review

SARS-CoV-2 is highly transmissible and affects the respiratory system. People with COVID-19 are at higher risk of physical and mental health conditions, which could impact bone health. The aim of this review was to explore the effects of COVID-19 on BMD, BTMs, and joints. An electronic search of the PubMed, Web of Science, Scopus, and Ovid Medline databases considered studies published between 1 January 2020 and 1 November 2023. The search was limited to English, original studies in adult humans. The title and abstract of the identified papers were screened, followed by a full-text review using inclusion and exclusion criteria. The data extracted included the study and participant characteristics, BTMs, BMD, and joint abnormalities. The Newcastle-Ottawa scale quality assessment tool was used to assess the risk of bias. Five studies involving 305 out of 495 infected individuals observed a reduced BMD after COVID-19, with the most significant reduction occurring a year later. Both bone resorption and bone formation markers decreased, while regulatory markers showed higher levels in infected patients. COVID-19 may harm bone health by increasing bone regulatory markers and reducing bone formation and absorption, leading to a lower BMD. Elderly, frail, and osteopenic or osteoporotic individuals are at higher risk and should be regularly monitored for bone loss if they have long COVID.

Exploring pathogen population density as a metric for understanding post-COVID infectious disease surges

After the easing of COVID-19 restrictions, peaks of common infectious diseases surpassed pre-pandemic levels, raising questions about causes and ways to monitor these changes. A proposed measure, the Pathogen Population Density (PPD) score, could help track these shifts. PPD refers to the concentration of infectious agents within a population at a given time and location, serving as a potential indicator of infection levels in susceptible individuals at the population level. It is likely that PPD remains relatively stable within a specific community, as an equilibrium forms between infections and susceptibility. During the pandemic, nonpharmaceutical interventions (NPIs) led to a reduction in infectious diseases, possibly lowering population immunity and decreasing the PPD score. Once NPIs were lifted, the PPD score likely increased sharply due to a larger pool of susceptible individuals, causing more primary infections and stronger recurrent infections, faster transmission, and more severe pathogenic outcomes at the individual level. Monitoring the PPD score over time could help predict when infection peaks will occur. PPD is influenced by factors such as public health strategies, vaccination programs, and the behavior of high-risk individuals. As a quantitative measure, PPD has the potential to serve as a valuable predictive and monitoring tool, helping public health officials anticipate and track changes in infectious disease dynamics. It could be an effective tool for managing future outbreaks or pandemics and serve as a communication tool between scientists and the public to understand the emergence of new disease peaks.

Post-COVID fatigue: Reduced quality-of-life associated with clinically relevant fatigue in mild disease courses

Fatigue is a pervasive symptom experienced by many individuals after COVID-19. Despite its widespread occurrence, fatigue remains a poorly understood and complex phenomenon. Our aim is to evaluate the subjective experience of mental fatigue after COVID-19 and to assess its significance for daily life functioning. In this online questionnaire study (N = 220), the Fatigue Severity Scale (FSS), World Health Organization Quality-of-Life assessment (WHOQoL) and a subjective severity rating of the COVID-19 disease progression were used. For our statistical analyses we utilized independent samples t-tests, one-way ANOVA with post-hoc analyses, and a multiple regression. As expected our findings revealed the COVID group reported significantly higher levels of subjective fatigue compared to the control group. Moreover, there was a significant difference between experienced fatigue across the four severity groups. Participants who had a milder course of disease also experienced severe subjective fatigue. Subjective fatigue explained 40% variance in quality-of-life. In conclusion, severe subjective fatigue appears to be associated with increased self-reported COVID-19 symptom severity and lower quality-of-life but is already observable in milder cases. This underscores, firstly, the importance of considering also less severe cases and, secondly, the need to develop rehabilitation and psychological interventions for fatigue.

Long COVID: plasma levels of neurofilament light chain in mild COVID-19 patients with neurocognitive symptoms

It is well known the potential of severe acute respiratory coronavirus type 2 (SARS-CoV-2) infection to induce post-acute sequelae, a condition called Long COVID. This syndrome includes several symptoms, but the central nervous system (CNS) main one is neurocognitive dysfunction. Recently it has been demonstrated the relevance of plasma levels of neurofilament light chain (pNfL), as a biomarker of early involvement of the CNS in COVID-19. The aim of this study was to investigate the relationship between pNfL in patients with post-acute neurocognitive symptoms and the potential of NfL as a prognostic biomarker in these cases. A group of 63 long COVID patients ranging from 18 to 59 years-old were evaluated, submitted to a neurocognitive battery assessment, and subdivided in different groups, according to results. Plasma samples were collected during the long COVID assessment and used for measurement of pNfL with the Single molecule array (SIMOA) assays. Levels of pNfL were significantly higher in long COVID patients with neurocognitive symptoms when compared to HC (p = 0.0031). Long COVID patients with cognitive impairment and fatigue symptoms presented higher pNfL levels when compared to long COVID patients without these symptoms, individually and combined (p = 0.0263, p = 0.0480, and 0.0142, respectively). Correlation analysis showed that levels of cognitive lost and exacerbation of fatigue in the neurocognitive evaluation had a significative correlation with higher pNfL levels (p = 0.0219 and 0.0255, respectively). Previous reports suggested that pNfL levels are related with higher risk of severity and predict lethality of COVID-19. Our findings demonstrate that SARS-CoV-2 infection seems to have a long-term impact on the brain, even in patients who presented mild acute disease. NfL measurements might be useful to identify CNS involvement in long COVID associated with neurocognitive symptoms and to identify who will need continuous monitoring and treatment support.

A brief overview of SARS-CoV-2 infection and its management strategies: a recent update

The COVID-19 pandemic has become a global health crisis, inflicting substantial morbidity and mortality worldwide. A diverse range of symptoms, including fever, cough, dyspnea, and fatigue, characterizes COVID-19. A cytokine surge can exacerbate the disease's severity. This phenomenon involves an increased immune response, marked by the excessive release of inflammatory cytokines like IL-6, IL-8, TNF-α, and IFNγ, leading to tissue damage and organ dysfunction. Efforts to reduce the cytokine surge and its associated complications have garnered significant attention. Standardized management protocols have incorporated treatment strategies, with corticosteroids, chloroquine, and intravenous immunoglobulin taking the forefront. The recent therapeutic intervention has also assisted in novel strategies like repurposing existing medications and the utilization of in vitro drug screening methods to choose effective molecules against viral infections. Beyond acute management, the significance of comprehensive post-COVID-19 management strategies, like remedial measures including nutritional guidance, multidisciplinary care, and follow-up, has become increasingly evident. As the understanding of COVID-19 pathogenesis deepens, it is becoming increasingly evident that a tailored approach to therapy is imperative. This review focuses on effective treatment measures aimed at mitigating COVID-19 severity and highlights the significance of comprehensive COVID-19 management strategies that show promise in the battle against COVID-19.

Identification of the risk factors for insomnia in nurses with long COVID-19

PURPOSE

To investigate the prevalence of insomnia among nurses with long COVID-19, analyze the potential risk factors and establish a nomogram model.

METHODS

Nurses in Ningbo, China, were recruited for this study. General demographic information and insomnia, burnout, and stress assessment scores were collected through a face-to face questionnaire survey administered at a single center from March to May 2023. We used LASSO regression to identify potential factors contributing to insomnia. Then, a nomogram was plotted based on the model chosen to visualize the results and evaluated by receiver operating characteristic curves and calibration curves.

RESULTS

A total of 437 nurses were recruited. 54% of the nurses had insomnia according to the Insomnia Severity Index (ISI) score. Eleven variables, including family structure, years of work experience, relaxation time, respiratory system sequelae, nervous system sequelae, others sequelae, attitudes toward COVID-19, sleep duration before infection, previous sleep problems, stress, and job burnout, were independently associated with insomnia. The R-squared value was 0.464, and the area under the curve was 0.866. The derived nomogram showed that neurological sequelae, stress, job burnout, sleep duration before infection, and previous sleep problems contributed the most to insomnia. The calibration curves showed significant agreement between the nomogram models and actual observations.

CONCLUSION

This study focused on insomnia among nurses with long COVID-19 and identified eleven risk factors related to nurses' insomnia. A nomogram model was established to illustrate and visualize these factors, which will be instrumental in future research for identifying nurses with insomnia amid pandemic normalization and may increase awareness of the health status of healthcare workers with long COVID-19.

Examining the long-term effects of COVID-19 in surgical nurses: Case of Aegean Region

PURPOSE

To examine the long-term effects of COVID-19 on surgical nurses.

BACKGROUND

Individuals contaminated with COVID-19 may face several metabolic or psychological issues, primarily in the respiratory, cardiovascular, nervous, musculoskeletal and renal systems during the late period. However, the long-term epidemiology is still not clear.

DESIGN

Descriptive cross-sectional study.

METHODS

The study included nurses (n = 509) who had been diagnosed with COVID-19 at least 12 weeks before and worked in surgical departments. We collected the study data via an online survey using the snowball sampling method between December 2021 and May 2022. This study followed the Reporting of Observational Studies in Epidemiology Guideline.

RESULTS

The mean age of the nurses was 31.66 ± 8.74 years. Nurses stated that they were diagnosed with COVID-19 approximately 36 weeks before participating in this study. We found that the nurses mostly experienced palpitation (83.5%), headache (73.5%), dyspnea (64.1%), anosmia (57.6%), arthralgia (55.7%) and burnout (58.4%) during the late period after COVID-19.

CONCLUSION

The long-term effects of COVID-19 were related to multiple organ dysfunctions.

NO PATIENT OR PUBLIC CONTRIBUTION

Since the study was conducted with healthy individuals who had previously experienced COVID-19, there is no patient contribution.

RELEVANCE TO CLINICAL PRACTICE

This study focuses on the long-term effects of COVID-19 on nurses. The results support the long-term effects of COVID-19 and are thought to contribute to the literature.

Positive Mental Health of Frontline Healthcare Professionals during COVID-19 First Wave and Second Wave in Spain: The Protective Role of Social Recognition

BACKGROUND

The study of the COVID-19 disease consequences on healthcare professionals' mental health has drawn a great interest in psychology and other behavioral sciences. Previous studies mainly focused on professionals' health in terms of psychopathology, therefore, there is no research examining their positive mental health during both the first and the second wave. Also, there is no research studying healthcare professionals' social recognition during the pandemic and the influence of this variable on professionals' positive health.

METHODS

Following the WHO's recommendations, our objective was to measure pathology (i.e., anxiety and traumatic intensity), positive health (i.e., Hedonic, Psychological and Social Well-being) and social recognition in a sample of 200 healthcare professionals in the frontline care of Covid-19 patients.

RESULTS

In both waves, participants showed high levels of anxiety and traumatic intensity, although, as expected, in the second (vs. the first) wave psychopathological symptoms decreased. Concerning positive health indicators, in the second wave, health professionals showed more hedonic and psychological well-being than in the first one. However, in the second wave social well-being was lower than in the first wave, an expected though apparently paradoxical result, linked to the decrease in healthcare professionals' social recognition between the first and the second wave. In fact, bootstrapping procedures and Sobel Test confirm the mediating role of social recognition on the effect of Covid-19 wave on social well-being.

CONCLUSIONS

Public institutions, governments, and society in general, should recognize health professionals' work, given that social recognition is a fundamental protection factor for social well-being.

Epidemiology of post-COVID conditions beyond 3 years and factors associated with their persistence longer than 2 years: A cross-sectional study

OBJECTIVE

This study aimed to investigate the epidemiology of post-coronavirus disease 2019 (COVID-19) conditions (PCCs) beyond 3 years and identify factors associated with their persistence longer than 2 years.

STUDY DESIGN

Cross-sectional questionnaire-based survey.

METHODS

We surveyed patients who had recovered from COVID-19 and visited our institution from February 2020 to November 2021. Demographic and clinical data and information on the presence and duration of PCCs were obtained. We identified factors associated with the persistence of PCCs longer than 2 years using multivariate linear regression analyses.

RESULTS

Among 935 patients surveyed, 407 completed the survey. Among them, 360 patients had mild disease in the acute phase. The proportions of participants with at least one symptom at 1, 2, and 3 years after symptom onset or COVID-19 diagnosis were 33.2%, 29.8%, and 5.7%, respectively. The numbers of participants with and without any residual symptoms 2 years after the onset of COVID-19 were 87 and 193, respectively. After multivariate adjustment, persistence of PCCs longer than 2 years was associated with lower body mass index, presence of any underlying medical conditions, and number of symptoms lasting for more than 1 month ≥ 5.

CONCLUSIONS

The prevalence of PCCs decreased 2 years after symptom onset or COVID-19 diagnosis. We also identified factors associated with PCC persistence longer than 2 years, which could help primary care physicians and patients with PCCs predict the duration of PCCs and better understand their natural history, thus reducing patients' anxiety about their duration.

Long-term changes in the phenotype and cytokine production of monocytes in COVID-19 recovered and vaccinated individuals

Monocytes play a crucial role in the immune response against pathogens. Here, we sought to determine COVID-19 and the vaccine Gam-COVID-Vac induce long-term changes in the phenotype and cytokine production of circulating monocytes. Monocytes were purified from peripheral blood mononuclear cells of healthy donors who had not had COVID-19 or vaccination, who had received two doses of Gam-COVID-Vac, and who had mild/moderate COVID-19 in the last 6 months and evaluated by flow cytometry. To investigate the effect of SARS-CoV-2 proteins, monocytes were cultured for 2 days with or without stimulation with recombinant SARS-CoV-2 S1 and N peptides. Monocytes obtained from vaccinated and recovered individuals showed increased basal expression of HLA-DR, CD63, CXCR2, and TLR7. We also observed an increased frequency of CD63+ classical monocytes in both groups, as well as an increased frequency of HLA-DR+ non-classical monocytes in the COVID-19-recovered group compared to the control group. Monocytes from vaccinated and recovered donors produced higher basal levels of IL-6, IL-1β, and TNF-α cytokines. Ex vivo stimulation with SARS-CoV-2 antigens induced increased expression of HLA-DR and TLR7 on monocytes obtained from the control group. The challenge with SARS-CoV-2 antigens had no effect on the production of IL-6, IL-1β, and TNF-α cytokines by monocytes. The acquired data offer compelling evidence of enduring alterations in both the phenotype and functional status of circulating monocytes subsequent to vaccination with Gam-COVID-Vac and mild/moderate COVID-19 infection. At least some of these changes appear to be a consequence of exposure to SARS-CoV-2 S1 and N antigens.

Chronic pain after hospital discharge on patients hospitalized for COVID-19: an observational study

BACKGROUND

There are few studies related to Coronavirus Disease 2019 (COVID-19) on the prevalence and nature of pain symptoms after hospital discharge, especially in individuals who develop moderate to severe disease forms. Therefore, this study aimed to evaluate the presence of chronic pain in patients discharged after hospitalization for COVID-19, and the relationship between the presence of chronic pain and intensive care stay, demographics, and risk factors for the worst Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outcome.

METHODS

A cross-sectional observational study was carried out on patients with COVID-19 who recovered after hospitalization. Patients were recruited at the least 3 months after discharge and their hospital's health files were prospected. The variables evaluated were demographics, the severity of SARS-CoV-2 infection (considering the need for intensive care), and the presence of chronic pain. The results were shown in a descriptive manner, and multivariate analysis expressed as Odds Ratios (ORs) and respective Confidence Intervals (CIs) for the outcomes studied. Statistical significance was set at p < 0.05.

RESULTS

Of 242 individuals included, 77 (31.8%) reported chronic pain related to COVID-19, with no correlation with the severity of infection. Female sex and obesity were associated with a higher risk for chronic pain with ORs of 2.69 (Confidence Interval [95% CI 1.4 to 5.0]) and 3.02 (95% CI 1.5 to 5.9). The limbs were the most affected areas of the body.

CONCLUSION

Chronic pain is common among COVID-19 survivors treated in hospital environments. Female sex and obesity are risk factors for its occurrence.

COVID-19 and Sleep Problems: A Perspective from Bibliometric Analysis

OBJECTIVES

The Coronavirus Disease 2019 (COVID-19) pandemic and the containment measures for COVID-19 have affected sleep quality in the population. This study explored sleep-related research from a bibliometric perspective to provide an overview of the research outputs in this field.

METHODS

Original and review articles were retrieved from the Web of Science Core Collection (WOSCC) database from December 2019 to 7 Aug 2023. R package "bibliometrix" was used to summarize the number of articles of authors, institutions, and countries; count the citations of the articles, and generate a Three-Fields Plot. VOSviewer software was applied to visualize the collaboration network among authors and institutions, and to conduct a co-occurrence analysis of keywords.

RESULTS

A total of 4,499 articles on COVID-19 and sleep, and 25,883 articles on non-COVID-19 and sleep were included. Sleep related articles were mainly published by authors from China, the USA, and Italy. For COVID-19 and sleep research, Huazhong University of Science was the most productive institution. The Psychiatry Research was the most influential journal across the different subject categories of this field. "Mental health", "anxiety", and "depression" were the most common keywords, while "sleep quality" and "quality of life" were the likely topic areas in terms of future research directions.

CONCLUSIONS

Our findings provide a comprehensive perspective for researchers to understand the wider landscape of both COVID-19 and non-COVID-19 sleep-related research area.

Factors associated with phenotypes of dyspnea in post-COVID-19 condition: a cross-sectional study

Post-COVID-19 condition (PCC) is defined as the persistence of symptoms, like fatigue and dyspnea, at least 3 months post-COVID infection. As dyspnea is a common symptom, we attempted to further clinically phenotype those with PCC-associated dyspnea. 1642 adults (average age of 49.6y with 63% female-predominance and BMI of 31.2 kg/m2) with physician confirmed diagnosis of PCC from June 2020-April 2023 in Alberta, Canada were included. Those with dyspnea were more likely to be female (56.5%, p = 0.005) and have higher BMI (31.3 kg/m2 vs. 29.5 kg/m2; p = 0.0008), history of asthma (21.1% vs. 12.3%; p < 0.001), more persistent PCC symptoms (p = 0.0001), more functional limitations, as well as lower quality of life (p < 0.0001). Multivariable-adjusted logistic regression analysis demonstrated dyspnea was independently associated with fatigue (OR = 4.20; CI = 2.71,6.59) and inversely associated with hospitalization for COVID-19 (OR = 0.53; CI = 0.32,0.91), age (OR = 0.98 per one year of age; CI = 0.96,0.99) and 6-min-walk-distance per 10 m difference (OR = 0.98, CI = 0.96,1.0). Fatigue was a predictor of dyspnea, and was associated with milder infection, higher BMI, and reduced 6-min-walk-distance despite normal pulmonary function. Reduced TLC or DLCO was associated with more severe infection and reduced 6-min-walk-distance. Thus, we speculate there are at least two dyspnea-associated phenotypes: phenotype with pronounced fatigue (normal PFT) and phenotype with pronounced pulmonary abnormalities (abnormal PFT). Improved understanding of the dyspnea-associated phenotypes may allow for better targeted rehabilitation.

The impact of comorbidity on the quality of life of people who recovered from COVID-19 in Bangladesh

Objectives

COVID-19 affects the quality of life (QoL) in a reverse way after recovery, which might be multiplied by the comorbid non-communicable diseases. This study explored the relationship between comorbidities and the QoL of people who recovered from COVID-19 in Bangladesh.

Methods

The cross-sectional study was conducted among 3244 participants between June 2020 and November 2020 using a pre-tested questionnaire through over-the-phone interviews. The WHOQOL-BREF was used to explore the QoL among the study participants. A multivariable linear regression model was conducted to identify the effects of the number of comorbidities on QoL scores of all four domains.

Results

Of 3244 patients who recovered from COVID-19, over one-third (39.4%) had one or more chronic diseases, such as hypertension, diabetes mellitus, ischemic heart disease, bronchial asthma/chronic obstructive pulmonary disease, chronic kidney disease, and cancer. Around 46.85% of the participants aged above 40 years presented with one to two chronic diseases, and 16.33% had three or more chronic diseases. Among all comorbidities, the participants with cancer and chronic kidney disease were found to have relatively lower scores in all four domains than other comorbidities. The lowest QoL scores were observed in the psychological domain. Those with three or more simultaneous chronic comorbidities had the lowest QoL score in all four domains: physical, psychological, social relationship, and environmental.

Conclusions

Persons who recovered from COVID-19 with comorbidities undergo a lower QoL. Therefore, special attention is required to these vulnerable groups to ensure their smooth recuperation.

Nirmatrelvir-Ritonavir for Acute COVID-19 in Patients With Cardiovascular Disease and Postacute Sequelae of SARS-CoV-2 Infection

Background

There is limited evidence of association of nirmatrelvir-ritonavir (NMV-r) and incidence of postacute sequelae of SARS-CoV-2 infection (PASC) in patients with pre-existing cardiovascular disease (CVD).

Objectives

The objective of this study was to assess the association of NMV-r in nonhospitalized, vaccinated patients with pre-existing CVD and occurrence of PASC.

Methods

We conducted a retrospective cohort study utilizing the TriNetX research network, including vaccinated patients with pre-existing CVD who developed COVID-19 between December 2021 and December 2022. Two cohorts were created based on NMV-r administration within 5 days of diagnosis: NMV-r and non-NMV-r cohort. The main outcome was presence of PASC, assessed between 30 to 90 days and 90 to 180 days after index COVID-19 infection. After propensity score matching, both cohorts were compared using t-test and chi-square test for continuous and categorical variables, respectively.

Results

A total of 26,953 patients remained in each cohort after propensity score matching. Broadly defined PASC occurred in 6,925 patients (26%) in the NMV-r cohort vs 8,150 patients (30.6%) in the non-NMV-r cohort (OR: 0.80; 95% CI: 0.76-0.82; P < 0.001) from 30 to 90 days and in 6,692 patients (25.1%) as compared to 8,910 patients (33.5%) (OR: 0.25, 95% CI: 0.23-0.29; P < 0.001) from 90 to 180 days. Similarly, narrowly defined PASC occurred in 5,335 patients (20%) in the NMV-r cohort vs 6,271 patients (23.6%) in the non-NMV-r cohort between 30 and 90 days (OR: 0.81, 95% CI: 0.78-0.84, P < 0.001) and in 5,121 patients (19.2%) as compared to 6,964 patients (26.1%) (OR: 0.67, 95% CI: 0.64-0.70, P < 0.001) between 90 and 180 days.

Conclusions

NMV-r in nonhospitalized vaccinated patients with pre-existing CVD with COVID-19 was associated with a reduction in PASC and health care utilization.

COVID-19 influenced gut dysbiosis, post-acute sequelae, immune regulation, and therapeutic regimens

The novel coronavirus disease 2019 (COVID-19) pandemic outbreak caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has garnered unprecedented global attention. It caused over 2.47 million deaths through various syndromes such as acute respiratory distress, hypercoagulability, and multiple organ failure. The viral invasion proceeds through the ACE2 receptor, expressed in multiple cell types, and in some patients caused serious damage to tissues, organs, immune cells, and the microbes that colonize the gastrointestinal tract (GIT). Some patients who survived the SARS-CoV-2 infection have developed months of persistent long-COVID-19 symptoms or post-acute sequelae of COVID-19 (PASC). Diagnosis of these patients has revealed multiple biological effects, none of which are mutually exclusive. However, the severity of COVID-19 also depends on numerous comorbidities such as obesity, age, diabetes, and hypertension and care must be taken with respect to other multiple morbidities, such as host immunity. Gut microbiota in relation to SARS-CoV-2 immunopathology is considered to evolve COVID-19 progression via mechanisms of biochemical metabolism, exacerbation of inflammation, intestinal mucosal secretion, cytokine storm, and immunity regulation. Therefore, modulation of gut microbiome equilibrium through food supplements and probiotics remains a hot topic of current research and debate. In this review, we discuss the biological complications of the physio-pathological effects of COVID-19 infection, GIT immune response, and therapeutic pharmacological strategies. We also summarize the therapeutic targets of probiotics, their limitations, and the efficacy of preclinical and clinical drugs to effectively inhibit the spread of SARS-CoV-2.

Long COVID in Children, Adults, and Vulnerable Populations: A Comprehensive Overview for an Integrated Approach

Long COVID affects both children and adults, including subjects who experienced severe, mild, or even asymptomatic SARS-CoV-2 infection. We have provided a comprehensive overview of the incidence, clinical characteristics, risk factors, and outcomes of persistent COVID-19 symptoms in both children and adults, encompassing vulnerable populations, such as pregnant women and oncological patients. Our objective is to emphasize the critical significance of adopting an integrated approach for the early detection and appropriate management of long COVID. The incidence and severity of long COVID symptoms can have a significant impact on the quality of life of patients and the course of disease in the case of pre-existing pathologies. Particularly, in fragile and vulnerable patients, the presence of PASC is related to significantly worse survival, independent from pre-existing vulnerabilities and treatment. It is important try to achieve an early recognition and management. Various mechanisms are implicated, resulting in a wide range of clinical presentations. Understanding the specific mechanisms and risk factors involved in long COVID is crucial for tailoring effective interventions and support strategies. Management approaches involve comprehensive biopsychosocial assessments and treatment of symptoms and comorbidities, such as autonomic dysfunction, as well as multidisciplinary rehabilitation. The overall course of long COVID is one of gradual improvement, with recovery observed in the majority, though not all, of patients. As the research on long-COVID continues to evolve, ongoing studies are likely to shed more light on the intricate relationship between chronic diseases, such as oncological status, cardiovascular diseases, psychiatric disorders, and the persistent effects of SARS-CoV-2 infection. This information could guide healthcare providers, researchers, and policymakers in developing targeted interventions.

The prevalence of feigning and concealment of Covid-19 infections in an international sample

We asked 463 participants from 21 countries whether they had feigned and/or concealed having a coronavirus infection during the pandemic period. 384 respondents (83%) reported having experienced a coronavirus infection. They were, on average, younger and reported more chronic health issues than participants who said they had never been infected. 65 (14%) admitted to having feigned the infection. Prevalence doubled (28%) when asked if they knew anyone who had feigned a coronavirus infection. Main motives for feigning were to stay at home and to obtain sick leave. As to having concealed a coronavirus infection, 56 (12%) responded affirmatively, but when asked about others, the prevalence reached 51% (n = 210). The most common reasons for concealment were to avoid letting others know and to not miss an event. Thus, both feigning and concealing infections can occur on a nontrivial scale, directly affecting prevalence rates in studies that rely on self-reported data collected from social platforms.

The Role of Social Media in the Experiences of COVID-19 Among Long-Hauler Women: Qualitative Study

BACKGROUND

The extant literature suggests that women are more vulnerable to COVID-19 infection and at higher risk for developing long COVID. Due to pandemic mitigation recommendations, social media was relied upon for various aspects of daily life, likely with differences of usage between genders.

OBJECTIVE

This study aimed to explore the role and functions of social media in the lives of long-hauler women.

METHODS

Participants were purposively snowball-sampled from an online health promotion intervention for long-hauler women with COVID-19 from March to June 2021. During this time, one-on-one, semistructured interviews were conducted online until data saturation was agreed to have been achieved (ie, 15 interviews). Interview transcripts and field notes were analyzed using an emergent, inductive approach.

RESULTS

In total, 15 women were enrolled. The main roles of social media included facilitating support group participation, experience sharing, interpersonal connections, and media consumption. Emergent themes demonstrated that participants rely on social media to fulfill needs of emotional support, social engagement, spirituality, health planning, information gathering, professional support, and recreationally for relaxation. As long-hauler women turn to social media to discuss symptom and health management as well as the intention to vaccinate, this study demonstrates both the associated benefits (ie, decreased isolation) and challenges (ie, misinformation, rumination, resentment, jealousy).

CONCLUSIONS

The public health implications of these findings support the development of gender-tailored health promotion interventions that leverage the benefits of social media, while mitigating the negative impacts, for women with long COVID.

Proposal and Definition of an Intelligent Clinical Decision Support System Applied to the Prediction of Dyspnea after 12 Months of an Acute Episode of COVID-19

Long COVID is a condition that affects a significant proportion of patients who have had COVID-19. It is characterised by the persistence of associated symptoms after the acute phase of the illness has subsided. Although several studies have investigated the risk factors associated with long COVID, identifying which patients will experience long-term symptoms remains a complex task. Among the various symptoms, dyspnea is one of the most prominent due to its close association with the respiratory nature of COVID-19 and its disabling consequences. This work proposes a new intelligent clinical decision support system to predict dyspnea 12 months after a severe episode of COVID-19 based on the SeguiCovid database from the Álvaro Cunqueiro Hospital in Vigo (Galicia, Spain). The database is initially processed using a CART-type decision tree to identify the variables with the highest predictive power. Based on these variables, a cascade of expert systems has been defined with Mamdani-type fuzzy-inference engines. The rules for each system were generated using the Wang-Mendel automatic rule generation algorithm. At the output of the cascade, a risk indicator is obtained, which allows for the categorisation of patients into two groups: those with dyspnea and those without dyspnea at 12 months. This simplifies follow-up and the performance of studies aimed at those patients at risk. The system has produced satisfactory results in initial tests, supported by an AUC of 0.75, demonstrating the potential and usefulness of this tool in clinical practice.

Accessing care for Long Covid from the perspectives of patients and healthcare practitioners: A qualitative study

BACKGROUND

Long Covid is an emerging long-term condition, with those affected raising concerns about lack of healthcare support.

OBJECTIVE

We conducted a qualitative study to identify facilitators and barriers to healthcare access for people with Long Covid, aiming to enhance our understanding of the specific nature of these barriers and how patient experiences may vary.

SETTING AND PARTICIPANTS

In the context of the Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE-ICP) Delphi study, a nationally distributed online survey was conducted. Eight patients and eight healthcare practitioners (HCP) were interviewed via telephone or video call. Framework analysis, sensitised by the candidacy theory, was used to identify barriers and facilitators over four levels of access to care.

RESULTS

Three themes were identified: (i) patients' efforts to navigate emerging pathways for Long Covid, (ii) the patient-HCP interaction and (iii) service resources and structural constraints. Barriers to specialist care included long waiting times, communication gaps across services and a lack of continuity in care. Facilitators included collaborative, patient-centred approaches, patients' active role in their healthcare and blended approaches for appointments. The perspectives of both patients and HCPs largely aligned.

DISCUSSION

The candidacy framework was valuable in understanding the experiences of people with Long Covid seeking access to healthcare. Individuals perceived themselves as eligible for care, but they often encountered obstacles in obtaining the expected level of care or, in some cases, did not receive it at all. Our findings are discussed in the context of the candidacy model through multiple processes of identification, negotiation, permeability and appearances at health services. These themes seem to be especially important for the emerging new pathway model and are relevant to both primary and secondary care.

CONCLUSIONS

This study highlights that despite these interviews being conducted two years after the start of the COVID-19 pandemic, people with Long Covid still struggle to access healthcare, emphasising the ongoing need to provide equitable timely healthcare access for people with Long Covid.

PATIENT OR PUBLIC CONTRIBUTION

People with Long Covid advised on all stages of this research.

Pulmonary function 3-6 months after acute COVID-19: A systematic review and multicentre cohort study

Aims

To describe pulmonary function 3-6 months following acute COVID-19, to evaluate potential predictors of decreased pulmonary function and to review literature for the effect of COVID-19 on pulmonary function.

Materials and methods

A systematic review and cohort study were conducted. Within the P4O2 COVID-19 cohort, 95 patients aged 40-65 years were recruited from outpatient post-COVID-19 clinics in five Dutch hospitals between May 2021-September 2022. At 3-6 months post COVID-19, medical records data and biological samples were collected and questionnaires were administered. In addition, pulmonary function tests (PFTs), including spirometry and transfer factor, were performed. To identify factors associated with PFTs, linear regression analyses were conducted, adjusted for covariates.

Results

In PFTs (n = 90), mean ± SD % of predicted was 89.7 ± 18.2 for forced vital capacity (FVC) and 79.8 ± 20.0 for transfer factor for carbon monoxide (DLCO). FVC was

Conclusion

A low DLCO 3-6 months following acute COVID-19 was observed more often than a low FVC, both in the P4O2 COVID-19 study and the literature review.

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Key Words

• Long COVID
• Post COVID-19
• Pulmonary function
• Transfer factor for carbon monoxide

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Affiliation(s)

Merel E.B. Cornelissen Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Asabi Leliveld Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Nadia Baalbaki Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Debbie Gach Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
Ivo van der Lee Department of Pulmonology, Spaarne Hospital, the Netherlands
Esther J. Nossent Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands
Lizan D. Bloemsma Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands
Anke H. Maitland-van der Zee Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ Amsterdam, the Netherlands Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands Amsterdam Public Health, Amsterdam, the Netherlands

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Being fit in the COVID-19 era and future epidemics prevention: Importance of cardiopulmonary exercise test in fitness evaluation

Endurance and resistance physical activity have been shown to stimulate the production of immunoglobulins and boost the levels of anti-inflammatory cytokines, natural killer cells, and neutrophils in the bloodstream, thereby strengthening the ability of the innate immune system to protect against diseases and infections. Coronavirus disease 19 (COVID-19) greatly impacted people's cardiorespiratory fitness (CRF) and health worldwide. Cardiopulmonary exercise testing (CPET) remains valuable in assessing physical condition, predicting illness severity, and guiding interventions and treatments. In this narrative review, we summarize the connections and impact of COVID-19 on CRF levels and its implications on the disease's progression, prognosis, and mortality. We also emphasize the significant contribution of CPET in both clinical evaluations of recovering COVID-19 patients and scientific investigations focused on comprehending the enduring health consequences of SARS-CoV-2 infection.

Myocardial Blood Flow Quantified Using Stress Cardiac Magnetic Resonance After Mild COVID-19 Infection

BACKGROUND

Severe COVID-19 infection is known to alter myocardial perfusion through its effects on the endothelium and microvasculature. However, the majority of patients with COVID-19 infection experience only mild symptoms, and it is unknown if their myocardial perfusion is altered after infection.

OBJECTIVES

The authors aimed to determine if there are abnormalities in myocardial blood flow (MBF), as measured by stress cardiac magnetic resonance (CMR), in individuals after a mild COVID-19 infection.

METHODS

We conducted a prospective, comparative study of individuals who had a prior mild COVID-19 infection (n = 30) and matched controls (n = 26) using stress CMR. Stress and rest myocardial blood flow (sMBF, rMBF) were quantified using the dual sequence technique. Myocardial perfusion reserve was calculated as sMBF/rMBF. Unpaired t-tests were used to test differences between the groups.

RESULTS

The median time interval between COVID-19 infection and CMR was 5.6 (IQR: 4-8) months. No patients with the COVID-19 infection required hospitalization. Symptoms including chest pain, shortness of breath, syncope, and palpitations were more commonly present in the group with prior COVID-19 infection than in the control group (57% vs 7%, P < 0.001). No significant differences in rMBF (1.08 ± 0.27 mL/g/min vs 0.97 ± 0.29 mL/g/min, P = 0.16), sMBF (3.08 ± 0.79 mL/g/min vs 3.06 ± 0.89 mL/g/min, P = 0.91), or myocardial perfusion reserve (2.95 ± 0.90 vs 3.39 ± 1.25, P = 0.13) were observed between the groups.

CONCLUSIONS

This study suggests that there are no significant abnormalities in rest or stress myocardial perfusion, and thus microvascular function, in individuals after mild COVID-19 infection.

Developing effective strategies to optimize physical activity and cardiorespiratory fitness in the long Covid population- The need for caution and objective assessment

The Post Covid-19 Condition (commonly known as Long Covid) has been defined by the World Health Organisation as occurring in individuals with a history of probable or confirmed SARS CoV 2 infection, usually within 3 months from the onset of acute Covid-19 infection with symptoms that last for at least two months which cannot be explained by an alternative diagnosis. Long Covid is associated with over two hundred recognised symptoms and affects tens of millions of people worldwide. Widely reported reductions in quality of life(QoL) and functional status are caused by extremely sensitive and cyclical symptom profiles that are augmented following exposure to physical, emotional, orthostatic, and cognitive stimuli. This manifestation prevents millions of people from engaging in routine activities of daily living (ADLs) and has important health and well-being, social and economic impacts. Post-exertional symptom exacerbation (PESE) (also known as post-exertional malaise) is an exacerbation in the severity of fatigue and other symptoms following physical, emotional, orthostatic and cognitive tasks. Typically, this will occur 24-72 h after "over-exertion" and can persist for several days and even weeks. It is a hallmark symptom of Long Covid with a reported prevalence of 86%. The debilitating nature of PESE prevents patients from engaging in physical activity which impacts functional status and QoL. In this review, the authors present an update to the literature relating to PESE in Long Covid and make the case for evidence-based guidelines that support the design and implementation of safe rehabilitation approaches for people with Long Covid. This review also considers the role of objective monitoring to quantify a patient's response to external stimuli which can be used to support the safe management of Long Covid and inform decisions relating to engagement with any stimuli that could prompt an exacerbation of symptoms.

Functional Impairment in Small Airways Associated With the Breathlessness Symptoms in Long-Coronavirus Disease

PURPOSE

This study aimed to determine the association between functional impairment in small airways and symptoms of dyspnea in patients with Long-coronavirus disease (COVID), using imaging and computational modeling analysis.

PATIENTS AND METHODS

Thirty-four patients with Long-COVID underwent thoracic computed tomography and hyperpolarized Xenon-129 magnetic resonance imaging (HP Xe MRI) scans. Twenty-two answered dyspnea-12 questionnaires. We used a computed tomography-based full-scale airway network (FAN) flow model to simulate pulmonary ventilation. The ventilation distribution projected on a coronal plane and the percentage lobar ventilation modeled in the FAN model were compared with the HP Xe MRI data. To assess the ventilation heterogeneity in small airways, we calculated the fractal dimensions of the impaired ventilation regions in the HP Xe MRI and FAN models.

RESULTS

The ventilation distribution projected on a coronal plane showed an excellent resemblance between HP Xe MRI scans and FAN models (structure similarity index: 0.87 ± 0.04). In both the image and the model, the existence of large clustered ventilation defects was not identifiable regardless of dyspnea severity. The percentage lobar ventilation of the HP Xe MRI and FAN model showed a strong correlation (ρ = 0.63, P < 0.001). The difference in the fractal dimension of impaired ventilation zones between the low and high dyspnea-12 score groups was significant (HP Xe MRI: 1.97 [1.89 to 2.04] and 2.08 [2.06 to 2.14], P = 0.005; FAN: 2.60 [2.59 to 2.64] and 2.64 [2.63 to 2.65], P = 0.056).

CONCLUSIONS

This study has identified a potential association of small airway functional impairment with breathlessness in Long-COVID, using fractal analysis of HP Xe MRI scans and FAN models.