Characterizing long COVID in an international cohort: 7 months of symptoms and their impact

All-cause healthcare resource utilization and costs among community-managed adults with long-COVID in France, 2020-2023

BACKGROUND

The clinical and economic burden of long COVID is poorly understood. We aim to assess all-cause healthcare resource utilization (HCRU) and costs in the primary care setting among adults with long COVID in France.

METHODS

A retrospective cohort study using the electronic healthcare records (EHRs) of confirmed and/or probable COVID-19 patients from The Health Improvement Network (THIN) data between March 2020 and December 2022 was conducted. Long COVID was identified per World Health Organization (WHO) definition as suggestive symptoms present ≥3 months following acute SARS-CoV-2 infection. Patients' characteristics, HCRU, direct healthcare and indirect costs (National Health Insurance-based prices) were summarized. Costs between patients with previous SARS-CoV-2 infection who developed long COVID, patients with previous SARS-CoV-2 infection who did not develop long COVID (COVID only), and contemporaneous controls without SARS-CoV-2 infection were compared (Non-COVID).

RESULTS

Long COVID developed among 30,122 (11.6%) adults; mean (SD) age was 50 (17) years, 63.6% were female and 27.5% had a Charlson Comorbidity Index score >2. During the post-infection follow-up (mean = 13 months), 97.3% of patients had general practitioner consultations (GP) and 62.4% had nursing care. Costs were highest during the first post-diagnosis year with per patient per year costs of €2,443 (total cost of €52 million), including costs for GP (€208) and specialist (€170) consultations, outpatient procedures (€413), retail pharmacy use (€595), biological testing (€147), and medical device usage (€172). Patients with long COVID had additional costs of €163 and €176 when compared to patients in the COVID only and Non-COVID cohorts, respectively.

LIMITATIONS

Since the THIN database is generated from GP EHRs, there is the possibility of measurement/documentation errors and missing values which could compromise the validity and accuracy of certain results.

CONCLUSION

Long COVID was associated with non-negligible HCRU, direct and indirect costs to the French healthcare system. These findings reinforce the importance of optimizing long-term resource allocation for patients infected with SARS-CoV-2.

The erasure of infection-associated chronic conditions: Critical interpretive synthesis of literature on healthcare for long COVID and related conditions in Brazil

Evidence is emerging that long COVID is at least as prevalent in the Global South as the Global North, but literature on long COVID healthcare in the Global South is in its infancy. Brazil is seeing significant levels of debility due to long COVID but a limited national evidence-base. long COVID shares symptomatology and appropriate care with a wider category of infection-associated chronic conditions (IACCs). This article reviews literature published between 2000 and 2023 addressing healthcare for long COVID and IACCs in Brazil, in the interest of exploring challenges and opportunities for the SUS (Brazil's universal health system) to offer appropriate long COVID healthcare. We find that long COVID and IACCs collectively are subject to erasure from Brazilian healthcare knowledge, through lack of expertise, a resource-limited health system prioritising urgent care, and the concentration of poor health in marginalised populations with limited decision-making power. A nascent intellectual will to address long COVID, and a tradition of social participation in healthcare governance present potential opportunities. We call for ignition of a global step-change in tackling healthcare for long COVID and IACCs. Global equity in long COVID healthcare requires the development and sharing of expertise regarding its universal and context-specific features.

Cognitive impairment and associated neurobehavioral dysfunction in post-COVID syndrome

There is a high prevalence of neuropsychiatric sequelae in post-COVID syndrome, most commonly chronic fatigue, the mechanisms of which remain poorly understood. As altered function of the reward system has been suggested as a causal factor, we aimed to distinguish whether reward processing or task-unspecific cognitive operations are impaired in post-COVID syndrome. Our cohort study included 24 patients diagnosed with post-COVID syndrome and 24 demographically matched healthy controls. Questionnaire assessment of neuropsychiatric symptoms and socio-demographic variables, the Monetary Incentive Delay Task during an fMRI scan, and pupillary measurements were performed. In addition to clinical neuropsychiatric symptoms, participants in the post-COVID group demonstrated significantly slower task performance compared to healthy controls, although the function of behavioral reward circuits appeared unimpaired. However, the influence of rewarding cues on post-COVID patients increased significantly over time during task performance, correlating with temporally delayed activation of the left frontal gyrus and increased activity in task-unspecific brain regions in post-COVID patients. Furthermore, slower reaction times on the task were associated with a lower pupil diameter and a higher pupillary unrest index. This study proposes that post-COVID syndrome is a process that may not affect reward processing, but leads to neural hypoarousal and temporally altered brain activity in frontal and task-unspecific brain regions.

Assessing the Impact of Post-COVID Clinics on 6-Month Health Care Utilization for Patients With Long COVID: A Single-Center Experience

Objective

To assess the impact of post-COVID clinics by examining the association between their early usage and downstream health care utilization.

Patients and Methods

In a case-control study spanning data from March 11, 2020 to June 1, 2023, patients with Long COVID were identified from a major health system using diagnosis codes. The Fast, Large-Scale Almost Matching Exactly algorithm was used to match patients who presented early to post-COVID clinics with patients with Long COVID who did not attend such clinics. Matching was performed on demographic characteristics, acute COVID severity, comorbidities, diagnosis date, and vaccination, to reduce confounders for the comparison of the health care utilization and mortality between cohorts.

Results

When exactly matching on all 46 features, the algorithm yielded 2814 matched patients, of whom 692 (24.6%; 66.6% females; mean [SD] age, 48.8 [14.5] years) were seen in post-COVID clinics within the first 6 months and 2122 (75.4%; 64.1% females; mean [SD] age, 49.7 [15.2] years) who were not. The average treatment effect (95% CI) of early post-COVID clinic usage was -0.60 (-0.83 to -0.39) on inpatient visits, -0.19 (-0.26 to -0.11) on emergency department visits, 7.62 (6.96-8.56) on outpatient visits, -$3467 (-$6267 to -$754) on estimated costs, and -0.006 (-0.010 to -0.003) on mortality.

Conclusion

Early usage of post-COVID clinics by patients with Long COVID is associated with not only fewer downstream inpatient stays, emergency department visits, estimated costs, and reduced mortality within the first 6 months but also greater outpatient utilization. Results suggest early post-COVID clinic involvement shifts care to outpatient settings, potentially reducing costs and mortality.

Optimization of a panel of behavioral tests for use in containment using a golden Syrian hamster model

Golden Syrian hamsters are an often-overlooked model in behavioral testing. While previously utilized for research examining circadian rhythms and mammalian reproduction, they are less common than murine models in both infectious disease and behavioral studies. However, coronavirus disease-19 (COVID-19) quickly pushed hamster modeling to the forefront due to its myriad of advantages over mice in recapitulating human pathology and transmission. At least 10 % of COVID-19 survivors suffer from post-acute sequelae of COVID-19 (PASC), a collection of some 200 sequelae with neurologic sequelae (neuro-PASC) presenting with potentially debilitating symptomology. This presents a clear need for a small animal model that recapitulates human disease with the ability to assess any potential long term neurological changes. We adapted and optimized a panel of behavioral tests from previously accepted murine models utilizing the golden Syrian hamster model for use within biocontainment facilities. Our panel includes grip strength, Porsolt forced swim, and novel object recognition testing to measure muscle fatigue or weakness, depression, and memory loss or cognitive impairment, respectively. Apart from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), this panel of tests is applicable to other pathogens that cause neurologic sequelae, such as Nipah or eastern equine encephalitis viruses, or any other model systems that require the use of hamsters. In this manuscript, we detail the methods for each of these three behavioral tests, how to interpret and analyze the resulting data, and emphasize additional factors for consideration. We also provide baseline data for both male and female golden Syrian hamsters.

NETosis: A key player in autoimmunity, COVID-19, and long COVID

NETosis, the process through which neutrophils release neutrophil extracellular traps (NETs), has emerged as a crucial mechanism in host defense and the pathogenesis of autoimmune responses. During the SARS-CoV-2 pandemic, this process received significant attention due to the central role of neutrophil recruitment and activation in infection control. However, elevated neutrophil levels and dysregulated NET formation have been linked to coagulopathy and endothelial damage, correlating with disease severity and poor prognosis in COVID-19. Moreover, it is known that SARS-CoV-2 can induce persistent low-grade systemic inflammation, known as long COVID, although the underlying causes remain unclear. It has been increasingly acknowledged that excessive NETosis and NET generation contribute to further pathophysiological abnormalities following SARS-CoV-2 infection. This review provides an updated overview of the role of NETosis in autoimmune diseases, but also the relationship between COVID-19 and long COVID with autoimmunity (e.g., latent and overt autoimmunity, molecular mimicry, epitope spreading) and NETosis (e.g., immune responses, NET markers). Finally, we discuss potential therapeutic strategies targeting dysregulated NETosis to mitigate the severe complications of COVID-19 and long COVID.

'The Second Arrow': A Collaborative Autoethnographic Exploration of What Can Be Learned From One Long COVID Journey

INTRODUCTION

Long COVID is a complex multisystem illness with multiple relapsing-remitting symptoms, which can vary in severity and impact people's daily lives. This study utilises the first author's experience of falling ill with and recovering from long COVID to investigate the lived experience of the illness. Learnings that could positively influence how people with long COVID, and health professionals, approach rehabilitation and recovery from the illness going forward are identified.

METHODS

Employing collaborative autoethnography, the first author investigated her personal experience of falling ill with, and rehabilitating from, long COVID, while soliciting input of the second author (an athletic therapist and physiotherapist, and researcher with expertise in chronic pain) for the purpose of analysis and interpretation. Reflexive thematic analysis was employed across a number of data sources available to the first author, including journal entries, text messages, emails, and pharmacy receipts.

RESULTS

Four themes were generated from the data, supported by a number of subthemes: (i) Psychosocial impact of long COVID, (ii) Invalidated, (iii) Validated, and (iv) Power and Ownership. The negative impact of a siloed and reductionist approach to care for long COVID is evident in the findings of this study. In addition, the need for healthcare environments that enhance autonomy and empowerment, and that implement patient-centred care, where the person living with chronic illness is supported to engage in management strategies that meet their needs, is underlined.

CONCLUSION

This study highlights the detrimental cost, both personally and financially, of the ongoing use of the biomedical model of care in the treatment of long COVID. Findings support the need for an interdisciplinary approach to care that considers the whole person and adopts a biopsychosocial approach to care. Furthermore, the need for healthcare professionals to actively listen to, respect, validate and support the person living with long COVID on their individualised recovery journey is evident.

PATIENT OR PUBLIC CONTRIBUTION

The first author was a long COVID patient, the context and extent of this is explained within the paper. As such, this paper is developed and written primarily from the perspective of a patient, as a first-hand narrative of the recovery journey from the illness, with the insights of a clinician (second author) providing context and the potential for a broader understanding of the journey. The goal of this work is, through the dissemination of the paper's findings, to improve pathways and outcomes for others living with long COVID.

Adult Long Coronavirus Disease 2019: Definition, Prevalence Pathophysiology, and Clinical Manifestations

Long coronavirus disease 2019 (COVID-19) is a multisystem disorder with variable manifestations and duration. One in 10 people with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection will develop some manifestation of long COVID-19. Currently, there is no one single etiologic factor for the symptoms and signs of long COVID-19 beyond exposure to the SARS-CoV-2 virus. There are multiple theories about the pathophysiology ranging from viral persistence, reactivation, autoimmunity, and immune depletion. Certain risk factors have been identified including female sex, severe acute/hospitalized COVID-19, previous infections with SARS-CoV-2, and absence of vaccinations.

Personalisation at the Core of Success: Process Evaluation of the LISTEN Randomised Controlled Trial Evaluating a Personalised Self-Management Support Intervention for People Living With Long Covid

BACKGROUND

The development and evaluation of rehabilitation interventions designed to support people with Long Covid (LC) remains an important ongoing priority. Many people with LC experience episodic, debilitating symptoms that can reduce their ability to engage in all areas of activity. The Long CovId personalised Self-managemenT support co-design and EvaluatioN (LISTEN) trial co-designed and evaluated a personalised self-management support intervention to build confidence and support people to live better with LC. This paper describes the context, implementation, mechanisms of impact and impacts from the LISTEN intervention, in comparison with usual LC services accessed within the National Health Service (NHS).

METHODS

A mixed methods process evaluation was nested within the LISTEN pragmatic, multi-site, randomised controlled trial. Data were collected from sites in England and Wales between September 2022 and January 2024. Observations and focus groups with healthcare practitioners (HCPs) delivering the intervention were conducted to assess fidelity. Standardised implementation measures, focussed on intervention feasibility, acceptability and appropriateness, were gathered from HCPs and intervention participants. Semi-structured interviews were undertaken with a subset of participants across both trial arms. Data were analysed independently using descriptive statistics, or reflexive thematic analyses, and subsequently integrated, drawing upon the Consolidated Framework for Implementation Research v2.

FINDINGS

Thirty-six HCPs participated in the process evaluation, and 197 intervention participants completed standardised implementation measures. Across both trial arms, 49 participants took part in semi-structured interviews. Six integrated themes were constructed from all data sources describing and illustrating links between the context, implementation, mechanisms of impact and impacts: 'Delivery during uncertainty and ambiguity', 'Diversity and consistency of usual care', 'Drivers for self-care and the impact of self-generated expertise', 'Appropriate if unexpected support', 'Personalisation at the core of success' and 'A spectrum of change'.

CONCLUSION

The LISTEN intervention is an appropriate, feasible intervention for participants and HCPs. The intervention can be delivered to a high level of fidelity following training and with ongoing HCP support. Access, receipt and perceptions of NHS LC services were variable. Personalised, relational interventions, such as LISTEN, can foster favourable impacts on confidence, knowledge and activity and are acceptable and strongly recommended within LC rehabilitation services.

PATIENT OR PUBLIC CONTRIBUTION

The study was supported by a patient and public involvement and engagement (PPIE) group from project conception to study end. Using their lived expertise, seven people with LC supported accessible recruitment (e.g., materials), data collection (e.g., topic guides), data interpretation (e.g., theme construction and reviewing findings) and dissemination activities (e.g., online webinars).

TRIAL REGISTRATION

ISRCTN36407216, registered 27/01/2022.

MyGuide long COVID: An online self-management tool for people with long COVID

Background

Long COVID is a relatively new condition for which patients are asked to employ self-management strategies to manage their symptoms. However, it can be challenging for individuals with long COVID to find reliable and actionable self-management resources. The objective of this project was to develop an online tool for individuals with long COVID that is patient-centered, accessible, and customizable to meet individual needs.

Methods

MyGuide Long COVID (www.longCOVIDguide.ca) was developed in British Columbia (BC), Canada, by a team that included long COVID clinicians and patient partners. Site visitors answer questions about their symptoms, and MyGuide generates a curated set of self-management resources tailored to their needs. Since its launch in August 2023, Google Analytics has been used to monitor website activity.

Results

Within the first year, MyGuide had 52,578 total page views and 8570 new users. The most popular method to access MyGuide was by computer (56.3 % of users), and the most represented city was Vancouver, BC (23.5 % of users). The most popular topics were "Post Exertional Malaise" (1339 sessions) and "What is long COVID?" (1257 sessions).

Conclusions

An online tool to support chronic disease self-management can be successfully co-developed with patient partners and engagement tracked using web analytics.

Risk tools for predicting long-term sequelae based on symptom profiles after known and undetected SARS-CoV-2 infections in the population

The aim was to determine the profile of long-term symptoms after known and undetected SARS-CoV-2 infections and to generate tools for risk and diagnostic assessment of Post-COVID syndrome (PCS). In the population-based Gutenberg COVID-19 Study (N = 10,250), sequential, systematic screening for SARS-CoV-2 was performed in 2020/2021. Individuals received a standardized interview on newly occurred or worsened symptoms since the infection or the pandemic. Robust Poisson regression models were fit to compare the frequency of symptoms between groups. Two scores were developed using machine learning techniques and prospectively validated in an independent cohort. Among n = 942 individuals, prevalence of long-term symptoms was 36.4% among individuals with known SARS-CoV-2 infection, 25.0% in those unknowingly infected, and 28.1% among the controls. Individuals with known infection more often reported smell (Prevalence ratio [PR] = 13.66 [95% confidence interval 4.99;37.41]) and taste disturbances (PR = 5.57 [2.62;11.81]), forgetfulness (PR = 2.88 [1.55;5.35]), concentration difficulties (PR = 2.83 [1.55;5.16], trouble with balance (PR = 2.74 [1.18;6.35]), and dyspnea (PR = 2.22 [1.18;4.19]) than controls. The risk score for predicting long-term sequelae based on symptoms during the acute infection had a cross-validated AUC of 0.74 and 0.72 when applied in an independent cohort (N = 6,570). The diagnostic score providing a probability of the presence of PCS had a cross-validated AUC of 0.66 and of 0.64 in the validation cohort (N = 3,176). Individuals with and without SARS-COV-2 infection reported persistent symptoms, but symptoms attributable to PCS were identified. The data-driven scores may help guide further diagnostic decisions in the initial management of PCS.

Utilizing Google Trends data to enhance forecasts and monitor long COVID prevalence

BACKGROUND

Long COVID, the persistent illness following COVID-19 infection, has emerged as a major public health concern since the outbreak of the pandemic. Effective disease surveillance is crucial for policymaking and resource allocation.

METHODS

We investigated the potential of utilizing Google Trends data to enhance long COVID symptoms surveillance. Though Google Trends provides freely available search popularity data, limitations in data normalization and retrieval restrictions have hindered its predictive capabilities. In our study, we carefully selected 33 search terms and 20 related topics from the long COVID symptoms list provided by the Centers for Disease Control and Prevention and the database "scite", and calculated their merged search volumes from Google Trends data using our developed statistical method for analysis.

RESULTS

We identify four related topics (ageusia, anosmia, chest pain, and headaches) that consistently exhibit increased search popularity before that of "long COVID." Additionally, nine related topics (aching muscle pain, anxiety, chest pain, clouding of consciousness, dizziness, fatigue, myalgia, shortness of breath, and hypochondriasis) show increased search popularity following that of "long COVID." We demonstrate that the merged search volume (MSV), derived from the relative search volume data downloaded from Google, can be used to forecast the prevalence of long COVID in a prediction study, supporting the use of the methodology in risk management regarding the prevalence of long COVID.

CONCLUSIONS

By utilizing a comprehensive list of search terms and sophisticated statistical analytics, our study contributes to exploring the potential of Google Trends data for forecasting and monitoring long COVID prevalence. These findings and methodologies can be used as prior knowledge to inform future infodemiological and epidemiological investigations.

Long COVID and endometriosis: a systematic review and meta-analysis

Long COVID conditions entail the persistence of COVID-19-related symptoms for at least eight weeks following SARS-CoV-2 infection. The prevalence of long COVID is estimated to range from 10 to 30% among individuals infected with SARS-CoV-2. Despite its growing impact on healthcare systems, long COVID remains poorly understood. In parallel, endometriosis, a chronic inflammatory condition affecting around 10% of reproductive-age women, is marked by symptoms such as pelvic pain and infertility. The aim of this study was to assess the association between endometriosis and long COVID. We performed a systematic review of long COVID among endometriosis patients in Pubmed/Medline, Cochran Library and Science Direct databases from inception to August 2023. We independently selected studies, extracted data, assessed risk of bias, and compared endometriosis versus non endometriosis patients for long. Pooled analyses were based on random-effect models, and the I2 statistic was used to quantify heterogeneity across studies. A total of 2 cross-sectional studies (N = 216,095 participants) were included. The pooled analysis comparing endometriosis to non-endometriosis patients significantly showed association for long COVID (pooled RR = 1.41 [1.31-1.52], I2 = 29%, p < 0.001). Women, who are disproportionately affected by long COVID, particularly those with endometriosis, may face compounded health challenges. While our findings suggest a possible association between endometriosis and long COVID, the evidence is currently limited to two observational studies. Further research involving diverse populations and robust study designs is needed to confirm this relationship and clarify underlying mechanisms.

Plasma protein biomarkers for long COVID-19: Predictors of symptom severity and mortality risk

INTRODUCTION

Long COVID-19 is marked by persistent symptoms beyond the acute phase, necessitating a deeper understanding of mortality risk factors for effective management. Plasma proteins hold promise as prognostic markers, offering insights into disease progression and aiding in mortality risk assessment.

METHOD

A total of 240 patients and 89 healthy controls were enrolled for this study. Two months post-COVID follow-up, patients were categorized as survivors (n = 212) and non-survivors (n = 28). Plasma samples underwent 2-dimensional Gel Electrophoresis (2DE) for protein separation, followed by LC-MS/MS for protein identification, and validation was performed using ELISA. Proteomic data analysis was conducted using Mascot version 2.3.02 and Samespots software 4.5.1. Statistical analyses were carried out using GraphPad Prism and IBM SPSS.

RESULTS

LC-MS/MS identified fibrinogen (Spot 14; 52.15 kDa/5.32 pI; protein score 2293) and haptoglobin (Spot 08; 45.86 kDa/6.56 pI; protein score 453) as prospective predictive biomarkers. ELISA results confirmed increased plasma levels of fibrinogen and haptoglobin in severe cases (P < 0.001 for both) and non-survivors (P < 0.01 and P < 0.0086, respectively). ROC analysis showed haptoglobin had moderate predictive power for mortality (AUC = 0.68; P = 0.0025), surpassing fibrinogen (AUC = 0.62; P = 0.0374).

CONCLUSION

Plasma fibrinogen and haptoglobin are promising biomarkers for assessing disease severity and mortality risk in long COVID. These findings highlight their potential for prognostic applications, warranting further research into their mechanistic roles in COVID-19 and broader clinical implications.

Post-acute sequelae SARS-CoV-2 infection and neuropathic pain: a narrative review of the literature and future directions

PURPOSE OF REVIEW

Neuropathic pain is a recognized and debilitating symptom of SARS-CoV-2 infection across acute, post-acute, and long-COVID phases. Initially emerging as acute or subacute symptoms, these neuropathic manifestations can evolve into chronic conditions, with approximately 10% of all SARS-CoV-2 cases (estimated 65 million individuals globally) developing post-acute SARS-CoV-2 (PASC) neuropathic sequalae. Given the limited literature specifically addressing neuropathic pain related to PASC, a deeper understanding is needed to improve management and reduce patient burden.

RECENT FINDINGS

PASC symptoms are associated with disease severity, elevated body mass indexes, preexisting psychological conditions, and addiction history. Sex differences appear to influence prevalence, and the multisystem nature of PASC complicates symptom presentation, with mood disorders, fatigue, and cognitive dysfunction contributing to altered pain perception. Proposed mechanisms include immune dysregulation, persistent viral protein effects, and neuroanatomical changes. Management typically involves a multimodal approach.

SUMMARY

This review examines SARS-CoV-2 neuropathic pain across the illness trajectory, examining its pathophysiology, prevalence, and treatment. It highlights the potential for subacute neuropathic symptoms to become chronic and calls for future research to refine long-term management strategies and assess broader healthcare implications.

Association of Pre-COVID Fitness With Post-COVID Fitness and Long COVID in the Cooper Center Longitudinal Cohort Study

BACKGROUND

Cross-sectional studies suggesting that SARS-CoV-2 infection and long COVID are associated with reduced cardiorespiratory fitness (CRF) lack preinfection CRF measures. The objective of this study was to determine the association of SARS-CoV-2 infection and long COVID with change in CRF.

METHODS

Cooper Center Longitudinal Study is a cohort study based at the Cooper Clinic, a preventive medicine clinic in Dallas, Texas; we included adults ages 20 to 74 years old with CRF assessed at least twice between 2017 and 2023. COVID status was defined as "prepandemic" (2 CRF measures pre-2020), "uninfected" (no self-reported COVID), "recovered" (self-reported COVID with symptoms ≤3 months), or "long COVID" (self-reported COVID with symptoms >3 months). CRF was estimated in metabolic equivalents via a maximal modified Balke treadmill protocol.

RESULTS

We included 4005 participants (mean age: 51.8 years, 26.8% women), of whom, 1666 (41.6%) reported COVID and 80 (4.8% of infected) reported long COVID along with 1826 uninfected and 513 pre-pandemic controls. At baseline, those who later developed long COVID had lower CRF (10.0 metabolic equivalents, 11.1 recovered, 10.7 uninfected, 11.3 prepandemic; P<0.001). All groups exhibited minor decreases in CRF (~0.2 metabolic equivalents; P<0.001 for each). CRF decreased slightly more among the infected (-0.1 metabolic equivalents greater decrease [95% CI, -0.1 to 0.0]; P=0.02) but not by long COVID status (P=0.10).

CONCLUSIONS

Pre-COVID fitness, on average, is lower among people who developed long COVID. COVID does not greatly accelerate age-related declines in CRF, even among some with long COVID, although few included participants had severely disabling long COVID. Future longitudinal research will clarify if differences in CRF by infection status emerge over longer follow-up.

SARS-CoV-2 damages cardiomyocyte mitochondria and implicates long COVID-associated cardiovascular manifestations

INTRODUCTION

With the COVID-19 pandemic becoming endemic, vigilance for Long COVID-related cardiovascular issues remains essential, though their specific pathophysiology is largely unexplored.

OBJECTIVES

Our study investigates the persistent cardiovascular symptoms observed in individuals long after contracting SARS-CoV-2, a condition commonly referred to as "Long COVID", which has significantly affected millions globally.

METHODS

We meticulously describe the cardiovascular outcomes in five patients, encompassing a range of severe conditions such as sudden cardiac death during exercise, coronary atherosclerotic heart disease, palpitation, chest tightness, and acute myocarditis.

RESULTS

All five patients were diagnosed with myocarditis, confirmed through endomyocardial biopsy and histochemical staining, which identified inflammatory cell infiltration in their heart tissue. Crucially, electron microscopy revealed widespread mitochondrial vacuolations and the presence of myofilament degradation within the cardiomyocytes of these patients. These findings were mirrored in SARS-CoV-2-infected mice, suggesting a potential underlying cellular mechanism for the cardiac effects associated with Long COVID.

CONCLUSION

Our findings demonstrate a profound impact of SARS-CoV-2 on mitochondrial integrity, shedding light on the cardiovascular implications of Long COVID.

Impact of COVID-19 vaccination on symptoms and immune phenotypes in vaccine-naïve individuals with Long COVID

BACKGROUND

The symptomatic and immune responses to COVID-19 vaccination of people with Long COVID are poorly characterized.

METHODS

In this prospective study, we evaluated changes in symptoms and immune responses after COVID-19 vaccination in 16 vaccine-naïve individuals with Long COVID. Surveys were administered before vaccination and at 2, 6, and 12 weeks after receiving the first vaccine dose of the primary series. Simultaneously, SARS-CoV-2-reactive TCR enrichment, SARS-CoV-2-specific antibody responses, antibody responses to other viral and self-antigens, and circulating cytokines were quantified before vaccination and at 6 and 12 weeks after vaccination.

RESULTS

At 12 weeks post-vaccination, self-reported improved health is seen in 10 out of 16 participants, 3 have no change, and 3 have worse health although 2 report transient improvement after vaccination. One participant reporting worse health was hospitalized twice with chest pain (after each dose). Symptom outcomes are most associated with plasma biosignatures. Higher baseline sIL-6R is associated with symptom improvement, and stably elevated levels of IFN-β and CNTF are associated with no improvement. Significant elevation in SARS-CoV-2-specific TCRs and spike protein-specific IgG are observed at 6 and 12 weeks after vaccination. No changes in reactivities are observed against herpes viruses and self-antigens.

CONCLUSIONS

In this study of 16 people with Long COVID, vaccination is associated with increased SARS-CoV-2 spike protein-specific IgG and T cell expansion in most participants. Specific immune features are associated with symptom change after vaccination and most participants experience improved health or no change following vaccination.

Reproducibility of genetic risk factors identified for long COVID using combinatorial analysis across US and UK patient cohorts with diverse ancestries

BACKGROUND

Long COVID is a major public health burden causing a diverse array of debilitating symptoms in tens of millions of patients globally. In spite of this overwhelming disease prevalence, staggering cost, severe impact on patients' lives and intense global research efforts, study of the disease has proved challenging due to its complexity. Genome-wide association studies (GWAS) have identified only four loci potentially associated with the disease, although these results did not statistically replicate between studies. A previous combinatorial analysis study identified a total of 73 genes that were highly associated with two long COVID cohorts in the predominantly (> 91%) white European ancestry Sano GOLD population, and we sought to reproduce these findings in the independent and ancestrally more diverse All of Us (AoU) population.

METHODS

We assessed the reproducibility of the 5343 long COVID disease signatures from the original study in the AoU population. Because the very small population sizes provide very limited power to replicate findings, we initially tested whether we observed a statistically significant enrichment of the Sano GOLD disease signatures that are also positively correlated with long COVID in the AoU cohort after controlling for population substructure.

RESULTS

For the Sano GOLD disease signatures that have a case frequency greater than 5% in AoU, we consistently observed a significant enrichment (77-83%, p < 0.01) of signatures that are also positively associated with long COVID in the AoU cohort. These encompassed 92% of the genes identified in the original study. At least five of the disease signatures found in Sano GOLD were also shown to be individually significantly associated with increased long COVID prevalence in the AoU population. Rates of signature reproducibility are strongest among self-identified white patients, but we also observe significant enrichment of reproducing disease associations in self-identified black/African-American and Hispanic/Latino cohorts. Signatures associated with 11 out of the 13 drug repurposing candidates identified in the original Sano GOLD study were reproduced in this study.

CONCLUSION

These results demonstrate the reproducibility of long COVID disease signal found by combinatorial analysis, broadly validating the results of the original analysis. They provide compelling evidence for a much broader array of genetic associations with long COVID than previously identified through traditional GWAS studies. This strongly supports the hypothesis that genetic factors play a critical role in determining an individual's susceptibility to long COVID following recovery from acute SARS-CoV-2 infection. It also lends weight to the drug repurposing candidates identified in the original analysis. Together these results may help to stimulate much needed new precision medicine approaches to more effectively diagnose and treat the disease. This is also the first reproduction of long COVID genetic associations across multiple populations with substantially different ancestry distributions. Given the high reproducibility rate across diverse populations, these findings may have broader clinical application and promote better health equity. We hope that this will provide confidence to explore some of these mechanisms and drug targets and help advance research into novel ways to diagnose the disease and accelerate the discovery and selection of better therapeutic options, both in the form of newly discovered drugs and/or the immediate prioritization of coordinated investigations into the efficacy of repurposed drug candidates.

Post-acute sequelae of COVID-19 in residents in long-term care homes: Examining symptoms and recovery over time

BACKGROUND

Post-COVID-19 condition (PCC) has been studied extensively since the inception of the COVID-19 pandemic. In the population of long-term care (LTC) home residents, however, information about PCC and recovery after the acute phase of COVID-19 is lacking. This study contributes evidence about symptoms over time in 459 residents in nine Canadian LTC homes.

METHODS

In a comprehensive retrospective chart review, we recorded medical symptoms in a 4-week period before contracting COVID-19 ("PRE-COVID") and during 24 weeks after contracting infection (a 4-week "ACUTE-COVID" period and five subsequent 4-week periods "POST1-5"). We investigated the number and type of symptoms over time, examined different "recovery trajectories", and compared the characteristics of residents across different trajectories.

RESULTS

In the sample overall, the number of different symptoms increased from PRE-COVID to ACUTE-COVID (mean difference of 3 symptoms, p<.001), returning to the PRE-COVID level within the first two months post-infection. An individual-level examination revealed that after ACUTE-COVID about a quarter of residents did not return to their symptom baseline. There was no statistically significant difference in demographic characteristics or PRE-COVID comorbidities across different recovery trajectories. Comparing the group of residents that did not return to their symptom baseline and the group that did, the risk for not returning to baseline increased with the number of symptoms in ACUTE-COVID (adjusted for age, sex, and PRE-COVID comorbidities, exp[B]=1.15, 95% CI [1.05;1.25], p=.002). Additionally, there was a greater increase in the number of symptoms from PRE-COVID to ACUTE-COVID in the former group (significant interaction effect, p<.001). We present symptom types in each time-period.

CONCLUSIONS

Group-level results indicated that the number of symptoms after contracting COVID-19 fell to the pre-COVID level within the first two months post-infection. An examination of individual-level symptom trajectories contributed a more granular picture of recovery after infection and characteristics of residents across different trajectories.

SARS-CoV-2-induced sensory perturbations: A narrative review of clinical phenotypes, molecular pathologies, and possible interventions

Background

The acute and post-acute sequelae of SARS-CoV-2 infection have been of great clinical interest since the inception of the COVID-19 pandemic. Despite a high prevalence of individuals with persistent symptoms, a wholistic view of the effects of SARS-CoV-2 on special sensory systems is lacking. Considering the significant impact of normal sensory function on quality of life, the goal of this review is to highlight unresolved issues related to SARS-CoV-2-associated insults to the sensory nervous system.

Major findings

In this narrative review, we discuss the epidemiology of SARS-CoV-2-induced sensory perturbations, underlying pathological mechanisms, and possible therapeutic strategies across the olfactory, gustatory, somatosensory, visual, and auditory systems. Examined literature included studies with human biospecimens, human-derived cell lines, and naturally susceptible animal models, which highlighted evidence of persistent functional disruption in all sensory systems. SARS-CoV-2 infection was associated with persistent inflammation in the olfactory epithelium/bulb, somatosensory ganglia, and gustatory systems, long-term transcriptional perturbations in the sensory central nervous system and peripheral nervous system, and detectable degeneration/apoptosis in the gustatory and visual systems. Few studies have proposed evidence-based therapeutic strategies for attenuating specific sensory abnormalities after SARS-CoV-2 infection.

Conclusion

While the olfactory system, and to some extent the visual and somatosensory systems, have been more thoroughly investigated from symptomatology, behavioral and molecular perspectives, there is still an unmet need for the development of therapeutics to treat COVID-induced impairment of these systems. Further, additional attention must be placed on COVID-associated impairment of the gustatory, visual, and auditory systems, which lack detailed mechanistic investigations into their pathogenesis.

Identification of soluble biomarkers that associate with distinct manifestations of long COVID

Long coronavirus disease (COVID) is a heterogeneous clinical condition of uncertain etiology triggered by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here we used ultrasensitive approaches to profile the immune system and the plasma proteome in healthy convalescent individuals and individuals with long COVID, spanning geographically independent cohorts from Sweden and the United Kingdom. Symptomatic disease was not consistently associated with quantitative differences in immune cell lineage composition or antiviral T cell immunity. Healthy convalescent individuals nonetheless exhibited higher titers of neutralizing antibodies against SARS-CoV-2 than individuals with long COVID, and extensive phenotypic analyses revealed a subtle increase in the expression of some co-inhibitory receptors, most notably PD-1 and TIM-3, among SARS-CoV-2 nonspike-specific CD8+ T cells in individuals with long COVID. We further identified a shared plasma biomarker signature of disease linking breathlessness with apoptotic inflammatory networks centered on various proteins, including CCL3, CD40, IKBKG, IL-18 and IRAK1, and dysregulated pathways associated with cell cycle progression, lung injury and platelet activation, which could potentially inform the diagnosis and treatment of long COVID.

Impact of COVID-19 on long-term outcomes in Parkinson's disease

OBJECTIVES

Patients with pre-existing Parkinson's disease (PD) face higher risks of severe acute COVID-19 outcomes than matched controls, but long-term post-COVID-19 outcomes remain largely unknown. This study investigated clinical outcomes up to 3.5 years post-infection in a Bronx inner-city PD population.

METHODS

This retrospective study evaluated 3512 patients with PD in the Montefiore Health System (January 2016-July 2023), which serves a large diverse population and was an epicenter of the early COVID-19 pandemic and subsequent infection surges. Comparisons were made with PD patients without a positive SARS-CoV-2 test (defined by polymerase chain reaction test). Outcomes were post-index date all-cause mortality, major adverse cardiovascular events (MACE), altered mental status, fatigue, dyspnea, headache, psychosis, dementia, depression, anxiety, dysphagia, falls, and orthostatic hypotension. Changes in Levodopa prescriptions were also tabulated. Adjusted hazard ratios (aHR) were computed accounting for competing risks.

RESULTS

PD patients with COVID-19 had similar demographics but a higher prevalence of pre-existing comorbidities compared to PD patients without COVID-19. PD patients with COVID-19 had greater risk of mortality (aHR = 1.58 [95% CI: 1.03, 2.41]), MACE (aHR = 1.57 [1.19, 2.07]), dyspnea, fatigue, and fall compared to PD patients without COVID-19. Levodopa dose adjustment was higher post-infection in the COVID-19 cohort.

CONCLUSIONS

Among PD patients, COVID-19 was associated with a higher risk of adverse long-term outcomes. PD patients who survive COVID-19 may benefit from heightened clinical awareness and close follow-up. Findings highlight the need to improve post-COVID care for PD patients to mitigate disease progression and maintain quality of life.

Long-term consequences of COVID-19 on sleep, mental health, fatigue, and cognition: a preliminary study

INTRODUCTION

Post-COVID-19 Syndrome (PCS) is defined as symptoms persisting beyond 12 weeks from the onset of symptoms. Notably, COVID-19 has been associated with long-term effects on the brain and mental health. This cross-sectional study aims to investigate depression, fatigue, sleep quality, and cognitive dysfunction, particularly working memory, in individuals with PCS compared to a healthy control group.

MATERIAL AND METHODS

Between April and December 2021, 45 COVID-19 individuals and 60 healthy individuals met the eligibility criteria. Demographic information and the Montreal Cognitive Assessment were collected. Two visual working memory tasks, Delayed Match-to-Sample (DMS) and n-back, were performed, along with self-report questionnaires: Beck Depression Inventory, Modified Fatigue Impact Scale, and Pittsburgh Sleep Quality Index.

RESULTS

A total of 105 participants were enrolled. Findings reveal that the PCS group exhibited notably higher levels of cognitive impairment (13.3% vs. 1.6%, p = 0.04), depression (53.9% vs. 25.9%, p = 0.03), and sleep disturbances (53.9% vs. 18.6%, p = 0.01) compared to the healthy control group. Sleep latency and sleep duration were particularly affected. No significant differences in working memory function were observed between the two groups (p = 0.90 for DMS and p = 0.98 for n-back).

CONCLUSION

The study highlights the higher prevalence of sleep disturbance, depression, and cognitive impairment in the PCS phase, with inflammation likely playing a significant role. Moreover, the study suggests that untreated depression and sleep disturbances may pose long-term risks for dementia. Understanding the underlying mechanisms is crucial for developing effective interventions and support for individuals recovering from the infection. Prospective longitudinal studies with larger and more diverse samples are warranted to confirm and expand upon these findings.

Defining brain fog across medical conditions

'Brain fog' is commonly reported in more than a dozen chronic diseases, but what is it? We review research across conditions which has characterised brain fog and evaluate its definitions and objective correlates. Brain fog has been used to refer to a variable set of overlapping symptoms implicating cognition, fatigue, and affect. It has been defined as a distinct symptom, a syndrome, or a nonspecific term. We consider the evidence that brain fog is a transdiagnostic entity with a common phenomenology and profile of objective cognitive deficits. We discuss where these commonalities arise and argue that linguistic ambiguity, shared cognitive impairments, and noncognitive factors are more likely than shared neurobiology. We suggest how future research might apply existing tools to disambiguate the phenomena that brain fog conflates.

Long-Term Health-Related Quality of Life in Working-Age COVID-19 Survivors: A Cross-Sectional Study

BACKGROUND

Most working-age (18-64) adults have been infected with SARS-CoV-2, and some may have developed post-COVID-19 condition (PCC). However, long-term health-related quality of life (HRQOL) following infection remains uncharacterized.

METHODS

In this cross-sectional study, COVID-19 survivors from throughout British Columbia (BC), Canada, completed a questionnaire >2 years after infection. PCC status was self-reported, and HRQOL was assessed using the EuroQol 5-dimension 5-level (EQ-5D-5L) instrument. We compared HRQOL in those with current PCC, those with recovered PCC, and those without a history of PCC. Multivariable analyses were weighted to be representative of COVID-19 survivors in BC.

RESULTS

Of the 1,135 analyzed participants, 19.2% had current PCC, and 27.6% had recovered PCC. Compared to those without a history of PCC, participants with recovered PCC had a similar mean EQ-5D health utility (adjusted difference -0.02 [95%CI -0.03, 0.00]), but those with current PCC had a lower health utility (adjusted difference -0.08 [95%CI -0.12, -0.05]). Participants with current PCC were also more likely to report problems with mobility (adjusted odds ratio (aOR) 6.00 [95%CI 2.88-12.52]), self-care (aOR 5.96 [95%CI 1.84-19.32]), usual activities (aOR 8.00 [95%CI 4.27-14.99]), pain/discomfort (aOR 4.28 [95%CI 2.46-7.48]), and anxiety/depression (aOR 3.45 [95%CI 1.90-6.27]).

CONCLUSIONS

In working-age adults who have survived >2 years following COVID-19, HRQOL is high among those who never had PCC or have recovered from PCC. However, individuals with ongoing symptoms have lower HRQOL and are more likely to have functional deficits. These findings underscore the importance of implementing targeted healthcare interventions to improve HRQOL in adults with long-term PCC.

Considerations for Long COVID Rehabilitation in Women

The coronavirus disease 2019 (COVID-19) pandemic has given rise to long COVID, a prolonged manifestation of severe acute respiratory syndrome coronavirus 2 infection, which presents with varied symptoms and conditions lasting beyond expected acute illness. Despite efforts, diagnostic and treatment approaches remain insufficient, particularly for women who experience higher prevalence rates. Rehabilitation professionals have played a crucial role during the pandemic. Individualized rehabilitation plans, encompassing various therapies and interdisciplinary collaborations, are essential. Addressing disparities and biological sex differences is paramount, requiring increased research, understanding, and advocacy for effective rehabilitative care tailored to all individuals affected by long COVID.

Analysis of risk factors for long COVID after mild COVID-19 during the Omicron wave in Japan

BACKGROUND

Post-COVID-19 syndrome, referred to as "long COVID," is characterized by persistent symptoms that develop during or after SRAS-CoV-2 infection lasting for ≥12 weeks, which cannot be explained by factors other than COVID-19. Previous studies before the Omicron pandemic have identified female sex, older age (≥50 years), severity of illness, obesity, diabetes, and smoking as risk factors for long COVID. However, data on long COVID following the emergence of the Omicron variants are limited.

METHODS

An online survey was conducted among outpatients diagnosed with mild COVID-19 at 14 participating institutions in Japan between July 30, 2022, and December 31, 2023.

RESULTS

Of the included 246 cases, 76 (35.5%) experienced at least one long COVID symptom 12 weeks after onset. Logistic regression analysis revealed that age ≥40 years was significantly associated with an increased risk of respiratory (odds ratio [OR]: 3.80, 95% confidence interval [CI]: 1.67-8.65) and neurologic symptoms (OR: 4.53, 95% CI: 1.84-11.13). Conversely, antiviral drug use was associated with a decreased risk of respiratory symptoms (OR: 0.31, 95% CI: 0.11-0.93).

CONCLUSION

Caution is warranted when treating patients over 40 years of age with mild COVID-19 due to their higher susceptibility to developing long COVID. Antiviral drugs may be beneficial in managing respiratory symptoms and mitigating disease severity.

Mental and Physical Health in Wilson Disease Patients With SARS-CoV-2 Infection and Relevance of Long-COVID

SARS-CoV-2 infection and Long COVID (LC) might lead to a significant deterioration of physical and mental health. Wilson disease (WD) patients have a chronic liver and/or neuropsychiatric disease, making it particularly interesting to investigate LC in WD. 51 WD patients were retrospectively examined, evaluating physical and mental health by a survey and neuropsychological tests (SF-12, PSQI, ISI, Epworth, Chalder-fatigue scale, PHQ-9, GAD-7, PSS, FLei) before and ~11 months after SARS-CoV-2 infection. LC was defined as the development of new, at least moderately severe symptoms (shortness of breath, chest pain, fatigue, brain fog, exercise capacity, concentration disturbances) and/or worsening of pre-existing symptoms. 70.6% had predominant hepatic and 29.4% had neuropsychiatric symptoms at WD diagnosis. Median age was 39 years; 56.1% were female. Patients were in stable maintenance phase with a median treatment duration of 23 years. When compared to before COVID-19, WD patients had significantly worse physical life quality, sleeping quality, and fatigue. After COVID-19, a high percentage of WD patients reported concentration disorders (60%), fatigue (55%), reduced exercise capacity (50%), shortness of breath (40%), chest pain (20%) and feeling of brain fog (15%). 39.2% (n = 20) of the WD patients were classified as LC. This LC-WD subgroup showed significantly impaired quality of life, a high stress level, and sleeping disturbances, fatigue, depression, anxiety, and cognitive impairment. A large proportion of WD patients experience LC symptoms, reduced life quality, and sleeping disorders after SARS-CoV-2 infection. WD patients post-infection should be well monitored and supported if they develop persisting symptoms or neuro-psychological problems.

Long-Term Persistent Headache After SARS-CoV-2 Infection: A Follow-Up Population-Based Study

BACKGROUND

Headache is a symptom of the long-COVID syndrome. The incidence and characteristics of de novo post-COVID headaches remain unclear. Our aim was to characterize new-onset headaches in a population-based prospective cohort of COVID-19 patients from the first pandemic wave.

METHODS

This study followed a prospective cohort of 732 COVID-19 patients consecutively diagnosed between March and June 2020. Neurological follow-up was performed face-to-face or by phone at 3, 12, and 24 months. A structured clinical questionnaire was used to characterize headaches before infection and 24 months postinfection.

RESULTS

Overall, 448 patients completed the 24-month follow-up, with a mean age of 51.6 years at SARS-CoV-2 infection; 272 (60.7%) were women. A prior history of headaches was reported by 115 (25.7%). Patients with either pre-existing or de novo persistent headaches were younger, more often women, and exhibited hyposmia, hypogeusia, and headache during the acute phase of infection. De novo persistent headaches occurred in 54 of 333 (16.2%) headache-naïve patients. Of these, 35 (64.8%) fulfilled migraine-like headache (MLH) criteria (mean age of 49.1 years at 24-month follow-up), with a cumulative incidence of 42/1000/year.

CONCLUSIONS

De novo persistent headaches are common 2 years after COVID-19, with MLH being the most frequent type. MLH incidence after COVID-19 is elevated and de novo "migraineurs-like" tend to be older compared to the general population. This is an important finding with potential implications for healthcare and quality of life, considering the high number of COVID-19 cases and the global burden of migraine.

Short and long-term trajectories of the post COVID-19 condition: Results from the EuCARE POSTCOVID study

BACKGROUND

Post COVID-19 condition (PCC) affects 10-40% of patients and is characterized by persisting symptoms at ≥ 4 weeks after SARS-CoV-2 infection. Symptoms can last 7 or even more months. How long PCC persists and any changes in its clinical phenotypes over time require further investigation. We investigated PCC trajectories and factors associated with PCC persistence.

MATERIAL AND METHODS

We included both hospitalized COVID-19 patients and outpatients from February 2020 to June 2023, who underwent at least one follow-up visit after acute infection at San Paolo Hospital, University of Milan. Follow-up visits were conducted at the post COVID-19 clinic or via telemedicine. During each follow-up examination, patients completed a short version of the World Health Organization (WHO) Case Report Form (CRF) for ongoing symptoms, the Hospital Anxiety and Depression Scale (HADS), and a screening tool for Post-Traumatic Stress Disorder (PTSD). Statistical analyses involved Chi-square, Mann-Whitney, Kruskal-Wallis tests, and logistic regression analysis.

RESULTS

We enrolled 853 patients (median age 62, IQR 52-73; 41% females). 551/853 (64.6%), 152/418 (36.4%) and 21/69 (30.4%) presented PCC at median follow up of 3 (IQR 2-3), 7 (IQR 6-10) and 26 (IQR 20-33) months, respectively (p < 0.001). The main clinical phenotypes were fatigue, respiratory sequelae, brain fog and chronic pain; anosmia/dysgeusia was observed mostly in the first post-acute period. Female sex, acute disease in 2020, a longer hospital stay and no COVID-19 vaccination were associated with persistence or resolution of PCC compared to never having had PCC. Anxiety, depression and PTSD were more common in PCC patients. By fitting a logistic regression analysis, acute infection in 2020 remained independently associated with persistent PCC, adjusting for age, sex, preexisting comorbidities and disease severity (AOR 0.479 for 2021 vs 2020, 95%CI 0.253-0.908, p = 0.024; AOR 0.771 for 2022 vs 2020, 95%CI 0.259-2.297, p = 0.641; AOR 0.086 for 2023 vs 2020, 95%CI 0.086-3.830, p = 0.565).

CONCLUSIONS

There was a reduction in the PCC burden 7 months following the acute phase; still, one third of patients experienced long-lasting symptoms. The main clinical presentations of PCC remain fatigue, respiratory symptoms, brain fog, and chronic pain. Having had SARS-CoV-2 infection during the first pandemic phases appears to be associated with persistent PCC.

Mitigating fatigue in long COVID patients with MYPplus: a clinical observation

PURPOSE

The COVID-19 pandemic has led to the emergence of a secondary public health crisis known as Long COVID. It is estimated that approximately 10% of individuals who contact COVID-19 develop Long COVID, with fatigue and brain fog being among the most commonly reported and debilitating symptoms. However, no standardized or effective treatments are currently available. This observational study aimed to evaluate the efficacy of MYPplus, an herbal formulation composed of Astragali Radix, Salviae Radix, and Aquilariae Lignum, in alleviating fatigue and brain fog in patients with Long COVID.

METHODS

Subjects with a score of 60 or higher on the Modified Korean version of the Chalder Fatigue scale (mKCFQ11) or a brain fog rating of 5 or higher on the visual analogue scale (VAS) took two capsules of MYPplus (500 mg per capsule) twice daily for 4 weeks. Changes in symptoms were assessed using the mKCFQ11, Multidimensional Fatigue Inventory (MFI-20), Fatigue VAS, Brain fog VAS, and overall quality of life using the Short-Form Health Survey (SF-12). Additionally, levels of three cytokines (TNF-α, TGF-β, IFN- γ) and cortisol were measured.

RESULTS

Fifty participants successfully completed the 4-week administration with MYPplus. At baseline, fatigue severity was 75.3 ± 10.9 in mKCFQ11, 70.9 ± 11.2 in MFI-20, 7.5 ± 1.2 in Fatigue VAS, 8.4 ± 1.1 in Brain fog VAS, and 45.3 ± 17.8 in SF-12. All parameters significantly improved (p < 0.01), with a decrease of 46% in mKCFQ11, 26% in MFI-20, 49% in Fatigue VAS, and 52% in Brain fog VAS, and an increase of 59% in SF-12, respectively. Unlikely others, the plasma level of TGF-β showed a declining pattern after MYPplus administration (from 765.0 ± 1759.7 to 243.9 ± 708.1 pg/mL, p = 0.07). No safety concerns were observed.

CONCLUSION

This pilot observational study suggests the clinical potential of MYPplus for managing patients with Long COVID, focusing on fatigue-related symptoms and quality of life. Further studies are required to confirm its efficacy and safety using large-scale randomized placebo-controlled trials in the future.

PROTOCOL REGISTRATION

This study has been retrospectively registered with the identifier number KCT0008948 on https://cris.nih.go.kr , as of 27/10/23.

Ashwagandha (Withania somnifera (L.) Dunal) for promoting recovery in long covid: protocol for a randomised placebo-controlled clinical trial (APRIL Trial)

BACKGROUND

Long covid describes a syndrome of persistent symptoms following COVID-19 and is responsible for substantial healthcare and economic burden. Currently, no effective treatments have been established. Ashwagandha (Withania somnifera (L.) Dunal) is a medicinal herb traditionally used in India for its immune-strengthening and anti-inflammatory properties. Withanolides, a family of steroid-derived molecules unique to Ashwagandha, have been shown to modulate inflammatory pathways in animal models, and several small randomised trials in humans support its effectiveness for reducing symptoms that are also associated with long covid. Therefore, this study aims to assess whether Ashwagandha is effective and safe for improving functional status and reducing symptom burden in adults living with long covid.

METHODS

A randomised double-blind placebo-controlled trial will be performed at participating general practice (GP) surgeries and long covid clinics across the UK. Individuals diagnosed with long covid will be screened for eligibility and then randomised 1:1 to take 1000 mg daily of Ashwagandha root extract tablets (standardised to <0.9% withanolides) or matching placebo tablets for 3 months (target, n = 2500). Monthly online surveys will be performed to collect patient-reported outcomes, and monthly safety monitoring, including liver function tests, will be conducted by clinical site teams. The primary outcome of the Post-COVID Functional Status Scale score at 3 months will be assessed by baseline-adjusted ordinal logistic regression, according to a pre-published statistical analysis plan. The secondary outcomes included validated quality of life and long covid symptom scales, work status and productivity and adverse events. The trial has been approved as a Clinical Trial of an Investigational Medicinal Produce by the Medicines and Healthcare Regulatory Authority and by the NHS Research Ethics Committee and Health Research Authority.

DISCUSSION

Treatments for long covid are urgently needed. This trial will robustly evaluate the safety and efficacy of a candidate treatment with a promising efficacy and safety profile. If found to be effective, the findings will likely influence treatment guidelines and improve health outcomes in those living with long covid.

TRIAL REGISTRATION NUMBER

This trial was pre-registered on 15/08/2022: ISRCTN12368131.

Mixed methods study of views and experience of non-hospitalised individuals with long COVID of using pacing interventions

Long COVID is highly prevalent and debilitating, with key symptoms including fatigue, breathlessness, and brain fog. Pacing is an approach to energy conservation used to help people with chronic conditions like ME/CFS manage the impact of their condition, and could be a useful strategy for people with Long COVID. The aim of this study was to explore the views and experiences of non-hospitalised adults with Long COVID of pacing as an intervention. This mixed methods study is part of the Therapies for Long COVID (TLC) Feasibility trial. A feasibility questionnaire was developed for participants. In addition, semi-structured interviews were conducted with a sub-sample of participants at the end of the study and these interviews were analysed using the reflexive thematic analysis approach. 28 participants completed the feasibility questionnaire and 19 participants took part in a qualitative interview. Participants found that pacing helped improve motivation and activity planning. Concerns included challenges due to time constraints, complexity of the intervention, and limited instructions. Pacing for Long COVID may offer potential benefits and is feasible but further research is required to demonstrate its benefits. Overall, research on pacing in the context of Long COVID has the potential to enhance our understanding of symptom management and rehabilitation strategies for this emerging population.

Does long COVID in people living with HIV resemble the functional phenotype of non-HIV individuals who had moderate or severe acute COVID-19? A retrospective cross-sectional study

Introduction

It has been postulated that individuals with long COVID have reduced exercise capacity, just as people living with HIV (PLWH), although having even lower exercise capacity. The extent to which long COVID in PLWH resembles long COVID in individuals who presented different COVID-19 phenotypes is unknown, so we aimed to determine if the long COVID profile in PLWH resembled the symptoms experienced by individuals with long COVID following mild/moderate or severe acute COVID-19, 2 years after the initial disease.

Material and methods

A pulmonary function test and a 6-min walk test (6MWT) were performed on adult individuals with PACS (Post-Acute COVID Syndrome) in 3 groups: COVID-19+PLWH (plwHCOV), mild/moderate COVID-19 (mmCOV); severe COVID-19 (seCOV).

Results

Sixty three individuals were included: plwHCOV (n = 12), mmCOV (n = 33) and seCOV (n = 18). Across all groups, males were predominant. BMI was 25 ± 3, 28 ± 4, and 32 ± 7 kg/m2 in plwHCOV, mmCOV, and seCOV, respectively (p = 0.003). The plwHCOV walked 545 m (±93) at the 6MWT, which was comparable to the mmCOV group (555 m ± 63) but significantly higher than the seCOV group (435 m ± 84) (p < 0.0001). The plwHCOV group had worse forced expiratory volume in 1st second (FEV1%, 80 ± 12) (p < 0.0001), forced vital capacity (FVC%, 83 ± 11) (p = 0.002) and FEV1/FVC (0.80 ± 0.1, p = 0.004) when compared to the seCOV group. Interestingly, PLWH had comparable 6MWT, FEV1, FVC, and FEV1/FVC results as mmCOV.

Conclusion

Our results indicate that even 2 years post-COVID-19 infection, PLWH exhibits significantly decreased spirometry compared to the seCOV group. Despite this lung function impairment, their functional capacity was similar to individuals with PACS following mild/moderate COVID-19.

COVID-19 and the impact of physical activity on persistent symptoms

Introduction

Physical activity is protective against chronic disease but whether activity is associated with persistent symptoms in non-hospitalized coronavirus disease 2019 (COVID-19) survivors is unknown. The purpose of the study was to determine the impact of the COVID-19 pandemic on physical activity levels and the influence of physical activity on acute COVID-19 and long COVID symptoms in non-hospitalized COVID-19 survivors.

Methods

In total, 64 non-hospitalized COVID-19 survivors (45 female participants, 40 ± 18 years) were assessed for activity levels, body composition, and symptoms of COVID-19 8.5 ± 4.7 months post-infection and categorized into two groups: (1) persistent symptoms and (2) no symptoms at the time of testing. Furthermore, 43 of the 64 participants (28 female participants, 46 ± 18 years) completed a follow-up questionnaire online 51.0 ± 39.7 months (4.25 years) post-infection. A subset of 22 COVID-19 survivors (16 female participants, 35 ± 16 years) were matched for age, sex, and body mass index with healthy controls. Physical activity was quantified using (1) self-reported questionnaire (International Physical Activity Questionnaire; IPAQ-SF) at three time periods; prior to COVID-19 infection, at the time of laboratory testing (8.5 ± 4.7 months after infection), and during an online follow-up (51.0 ± 39.7 months, i.e., 4.25 years after infection); and (2) 7 days of wearing an ActiGraph accelerometer following laboratory testing.

Results

Physical activity (IPAQ-SF) declined in COVID-19 survivors from pre-COVID-19 infection to 8.5 ± 4.7 months after infection [3,656 vs. 2,656 metabolic equivalent of task (MET) min/week, 27% decrease, p < 0.001, n = 64] and rebounded to levels similar to pre-COVID-19 infection at 4.25 years after infection (p = 0.068, n = 43). Activity levels quantified with accelerometry did not differ between COVID-19 survivors and controls. However, COVID-19 survivors who reported persistent symptoms 8.5 months after infection (n = 29) engaged in less moderate-vigorous physical activity and steps/day than those without persistent symptoms (n = 27) (37 vs. 49 MET min/day, p = 0.014 and 7,915 vs. 9,540 steps/day, p = 0.014).

Discussion

Both COVID-19 survivors and matched controls reported reductions in physical activity indicating that lower levels of activity were likely due to the pandemic rather than COVID-19 infection alone. However, those who were most affected by COVID-19 infection with persistent symptoms had the greatest reductions in physical activity, even at ∼8 months and ∼4 years post-infection.

Correlation Between COVID-19 Recovery, Executive Function Decline, and Emotional State

Objective

The aim of this study was to determine whether there is a relationship between the time since recovery from coronavirus disease 2019 (COVID-19) and alterations in executive functions. We also evaluate the emotional state of post-COVID-19 patients.

Patients and Methods

We assessed patients between 18 and 50 years old, who had a history of COVID-19 with mild, moderate, or severe illness. We used the Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales-3 (BANFE-3), Mini-Mental State Examination (MMSE), and Mini-International Neuropsychiatric Interview (MINI), in addition to a semi-structured interview. Spearman's correlation coefficient was used, with a p value <0.05 indicating significance.

Results

We evaluated 67 patients with a mean age of 34.6±9.6 years, most of whom had ≥13 years of schooling (n=55, 82.1%). Among them, 52 (77.6%) reported persistent symptoms after resolution of the condition, with fatigue being the most frequent (n=20, 29.9%). Most participants had an adequate score on the MMSE (n=60, 89.6%). However, 19 (28.4%) showed alterations in the BANFE-3 total score, with mental flexibility as the most affected function (n=25, 37.3%). In participants from the first COVID-19 wave, a negative correlation was observed between the standardized orbitofrontal area scores and the time since recovery from the infection (r=-0.841, p=0.016), suggesting a pattern of deterioration over time, mainly in stimulus inhibition (r=0.880, p=0.021). Regarding emotional state, 45 subjects (67.2%) exhibited emotional alterations, with anxiety symptoms being the most frequent (n=33, 49.3%). Furthermore, individuals with depressive symptoms (n=32, 47.8%) were more likely to experience executive function impairment after COVID-19 (ExpB 0.302, 95% CI 0.098-0.933, p=0.038).

Conclusion

COVID-19 could lead to alterations in executive functions, probably resulting from progressive damage to orbitofrontal area functions, mainly in stimulus inhibition. However, the generalizability of these findings is limited, highlighting the need for further research with robust methodology. Furthermore, depression appears to be an indicator of cognitive impairment in individuals recovering from COVID-19. Therefore, cognitive rehabilitation and psychological support are essential for patients affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.

Factors associated with the presence and intensity of ongoing symptoms in Long COVID

OBJECTIVE

Identification of modifiable factors associated with symptom intensity among people seeking care for Post-Acute Sequelae of SARS-CoV-2 infection (PASC) could help guide the development of comprehensive, whole-person care pathways to alleviate symptoms irrespective of potential underlying pathophysiologies. We aimed to better define the key contributors to PASC, and sought the factors associated with PASC symptom presence and intensity.

METHODS

In this cross-sectional study, 249 patients presenting for PASC care at a dedicated Post-COVID-19 clinic completed a standardized screening assessment prior to initial visit and evaluation by a general internist or nurse practitioner. We measured 46 symptoms based on the WHO's Global COVID-19 Clinical Platform Case Report Form for Post COVID Condition and performed a factor analysis and item response theory based 2-parameter logistic model to develop a population-based t-score to measure PASC symptom presence and intensity (PASC-SPI). A multivariable linear regression analysis was used to assess factors associated with PASC-SPI, accounting for demographics, comorbidities, COVID-19 infection duration and severity, and mental health.

RESULTS

Greater PASC-SPI was associated with greater symptoms of anxiety, a longer duration of COVID-19 infection, and hypercholesterolemia. Lower PASC-SPI was associated with older age, self-reported 1-3 units of alcohol per week, and self-reported clinician confirmation of COVID-19 diagnosis. Symptoms of anxiety accounted for a considerably higher proportion of variation in PASC-SPI than other variables.

CONCLUSION

Symptoms of anxiety were the strongest correlate of PASC-SPI, highlighting it as both a potential neuroinflammatory marker of PASC and a modifiable component of the illness. This emphasizes the need for comprehensive, whole person treatment strategies that integrate evidence-based interventions to address the multifaceted nature of PASC.

Can Personality Traits Affect Sleep Quality in Post-COVID-19 Patients?

Objectives: In the present study, we aimed (i) to describe the personality traits of a cohort of post-COVID-19 condition (PCC) patients compared with a healthy control (HC) group, (ii) to evaluate the relationship between sleep quality and personality traits, and (iii) to investigate whether this relationship differs according to disease severity. Methods: We included 599 participants from the Nautilus Project (ClincalTrials.gov IDs: NCT05307549 and NCT05307575) with an age range from 20 to 65 years old. Of 599 participants, 280 were nonhospitalized (mild PCC), 87 were hospitalized (hospitalized PCC), 98 were in the PCC-ICU, and 134 were in the HC group. We assessed sleep quality with the Pittsburgh Sleep Quality Index (PSQI) and personality traits with the NEO Five-Factor Inventory (NEO FFI). Results: We found that mild-PCC patients had higher scores of neuroticism than HCs (p < 0.001) and ICU-PCC patients did (p = 0.020). The higher the neuroticism score was, the higher the total PSQI score (B 0.162; p < 0.001), the worse the sleep latency (B 0.049; p < 0.001), the greater the degree of sleep disturbance (B 0.060; p < 0.001), the greater the use of sleeping medication (B 0.035; p = 0.033), and the greater the incidence of daytime disturbances (B 0.065; p < 0.001) among the PCC patients. High neuroticism is also an indicator of worse sleep quality in mild-PCC (t = 3.269; p 0.001) and hospitalized-PCC (t = 6.401; p < 0.001) patients and HCs (t = 4.876; p < 0.001) but not in ICU-PCC patients. Conclusions: Although neuroticism affected sleep quality in both the PCC patients and HCs, the clinical implications and magnitude of the relationship were more significant in the PCC group. Specific and multidimensional interventions are needed to treat sleep problems in this population, and the influence of their personality traits should be considered.

Anxiety and depression in healthcare workers 2 years after COVID-19 infection and scale validation

This study aims to assess the levels of anxiety and depression among healthcare workers two years post COVID-19 infection and to validate the reliability and validity of the PHQ-9 and GAD-7 scales in this population. This cross-sectional study was conducted in June 2024 using a simple random sampling approach to survey healthcare institution workers. A total of 1038 valid samples were collected, and anxiety and depression levels were assessed using the PHQ-9 and GAD-7 scales. Participants included healthcare workers such as doctors, nurses, administrative staff, and students. Data analysis included descriptive statistics, correlation analysis, univariate, and multivariate analyses to explore the effects of variables such as occupation and gender on anxiety and depression. Long COVID was reported in 50.8% of participants. Occupational categories significantly influenced anxiety and depression levels: compared to students (reference group), doctors, nurses, and administrative staff exhibited significantly lower scores. Non-long COVID participants showed significantly lower anxiety and depression scores than those with long COVID. Additionally, the PHQ-9 and GAD-7 scales demonstrated high reliability and validity among COVID-19 population. Two years after COVID-19 infection, anxiety and depression levels among healthcare institution workers remain significantly influenced by occupational category and long COVID status. For healthcare workers, particularly those with long COVID and student groups, policymakers and healthcare administrators should consider optimizing mental health support systems. This includes implementing regular mental health screenings, providing personalized psychological interventions, offering counseling services, reducing work-related stress, and promoting the use of mental health assessment tools to improve the psychological well-being of this population.

Vaccination rate and symptoms of long COVID among dental teams in Germany

Although COVID-19 is no longer a global public health threat, its consequences persist, with long COVID affecting at least 10% of patients and manifesting in various organ systems. National and international health agencies promoted vaccination to enhance population immunity, prioritizing healthcare personnel due to their high occupational risk. In a previous study, we found that the risk of SARS-CoV-2 transmission among dental teams in Germany was not higher than in the general population. This follow-up investigation aims to assess the vaccination status and the prevalence and severity of long COVID symptoms among dental teams in Germany. As part of a follow-up investigation involving the original cohort, 267 team members from 186 German dental practices previously included in the initial study completed an online questionnaire. The questionnaire covered three topics: (1) vaccination status, (2) confirmed COVID-19 diagnosis, and (3) self-reported long COVID symptoms. One hundred and seventy-two dentists (64.4%), 74 dental assistants (27.7%) and 21 dental hygienists (7.9%) completed the questionnaire. In total, 245 participants (91.8%) were at least once vaccinated. A COVID-19 infection after January 1st 2021 was reported by 146 (54.7%) participants, of which 33 participants (22.6%) suffered from long COVID symptoms. Our results showed lower vaccination rates among dental auxiliary personnel compared to dentists (95.9% vs. 84.2%). Individuals with long COVID symptoms were more often dental assistants (48.5% vs. 29.2%) or dental hygienists (15.2% vs. 8.0%) than dentists (36.4% vs. 62.8%) compared to the group not reporting long COVID symptoms (p = 0.025). In addition, it is unlikely that dental healthcare personnel are more prone to experiencing more severe symptoms compared to the general population. Vaccination against SARS-CoV-2 is likely to help against symptoms of long COVID.

Sickness absence among blue-collar workers in the retail and wholesale industry during the COVID-19 pandemic; a longitudinal cohort study

Sickness absence (SA) changed in various occupations during the COVID-19 pandemic. The aim was to investigate the prevalence of all-cause sickness absence (SA) during the COVID-19 pandemic in relation to in the preceding years, as well as factors associated with all-cause SA and SA due to COVID-19 and COVID-like diagnoses during the COVID-19 pandemic among blue-collar workers in the retail and wholesale industry. A population-based longitudinal cohort study using microdata linked from nationwide registers in Sweden. All 297 378 blue-collar employees aged 18-67 years in wholesale and retail in 2019 were followed during 2016-2021 regarding SA in spells > 14 days. Yearly prevalence rates were calculated for all-cause SA in sociodemographic and occupational groups. Logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for all-cause SA and SA due to COVID-19 or COVID-like diagnoses in 2020 and 2021. The annual prevalences of SA were 7.5-8% in 2016-2018, 10% in 2020, and 9% in 2021. The prevalence of SA due to COVID-19 or COVID-like diagnoses was 2.1% in 2020 and 1.6% in 2021. The OR was higher in the older age groups (OR age 55-64 = 2.38, 95% CI 2.20-2.57 compared to age 25-34). There were few significant occupational differences, however, warehouse and terminal staff had a higher OR (1.37, 1.27-1.48) than sales assistants, daily goods. While SA rates increased during the COVID-19 pandemic, the distribution of SA between sociodemographic or occupational groups did not change markedly. The distribution of SA due to COVID-19 and COVID-like diagnoses was similar to all-cause SA.

Factors Influencing Physical Performance and Quality of Life in Post-COVID-19 Patients

Background: This study aims to identify the factors related to demographic variables and physical performance associated with quality of life (QoL) in post-COVID-19 pa-tients who have recovered from mild infection and were not hospitalized. Methods: Seventy-four post-COVID-19 individuals who recovered from mild COVID-19 infec-tion were assessed for the baseline demographic variables (age, sex, height, weight, body mass index; BMI) and clinical information (comorbidities, duration of COVID-19 infection, and exercise habits). Vital signs (heart rate, blood pressure, and oxygen sat-uration; SpO2) were measured. Physical performance was evaluated for upper- and lower-limb muscle strength, ability of balance, and cardiorespiratory performance. All participants were assessed for QoL. Results: Hand grip strength was negatively asso-ciated with gender and age while positively associated with the duration of COVID-19. Quadricep strength also showed a negative association with gender and duration of COVID-19. Age was positively associated with multiple quality of life dimensions, while emotional role limitations were negatively associated with the duration of COVID-19 and waist circumference. Mental health was negatively linked to BMI. Conclusions: This study highlights the complex impact of COVID-19 on physical per-formance and QoL, revealing that older adults often report better QoL despite reduced muscle strength, particularly in women. The findings emphasize the need for targeted rehabilitation programs addressing both physical and emotional health for vulnerable groups.

Identifying commonalities and differences between EHR representations of PASC and ME/CFS in the RECOVER EHR cohort

BACKGROUND

Shared symptoms and biological abnormalities between post-acute sequelae of SARS-CoV-2 infection (PASC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) could suggest common pathophysiological bases and would support coordinated treatment efforts. Empirical studies comparing these syndromes are needed to better understand their commonalities and differences.

METHODS

We analyzed electronic health record data from 6.5 million adult patients from the National COVID Cohort Collaborative. PASC and ME/CFS diagnostic groups were defined based on recorded diagnoses, and other recorded conditions within the two groups were used to train separate machine learning-driven computable phenotypes (CPs). The most predictive conditions for each CP were examined and compared, and the overlap of patients labeled by each CP was examined. Condition records from the diagnostic groups were also used to statistically derive condition clusters. Rates of subphenotypes based on these clusters were compared between PASC and ME/CFS groups.

RESULTS

Approximately half of patients labeled by one CP are also labeled by the other. Dyspnea, fatigue, and cognitive impairment are the most-predictive conditions shared by both CPs, whereas other most-predictive conditions are specific to one CP. Recorded conditions separate into cardiopulmonary, neurological, and comorbidity clusters, with the cardiopulmonary cluster showing partial specificity for the PASC groups.

CONCLUSIONS

Data-driven approaches indicate substantial overlap in the condition records associated with PASC and ME/CFS diagnoses. Nevertheless, cardiopulmonary conditions are somewhat more commonly associated with PASC diagnosis, whereas other conditions, such as pain and sleep disturbances, are more associated with ME/CFS diagnosis. These findings suggest that symptom management approaches to these illnesses could overlap.

The impact of long COVID on UK healthcare workers and their workplace: a qualitative study of healthcare workers with long COVID, their families, colleagues and managers

BACKGROUND

Healthcare workers (HCWs) have been particularly impacted by long COVID, with negative effects on their work patterns and wellbeing. The aim of this study was to explore the intersection between work and long COVID for HCWs, to understand the impact of long COVID on their professional identify, their orientation to work, their wellbeing as professionals, and support needs and strategies for them as well as their managers to continue to work.

METHODS

This qualitative study was conducted through semi-structured online interviews with three groups: HCWs with long COVID, their support network members, and healthcare managers between March 2023 and May 2024. To maintain confidentiality and address concerns about workplace stigma, healthcare managers were not matched with specific HCWs. Participants were recruited through purposive and snowball sampling, until data saturation was reached, defined as the point at which no new insights or themes were identified. Data were analysed using reflexive thematic analysis.

RESULTS

A total of 42 participants were interviewed from three groups, comprising 24 HCWs, five support network members, and 13 healthcare managers. Four key themes were identified describing experiences of long COVID for HCWs: (1) Living and coping with long COVID as a HCW, (2) Workplace impact and adjustments, (3) The uncertain nature of long COVID and challenges of the definition, and (4) Feelings of guilt, stigma and blame.

CONCLUSION

In conclusion, long COVID has created significant challenges not only for HCWs but also for their managers, who struggled with staffing shortages and lack of clear guidance, and support network members who experienced emotional strain while providing care. The combination of these challenges threatens NHS workforce stability and service delivery. Developing and embedding flexible, standardised workplace interventions-such as phased return-to-work policies and tailored occupational health support-could mitigate these impacts and inform scalable solutions across diverse healthcare systems. Enhanced training for healthcare managers and further research into culturally diverse coping mechanisms could improve support for affected HCWs, reduce stigma, and contribute to a more stable and resilient healthcare workforce. While based in the UK, these findings offer important insights for health systems globally that are grappling with the long-term workforce implications of long COVID.

Associations between different measures of SARS-CoV-2 infection status and subsequent economic inactivity: A pooled analysis of five longitudinal surveys linked to healthcare records

INTRODUCTION

Following the acute phase of the COVID-19 pandemic, a record number of people became economically inactive in the UK. We investigated the association between coronavirus infection and subsequent economic inactivity among people employed pre-pandemic, and whether this association varied between self-report versus healthcare recorded infection status.

METHODS

We pooled data from five longitudinal studies (1970 British Cohort Study, English Longitudinal Study of Ageing, 1958 National Child Development Study, Next Steps, and Understanding Society), in two databases: the UK Longitudinal Linkage Collaboration (UKLLC), which links study data to NHS England records, and the UK Data Service (UKDS), which does not. The study population were aged 25-65 years between April 2020 to March 2021. The outcome was economic inactivity measured at the time of the last survey (November 2020 to March 2021). The exposures were COVID-19 status, indicated by a positive SARS-CoV-2 test in NHS records (UKLLC sample only), or by self-reported measures of coronavirus infection (both samples). Logistic regression models estimated odds ratios (ORs) adjusting for potential confounders including sociodemographic variables and pre-pandemic health.

RESULTS

Within the UKLLC sample (N = 8,174), both a positive SARS-CoV-2 test in NHS records (5.9% of the sample; OR 1.08, 95%CI 0.68-1.73) and self-reported positive tests (6.5% of the sample; OR 1.07, 95%CI 0.68-1.69), were marginally and non-significantly associated with economic inactivity (5.3% of the sample) in adjusted analyses. Within the larger UKDS sample (n = 13,881) reliant on self-reported ascertainment of infection (6.4% of the sample), the coefficient indicated a null relationship (OR 0.98, 95%CI 0.68-1.40) with economic inactivity (5.0% of sample).

CONCLUSIONS

Among people employed pre-pandemic, testing positive for SARS-CoV-2 was not associated with increased economic inactivity, although we could not exclude small effects. Ascertaining infection through healthcare records or self-report made little difference to results. However, processes related to record linkage may introduce small biases.

Adult Outpatients with Long COVID Infected with SARS-CoV-2 Omicron Variant. Part 1: Oral Microbiota Alterations

BACKGROUND

Many individuals experience long COVID after SARS-CoV-2 infection. As microbiota can influence health, it may change with COVID-19. This study investigated differences in oral microbiota between COVID-19 patients with and without long COVID.

METHODS

Based on a prospective follow-up investigation, this nested case-control study evaluated the differences in oral microbiota in individuals with and without long COVID (Symptomatic and Asymptomatic groups), which were assessed by 16S rRNA sequencing on tongue coating samples. A predictive model was established using machine learning based on specific differential microbial communities.

RESULTS

One-hundred-and-eight patients were included (n=54 Symptomatic group). The Symptomatic group had higher Alpha diversity indices (observed_otus, Chao1, Shannon, and Simpson indices), differences in microbial composition (Beta diversity), and microbial dysbiosis with increased diversity and relative abundance of pathogenic bacteria. Marker bacteria (c__Campylobacterota, o__Coriobacteriales, o__Pseudomonadales, and o__Campylobacterales) were associated with long COVID by linear discriminant analysis effect size and receiver operating characteristic curves (AUC 0.821).

CONCLUSION

There were distinct variations in oral microbiota between COVID-19 patients with and without long COVID. Changes in oral microbiota may indicate long COVID.

Patient-provider relationships and long COVID: A cross-sectional survey about impact on quality of life

BACKGROUND

In the United States (U.S.), it is estimated that 17.6 % of adults have experienced Long COVID, a condition where symptoms newly develop and linger after initial COVID-19 infection. Long COVID is associated with significantly reduced quality of life (QoL), and patient-provider relationships have been shown to influence QoL for patients in general.

OBJECTIVE

The objective for this study was to better understand the role of patient-provider relationships in shaping QoL among U.S. adults with Long COVID.

METHODS

This study carried out an online survey among U.S. adult with Long COVID (N = 792).

RESULTS

Respondents with at least a bachelor's degree reported higher QoL, and older respondents were more likely to report lower QoL; trust in providers was a significant predictor of higher QoL, while dismissal of Long COVID symptoms was associated with lower QoL (all p < .05).

CONCLUSIONS

Healthcare providers should be aware of the importance of trust in the relationship with their Long COVID patients and the impact this may have on patients' QoL. Researchers and policy makers should include an increasing focus on training for providers who treat patients with Long COVID in order to strengthen patient-provider relationships.

Long-COVID and postural orthostatic tachycardia syndrome: a preliminary comparison of neuropsychological performance

PURPOSE

The aim of the study is to analyze and compare the cognitive profile between 59 patients with long-COVID [LC; 30 of them with and 29 without a positive coronavirus disease 2019 (COVID-19) confirmatory test] and 31 patients with postural orthostatic tachycardia syndrome (POTS) and a matched group of 39 healthy control participants.

METHODS

Participants were examined on a battery of neuropsychological tests, including verbal memory, visuospatial abilities, attention, processing speed, verbal fluency, working memory, and visual memory. Anxious-depressive symptomatology was also analyzed and then controlled for possible influence on cognitive performance.

RESULTS

Patients with LC and POTS showed significantly lower performance compared with healthy peers. Differences on anxious and depressive symptoms were also found between the clinical and control groups, resulting in LC without a positive confirmatory test group exhibiting the highest rates of anxious symptoms. After controlling the effects of anxious-depressive symptomatology, the differences were eliminated for some of the cognitive variables, but additional differences were found between patients with LC and POTS after post hoc analysis.

CONCLUSIONS

Findings from the present study contribute toward the reinforcement of the evidence on cognitive alterations associated with LC and POTS. Anxious-depressive symptomatology has to be considered in both clinical groups since it could be affecting cognitive performance.