Post-acute COVID-19 Syndrome Negatively Impacts Physical Function, Cognitive Function, Health-Related Quality of Life, and Participation

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.

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.

[How do people with long COVID cope with their symptoms and everyday limitations? A qualitative study with four focus groups]

BACKGROUND

The heterogenous and fluctuating intensity of long COVID symptoms poses a challenge to both patients and healthcare providers due to a lack of causal treatment options. The aim of supportive therapies is to help individuals cope with symptoms in daily life and maintain functionality. This study aims to identify coping strategies employed by those affected by long COVID and their perceived benefits.

METHODS

A qualitative study was conducted with four focus groups comprising 23 adult patients suffering from long COVID. The recorded and transcribed group discussions were analyzed using content-structuring content analysis according to Kuckartz. The results were then systematically analyzed, interpreted, and put in a theoretical context.

RESULTS

Participants utilized healthcare resources but developed their own strategies for dealing with long COVID because of their dissatisfaction with medical care. These strategies included energy and resource management, physical activity, enhancing health literacy, changing mindset and lifestyle, infection prevention, using medical aids, and dietary changes.

CONCLUSIONS

This study demonstrates that people with long COVID employ a variety of strategies to cope with impairments in everyday life. According to the interviewees, integrating these approaches into the treatment of long COVID can help to reduce the burden of symptoms on those affected, restore their everyday functionality, and improve their self-efficacy and quality of life. Established concepts like "pacing" or "shared-decision making" can serve as a starting point for developing individualized coping strategies and treatment concepts together with patients.

Post-acute sequelae of COVID-19 in people of Black ethnicities living with HIV in the United Kingdom

BackgroundThe COVID-19 pandemic disproportionately affected people of Black ethnicities, however, there are limited data on the post-acute sequelae of COVID-19 infection in these populations, and none in those with HIV.MethodsWe conducted a cross-sectional study in people of Black ethnicities with HIV in the UK. Participants were assessed for functional impairment, frailty, respiratory symptoms, anxiety and depression; they were also asked to rate aspects of their physical and mental health on a scale from 1 (poor) to 10 (excellent), both at enrolment and prior to the pandemic. We report associations with COVID-19 history and recovery status.ResultsWe enrolled 183 participants between June 2021 and October 2022, 131 (72%) of whom reported COVID-19. A history of COVID-19 was associated with a reduced ability to carry out usual activities (OR 2.54 [1.03-6.21], p = 0.04), an increase in pain, tiredness and breathlessness, and overall decline in physical health. Of those with a history of COVID-19, 111 (85%) reported to have fully recovered. Those who had not fully recovered reported poorer functional status (p < 0.001) and had higher generalised anxiety scores (p = 0.02). Objective measures of physical function were similar in those who reported no COVID-19, COVID-19 with full recovery, and COVID-19 with incomplete recovery.ConclusionsIn this cohort of Black people with HIV, participants with a history of COVID-19 reported a reduced ability to carry out activities of daily living and various other health issues. Although most people reported full recovery from COVID-19, self-reported limitations in functional status and anxiety were common sequelae.

Impact of Long COVID on Health-Related Quality of Life Among COVID-19 Survivors in Saudi Arabia

Background: Long COVID (LC) has emerged as a significant epidemiological and public health issue, affecting patients' health-related quality of life (HRQoL). This study explored the impact of LC on HRQoL in COVID-19 survivors in the Eastern Province of Saudi Arabia and examined the sociodemographic and clinical factors that influence HRQoL. Methods: This cross-sectional study included 1024 participants, and data were collected through face-to-face interviews using a structured questionnaire that incorporated the EQ-5D-5L tool to assess HRQoL. Sociodemographic information, acute COVID-19 symptoms, and LC symptoms were recorded. Statistical analyses included bivariate analyses and multivariable generalized linear modelling. Results: Of all participants, 63.8% reported experiencing LC symptoms, with fatigue, cough, and anosmia being the most common. Participants with LC had significantly lower HRQoL scores (mean EQ-5D-5L index score, 0.93) than those without LC (mean score, 0.98; p < 0.001). The key factors influencing lower HRQoL included a higher number of LC symptoms, older age, the presence of pneumonia during acute COVID-19, and pre-existing conditions such as anxiety and hypertension. Conclusions: LC negatively impacts HRQoL, with older age, chronic diseases, and the number of LC symptoms being strong predictors of poor outcomes. Interventions targeting rehabilitation and psychosocial support are critical for improving the long-term health outcomes of patients with LC.

Post COVID-19 infection and quality of life of healthcare workers at Sahloul University Hospital of Sousse in Tunisia

BACKGROUND

Since the COVID-19 pandemic, health care workers (HCWs) faced an enormous physical and mental burden, sometimes altering their quality of life due mainly to persistent challenges stemming from their frontline position.

AIMS

Todetermine the prevalence of post-COVID-19 syndrome, and its impact on the Health-Related Quality of Life (HRQoL) among HCWs.

METHODS

This is an exhaustive cross-sectional study with analytical scope, conducted among all HCWs of the University Hospital Sahloul of Sousse, Tunisia, who have contracted COVID-19 between September 2020 and 30 March 2021 (N=529 cases).The post-covid medical check-up was carried out three months after the acute phase of the COVID-19 infection (December 2020 to June 2021). HRQoL was assessed using the SF-12 (12-item Short Form Health Survey) questionnaire. Bivariate study and multiple linear regressions were performed to identify the different factors influencing the quality of life of HCWs.

RESULTS

During the study period, 529 HCWs were diagnosed with SARS CoV-2 infection, out of them 249 participants were included (47% participation rate). Post covid-19 syndrome was reported in 65% of cases. A low overall quality of life (QoL) score was reported in 28.6% of cases. Low physical and mental composite scores were reported in 34.3% and 29.4% of cases respectively. In the multiple linear regression analysis, gender, post COVID-19 syndrome and time off work were significantly associated with SF12 scores.

CONCLUSION

In our study, HCWs experienced a significant deterioration in HRQoL after COVID-19 with a high incidence of post-COVID-19 syndrome. The need of long-term follow-up after SARS-CoV-2 infection remains essential to support HCWs and mitigate long-term impacts.

Nasal cytological evidence of chronic inflammation in the olfactory cleft in post-viral olfactory dysfunction

PURPOSE

This study investigated nasal cytological alterations in patients with persistent post-viral olfactory dysfunction. The primary objective was to evaluate the role of immune dysregulation and chronic local inflammation within the nasal mucosa in sustaining long-term olfactory impairment.

METHODS

An observational case-control study was conducted at the Otorhinolaryngology Department of the University of Rome Tor Vergata. Thirty-six patients with persistent olfactory dysfunction were compared to two control groups: one comprised subjects recovered from SARS-CoV-2 infection without olfactory impairment, and the other included individuals without a history of COVID-19 or olfactory dysfunction. Psychophysical olfactory function was assessed using the TDI (Threshold, Discrimination, and Identification) test. Nasal cytology samples were obtained via nasal brushing at the level of the olfactory cleft and stained using the May-Grunwald-Giemsa technique. Cellular alterations were evaluated using a semiquantitative grading system.

RESULTS

Patients with persistent olfactory dysfunction exhibited increased lymphocytes and neutrophils compared to both control groups, indicating ongoing local inflammation. Ciliocytophthoria was notably present in a significant portion of the olfactory dysfunction group, while absent or minimally present in controls. Eosinophils and mast cells were rare across all groups.

CONCLUSION

Persistent post-viral olfactory dysfunction is associated with sustained immune activation and epithelial damage localized to the olfactory cleft. Elevated lymphocytes, neutrophils, and ciliocytophthoria emphasize the role of chronic inflammation in the pathogenesis of prolonged olfactory deficits. These findings highlight the potential utility of targeted therapies to modulate immune responses and promote olfactory recovery in affected patients.

PTSS, perceived stress, and social media use affecting somatic symptoms in healthcare workers recovering from COVID after ending China's dynamic zero-COVID policy: A moderated mediation model

BACKGROUND

Persistent somatic symptoms brought by COVID are a matter of concern. Post-traumatic stress symptoms (PTSS) and perceived stress have been recognized as risk factors for somatic symptoms. Recently, the associations between social media use and COVID-related PTSS have also been noticed. However, the pathways these factors contribute to persistent somatic symptoms after COVID remain unclear. This study aims to investigate the role of perceived stress as a mediator in COVID-related PTSS and somatic symptoms, and whether social media use moderated the mediation in a sample of healthcare workers (HCWs) during the subacute phase of COVID in the context of the end of China's dynamic zero-COVID policy.

METHODS

Questionnaire data from 2281 Chinese HCWs were included in the study. COVID-related PTSS, perceived stress, and somatic symptoms were measured, and a moderated mediator model was developed.

RESULTS

The effect of COVID-related PTSS on somatic symptoms was partially mediated by perceived stress. Moreover, social media use positively moderated the relationship between COVID-related PTSS and perceived stress. That is, at higher frequencies of social media use, COVID-related PTSS played a stronger role in perceived stress.

CONCLUSION

Our findings suggest that perceived stress and frequency of social media use play a facilitating role in the impact of COVID-related PTSS on somatic symptoms. From a psychosocial perspective, this study identifies psychological interventions targeting stress and benign media communication as potential interventions for persistent somatic symptoms after COVID infection and prevention of long-term COVID.

Pre-pandemic leukocyte count is associated with severity of post-acute sequelae of SARS-CoV-2 infection among older women in the Women's Health Initiative

OBJECTIVE

Although dysregulated inflammation has been postulated as a biological mechanism associated with post-acute sequelae of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection (PASC) and shown to be a correlate and an outcome of PASC, it is unclear whether inflammatory markers can prospectively predict PASC risk. We examined the association of leukocyte count and high-sensitivity C-reactive protein (hsCRP) concentrations, measured ~25 years prior to the coronavirus disease 2019 (COVID-19) pandemic, with PASC, PASC severity, and PASC-associated cognitive outcomes at follow-up among postmenopausal women.

METHODS

Using biomarker data from blood specimens collected during pre-pandemic enrollment (1993-1998) and data on 1,237 Women's Health Initiative participants who completed a COVID-19 survey between June 2021 and February 2022, we constructed multivariable regression models that controlled for pertinent characteristics. PASC status was defined according to established World Health Organization criteria.

RESULTS

Controlling for baseline characteristics, log e -transformed leukocyte count (β = 0.27; 95% confidence interval, 0.07-0.47, P = 0.009) and leukocyte count ≥5.5 × 1,000 cells/µL (β = 0.13; 95% confidence interval, 0.02-0.23; P = 0.02) were positively associated with PASC severity, defined as the sum of PASC symptoms, but not associated with overall PASC occurrence or PASC-related cognitive outcomes. Concentration of hsCRP, available on only ~27% of participants, was not associated with any of the PASC outcomes, controlling for the same covariates.

CONCLUSIONS

Leukocyte count, a widely available clinical marker of systemic inflammation, is an independent predictor of PASC severity in postmenopausal women. Heightened inflammation preceding SARS-CoV-2 infection may contribute to PASC development. Limited statistical power to assess hsCRP role warrants further study.

Coronavirus anxiety and its relationship to mood and cognition in post-acute sequelae of COVID-19

Background: Subjective and objective cognitive dysfunction may be observed in patients with post-acute sequelae of COVID-19 (PASC), and are associated with depression and general anxiety. Coronavirus anxiety (CA) is associated with subjective cognition, depression, and general anxiety in community samples. We determined the base rate of CA in patients with PASC and its relation to mood, subjective and objective cognition. Design and Methods: Participants were 79 patients with PASC referred for clinical neuropsychological evaluation, who completed the Coronavirus Anxiety Scale (CAS), BDI-II, BAI, BRIEF-A, and cognitive tests. Results: Base rate of clinically elevated CAS was low (5.1%), whereas BDI-II (78.6%), BAI (80%), and BRIEF-A Global Executive Composite (GEC; 60.3%) were high. Objective dysfunction was most common for Color-Word Interference (20.8%) and Trail Making Test (TMT) Part-B (23.1%). Greater CA was associated with worse depression, general anxiety, BRIEF-A GEC, and TMT Part-A. Higher GAI accounted for the CAS and BRIEF-A GEC association. Longer time since pandemic onset was only associated with decreasing CA. Exploratory factor analysis supported a unidimensional structure for the CAS. Conclusions: Clinically elevated CA is rare in patients with PASC seen for neuropsychological evaluation. Higher CA is associated with worse mood and subjective executive dysfunction, though the latter was accounted for by general anxiety. Patients with PASC who endorse a high level of CA would likely benefit from interventions to reduce emotional distress.

Prevalence of depression, anxiety, stress, and suicide tendency among individual with long-COVID and determinants: A systematic review and meta-analysis

BACKGROUND

While mental health alterations during active COVID-19 infection have been documented, the prevalence of long-term mental health consequences remains unclear. This study aimed to determine the prevalence of mental health symptoms-depression, anxiety, stress, and suicidal tendencies-and to identify their trends and associated risk factors in individuals with long-COVID.

METHODS

We conducted a systematic literature search of databases including PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, Web of Science, and PsycINFO up to August 2024, targeting observational studies published in English. Study quality was assessed using structured standard tools. The primary outcome was the pooled prevalence of depression, anxiety, stress, and suicidal tendencies in individuals with long-COVID. Secondary outcomes included trends in these mental health problems over time and identification of associated determinants.

RESULTS

A total of 94 eligible studies were included in the analysis. The pooled prevalence estimates, regardless of follow up times duration, were as follows: depression, 25% (95%CI:22-28%; PI:1-59%); anxiety (adjusted via trim and fill method), 23%(95%CI:21-25%;PI:2-35%); composite outcomes of depression and/or anxiety, 25% (95%CI:23-27%;PI:2-51%); stress, 26%(95%CI:13-39%;PI:1-69%); and suicidality, 19%(95%CI:15-22%;PI:13-25%). The results of meta-regression analyses revealed a statistically significant trend showing a gradual decrease in the prevalence of the composite outcome of anxiety and/or depression over time (RD = -0.004,P = 0.022). Meta-regression results indicated that being female and younger age were significantly associated with a higher prevalence of mental health symptoms. Study design and study setting did not contribute to heterogeneity.

CONCLUSION

One-fourth of individual with long-COVID experience mental health symptoms, including depression, anxiety, and stress, which remain prevalent even two years post-infection despite a slight decreasing trend. Factors such as female gender and younger age were linked to higher rates of anxiety and depression. These findings indicate the need for ongoing mental health screening and early interventions to mitigate long-term psychological distress in long-COVID patients.

Predictors of Post-Acute Sequelae of COVID-19 in a Diverse Urban Population

BACKGROUND

Post-acute sequelae of SARS-CoV-2 infection (PASC) are ongoing, relapsing, or new symptoms present at least 3 months after infection. Predictors of PASC, particularly across diverse racial and ethnic groups, remain unclear.

OBJECTIVES

Assess the prevalence of PASC 1 year after infection, examining differences in PASC prevalence by the social construct of race.

DESIGN

Retrospective observational cohort study.

PARTICIPANTS

In total, 863 adults aged 18 years or older, who were assessed for COVID-19 at two hospitals in New York City during the first two waves of the pandemic (March to July 2020 and January to March 2021).

MAIN MEASURES

Prevalence of self-reported PASC, including its respiratory and neurological phenotypes. Data were gathered via telephone surveys conducted 11-15 months following diagnosis. Logistic regression models were used to identify predictors of PASC.

KEY RESULTS

In total, 54.1% of those diagnosed with COVID-19 reported PASC symptoms 1 year after infection. Racial and ethnic disparities in the prevalence of PASC varied by PASC phenotype and by the time of initial diagnosis (Wave 1 versus Wave 2). Asian adults had significantly lower odds of reporting any PASC compared to White adults (AOR = 0.55, p=0.02), particularly for neurological symptoms (AOR = 0.5, p=0.01). Black adults had significantly higher odds of reporting respiratory PASC (AOR = 2.67, p<0.001) and lower odds of neurological PASC (AOR = 0.54, p=0.02). Females had higher odds of respiratory (AOR = 1.45, p=0.04) and neurological PASC (AOR = 1.45, p=0.02). Loneliness was consistently associated with higher odds of all PASC categories.

CONCLUSIONS

This study reveals a high prevalence of PASC 1 year post-infection, with notable racial and ethnic disparities. The results underscore the need for long-term monitoring of those infected with COVID-19 during the initial waves, with a focus on identifying and addressing yet unmeasured social determinants of health that contribute to these disparities.

Feasibility of teleyoga for people with post COVID-19 condition- a mixed method design

BACKGROUND

Evidence about rehabilitation of post COVID-19 condition is scarce. Yoga has been found beneficial in other chronic conditions and can be delivered in a digital format at home. The aim of the study was to explore the feasibility of teleyoga in persons with post COVID-19 condition by assessing adherence, safety, limited efficacy and experiences.

METHODS

Pre-post mixed-method design. Participants were recruited from a post COVID-19 rehabilitation clinic. The intervention included standardised live-streamed teleyoga sessions twice/week for 7 weeks and individual yoga using a digital application during 12 weeks. Adherence to the teleyoga intervention was measured by registration of participation and by analysing the log in the application. Safety was measured by registration of serious adverse events. Limited efficacy examined trends in the predicted direction for better outcome in patients with a post-COVID condition in the 6-minute walk test, gait speed, cognition, health-related quality-of-life, mental distress, sleep and exercise motivation. We also assessed patients' experiences after the intervention.

RESULTS

Nine women and 2 men were enrolled, aged between 27 and 61 years, and duration of post COVID-19 3-12 months. Adherence: Half of the participants participated in more than 50% of the online yoga sessions. They enjoyed the digital format and the social aspect of the online yoga sessions. Some participants experienced that the yoga sessions of 60 min were too long. People with post COVID-19 felt motivated to participate, however they felt conflicted when other commitments took time away from yoga. Adherence to the yoga application varied, 6 patients used it less than 50% of the recommended time.

SAFETY

Persons with post COVID-19 experienced symptoms due to their disease, which could increase during the yoga sessions that made it harder to participate. There were no reported serious adverse events. Limited efficacy: Participants expressed that they breathed more consciously and experienced relaxation and reduction of stress and anxiety. After 7 weeks of teleyoga there was a significant improvement in cognitive function (p-value = 0.048). No differences were found in the physical tests, health-related quality-of-life, anxiety and depression, sleep or in exercise motivation.

CONCLUSION

Adherence to the online yoga sessions was quite low and might be improved with shorter yoga sessions. Online yoga was safe, but some participants experienced an increase in symptoms. Teleyoga was associated with improved cognition, breathing and relaxation. The results show that online yoga could be feasible for people post COVID-19, but adaptation of the yoga-program may be required, especially as many patients experience an increase of symptoms. Furthermore, the teleyoga should be more flexible with regards to the duration and the number of sessions. As few participants were adherent to the application, the relevance and usefulness of this needs to be further explored.

Self-reported health, persistent symptoms, and daily activities 2 years after hospitalization for COVID-19

Introduction

Since the onset of the COVID-19 pandemic, 775 million cases have been reported globally. While many individuals recover fully, a significant proportion develop persistent symptoms. Numerous studies have investigated the long-term symptoms of COVID-19; however, the full extent and impact of these symptoms remain inadequately understood. The aim of this study was to investigate the prevalence of self-reported persistent symptoms, focusing on respiratory symptoms and fatigue and the impact on functional status 2 years after hospitalization for COVID-19.

Methods

This study is prospective and includes participants from a longitudinal multi-center cohort that follows patients previously hospitalized due to COVID-19 (n = 211). The current study encompasses the 2-year follow-up, using post-hospitalization questionnaire surveys. Analyzed data were collected before discharge and at the 2-year follow-up. Participants were grouped by age, sex and COVID-19 severity and group comparisons where conducted. Logistic regression analysis was used to study functional impairment.

Results

Two years after hospital discharge due to COVID-19, 125 participants completed the 2-year follow-up. The mean age of participants was 66 years (SD 12.2), and 68% were male. The majority of participants reported present respiratory symptoms (n = 83, 69%) and fatigue (n = 98, 78%) at the 2-year follow-up. Persistent respiratory symptoms and fatigue impacted functional status substantially (p = <0.001, p = 0.028, respectively). No significant differences were observed among groups depending on age, sex, or severity of COVID-19.

Conclusion

For some individuals regardless of age, sex or COVID-19 severity, respiratory symptoms and fatigue may persist for up to 2 years following COVID-19. Hence, having available support from professionals knowledgeable about COVID-19 is imperative. Further research is important to unravel the mechanisms of long-term symptoms following COVID-19 and to develop effective therapeutic and rehabilitative interventions.

Tackling persistent neurological symptoms in patients following acute COVID-19 infection: an update of the literature

INTRODUCTION

The COVID-19 pandemic has taught myriad lessons and left several questions we are yet to comprehend. Initially, the scientific community was concerned with the management of acute disease and immunization. Once the peak of the pandemic receded, it became clear that a proportion of patients were far from fully recovered. Researchers started to recognize those persisting symptoms as a new entity termed 'Long COVID,' where neurological symptoms are evident and have a major impact on quality of life.

AREAS COVERED

The main purpose of this narrative review is to analyze and synthesize the current literature regarding Long COVID, its relation to the nervous system, and to explore the evidence on treatments for persistent neurological symptoms. The most common reported and observed neurologic manifestations include fatigue, cognitive impairment, pain, polyneuropathy, and neuropsychiatric disorders. A variety of pharmacologic and non-pharmacologic therapies have been evaluated and yielded mixed results. Many of them focused on immunomodulation and none currently have U.S. FDA approval.

EXPERT OPINION

Challenges remain in terms of clinical characterization and prognosis of Long COVID, besides understanding its pathophysiology. Standardization of biomarkers and diagnostic criteria will allow the use of common nomenclature and data elements in the design of future clinical studies.

Posthospitalization COVID-19 cognitive deficits at 1 year are global and associated with elevated brain injury markers and gray matter volume reduction

The spectrum, pathophysiology and recovery trajectory of persistent post-COVID-19 cognitive deficits are unknown, limiting our ability to develop prevention and treatment strategies. We report the 1-year cognitive, serum biomarker and neuroimaging findings from a prospective, national study of cognition in 351 COVID-19 patients who required hospitalization, compared with 2,927 normative matched controls. Cognitive deficits were global, associated with elevated brain injury markers and reduced anterior cingulate cortex volume 1 year after COVID-19. Severity of the initial infective insult, postacute psychiatric symptoms and a history of encephalopathy were associated with the greatest deficits. There was strong concordance between subjective and objective cognitive deficits. Longitudinal follow-up in 106 patients demonstrated a trend toward recovery. Together, these findings support the hypothesis that brain injury in moderate to severe COVID-19 may be immune-mediated, and should guide the development of therapeutic strategies.

Cognitive domains affected post-COVID-19; a systematic review and meta-analysis

BACKGROUND AND PURPOSE

This review aims to characterize the pattern of post-COVID-19 cognitive impairment, allowing better prediction of impact on daily function to inform clinical management and rehabilitation.

METHODS

A systematic review and meta-analysis of neurocognitive sequelae following COVID-19 was conducted, following PRISMA-S guidelines. Studies were included if they reported domain-specific cognitive assessment in patients with COVID-19 at >4 weeks post-infection. Studies were deemed high-quality if they had >40 participants, utilized healthy controls, had low attrition rates and mitigated for confounders.

RESULTS

Five of the seven primary Diagnostic and Statistical Manual of Mental Disorders (DSM-5) cognitive domains were assessed by enough high-quality studies to facilitate meta-analysis. Medium effect sizes indicating impairment in patients post-COVID-19 versus controls were seen across executive function (standardised mean difference (SMD) -0.45), learning and memory (SMD -0.55), complex attention (SMD -0.54) and language (SMD -0.54), with perceptual motor function appearing to be impacted to a greater degree (SMD -0.70). A narrative synthesis of the 56 low-quality studies also suggested no obvious pattern of impairment.

CONCLUSIONS

This review found moderate impairments across multiple domains of cognition in patients post-COVID-19, with no specific pattern. The reported literature was significantly heterogeneous, with a wide variety of cognitive tasks, small sample sizes and disparate initial disease severities limiting interpretability. The finding of consistent impairment across a range of cognitive tasks suggests broad, as opposed to domain-specific, brain dysfunction. Future studies should utilize a harmonized test battery to facilitate inter-study comparisons, whilst also accounting for the interactions between COVID-19, neurological sequelae and mental health, the interplay between which might explain cognitive impairment.

[Post-COVID-19 Functional status scale: Concordance between evaluator-administered versus self-assessed version in patients with post-COVID-19 syndrome]

INTRODUCTION

Patients diagnosed with COVID-19 may present sequelae which are called Post COVID-19 Syndrome or Long COVID in which physical, psychological and/or social complications are evident. The objective of this study was to evaluate the agreement of the Post-COVID-19 Functional Status Scale (PCFS) of the evaluator-administered version vs patient self-assessed in post-COVID-19 patients.

METHODS

Observational study in patients diagnosed with COVID-19 with subsequent recovery. Once the project was approved by the ethics committee and the patients signed the informed consent, a survey was carried out to collect sociodemographic and clinical data and the application of the PCFS scale, in its two forms, self-administered and by an evaluator.

RESULTS

97 patients entered the study, 57.7% being women. The agreement analysis determined a concordance index of 0.857 95% CI (0.7-0.934) (almost perfect agreement). The agreement for women was 0.817 95% CI 0.700-0.934 and for men 0.907 95% CI (0.806-1).

CONCLUSION

The use of the Spanish version of the PCFS scale carried out by the health professional compared to the version self-assessed by patients, demonstrates adequate agreement.

A digital intervention for cognitive deficits following COVID-19: a randomized clinical trial

Post-COVID-19 cognitive deficits are common, persistent, and disabling. Evidence on effective treatments is limited. The goal of this study was to investigate the efficacy of a digital intervention to reduce cognitive and functional deficits in adults with persistent post-COVID-19 cognitive dysfunction. We used the remotely-delivered intervention in a randomized clinical trial conducted from July 13, 2021 to April 26, 2023. We hypothesized that participants in the intervention group would improve in measures of cognition and daily functioning. Participants were adults with cognitive deficits persisting >4 weeks following acute COVID-19 illness. Of 183 participants screened, 110 were enrolled; 98 participants (78.6% female; mean age = 48.1) completed at least one study visit. Participants were randomized 1:1 to the intervention (AKL-T01) or waitlist control. AKL-T01 is a digital therapeutic using a videogame interface to target attention and executive control. The intervention was delivered remotely for 6 weeks. The primary outcome was change in performance on a sustained attention measure (Digit Symbol Matching Task). The difference in the primary outcome between the intervention (n = 49) and controls (n = 49) was not statistically significant (F [3,261] = 0.12, p = 0.95). Secondary cognitive outcomes of task-switching (F[3,262] = 2.78, p = 0.04) and processing speed (F[3,267] = 4.57, p = 0.004) improved in the intervention relative to control. Secondary measures of functioning also improved in the intervention relative to control, including disability (F[1,82] = 4.02, p = 0.05) and quality of life (F[3,271] = 2.66, p = 0.05). Exploratory analyses showed a greater reduction in total fatigue (F[1,85] = 4.51, p = 0.04), cognitive fatigue (F[1,85] = 7.20, p = 0.009), and anxiety (F[1,87] = 7.42, p = 0.008) in the intervention relative to control. Despite the lack of improvement in sustained attention, select post-COVID-19 cognitive deficits may be ameliorated by targeted cognitive training with AKL-T01, with associated improvements in quality of life and fatigue. If replicated, the scalable nature of this digital intervention may help address substantial need for accessible, effective treatments among individuals with long COVID.

Follow-Up of Cardiopulmonary Responses Using Submaximal Exercise Test in Older Adults with Post-COVID-19

BACKGROUND

Data on cardiopulmonary fitness in older adults in the longer term after coronavirus disease 2019 (COVID-19) are of interest as the time required for the full recovery of physical fitness after COVID-19 remains unclear. Some studies have reported that patients do not recover physical fitness for up to 6 or 12 months after COVID-19, whereas other studies have observed full recovery after 12-months. Therefore, this study evaluated and compared the cardiopulmonary responses induced by the 6-minute walk test (6MWT) and 1-minute sit-to-stand-test (1-min-STST) results at 3, 6, and 12 months in older adults with and without COVID-19.

METHODS

This study included 59 older adults aged ≥60 with and without a history of COVID-19. The cardiopulmonary response parameters including heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse oxygen saturation (O2 sat), rate of perceived exertion (RPE), and leg fatigue were evaluated in the participants after 6MWT and 1-min-STST assessments.

RESULTS

Post-COVID-19, older adults showed statistically significant differences in HR, SBP, DBP, O2 sat, RPE, leg fatigue, 6MWT time, and 1-min-STST step numbers at 3, 6, and 12 months (p<0.001). Moreover, older adults showed statistically significant differences in HR, SBP, DBP, RPE, leg fatigue, O2 sat, and 6MWT distance at 3 months post-COVID-19 compared with those in older adults without COVID-19 (p<0.001).

CONCLUSION

While older adults showed recovery of cardiopulmonary response parameters according to 6MWT and 1-min-STST findings at the 12-month follow-up post-COVID-19, these results of these measurements did not return to the values observed in older adults without COVID-19.

Understanding recovery of people recovering from COVID-19 receiving treatment from primary care allied health professionals: a mixed-methods study

PURPOSE

To quantitatively assess changes in recovery of people recovering from COVID-19 treated by a primary care allied health professional, and to qualitatively describe how they dealt with persistent complaints.

MATERIALS AND METHODS

This mixed-methods study is part of a Dutch prospective cohort study, from which thirty participants were selected through purposive sampling. Quantitative data on recovery were collected at start of treatment and 6 months. Additionally, by use of semi-structured interviews participants were asked on how persistent complaints influenced their lives, and how they experienced received primary care allied health treatment.

RESULTS

Despite reported improvements, most participants still experienced limitations at 6 months. Hospital participants reported a higher severity of complaints, but home participants reported more diverse complaints and a longer recovery. Most participants were satisfied with the primary care allied healthcare. Tender loving care and a listening ear, learning to manage limits, and support and acceptance of building up in small steps were perceived as contributing most to participants' recovery.

CONCLUSION

Although improvements were reported on almost all outcomes, most participants suffered from persistent complaints. Despite these persistent complaints, many participants reported being better able to cope with persistent complaints because they had decreased substantially in their intensity.

TRIAL REGISTRATION

Clinicaltrials.gov registry (NCT04735744).

Through Their Eyes: Using Photovoice to Capture the Capacity-Building Journey of Long Covid Patient Experts

BACKGROUND

Long Covid, characterised by persistent symptoms following the coronavirus disease 2019 (COVID-19) infection, significantly impacts the quality of life. Engaging patients in research and care through participatory methods can enhance a shared understanding of illness and improve the relevance of research.

OBJECTIVE

We define Patient Experts (PEs) as persons (including patients, caregivers and providers) who have completed a series of training sessions on team building, research methods and communication at the Patient Engagement Studio, University of South Carolina (PES USC). This study explores the use of photovoice to document the experiences and capacity-building journey of Long Covid PEs within PES USC.

METHODS

The study employed photovoice within the COVID-19-Focused Virtual Patient Engagement Studio (CoVIP Studio). PEs submitted photographs and narratives at two distinct time points. Among the 18 PEs who participated in the project, 47 photos were collected during the training, and 31 were collected at the project's conclusion. Thematic analysis was conducted to capture changes in patient perspectives and engagement.

RESULTS

Initial themes identified were "Hope through Community," "Collaborative Education and Research" and "Strength and Endurance." By the project's end, themes had evolved to "Working as a Team to Share and Acquire Knowledge," "Enhanced Confidence in the Future of Care" and "Perseverance and Progress." These findings highlight the transformative impact of patient engagement and the utility of photovoice in documenting longitudinal shifts in patient perspectives.

CONCLUSION

Photovoice effectively engaged Long Covid patients and captured their evolving roles and perceptions as PEs. The study underscores the value of patient-led participatory methods in enhancing the relevance and applicability of clinical research, advocating for their broader adoption to improve patient-centred care and research outcomes.

PATIENT OR PUBLIC CONTRIBUTION

A CoVIP Studio stakeholder advisory board (CoVIP SAB) guided the co-development and implementation of this project. The CoVIP SAB comprised nine members with complementary skills and expertise, including three patients, three clinicians who provide care to patients with COVID-19 and three researchers with expertise in patient-centred research, COVID-19 and/or patient engagement and collaborate with patients as co-investigators. The board contributed to project design and implementation, refining photovoice prompts and shaping dissemination strategies. In addition, one PE who actively participated in all phases of the project contributed to the writing of this paper and is a coauthor. All project activities involved patients and/or caregivers with lived experience of Long Covid.

Multidisciplinary rehabilitation with a focus on physiotherapy in patients with Post Covid19 condition: an observational pilot study

There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9 days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12 years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97 m to 512 ± 87 m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients.

Headache severity in patients with post COVID-19 condition: a case-control study

Post COVID-19 conditions (PCC) present with a wide range of symptoms. Headache is one of the most frequently reported neurological symptoms by patients with PCC. We aimed to assess the prevalence of headache in patients with PCC who attended the Post-COVIDLMU outpatient department at LMU University Hospital in Munich. We hypothesized that headaches occur more frequently in patients with PCC than in the control group. Patients answered a questionnaire containing sociodemographic characteristics, their current symptoms, and prior psychiatric and somatic diagnoses, the WHO Quality of Life assessment (WHOQOL-BREF), 9-item Patient Health Questionnaire (PHQ-9), and the Fatigue Severity Scale (FSS). 188 PCC patients were included in this study and compared to a control group of patients with a history of COVID-19 or a different infectious disease - but no consecutive post-infectious condition (nc=27). 115 (61%) of our PCC patients were female. The median age was 41 years. 60 (32%, p = 0.001) had a pre-existing psychiatric diagnosis. PCC was associated with worse outcomes in all four domains of the WHOQOL-BREF (p < 0.001), high levels of fatigue (FSS; p < 0.001), and a higher likeliness for symptoms of depression (PHQ-9; p < 0.001). We were able to confirm that psychiatric disorders are more frequently associated with headaches in PCC patients. Headache should be assessed and treated in the context of PCC not only by neurologists but by multi-professional teams and regarding all PCC symptoms.

Medium- to long-term health condition of patients post-COVID-19, exercise intolerance and potential mechanisms: A narrative review and perspective

Background

Patients recovering from COVID-19 often present with impaired health and persisting symptoms such as exercise intolerance ⩾3 months post-infection. Uncertainty remains about long-term recovery. We aimed to review studies examining cardiac function, macro- or microvascular function, blood biomarkers and physical activity in adult patients post-COVID-19 and highlight current knowledge gaps.

Results

Using echocardiography, persistent cardiac involvement of the left ventricle was observed in a fraction of patients both hospitalized and non-hospitalized. Ventricular dysfunction was often subclinical but may partly contribute to exercise intolerance post-COVID-19. Endothelial dysfunction was seen on micro- and macrovascular levels using retinal vessel imaging methods and brachial artery flow-mediated dilation, respectively. Studies reporting blood biomarkers of disease-specific impairment and endothelial dysfunction yielded upregulated inflammation, hypercoagulability, organ and endothelial damage up to several months after infection. Omics' scale lipid profiling studies provide preliminary evidence of alterations in several lipid subspecies, mostly during acute COVID-19, which might contribute to subsequent endothelial and cardiometabolic dysfunction. Yet, more robust evidence is warranted. Physical activity may be reduced up to 6 months post-COVID-19. However, studies measuring physical activity more precisely using accelerometry are sparse. Overall, there is growing evidence for long-term multiple organ dysfunction.

Conclusion

Research combining all the above methods in the search for underlying mechanisms of post-COVID-19 symptoms is mostly missing. Moreover, studies with longer follow-ups (i.e. ⩾18 months) and well-matched control groups are lacking. The findings may aid the development of rehabilitation regimes for post-COVID-19 syndrome.

Condensed abstract

This review examined cardiac function, vascular function, blood biomarkers and physical activity in patients post-COVID-19. Evidence suggests long-term dysfunction in multiple organ systems and exercise intolerance due to various factors, including endothelial damage and, in some patients, subclinical ventricular dysfunction. We highlight knowledge gaps for further research to aid post-COVID-19 rehabilitation.

Facilitators and barriers of long-term exercise adherence in healthcare workers formerly suffering from post-COVID-19 syndrome : A qualitative 1-year follow-up and quantitative pilot study of the COFIT trial

BACKGROUND

Early exercise intervention studies showed promising positive effects of physical exercising on post-COVID-19 symptoms; however, little is known about long-term training adherence and what influences it.

MATERIAL AND METHODS

Semi-structured interviews were conducted with 17 participants of the 8‑week original exercise intervention study. Facilitators and barriers were identified via thematic analysis and compared between those participants who continued their regular exercise behavior (continuous exercise group, CEG, n = 7) and those who stopped exercising (discontinuous exercise group, DEG, n = 10). Physical performance parameters and questionnaires regarding psychological health dimensions and work ability were assessed analogously to the original study.

RESULTS

Qualitative analysis showed that two of the top three facilitators, (improving physical and mental health, sport has high priority) were the same in both groups. The respective third of the top three facilitators was (re)build physical and cognitive performance in the CEG and training in the group in the DEG. The top three barriers (exhaustion, sport has little priority, procrastination) were not only the same in both groups but also in the same order.

CONCLUSION

The strongest post-COVID-19 associated facilitator for long-term exercise adherence is when the need for further reconditioning is felt. The strongest post-COVID-19 associated barrier is exhaustion. Availability of exercising in a group is a key factor in increasing long-term exercise adherence.

Distinguishing pain profiles among individuals with long COVID

Background

For many people with long COVID (LC), new-onset pain is a debilitating consequence. This study examined the nature of new-onset pain and concomitant symptoms in patients with LC to infer mechanisms of pain from the relationships between pain and health-related factors.

Methods

Pain and other symptoms were evaluated in 153 individuals with LC using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs, EuroQoL Visual Analog Scale, and Quality of Life in Neurological Disorders. The relationships between pain and patient factors were analyzed using Chi Square and independent t-tests.

Results

20.3% of individuals who reported new-onset pain had neuropathic pain, which was associated with lower quality of life and higher rates of cognitive dysfunction compared to those with non-neuropathic pain. Other symptoms were similar between groups, however heart-related symptoms were more prevalent in individuals with neuropathic pain and mood swings were more prevalent for individuals with non-neuropathic pain.

Conclusions

Characterizing the relationships between NP and quality of life in individuals with LC can aid in developing better clinical management strategies. Understanding the associations between NP and cognitive dysfunction provides the imperative foundation for future studies further examining the pathophysiological mechanisms underlying pain development in LC.

Impact of post-COVID symptoms on activity and participation of women and men

Post-COVID syndrome is affecting many organ systems and arises as a major public health problem with millions of cases worldwide. The primary aim of this study is the analysis of health problems, activity limitations and participation restrictions (ALPR) of participants with post-COVID symptoms and the investigation of correlations between these elements to derive statements about the rehabilitation need, also depending on sex. A retrospective cohort study was performed to collect longitudinal data from January 2022 to January 2023 using the Covid-19 Rehabilitation Needs Questionnaire (RehabNeQ). Patients completed the questionnaire at the Department of Rehabilitation- and Sports Medicine at Hannover Medical School. The 1st assessment included 307 study participants, of whom 54 showed up for the 2nd, 7 for the 3rd and one for the 4th assessment. Study participants with post-COVID symptoms also experience ALPR. The results show no significant difference in symptom intensity in women and men, but in intensity of ALPR. We found many correlations of varying degrees between various factors with ALPR. We found frequent correlations between fatigue and several ALPR. While these correlations apply to both sexes, we also found different correlations in women and men, indicating the different rehabilitation need of women and men.

Prevalence, Risk Factors, and Impact of Long COVID Among Adults in South Korea

OBJECTIVES

This study aimed to identify the prevalence, risk factors, and impact of long COVID in a community-based representative sample of patients with COVID-19 aged 19-64 years.

METHODS

A total of 975 participants completed online or telephone surveys at 1 and 3 months post-diagnosis, covering persistent symptoms, daily activity limitations, vaccination status, and underlying diseases.

RESULTS

Long COVID, as defined by the WHO criteria, had a prevalence of 19.7-24.9% in females and 12.7% in males. Logistic regression revealed that the odds of having long COVID symptoms were higher among females compared to males (OR, 2.43; 95% CI, 1.53-3.87), and higher in those aged ≥ 30 years compared to those aged 19-29 years: 30-39 years (OR, 2.91; 95% CI, 1.59-5.33), 40-49 years (OR, 2.72; 95% CI, 1.51-4.89), and 50-64 years (OR, 1.96; 95% CI, 1.10-3.49). Additionally, patients with underlying diseases had higher odds of long COVID symptoms compared to those without underlying diseases (OR, 1.81; 95% CI, 1.24-2.64). Among those with long COVID, 54.2% experienced daily activity limitations, and 40.6% received treatment. Furthermore, lower income groups faced greater daily activity limitations but had similar treatment rates to higher income groups.

CONCLUSIONS

These findings emphasize the need for interest in and the development of programs to support these low-income populations.

Automotive workers: the role of coordinative and conditional abilities as effectiveness wellness indicator

Introduction

Noncommunicable diseases are on the rise due to sedentary and unhealthy lifestyles. The World Health Organization (WHO) and the American College of Sports Medicine (ACSM) recommend maintaining a healthy diet and engaging in regular physical activity, particularly in the workplace. Prolonged and repetitive work tasks can result in extended sick leave and decreased productivity while at work. Therefore, it is important to identify predictive factors that can act as indicators of the health status of employees. Utilizing motor abilities assessment tests can help to identify health issues at an early stage. Promoting preventive health measures is crucial for addressing chronic diseases and enhancing overall occupational well-being. The purpose of the study was to characterize workers' motor abilities and fitness levels and identify potential indicators.

Methods

A total of 605 workers participated in this study, including 529 male participants with a height of 176 ± 0.09 cm and a body mass of 75.9 ± 14.1 kg and 77 female participants with a height of 162 ± 0.11 cm and an average body mass of 58.9 ± 11.1 kg. These individuals were enrolled during an Italian automotive corporation's mandatory annual medical check-up. The participants were categorized into three groups based on their occupational roles: blue-collar, manager, and white-collar groups. The participants underwent motor abilities assessment tests for upper-limb strength, trunk flexibility, and reaction time.

Results

The blue-collar group reported the best results in upper-limb strength (93.3 kgf ± 18.60), but had the worst results in flexibility (21.7 cm ± 7.90), total reaction time (58.8 s ± 4.74); and average intermedium (0.68 ms ± 0.11). The white-collar group reported the best result in flexibility (23.7 cm ± 8.94) and reaction time (48.5 s ± 4.38; 0.64 ms ± 0.09).

Conclusion

Despite being frequently used to assess health status, handgrip measurements may not provide accurate differentiations because of the common use of blue-collar workers for tasks that require upper-limb strength. In contrast, reaction time metrics appear more reliable and discriminative in evaluating a worker's physical fitness.

Effectiveness of a Person-Centered Interdisciplinary Rehabilitation Treatment of Post-COVID-19 Condition: Protocol for a Single-Case Experimental Design Study

BACKGROUND

Patients with post-COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. A person-centered, biopsychosocial, interdisciplinary rehabilitation program, adapted to expert opinions and the patient's needs, was therefore developed.

OBJECTIVE

This study aims to present a study protocol for a clinical trial to evaluate the effect of a new, person-centered, interdisciplinary rehabilitation treatment for PCC. It is aimed at improving participation in society and health-related quality of life in patients with PCC who perceive a high level of disability in daily activities or participation.

METHODS

A total of 20 Dutch adults, aged 18 years or older, with high levels of disability in daily activities and participation in society will be included in this replicated and randomized single-case experimental design study, from October 2023 onward. The replicated and randomized single-case experimental design consists of 3 phases. The baseline phase is the observational period, in which no specific treatment will be given. In the intervention phase, patients will receive the new outpatient treatment 3 times a week for 12 weeks, followed by a 12-week follow-up phase. During the intervention phase, the treatment will be personalized according to the patient's physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. The primary outcomes of the study are daily diaries, which consist of 8 questions selected from validated questionnaires (Utrecht Scale for Evaluation of Rehabilitation-Participation, EQ-5D-5L, and the Hospital Anxiety and Depression Scale). The other primary outcome measurements are participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) and health-related quality of life (EQ-5D-5L). The secondary outcomes are physical tests and validated questionnaires aimed at physical, mental, and cognitive complaints. Effect evaluation based on daily assessments will include visual analysis, calculation of effect sizes (Nonoverlap of All Pairs), randomization tests, and multilevel analysis. In addition, other analyses will be based on ANOVA or a 2-tailed Student t test.

RESULTS

Data collection for this study started in October 2023 and is planned to be completed in July 2024. The results will be published in peer-reviewed journals and presented at international conferences.

CONCLUSIONS

This is the first study investigating the effect of an interdisciplinary rehabilitation treatment with a person-centered, biopsychosocial approach in patients with PCC. Our findings will help to improve the treatment and support of patients with PCC.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00032636; https://drks.de/search/en/trial/DRKS00032636.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63951.

Effects of a plank-based strength training programme on muscle activation in patients with long COVID: a case series

BACKGROUND

This study aimed to analyse the effects of a plank-based strength training programme on muscle activation in patients with long COVID.

SUBJECTS AND METHODS

Case series study that included patients with long COVID who participated in a 12-week trunk and pelvic muscle strength training programme. Clinical variables and the modified fatigue impact scale (MFIS) were used to assess fatigue levels. Percentage of muscle activation during a core muscle plank was measured via surface electromyography. Pre- and post-intervention results were compared using the Wilcoxon signed-rank test and evaluated with Cohen's D effect size (ES).

RESULTS

Twenty-one subjects participated in the study; 81% female, mean age 47.5 years (range: 28-55 years), and median duration of symptoms 21 months (range: 5-24 months); 90.5% of the participants experienced fatigue (MFIS score = 38). Muscle activation during plank exercises improved across all muscles after the intervention, with significant increases in the left (p = 0.011, medium ES) and right external oblique (p =0.039, small ES) muscles and the right latissimus dorsi muscle (p = 0.039, small ES). Additionally, significant reductions in fatigue were observed in the total MFIS score (p = 0.004, medium ES) and in the physical (p < 0.001, large ES) and psychosocial subscales (p = 0.033, small ES).

CONCLUSIONS

Results suggest that a plank-based strength training programme may be effective in enhancing trunk and pelvic muscle activation in individuals with long COVID.

Symptoms Six Weeks After COVID-19 Are Reduced Among US Health Care Personnel Receiving Additional Vaccine Doses During the Omicron Period, December 2021-April 2022

Background

The objective of this study was to test the hypothesis that subsequent doses of the coronavirus disease 2019 (COVID-19) vaccine are associated with lower incidence of COVID-19-like symptoms at 6 weeks after infection.

Methods

This study was a case-control analysis of health care personnel in an ongoing multicenter COVID-19 vaccine effectiveness study. We enrolled participants at the time of COVID-19-like symptoms between December 19, 2021, and April 27, 2022, which corresponded to the early Omicron-predominant period after original monovalent severe acute respiratory syndrome coronavirus 2 additional vaccination doses became available. Our outcome was self-reported symptoms completed 6 weeks after the onset of symptoms.

Results

We enrolled 2478 participants, of whom 1422 (57%) had COVID-19. The prevalence of symptoms at 6 weeks was 26% (n = 373) in those with COVID-19 and 18% (n = 195) in those without COVID-19. Fatigue (11%) and difficulty sleeping (7%) were most strongly associated with COVID-19. A total of 1643 (66%) participants received a subsequent vaccine dose (after the primary series). Participants with COVID-19 who had received a subsequent vaccination had lower odds of symptoms at 6 weeks (adjusted odds ratio [aOR], 0.55; 95% CI, 0.43-0.70), but this relationship was not observed in those without COVID-19 (aOR, 0.87; 95% CI, 0.59-1.29).

Conclusions

Health care personnel who received subsequent doses of original monovalent COVID-19 vaccine had a lower prevalence of symptoms at 6 weeks than those that did not.

Physical exercise-related manifestations of long COVID: A systematic review and meta-analysis

Objective

This study aims to systematically assess physical exercise-related symptoms of post-acute sequelae of SARS-CoV-2 infection (PASC or long COVID) in coronavirus disease 2019 (COVID-19) survivors.

Methods

Eight databases were systematically searched on March 03, 2024. Original studies that compared physical exercise-related parameters measured by exercise testing between COVID-19 survivors who recovered from SARS-CoV-2 infection over 3 months and non-COVID-19 controls were included. A random-effects model was utilized to determine the mean differences (MDs) or standardized MDs in the meta-analysis.

Results

A total of 40 studies with 6241 COVID-19 survivors were included. The 6-min walk test, maximal oxygen consumption (VO2max), and anaerobic threshold were impaired in COVID-19 survivors 3 months post-infection compared with non-COVID-19 controls in exercise testing, while VO2 were comparable between the two groups at rest. In contrast, no differences were observed in SpO2, heart rate, blood pressure, fatigue, and dyspnea between COVID-19 survivors and non-COVID-19 controls in exercise testing.

Conclusion

The findings suggest an underestimation of the manifestations of PASC. COVID-19 survivors also harbor physical exercise-related symptoms of PASC that can be determined by the exercise testing and are distinct from those observed at rest. Exercise testing should be included while evaluating the symptoms of PASC in COVID-19 survivors.

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

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

Optimizing cardiopulmonary rehabilitation duration for long COVID patients: an exercise physiology monitoring approach

The presence of prolonged symptoms after COVID infection worsens the workability and quality of life. 200 adults with long COVID syndrome were enrolled after medical, physical, and mental screening, and were divided into two groups based on their performance. The intervention group (n = 100) received supervised rehabilitation at Department of Pulmonology, Semmelweis University with the registration number 160/2021 between 01/APR/2021-31/DEC/2022, while an age-matched control group (n = 100) received a single check-up. To evaluate the long-term effects of the rehabilitation, the intervention group was involved in a 2- and 3-month follow-up, carrying out cardiopulmonary exercise test. Our study contributes understanding long COVID rehabilitation, emphasizing the potential benefits of structured cardiopulmonary rehabilitation in enhancing patient outcomes and well-being. Significant difference was found between intervention group and control group at baseline visit in pulmonary parameters, as forced vital capacity, forced expiratory volume, forced expiratory volume, transfer factor for carbon monoxide, transfer coefficient for carbon monoxide, and oxygen saturation (all p < 0.05). Our follow-up study proved that a 2-week long, patient-centered pulmonary rehabilitation program has a positive long-term effect on people with symptomatic long COVID syndrome. Our data showed significant improvement between two and three months in maximal oxygen consumption (p < 0.05). Multidisciplinary, individualized approach may be a key element of a successful cardiopulmonary rehabilitation in long COVID conditions, which improves workload, quality of life, respiratory function, and status of patients with long COVID syndrome.

Connecting the Dots: Unveiling the Overlapping Realities of Long Coronavirus Disease and Post-Intensive Care Syndrome

Critical care areas saw an unprecedented number of patients throughout the coronavirus disease 2019 (COVID-19) pandemic. Unfortunately, many of these patients continue to experience lingering symptoms long after their discharge from the intensive care unit, related to post-intensive care syndrome and/or post-acute sequelae of COVID-19. Nurses should be aware of these often invisible illnesses and attentive to the fact that this patient population requires ongoing support via multidisciplinary, coordinated care.

Kotton C, V. Riella L. Post-acute Sequelae of COVID-19 Among Solid Organ Transplant Recipients: Insights From the Omicron Period

Background

In solid organ transplant recipients (SOTRs), studies investigating post-acute sequelae of SARS-CoV-2 infection (PASC) are limited, and risk factors for their development require further investigation.

Methods

In this cross-sectional study, we evaluated PASC symptoms among SOTRs followed at our institutions who had COVID-19 during the Omicron period from December 28, 2021, to November 4, 2022. Participants were surveyed using a newly published PASC score containing 13 symptoms experienced for ≥30 d. PASC was defined as a score of ≥12.

Results

Of 299 SOTRs invited, 93 completed the survey and were analyzed. The mean age was 58 y and 43% were women. Forty-six individuals (49%) reported experiencing ≥1 PASC symptom for ≥30 d, of whom 13 (14%) met the PASC definition. Multivariable analysis showed that female sex (adjusted odds ratio [aOR] = 0.32; 95% confidence interval [CI], 0.12-0.83), years from transplantation (aOR = 0.90 per additional year; 95% CI, 0.81-0.99), and tixagevimab-cilgavimab preexposure prophylaxis (aOR = 0.33; 95% CI, 0.12-0.84) were associated with significantly lower odds of developing ≥1 PASC symptom.

Conclusions

PASC symptoms are common in SOTRs infected during the Omicron period. PASC symptoms are less frequent in those with a longer time since transplant and in those who received tixagevimab-cilgavimab. New SARS-CoV-2 prevention and treatment strategies should also evaluate PASC symptoms as outcomes.

Impact of Spa Therapy on Symptoms and Quality of Life in Post-COVID-19 Patients with Chronic Conditions

Background: With limited pharmacological interventions, post-COVID-19 condition is a clinical challenge, and supplementary therapies are essential for symptom relief and enhancing quality of life (QoL). In our prospective observational study, we aimed to evaluate the impact of Salus per aquam (Spa) therapy on post-COVID-19 symptoms and QoL in individuals who suffer from chronic joint, musculoskeletal, skin, and/or respiratory conditions. Methods: A total of 159 individuals undergoing Spa therapy were enrolled, and 78 of them had post-COVID-19 symptoms, assessed using Visual Analogue Scale (VAS) and modified British Medical Research Council Questionnaire (mMRC-DS scales), as well as the Short Form 36 Health Status Survey (SF-36) questionnaire for QoL. Results: Spa therapy significantly reduced most post-COVID-19 symptoms, especially chronic fatigue, pain, brain fog, and persistent cough (all p < 0.05), as well as physical (+72%) and emotional (+66%) limitations. When stratified by sex, males showed a greater improvement from baseline, while females consistently displayed a higher amelioration in all QoL dimensions. Moreover, full vaccination with 3-4 doses significantly protected against SARS-CoV-2 re-infections and post-COVID-19 development (p < 0.05). Conclusions: Spa therapy demonstrated effectiveness in mitigating post-COVID-19 symptoms and enhancing QoL in patients suffering from chronic diseases.

Long COVID impacts: the voices and views of diverse Black and Latinx residents in Massachusetts

OBJECTIVE

To understand how Long COVID is impacting the health and social conditions of the Black and Latinx communities.

BACKGROUND

Emerging research on Long COVID has identified three distinct characteristics, including multi-organ damage, persistent symptoms, and post-hospitalization complications. Given Black and Latinx communities experienced significantly higher COVID rates in the first phase of the pandemic they may be disproportionately impacted by Long COVID.

METHODS

Eleven focus groups were conducted in four languages with diverse Black and Latinx individuals (n = 99) experiencing prolonged symptoms of COVID-19 or caring for family members with prolonged COVID-19 symptoms. Data was analyzed thematically.

RESULTS

Most participants in non-English language groups reported they were unfamiliar with the diagnosis of long COVID, despite experiencing symptoms. Long COVID impacts spanned financial and housing stability to physical and mental health impacts. Participants reported challenging encounters with health care providers, a lack of support managing symptoms and difficulty performing activities of daily living including work.

CONCLUSIONS

There is a need for multilingual, accessible information about Long COVID symptoms, improved outreach and healthcare delivery, and increased ease of enrollment in long-term disability and economic support programs.

Epigenetic patterns, accelerated biological aging, and enhanced epigenetic drift detected 6 months following COVID-19 infection: insights from a genome-wide DNA methylation study

BACKGROUND

The epigenetic status of patients 6-month post-COVID-19 infection remains largely unexplored. The existence of long-COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), suggests potential long-term changes. Long-COVID includes symptoms like fatigue, neurological issues, and organ-related problems, regardless of initial infection severity. The mechanisms behind long-COVID are unclear, but virus-induced epigenetic changes could play a role.

METHODS AND RESULTS

Our study explores the lasting epigenetic impacts of SARS-CoV-2 infection. We analyzed genome-wide DNA methylation patterns in an Italian cohort of 96 patients 6 months after COVID-19 exposure, comparing them to 191 healthy controls. We identified 42 CpG sites with significant methylation differences (FDR < 0.05), primarily within CpG islands and gene promoters. Dysregulated genes highlighted potential links to glutamate/glutamine metabolism, which may be relevant to PASC symptoms. Key genes with potential significance to COVID-19 infection and long-term effects include GLUD1, ATP1A3, and ARRB2. Furthermore, Horvath's epigenetic clock showed a slight but significant age acceleration in post-COVID-19 patients. We also observed a substantial increase in stochastic epigenetic mutations (SEMs) in the post-COVID-19 group, implying potential epigenetic drift. SEM analysis identified 790 affected genes, indicating dysregulation in pathways related to insulin resistance, VEGF signaling, apoptosis, hypoxia response, T-cell activation, and endothelin signaling.

CONCLUSIONS

Our study provides valuable insights into the epigenetic consequences of COVID-19. Results suggest possible associations with accelerated aging, epigenetic drift, and the disruption of critical biological pathways linked to insulin resistance, immune response, and vascular health. Understanding these epigenetic changes could be crucial for elucidating the complex mechanisms behind long-COVID and developing targeted therapeutic interventions.

Prevalence and predictors of persistent cognitive and psychological symptoms in non-hospitalized post-COVID-19 patients seeking care at an outpatient post-COVID-19 clinic

Introduction

There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes.

Methods

This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses.

Results

A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels (β = 0.217, p < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms (β = -0.325, p < 0.001), PTSS (β = -0.290, p < 0.001), and cognitive symptoms (β = -0.220, p < 0.001).

Discussion

Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches.

Recovering from COVID-19 (ReCOV): Feasibility of an Allied-Health-Led Multidisciplinary Outpatient Rehabilitation Service for People with Long COVID

BACKGROUND

A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID.

METHODS

A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage).

RESULTS

During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control (p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004]).

CONCLUSIONS

A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.

Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19, one year after discharge: a cross-sectional study

BACKGROUND

Patients with COVID-19 often experience severe long-term sequelae. This study aimed to assess resilience and Quality of Life (QoL) of patients who underwent mechanical ventilation due to COVID-19, one year after discharge.

METHODS

This cross-sectional study enrolled patients who received mechanical ventilation for severe COVID-19 and were assessed one-year post-discharge. Participants completed a structured questionnaire via telephone comprising the Connor-Davidson Resilience Scale (CD-RISC) and the Post-COVID-19 Functional Status scale (PCFS). To establish the association between QoL and resilience, Spearman correlations were calculated between the PCFS and the CD-RISC. Linear regression models were adjusted to evaluate which factors were associated with QoL, with the total score of PCFS as the dependent variable.

RESULTS

A total of 225 patients were included in the analysis. The CD-RISC had a median score of 83 (IQR 74-91). The PCFS results showed that 61.3% (n = 138) of the patients were able to resume their daily activities without limitations. Among them, 37.3% (n = 84) were classified as Grade 0 and 24% (n = 54) as Grade 1. Mild and moderate functional limitations were found in 33.7% of the patients, with 24.8% (n = 56) classified as Grade 2 and 8.8% (n = 20) as Grade 3. Severe functional limitations (Grade 4) were observed in 4.8% (n = 11) of the patients. High CD-RISC scores were associated with lower levels of PCFS score (p < 0.001).

CONCLUSIONS

In this cohort of critically ill patients who underwent mechanical ventilation due to COVID-19, 38% of patients experienced a significant decline in their QoL one year after hospital discharge. Finally, a high level of resilience was strongly associated with better QoL one year after discharge.

Resonant breathing improves self-reported symptoms and wellbeing in people with Long COVID

Introduction

Long COVID involves debilitating symptoms, many of which mirror those observed with dysautonomia, and care must be taken with rehabilitation for autonomic dysfunction to avoid post-exertional malaise/post-exertional symptom exacerbation. Resonant breathing (breathing slowly at a defined rate of breaths per minute) requires less exertion and can potentially improve autonomic function. The objective of this work was to report on the impact of a resonant breathing program on self-reported symptoms and wellbeing in people with Long COVID.

Methods

A retrospective analysis of de-identified data was completed in a convenience sample of people with Long COVID, who participated in the Meo Health (formerly known as Stasis HP) resonant breathing program. Participants completed baseline and follow up surveys.

Results

Data were available for 99 participants. Most measures of symptoms and wellbeing improved at follow up, with the largest differences per participant seen in sense of wellness (47.3%, p < 0.0001), ability to focus (57.5%, p < 0.0001), ability to breathe (47.5%, p < 0.0001), ability to control stress (61.8%, p < 0.0001) and sleep quality (34.9%, p = 0.0002). Most (92%) participants reported improvement at follow up on the Patient Global Impression of Change Scale.

Conclusion

Self-reported symptoms and wellbeing improved in people with Long COVID completing resonant breathing. Resonant breathing can be considered as an option within the broader treatment plan of people with Long COVID.

Pulmonary function and chest CT abnormalities 3 months after discharge from COVID-19, 2020-2021: A nation-wide multicenter prospective cohort study from the Japanese respiratory society

BACKGROUND

No comprehensive analysis of the pulmonary sequelae of coronavirus disease 2019 (COVID-19) in Japan based on respiratory function tests and chest computed tomography (CT) has been reported. We evaluated post-COVID-19 conditions, especially focusing on pulmonary sequelae assessed by pulmonary function tests and chest CT.

METHODS

For this prospective cohort study, we enrolled 1069 patients who presented pneumonia at the time of admission in 55 hospitals from February 2020 to September 2021. Disease severity was classified as moderateⅠ, moderate II, and severe, defined primarily according to the degree of respiratory failure. The data on post-COVID-19 conditions over 12 months, pulmonary function, and chest CT findings at 3 months were evaluated in this study. Additionally, the impact of COVID-19 severity on pulmonary sequelae, such as impaired diffusion capacity, restrictive pattern, and CT abnormalities, was also evaluated.

RESULTS

The most frequently reported post-COVID-19 conditions at 3 months after COVID-19 were muscle weakness, dyspnea, and fatigue (48.4%, 29.0%, and 24.7%, respectively). The frequency of symptoms gradually decreased over subsequent months. In pulmonary function tests at 3 months, the incidence of impaired diffusion capacity and restrictive pattern increased depending on disease severity. There also were differences in the presence of chest CT abnormalities at the 3 months, which was markedly correlated with the severity.

CONCLUSION

We reported a comprehensive analysis of post-COVID-19 condition, pulmonary function, and chest CT abnormalities in Japanese patients with COVID-19. The findings of this study will serve as valuable reference data for future post-COVID-19 condition research in Japan.

Long COVID among US adults from a population-based study: Association with vaccination, cigarette smoking, and the modifying effect of chronic obstructive pulmonary disease (COPD)

OBJECTIVE

Post-COVID Conditions (or Long COVID) have been widely reported, but population-based studies exploring the relationship between its risk factors are lacking. We examined the associations between Long COVID, chronic obstructive pulmonary disease [COPD], vaccination status, and cigarette smoking. We also tested for the modifying effect of COPD status.

METHODS

Data from the 2022 US nationwide Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. Our primary outcome was Long COVID (Yes/No) after a positive COVID-19 diagnosis. Predictor variables were COPD, coronary heart disease (CHD), diabetes, asthma, body mass index, cigarette smoking status, and number of COVID-19 vaccinations (0-4). Weighted multivariable logistic regression models were used and adjusted for sociodemographic factors. Regression models were used to explore the modifying effects of COPD status.

RESULTS

The weighted prevalence of Long COVID among survivors (N = 121,379) was 21.8% (95%CI: 21.4, 22.3), with tiredness/fatigue (26.2% [95%:25.1, 27.2]) as the most common symptom. Respondents with COPD (aOR: 1.71 [95%CI: 1.45, 2.02]), current daily smokers (aOR: 1.23 [95%CI:1.01, 1.49]), and former smokers (aOR: 1.24 [95%CI:1.12, 1.38]) (vs. never established smokers) had higher odds of Long COVID. However, respondents who had received three (aOR: 0.75 [95%CI:0.65, 0.85]) and four (aOR: 0.71 [95%CI:0.58, 0.86]) vaccine doses (vs. no vaccine) had lower odds of Long COVID. COPD had a modifying effect on the relationship between cigarette smoking and Long COVID (p-value: 0.013).

CONCLUSION

Our findings underscore a complex interaction between COPD, cigarette smoking, and Long COVID. Further, COVID-19 vaccination may be protective against Long COVID.

Medication utilization patterns in patients with post-COVID syndrome (PCS): Implications for polypharmacy and drug-drug interactions

BACKGROUND

Post-COVID syndrome (PCS) causes lasting symptoms like fatigue and cognitive issues. PCS treatment is nonspecific, focusing on symptom management, potentially increasing the risk of polypharmacy.

OBJECTIVES

To describe medication use patterns among patients with Post-COVID Syndrome (PCS) and estimate the prevalence of polypharmacy, potential drug-drug interactions, and anticholinergic/sedative burden.

METHODS

A cross-sectional analysis of baseline data from the Quebec Action for Post-COVID cohort, consisting of individuals self-identifying with persistent COVID-19 symptoms beyond 12 weeks. Medications were categorized using Anatomical Therapeutic Classification (ATC) codes. Polypharmacy was defined as using 5 or more concurrent medications. The Anticholinergic and Sedative Burden Catalog assessed anticholinergic and sedative loads. The Lexi-Interact checker identified potential drug-drug interactions, which were categorized into 3 severity tiers.

RESULTS

Out of 414 respondents, 154 (average age 47.7 years) were prescribed medications related to persistent COVID-19 symptoms. Drugs targeting the nervous system were predominant at 54.5%. The median number of medications was 2, while 11.7% reported polypharmacy. Over half of the participants prescribed medications used at least 1 anticholinergic or sedative medication, and 25% had the potential risk for clinically significant drug-drug interactions, primarily needing therapy monitoring.

CONCLUSIONS

Our study reveals prescription patterns for PCS, underscoring the targeted management of nervous system symptoms. The risks associated with polypharmacy, potential drug-drug interactions, and anticholinergic/sedative burden stress the importance of judicious prescribing. While limitations like recall bias and a regional cohort are present, the findings underscore the imperative need for vigilant PCS symptom management.

Post-acute COVID-19 syndrome in previously hospitalized patients

INTRODUCTION

With the prolongation of the COVID-19 pandemic, more individuals are experiencing sequelae after COVID-19 infection, also known as post-acute COVID-19 syndrome (PCS). The aims of this study were to describe the prevalence and characteristics of PCS symptoms such as fatigue, anxiety, and depression and to compare these symptoms according to participant characteristics in patients who had been previously hospitalized due to COVID-19.

DESIGN

A descriptive cross-sectional study design was used.

METHODS

We included 114 individuals who had been hospitalized for COVID-19 and were discharged from the hospital at least 4 weeks before. Symptoms were assessed using the Fatigue Severity Scale, the Hospital Anxiety-Depression Scale, and the PCS symptom questionnaire developed by the authors. We used descriptive statistics, the Student's t-test, the Wilcoxon rank-sum test, and the Kruskal-Wallis test for statistical analyses.

RESULTS

The most prevalent symptoms were anxiety (66.7%), fatigue (64.0%), headache (57.9%), and concentration or memory difficulties (57.9%). Concentration or memory difficulties and sleep disturbances had the highest mean frequency. Concentration or memory difficulties were rated with the highest mean severity, and cough, loss of taste, and muscle and joint pain had the highest mean distress scores. Female participants, individuals hospitalized for more than 2 weeks, individuals discharged more than 9 months ago, unvaccinated patients, and those who tried at least one symptom relief method reported higher symptom distress.

CONCLUSION

The findings of this investigation into the frequency, severity, and distress of symptoms shed light on the identification of post-COVID symptoms in detail. To objectively evaluate and comprehend the symptom trajectories of PCS, prospective studies about the development of symptom assessment tools and studies with a longitudinal design should be conducted.

CLINICAL RELEVANCE

A substantial number of respondents reported numerous symptoms and expressed symptom distress; therefore, the development of nursing interventions and treatments to alleviate PCS symptoms is crucial.

Meta-analysis of Cognitive Function Following Non-severe SARS-CoV-2 Infection

To effectively diagnose and treat subjective cognitive symptoms in post-acute sequalae of COVID-19 (PASC), it is important to understand objective cognitive impairment across the range of acute COVID-19 severity. Despite the importance of this area of research, to our knowledge, there are no current meta-analyses of objective cognitive functioning following non-severe initial SARS-CoV-2 infection. The aim of this meta-analysis is to describe objective cognitive impairment in individuals with non-severe (mild or moderate) SARS-CoV-2 cases in the post-acute stage of infection. This meta-analysis was pre-registered with Prospero (CRD42021293124) and utilized the PRISMA checklist for reporting guidelines, with screening conducted by at least two independent reviewers for all aspects of the screening and data extraction process. Fifty-nine articles (total participants = 22,060) with three types of study designs met our full criteria. Individuals with non-severe (mild/moderate) initial SARS-CoV-2 infection demonstrated worse objective cognitive performance compared to healthy comparison participants. However, those with mild (nonhospitalized) initial SARS-CoV-2 infections had better objective cognitive performance than those with moderate (hospitalized but not requiring ICU care) or severe (hospitalized with ICU care) initial SARS-CoV-2 infections. For studies that used normative data comparisons instead of healthy comparison participants, there was a small and nearly significant effect when compared to normative data. There were high levels of heterogeneity (88.6 to 97.3%), likely reflecting small sample sizes and variations in primary study methodology. Individuals who have recovered from non-severe cases of SARS-CoV-2 infections may be at risk for cognitive decline or impairment and may benefit from cognitive health interventions.