Long covid-mechanisms, risk factors, and management

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

Objective

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

Patients and Methods

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

Results

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

Conclusion

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

Postacute Sequelae From SARS-CoV-2 at the University of Illinois Hospital and Clinics: An Examination of the Effects of Long COVID in an Underserved Population Utilizing Manual Extraction of Electronic Health Records

Background

Although there has been a steady decrease in morbidity and mortality from the SARS-CoV-2 virus since the 2020-2021 period, thousands of Americans are still infected with the virus daily. Some proportion of these infected individuals will go on to develop postacute sequelae from SARS-CoV-2 (PASC, or Long COVID), manifesting symptoms 4 weeks or more after recovery from COVID-19. PASC and its underlying pathophysiology are still poorly described and understood. Although hundreds of peer-reviewed, published investigations on Long COVID exist, few have focused on underserved urban patient populations. Most of the published research has involved reviews of diagnostic codes from electronic health records, or responses to questionnaires.

Methods

We sought to review Long COVID in an underserved population in Chicago, and to go beyond electronic health record reviews of diagnostic codes, utilizing in-depth chart reviews, gleaned via manual extraction, focusing on notations of care providers. We investigated which specific preexisting conditions, if any, might be associated with specific Long COVID symptomatology's, and if any preexisting conditions predicted Long COVID. Study participants included 204 Long COVID patients, 98 COVID-19-positive patients, and 104 healthy (no history of COVID-19 infection) patients from an inner-city health system caring for underserved communities, whose records were reviewed via manual data extraction from electronic health records, focusing on provider notes in patient charts.

Results

Our Long COVID symptom frequencies were distinct compared to frequencies from other reviews that did not focus on underserved populations and done with medical records when only diagnostic codes are utilized. Preexisting medical conditions did not predict similar Long COVID symptomologies, save for the significant association between preexisting cough/dyspnea/pulmonary conditions and preexisting migraine/headache and their analogous Long COVID symptoms.

Conclusions

The odds of having Long COVID increased comparatively in subjects hospitalized with COVID-19, subjects with BMI >30, and female subjects.

Predictive Ability of Previous Pain and Disease Conditions on the Presentation of Post-COVID Pain in a Danish Cohort of Adult COVID-19 Survivors

BACKGROUND

Even though many post-COVID pain risk factors have been identified, little is known about the predictive profiles of these risk factors for the development of post-COVID pain.

METHODS

Data was collected from two separate questionnaires assessing demographics, pre-existing medical comorbidities, pain history, and post-COVID pain experience. Socioeconomic data and COVID-19 RT-PCR test results were collected from Danish registries. The study cohort (n = 68,028) was stratified into two groups reporting pre-COVID pain (n = 9090) and no pre-COVID pain (n = 55,938). Forward-selection prediction models were employed to identify predictor profiles for post-COVID pain in the full study cohort (Model 1) and the stratified groups with (Model 2) and without (Model 3) pre-COVID pain from 58 potential risk factors.

RESULTS

Model 1 achieved a 5-fold cross-validated AUC (cvAUC) of 0.68. Use of pain medication, stress, high income, age, female gender, and weight were the top predictors contributing to 97% of the model performance. Model 2 (cvAUC = 0.69) identified use of pain medication, breathing pain, stress, height, physical activity, and weight as the top predictors contributing to 98.6% of model predictive performance. Model 3 (cvAUC = 0.65) identified stress, female gender, weight, higher education, age, high income, and physical activity as the top predictors contributing to 98.5% of model predictive performance. Height was unique to Model 2, while being female and higher income were unique to Model 3.

CONCLUSIONS

The study highlights potential important predictors, and further research is needed to describe these in detail. The results may apply to the understanding of post-viral pain sequelae after other viral infections.

SIGNIFICANCE STATEMENT

The explorative study investigates the predictive ability of a battery of pre-COVID risk factors potentially associated with the development of post-COVID pain. This article presents the profiles of predictors of interest in COVID-19 survivors with and without pre-COVID pain. The results will contribute to the understanding of patient profiles that might develop post-COVID pain conditions and provide a first step towards focused clinical predictive research.

Impact of Pre-Infection COVID-19 Vaccination on the Incidence and Severity of Long COVID: A Retrospective Case-Control Study

Long COVID is an emerging condition with an important impact on the quality of life of affected individuals. This study aims to analyse the association between complete vaccination prior to SARS-CoV-2 infection and the subsequent development of long COVID, including its symptoms and their frequency through a retrospective case-control study. Cases included participants with long COVID, while controls were participants without long COVID but who had a SARS-CoV-2 infection. Data were collected through a self-reported survey. The study demonstrates a significant association between vaccination and a lower incidence of long COVID, adjusted for sex, age, university education, body mass index, physical activity, race, tobacco use, alcohol intake, adherence to Mediterranean diet, previous illness, flu vaccination, health care worker, high-risk COVID worker and sleep hours and sedentarism (OR 0.49, CI 95% 0.28-0.87). Furthermore, there is a statistically significant association between vaccination and reduced symptoms such as anosmia, dysgeusia, myalgia or arthralgia, as well as a lower overall number, adjusted for the aforementioned variables. These findings suggest that the vaccine could be associated not only to a milder course of SARS-CoV-2 infection but also with an improvement in the state of long COVID and its symptoms.

Incidence, associated factors and impact of the post-COVID-19 condition in Brazil: Study protocol of an observational cohort during the Omicron phase

The novel coronavirus (SARS-CoV-2) has caused a significant impact in Brazil, with over 37 million cases and 690,000 deaths. Survivors often experience prolonged symptoms, termed post-COVID-19 condition or long COVID, affecting various aspects of life. Data on post-COVID-19 in Brazil, particularly amid the Omicron variant, are limited. This study aims to address this gap by assessing the incidence, associated factors, and impact of post-COVID-19 in adults infected during the Omicron phase, using the World Health Organization case definition. This Brazilian cohort study involves virtual recruitment and a nested case-control design. Participants from all regions will be recruited through electronic announcements. Inclusion criteria comprise age ≥ 18, Brazilian residency, and confirmed symptomatic SARS-CoV-2 infection. A nested case-control study will compare cognitive domains in post-COVID-19 cognitive dysfunction cases and controls. Data collection will utilize standardized instruments, including the EQ-5D-3L, Lawton & Brody Scale, Barthel Index, and others. Statistical analyses will employ adjusted models for primary and secondary outcomes. The study follows ethical guidelines, with an informed consent process tailored to participant preferences. Confidentiality measures include restricted access and secure electronic data storage. Results will be disseminated in academic forums, peer-reviewed journals, and directly communicated to participants. Authorship criteria align with international standards, and data sharing requests will be evaluated by the steering committee. The study is currently recruiting participants.

A biopsychosocial analysis of risk factors for persistent physical, cognitive, and psychological symptoms among previously hospitalized post-COVID-19 patients

A significant number of COVID-19 survivors continue to experience persistent physical, cognitive, and psychological symptoms up to one year after discharge. This study aimed to examine the frequency, severity, and progression of and risk factors for these symptoms. This single-centre retrospective cohort study included 126 COVID-19 patients admitted to the VieCuri Medical Centre between 2020 and 2022. Follow-up assessments were conducted at 3 and 12 months postdischarge, including pulmonary function tests, CT scans, bioimpedance analysis, and questionnaires on physical, cognitive, and psychological symptoms. At both follow-up assessments, 31-32% of patients reported moderate to severe physical symptoms, 26-27% reported multiple cognitive symptoms, and 14-18% experienced depressive or posttraumatic stress symptoms (PTSSs). Only anxiety symptoms significantly decreased between the 3-month follow-up and the 12-month follow-up (from 22 to 12%; p = .014). The persistence of symptoms at 12 months was significantly associated with premorbid conditions (chronic respiratory disease, multiple comorbidities), illness severity (infection during the third wave), physical factors (COVID-19-related pulmonary abnormalities, lower total lung capacity, and dyspnoea), and cognitive and psychological factors (cognitive symptoms, anxiety, depression, and PTSS) (p < .05). These findings suggest that a significant proportion of COVID-19 survivors continue to experience persistent symptoms due to biopsychosocial factors, thus emphasizing the need for a biopsychosocial approach in early screening and treatment.

Replicon RNA vaccines: design, delivery, and immunogenicity in infectious diseases and cancer

Replicon RNA (RepRNA) represents a cutting-edge technology in the field of vaccinology, fundamentally transforming vaccine design and development. This innovative approach facilitates the induction of robust immune responses against a range of infectious diseases and cancers. RepRNA vaccines leverage the inherent capabilities of RNA-dependent RNA polymerase associated with self-replicating repRNA, allowing for extreme replication within host cells. This process enhances antigen production and subsequently stimulates adaptive immunity. Additionally, the generation of double-stranded RNA during RNA replication can activate innate immune responses. Numerous studies have demonstrated that repRNA vaccines elicit potent humoral and cellular immune responses that are broader and more durable than those generated by conventional mRNA vaccines. These significant immune responses have been shown to provide protection in various models for infectious diseases and cancers. This article will explore the design and delivery of RepRNA vaccines, the mechanisms of immune activation, preclinical studies addressing infectious diseases and tumors, and related clinical trials that focus on safety and immunogenicity.

"Stuck Due to COVID": Applying the Power and Control Model to Migrant and Refugee Women's Experiences of Family Domestic Violence in the Context of the COVID-19 Pandemic

The COVID-19 pandemic had acute and lasting gendered impacts around the world, with UN Women declaring a shadow pandemic of violence against women. This study aimed to explore the impact of the COVID-19 pandemic on migrant and refugee women's experiences of family domestic violence (FDV) in Western Australia (WA) using a community-based participatory research approach. Thirty-eight interviews and two qualitative surveys conducted with 27 women were included in the analysis. Interview and survey data underwent reflexive thematic analysis informed by the Power and Control Wheel, generating three themes and ten subthemes: (1) the facets of violence women experienced (isolation; economic violence; emotional violence; visa vulnerabilities; fear and uncertainty), (2) the systemic enablers of FDV and barriers to seeking help (FDV service provision; the immigration system), and (3) the impact of the COVID-19 pandemic and government measures on women and family (enabling FDV; reducing the impact of FDV; COVID-19 paled into insignificance). While for some migrant and refugee women, government measures facilitated access to support for FDV, our findings show that for others, the COVID-19 pandemic exacerbated and became part of the violence they had already experienced. Recommendations for tailored FDV and other support during the COVID-19 pandemic are discussed, including the expansion of family violence provisions for all visa types.

Follow-up of long COVID based on the definition of WHO: a multi-centre cross-sectional questionnaire-based study

BACKGROUND

Since long COVID has hindered people from normal life, it is essential to understand its full spectrum of manifestation. However, it was heterogeneous in the existing studies and few large-scale studies have been conducted on Asian populations. Here, we conducted a multi-centre questionnaire-based study among Chinese people to explore the long COVID based on the definition of WHO.

METHODS

During March 20, 2023 and June 18, 2023, individuals with a history of confirmed or self-reported SARS-CoV-2 infection were recruited from three hospitals to fill out the questionnaire for long COVID. Each symptom was assigned with 0 to 3 points based on their severity. And the long COVID score was a sum of these points of each symptom. The reporting rate, time trend and risk factors of long COVID stratified by different systems were explored.

RESULTS

3,693 individuals were recruited for the study. The reporting rate of at least one persistent long COVID symptoms and symptoms impacting daily life was 30.2% (1,117) and 10.7% (394). Systemic symptoms (20.7%, 765) were most easily reported. The most common symptoms were fatigue (16.3%, 602), cough (6.3%, 234) and expectoration (5.5%, 203). The reporting rate of long COVID and long COVID score decreased over time during a 180-day follow-up period (P < 0.05). For long COVID, older age (OR: 1.63, 1.38-1.93), female (OR: 1.19, 1.03-1.38) and SARS-CoV-2 reinfection (OR: 3.56, 2.63-4.80) were risk factors; while number of COVID-19 vaccine doses (OR: 0.87, 0.81-0.94) was a protective factor. The use of traditional Chinese medicine (OR: 0.51, 0.37-0.71) was a protective factor for symptoms impacting daily life.

CONCLUSIONS

Early interventions should be taken to minimize the impact of long COVID, especially for the elderly, females and those with SARS-CoV-2 reinfection. COVID-19 booster vaccination might play a potential role in minimizing the impact of long COVID.

STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy (STRONGER): study protocol for a randomised, open label clinical trial in patients with persistent neurological symptoms after COVID-19 infection

INTRODUCTION

Increasing awareness of the high frequency, wide spectrum and disabling nature of symptoms that can persist following COVID-19 infection has prompted the investigation of management strategies. Our study aims to determine the effectiveness of atorvastatin on cognitive function, physical activity, mood, health-related quality of life and features of neurovascular impairment and neuroinflammation in adults with ongoing neurological symptoms after COVID-19 infection.

METHODS AND ANALYSIS

The STatin TReatment for COVID-19 to Optimise NeuroloGical recovERy study is an ongoing international, investigator-initiated and conducted, multicentre, prospective, randomised, open label, blinded endpoint trial with fixed time points for outcome assessments. A total of 410 participants with long covid neurological symptoms were planned to be randomly assigned to either the intervention group to receive 40 mg atorvastatin for 12 months or to a control group of no treatment, on top of usual care.

ETHICS AND DISSEMINATION

This study protocol was designed, implemented and reported, in accordance with the International Conference on Harmonisation guidelines for Good Clinical Practice, the National Health and Medical Research Council of Australia, the National Statement on Ethical Conduct in Human Research and with the ethical principles laid down in the World Medical Association Declaration of Helsinki. Central ethics committee approval was obtained from Sydney Local Health District Royal Prince Alfred Hospital Ethics (No: X21-0113 and 2021/ETH00777 10) in Australia. Site-specific ethics committee approvals were obtained elsewhere before any local study activities. All participants provided written informed consent.

TRIAL REGISTRATION NUMBER

The study protocol is registered at Clinicaltrials.gov (NCT04904536).

Long COVID and Associated Factors Among Chinese Residents Aged 16 Years and Older in Canada: A Cross-Sectional Online Study

As the COVID-19 pandemic evolved, long COVID emerged as a significant threat to public health, characterized by one or more persistent symptoms impacting organ systems beyond 12 weeks of infection. Informative research has been derived from assessments of long COVID among the Chinese populace. However, none of these studies considered the COVID-19 experience of Chinese residents in Canada. Objectives: We aimed to fill this literature gap by delineating the long COVID experience, prevalence, and associated factors among a sample of Chinese residing in Canada during the pandemic. Methods: The present study employed a cross-sectional online survey questionnaire distributed to a sample of Canadian Chinese using a convenience sampling procedure from 22 December 2022 to 15 February 2023. Respondents were probed for sociodemographic background and health-, COVID-, and vaccine-related characteristics. Logistic LASSO regression was used for model building, and multivariate logistic regression was used to identify factors associated with developing long COVID. Results: Among 491 eligible participants, 63 (12.83%) reported experiencing long COVID with a mean duration of 5.31 (95% CI: 4.06-6.57) months and major symptoms including difficulty concentrating (21.67%), pain/discomfort (15.00%), as well as anxiety/depression (8.33%). Our final model identified significant associations between long COVID and two or more COVID-19 infections (OR = 23.725, 95% CI: 5.098-110.398, p < 0.0001), very severe/severe symptoms (OR = 3.177, 95% CI: 1.160-8.702, p = 0.0246), over-the-counter medicine (OR = 2.473, 95% CI: 1.035-5.909, p = 0.0416), and traditional Chinese medicine (OR = 8.259, 95% CI: 3.016-22.620, p < 0.0001). Further, we identified a significant protective effect of very good/good health status (OR = 0.247, 95% CI: 0.112-0.544, p = 0.0005). Conclusions: Long COVID effected a notable proportion of Canadian Chinese for a prolonged period during the COVID-19 pandemic. Our findings underscore the importance of preexisting health status and reinfection prevention when managing long COVID. Moreover, our work indicates an association between using over-the-counter medicine or traditional Chinese medicine and long COVID experience among Canadian Chinese.

Predicting viral host codon fitness and path shifting through tree-based learning on codon usage biases and genomic characteristics

Viral codon fitness (VCF) of the host and the VCF shifting has seldom been studied under quantitative measurements, although they could be concepts vital to understand pathogen epidemiology. This study demonstrates that the relative synonymous codon usage (RSCU) of virus genomes together with other genomic properties are predictive of virus host codon fitness through tree-based machine learning. Statistical analysis on the RSCU data matrix also revealed that the wobble position of the virus codons is critically important for the host codon fitness distinction. As the trained models can well characterise the host codon fitness of the viruses, the frequency and other details stored at the leaf nodes of these models can be reliably translated into human virus codon fitness score (HVCF score) as a readout of codon fitness of any virus infecting human. Specifically, we evaluated and compared HVCF of virus genome sequences from human sources and others and evaluated HVCF of SARS-CoV-2 genome sequences from NCBI virus database, where we found no obvious shifting trend in host codon fitness towards human-non-infectious. We also developed a bioinformatics tool to simulate codon-based virus fitness shifting using codon compositions of the viruses, and we found that Tylonycteris bat coronavirus HKU4 related viruses may have close relationship with SARS-CoV-2 in terms of human codon fitness. The finding of abundant synonymous mutations in the predicted codon fitness shifting path also provides new insights for evolution research and virus monitoring in environmental surveillance.

Post COVID-19 among young adults- prevalence and associations with general health, stress, and lifestyle factors

BACKGROUND

The prevalence of post COVID-19 condition (PCC) after mild infection among young adults is largely unknown, as are its impact on health and lifestyle factors.

OBJECTIVE

To assess the prevalence of PCC among young adults and its impact on general health, stress, and changes in lifestyle factors three years after the onset of the pandemic.

METHODS

The study population (n = 2,098) included participants from the population-based cohort BAMSE (aged 27-30 years). PCC symptoms and changes in lifestyle factors during the pandemic were assessed in a questionnaire distributed in September-December 2023 and analyzed cross-sectionally. Stress, physical activity, and general health were also assessed pre-pandemic (2016-2019) and analyzed longitudinally. PCC was defined as ≥ 1 symptom lasting for ≥ 2 months after COVID-19.

RESULTS

In total, 1,577 (75.5%) reported previous COVID-19. Among these, 166 (10.5%) reported previous and 62 (3.9%) ongoing PCC. The most common ongoing symptoms were altered smell/taste, psychological symptoms, and fatigue. Both pre- and post-pandemic general health differed significantly in relation to PCC in cross-sectional analyzes (all p < 0.05), with the lowest health reported by those with ongoing PCC. Participants with ongoing PCC also had a reduction in well-being in longitudinal analyses (p = 0.04). This group also reported more adverse changes in lifestyle factors and health during the pandemic such as reduced physical activity (p < 0.001) and worsened dietary habits (p = 0.03). However, there was no significant difference in the longitudinally measured perceived stress scale among individuals with PCC.

CONCLUSIONS

Almost 4% of young adults with previous self-reported COVID-19 had ongoing symptoms of PCC three years after the onset of the pandemic. This group reported poorer health and more adverse changes in lifestyle factors than participants without PCC. Targeted healthcare interventions for young adults with PCC are warranted.

CD147-high classical monocytes: a cellular biomarker for COVID-19 disease severity and treatment response

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to severe coronavirus disease 2019 (COVID-19), which is characterized by cytokine storm and organ dysfunction. The spike S1 subunit induces inflammatory cytokine production, but the immune cell subsets that respond to S1 stimulation and contribute to disease severity remain unclear.

METHODS

We analyzed serum samples and peripheral blood mononuclear cells (PBMCs) from patients with COVID-19 (moderate: n = 7; severe: n = 25) and healthy controls (n = 38). Using mass cytometry (cytometry by time-of-flight; CyTOF), we analyzed immune cell responses to S1 subunit stimulation in PBMCs from healthy donors and patients with COVID-19. We examined correlations among identified cell populations, serum cytokine levels, and clinical parameters.

RESULTS

Serum S1 subunit levels correlated with disease severity and inflammatory cytokine concentrations. S1 subunit stimulation induced dose-dependent cytokine production from PBMCs, predominantly from myeloid cells. CyTOF analysis identified classical monocytes with high CD147 expression (CD147hi cMono) as the primary source of S1-induced cytokines. The proportion of CD147hi cMono increased significantly in severe COVID-19 and decreased with clinical improvement. The frequency of CD147hi cMono showed a stronger positive correlation with clinical severity markers in younger patients compared to older patients.

CONCLUSIONS

CD147hi cMono are the primary cellular source of S1-induced inflammatory cytokines and may serve as potential biomarkers for monitoring COVID-19 severity and treatment response.

The clinical risk and post-COVID-19 sequelae in patients with myasthenia gravis: a retrospective observational study

Background

There are indeed several studies addressing the severity of Coronavirus disease 2019 (COVID-19) infection in myasthenia gravis (MG) patients. However, data on post-COVID-19 sequelae in MG patients remain limited. To address this gap, we collected clinical data on the condition and prognosis of MG patients with COVID-19 infection, aiming to investigate factors influencing both the severity of the infection and the occurrence of post-COVID-19 sequelae at 1 and 12 months after recovery.

Method

This was a retrospective analysis of 150 MG patients with COVID-19 infection from November 1, 2022 to March 1, 2023 at the First Affiliated Hospital of Guangzhou University of Chinese Medicine, including patient demographics, clinical characteristics, and post-COVID-19 sequelae. Multivariable binary logistic and linear regression models were employed to ascertain the variables influencing the severity. The evolution of the post-COVID-19 sequelae was analyzed using McNemar's test.

Result

In 150 MG patients, 128 (85.3%) patients were presented with COVID-19 infection, and 23 (18%) patients were hospitalized. The severity was associated with the daily corticosteroid dose (OR = 1.08, p = 0.02) and the frequency of myasthenia crises pre-COVID-19 (b = 7.8, t = 2.14, p = 0.035). Compared to normal patients, MG patients are more likely to experience post-COVID-19 sequelae such as insomnia, myalgia, dizziness, cough, expectoration, and sore throat at 12 months after recovery. Among these, the prevalence of myalgia, dizziness, rash, and vision impairment was significantly higher.

Conclusion

Compared to normal patients, MG patients are prone to developing severe COVID-19 infection, which is associated with the daily corticosteroid dose and the frequency of myasthenia crises pre-COVID-19. Additionally, they are prone to experiencing post-COVID-19 sequelae, including insomnia, myalgia, dizziness, cough, expectoration, and sore throat, at 12 months after recovery.

Burden of non-COVID-19 lower respiratory infections in China (1990-2021): a global burden of disease study analysis

BACKGROUND

The assessment of lower respiratory infection (LRI) mortality, incidence, and responsible pathogens in China provides a scientific basis for the prevention and management of LRI, especially for evaluating the impact of coronavirus disease 2019 (COVID-19). We provide a national estimate of the non-COVID-19 LRI burden and trends on people from 1990 to 2021 based on Global Burden of Disease (GBD) study 2021.

METHODS

We estimated China's mortality, incidence, disability-adjusted life years (DALYs), risk factors and aetiology attribution for LRI without including COVID-19 by using the estimated data of GBD study 2021. Mortality, incidence, DALYs, risk factors and aetiology were stratified by sex and age. Trends were evaluated using estimated annual percentage change.

RESULTS

In 2021, it is estimated that there were 206930.22 deaths (95% uncertainty interval [UI]: 171260.88-251990.47), with all-age mortality rate of 14.54 deaths (95% UI: 12.04-17.71) per 100,000 population. Compared to 2019, the all-age mortality rate had a 3.60% increase. Analyzing risk factors from 1990 to 2021, we found that the percentage of DALYs attributed to tobacco increased from 7.44% (95% UI: 1.26-15.72%) to 22.14% (95% UI: 3.28-38.41%), and that attributable to ambient particulate matter pollution increased from 19.84% (95% UI: 8.79-30.20%) to 32.72% (95% UI: 22.78-41.77%). The leading cause of mortality from LRIs remains Streptococcus pneumoniae from 1990 to 2021. However, the proportions of viral infections decreased. Compared to 2019, the proportion of deaths in 2021 caused by Influenza decreased from 13.03 to 2.70%, and the proportion of deaths due to RSV decreased from 2.21 to 0.41%.

CONCLUSIONS

In China, substantial progress has been made in reducing LRI mortality, yet LRIs have remained a threat in China from 1990 to 2021. During the COVID-19 pandemic, the mortality attributable to Influenza and RSV declined. Effective vaccines and treatments targeted at the main pathogens of LRI are important.

CLINICAL TRIAL NUMBER

Not applicable.

Virtual recovery: efficacy of telerehabilitation on dyspnea, pain, and functional capacity in post-COVID-19 syndrome

BACKGROUND

Post-COVID-19 syndrome (PCS) causes persistent symptoms that impair quality of life, and telerehabilitation (TR) provides an effective remote alternative for addressing these challenges.

AIM

This study aimed to evaluate the effects of a TR-based exercise program on dyspnea, pain intensity, and functional capacity in individuals with PCS.

DESIGN

Sixty PCS patients were randomized into a telerehabilitation group (TG, n = 32) or a control group (CG, n = 28). The TG received supervised TR sessions twice a week for 6 weeks, while the CG performed unsupervised home exercises. Assessments were conducted at the baseline and the end of 6 weeks.

RESULTS

TG showed significantly greater improvements compared to CG. mMRC decreased by 1.16 (95% CI, 0.93-1.38) vs. 0.36 (95% CI, 0.17-0.55), NPRS by 1.44 (95% CI, 0.95-1.92) vs. 0.6 (95% CI, 0.28-0.93), and 5-TST improved by 6.8 s (95% CI, 5.59-8.01) vs. 2.12 s (95% CI, 1.08-3.17). Significant differences were also observed for PSQI (p = 0.018) and HADS-anxiety (p = 0.001).

CONCLUSIONS

A TR-based exercise program significantly reduced dyspnea and pain intensity while improving functional capacity in PCS patients, making it an effective alternative to unsupervised exercise regimens.

TRIAL REGISTRATION

This study is prospectively registered at NCT05381675 ( clinicaltrials.gov ).

The health-related quality of life among stroke survivors with post-COVID conditions living in the United States

BACKGROUND AND AIM

It is widely recognized that a considerable number of COVID-19 survivors continue to experience post-COVID conditions (PCCs). Given that stroke survivors face a heightened risk of PCCs compared to the general population, our objective was to assess the impact of PCCs on the health-related quality of life (HRQL) among stroke survivors in the United States.

METHOD

We used the Behavioral Risk Factor Surveillance System data 2022. Respondents with a history of COVID-19 infection and stroke were selected and classified based on whether they experienced PCCs. Finally, the HRQL-related items, including self-reported general health (SRGH), the number of days with compromised mental and physical health, and the daily efficiency, were compared between the two groups.

RESULTS

Overall, 3988 respondents (42.8 % aged above 64 years old, 45.8 % men) were enrolled. Compared to stroke survivors without PCCs, those with PCCs had significantly worse SRGH and a higher number of days with compromised mental and physical health. However, although multivariate regression analysis supported the adverse impact of PCCs on the SRGH of stroke survivors, the results were not statistically significant (aOR = 1.32,CI95 %:[0.98-1.78],p = 0.070). Fatigue and dyspnea emerged as the most significantly associated symptoms with impaired SRGH. Additionally, lower education and annual household income level, smoking, lack of physical activity, and comorbidities including diabetes, heart, and pulmonary disease were associated with a higher prevalence of unfavorable SRGH among stroke survivors with PCCs.

CONCLUSION

Our study highlights that PCCs might be associated with worse SRGH. Lower education, income, and physical activity, smoking, and comorbidities were associated with a higher rate of unfavorable SRGH among stroke survivors with PCCs.

Long COVID after SARS-CoV-2 during pregnancy in the United States

Pregnancy alters immune responses and clinical manifestations of COVID-19, but its impact on Long COVID remains uncertain. This study investigated Long COVID risk in individuals with SARS-CoV-2 infection during pregnancy compared to reproductive-age females infected outside of pregnancy. A retrospective analysis of two U.S. databases, the National Patient-Centered Clinical Research Network (PCORnet) and the National COVID Cohort Collaborative (N3C), identified 29,975 pregnant individuals (aged 18-50) with SARS-CoV-2 infection in pregnancy from PCORnet and 42,176 from N3C between March 2020 and June 2023. At 180 days after infection, estimated Long COVID risks for those infected during pregnancy were 16.47 per 100 persons (95% CI, 16.00-16.95) in PCORnet using the PCORnet computational phenotype (CP) model and 4.37 per 100 persons (95% CI, 4.18-4.57) in N3C using the N3C CP model. Compared to matched non-pregnant individuals, the adjusted hazard ratios for Long COVID were 0.86 (95% CI, 0.83-0.90) in PCORnet and 0.70 (95% CI, 0.66-0.74) in N3C. The observed risk factors for Long COVID included Black race/ethnicity, advanced maternal age, first- and second-trimester infection, obesity, and comorbid conditions. While the findings suggest a high incidence of Long COVID among pregnant individuals, their risk was lower than that of matched non-pregnant females.

Maximal oxygen uptake, pulmonary function and walking economy are not impaired in patients diagnosed with long COVID

INTRODUCTION

SARS-CoV-2 may result in the development of new symptoms, known as long COVID, a few months after the original infection.

PURPOSE

It is elusive to what extent physical capacity in patients diagnosed with long COVID is impacted.

METHODS

We compared maximal oxygen uptake (V̇O2max), one of the single most important factors for cardiovascular health and mortality, expired lung volumes and air flow, oxygen cost of walking and 6-min-walking-test (6MWT), in 20 patients diagnosed with long COVID (11 males and 9 females; 44 ± 16 years (SD); 26.7 ± 3.8BMI, duration of acute phase 1.7 ± 1.2 weeks, tested 4 ± 3 months after long COVID diagnosis) with 20 healthy age and sex matched controls (11 males and 9 females; 44 ± 16 years; 25.9 ± 4.0BMI).

RESULTS

Long COVID patients had a V̇O2max of 41.4 ± 16.2 mL∙kg-1∙min-1(men) and 38.2 ± 7.5 (women) and this was not different from controls. Similarly, mean spirometry measures in the patient group (VC; FVC; FEV1; FEV1/FVC) were also not different (85-106%) from predicted healthy values. Finally, inclined treadmill (5%, 4 km∙h-1) walking economy was not different between the groups (long COVID: 15.2 ± 1.1 mL∙kg-1∙min-1; controls: 15.2 ± 1.2 mL∙kg-1∙min-1), while the 6MWT revealed a difference (long COVID: 606 ± 118 m; controls: 685 ± 85 m; p = 0.036).

CONCLUSION

V̇O2max, oxygen cost of walking, and spirometry measurements did not appear to be impaired in patients diagnosed with long COVID with a prior mild to moderate SARS-CoV-2 infection. The typical outcomes in these essential factors for health and longevity implies that while long COVID can present with a range of symptoms, caution should be made when attributing these symptoms directly to compromised pulmonary function or V̇O2max.

Exploring the association of social isolation and loneliness on the experience of COVID-19 infection and hospitalization in the Japanese population: the JACSIS study

PURPOSE

Social isolation and loneliness have been long-standing public health concerns, and the coronavirus disease 2019 (COVID-19) pandemic has exacerbated these issues. Therefore, this study aimed to investigate the associations of social isolation and loneliness during the pandemic with experience of COVID-19 infection and hospitalization in the Japanese population.

METHODS

Data were sourced from the Japan COVID-19 and Society Internet Survey (JACSIS), a large-scale, web-based national survey of individuals aged 15-79. This study used JACSIS data from 2020 to 2022, representing the first and third years of the pandemic. Social isolation was measured by the frequency of direct and indirect contact with people other than co-residing family members. Loneliness was evaluated using the UCLA Loneliness Scale, while COVID-19 infection and hospitalization were self-reported.

RESULTS

A total of 13,612 individuals were included, of whom 1.5% had experienced hospital admission due to COVID-19, and 9.3% were infected but not hospitalized. Social isolation was inversely associated with COVID-19 infection risk (odds ratio = 0.77; 95% confidence interval: 0.66-0.90), while a higher level of loneliness was related to hospitalization (odds ratio = 2.21; 95% confidence interval: 1.59-3.09). Sex-stratified analyses revealed stronger associations in men than women.

CONCLUSION

This study highlights the complex relationship between psychosocial factors and infectious disease outcomes, underscoring the need for comprehensive approaches to address the multifaceted challenges posed by global health crises.

Self-reported Health Service Utilization and Barriers to Care Among US Adults with a History of Post COVID-19 Condition

BACKGROUND

Millions of US adults continue to experience symptoms of post COVID-19 condition (PCC). More data on health service utilization patterns and barriers to care in this population are needed to understand how to care for people with PCC.

OBJECTIVE

To evaluate health service utilization and barriers to medical care among individuals with a history of PCC compared with other US adults.

DESIGN

Data were analyzed from the 2022 National Health Interview Survey (NHIS), a nationally representative, cross-sectional survey of the US population.

PARTICIPANTS

US adults.

MAIN MEASURES

Health service utilization and the presence of financial and nonfinancial barriers to care in the preceding 12 months.

KEY RESULTS

There were 24,905 individuals included in the analysis, representing approximately 230 million US adults. The weighted prevalence of those with a history of PCC was 6.9% (95%CI, 6.5-7.3). Compared to other US adults, participants with a history of PCC were more likely to have had an urgent care visit (adjusted odds ratio (aOR) 1.52 [95%CI, 1.34-1.72]), emergency room visit (aOR 1.94 [95%CI 1.71-2.21]), hospitalization (aOR 1.48 [95%CI, 1.24-1.77]), rehabilitation services (aOR 1.35 [95%CI, 1.14-1.60]), home care (aOR 1.55 [95%CI, 1.66-2.26]), mental health counseling (aOR 1.39 [95%CI, 1.17-1.65]), and complementary and integrative medicine services (aOR 1.29 [95%CI, 1.13-1.49]). Furthermore, respondents with a history of PCC were more likely to report at least one financial barrier to care (aOR 1.71 [95%CI, 1.48-1.97]) and at least one nonfinancial barrier (aOR 1.77 [95%CI, 1.56-2.00]). A greater proportion of participants with a history of PCC reported a financial barrier and nonfinancial barrier than adults with most other chronic conditions captured by NHIS.

CONCLUSIONS

Individuals with a history of PCC were more likely to use a variety of health services and report barriers to medical care. Health systems should consider developing accessible, multidisciplinary care pathways for this population.

Long COVID: Pathophysiology, current concepts, and future directions

Long COVID, an umbrella term referring to a variety of symptoms and clinical presentations that emerges in a subset of patients after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has a significant effect on quality of life and places a substantial burden on health care systems worldwide, straining financial and human resources. The pathophysiology of long COVID remains incompletely understood, though several hypotheses have been proposed to explain different aspects of this complex condition. SARS-CoV-2 persistence, direct organ damage, innate and adaptive immune system perturbation, autoimmunity, latent virus reactivation, endothelial dysfunction, and microbiome disturbances are among the most relevant avenues for elucidating the evolution, complexity, and mechanisms of long COVID. Active investigation regarding potential biomarkers for long COVID and its associated disease endotypes highlights the role of inflammatory mediators, immunophenotyping, and multiomics approaches. Further advances in understanding long COVID are needed to inform current and future therapeutics.

Molecular Basis of High-Blood-Pressure-Enhanced and High-Fever-Temperature-Weakened Receptor-Binding Domain/Peptidase Domain Binding: A Molecular Dynamics Simulation Study

The entry and infection of the Severe Acute Respiratory Syndrome Coronavirus 2 virus (SARS-CoV-2) involve recognition and binding of the receptor-binding domain (RBD) of the virus surface spike protein to the peptidase domain (PD) of the host cellular Angiotensin-Converting Enzyme-2 (ACE2) receptor. ACE2 is also involved in normal blood pressure control. An association between hypertension and COVID-19 severity and fatality is evident, but how hypertension predisposes patients diagnosed with COVID-19 to unfavorable outcomes remains unclear. High temperature early during SARS-CoV-2 infection impairs binding to human cells and retards viral progression. Low body temperature can prelude poor prognosis. In this study, all-atom molecular dynamics simulations were performed to examine the effects of high pressure and temperature on RBD/PD binding. A high blood pressure of 940 mmHg enhanced RBD/PD binding. A high temperature above 315 K significantly weakened RBD/PD binding, while a low temperature of 305 K enhanced binding. The curvature of the PD α1-helix and proximity of the PD β3β4-hairpin tip to the RBM motif affected the compactness of the binding interface and, hence, binding affinity. These findings provide novel insights into the underlying mechanisms by which hypertension predisposes patients to unfavorable outcomes in COVID-19 and how an initial high temperature retards viral progression.

The Impact of Long COVID on Language Proficiency Across Different School Levels in Hong Kong

Long COVID, where symptoms persist after recovering from COVID-19, can affect cognitive functions like language. However, little is known about its impact on children's language skills, especially across different school levels. This study investigated the impact of long COVID on language proficiency among 1244 children (Asian; 53.5% boys) from kindergartens (N = 408, Mage = 4.42 ± 1.26 years), primary schools (N = 547, Mage = 9.69 ± 1.96 years), and secondary schools (N = 289, Mage = 14.97 ± 1.85 years) in Hong Kong. Language proficiency was assessed using the Language Experience and Proficiency Questionnaire (LEAP-Q), which measured speaking, listening, reading, and writing in both Chinese and English. Participants were categorized into three groups: long COVID, recovered from COVID-19, and no history of COVID-19. One-way and two-way ANOVAs were used to analyze the differences in language proficiency across these groups and school levels. Children with long COVID symptoms exhibited significantly lower overall language proficiency, particularly in speaking and listening, compared to those in the recovered and no-COVID groups. The effect was more pronounced among primary and secondary students, with secondary school students showing the most substantial deficits. No significant differences were found between the recovered and no-COVID groups. The results suggest that long COVID might have detrimental effects on children's linguistic proficiency. The language development of older students who suffered from long COVID could benefit from receiving targeted educational and therapeutic interventions.

Long-Term Impact of COVID-19 on Disorders of Gut-Brain Interaction: Incidence, Symptom Burden, and Psychological Comorbidities

BACKGROUND

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has highlighted the potential exacerbation of gastrointestinal symptoms in patients with disorders of gut-brain interaction (DGBIs). However, the distinct symptom trajectories and psychological burden in patients with post-COVID-19 DGBIs compared with patients with pre-existing irritable bowel syndrome (IBS)/functional dyspepsia (FD) and non-DGBI controls remain poorly understood.

OBJECTIVES

To examine the long-term gastrointestinal symptom progression and psychological comorbidities in patients with post-COVID-19 DGBI, patients with pre-existing IBS/FD and non-DGBI controls.

METHODS

This post hoc analysis of a prospective multicenter cohort study reviewed patient charts for demographic data and medical history. Participants completed the Gastrointestinal Symptom Rating Scale at four time points: baseline, 1, 6, and 12 months, and the Hospital Anxiety and Depression Scale at 6 and 12 months. The cohort was divided into three groups: (1) post-COVID-19 DGBIs (2) non-DGBI, and (3) pre-existing IBS/FD, with the post-COVID-19 DGBIs group compared to the latter two control groups.

RESULTS

Among 599 eligible patients, 27 (4.5%) were identified as post-COVID-19 DGBI. This group experienced worsening abdominal pain, hunger pain, heartburn, and acid regurgitation, unlike symptom improvement or stability in non-DGBI controls (p < 0.001 for all symptoms, except hunger pain, p = 0.001). While patients with pre-existing IBS/FD improved in most gastrointestinal symptoms but worsened in constipation and incomplete evacuation, patients with post-COVID-19 DGBI exhibited consistent symptom deterioration across multiple gastrointestinal domains. Anxiety and depression remained unchanged in patients with post-COVID-19 DGBI, contrasting with significant reductions in controls (non-DGBI: p = 0.003 and p = 0.057; pre-existing IBS/FD: p = 0.019 and p = 0.007, respectively).

CONCLUSIONS

COVID-19 infection is associated with the development of newly diagnosed DGBIs and distinct symptom trajectories when compared with patients with pre-existing IBS/FD. Patients with post-COVID-19 DGBI experience progressive gastrointestinal symptom deterioration and persistent psychological distress, underscoring the need for tailored management strategies for this unique subgroup.

Exploring Coronavirus Disease 2019 Risk Factors: A Text Network Analysis Approach

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic has significantly affected global health, economies, and societies, necessitating a deeper understanding of the factors influencing its spread and severity. Methods: This study employed text network analysis to examine relationships among various risk factors associated with severe COVID-19. Analyzing a dataset of published studies from January 2020 to December 2021, this study identifies key determinants, including age, hypertension, and pre-existing health conditions, while uncovering their interconnections. Results: The analysis reveals five thematic clusters: biomedical, occupational, demographic, behavioral, and complication-related factors. Temporal trend analysis reveals distinct shifts in research focus over time. In early 2020, studies primarily addressed immediate clinical characteristics and acute complications of COVID-19. By mid-2021, research increasingly emphasized long COVID, highlighting its prolonged symptoms and impact on quality of life. Concurrently, vaccine efficacy became a dominant topic, with studies assessing protection rates against emerging viral variants, such as Alpha, Delta, and Omicron. This evolving landscape underscores the dynamic nature of COVID-19 research and the adaptation of public health strategies accordingly. Conclusions: These findings offer valuable insights for targeted public health interventions, emphasizing the need for tailored strategies to mitigate severe outcomes in high-risk groups. This study demonstrates the potential of text network analysis as a robust tool for synthesizing complex datasets and informing evidence-based decision-making in pandemic preparedness and response.

Wearable data reveals distinct characteristics of individuals with persistent symptoms after a SARS-CoV-2 infection

Understanding the factors associated with persistent symptoms after SARS-CoV-2 infection is critical to improving long-term health outcomes. Using a wearable-derived behavioral and physiological dataset (n = 20,815), we identified individuals characterized by self-reported persistent fatigue and shortness of breath after SARS-CoV-2 infection. Compared with symptom-free COVID-19 positive (n = 150) and negative controls (n = 150), these individuals (n = 50) had higher resting heart rates (mean difference 2.37/1.49 bpm) and lower daily step counts (mean 3030/2909 steps fewer), even at least three weeks prior to SARS-CoV-2 infection. In addition, persistent fatigue and shortness of breath were associated with a significant reduction in mean quality of life (WHO-5, EQ-5D), even before infection. Here we show that persistent symptoms after SARS-CoV-2 infection may be associated with pre-existing lower fitness levels or health conditions. These findings additionally highlight the potential of wearable devices to track health dynamics and provide valuable insights into long-term outcomes of infectious diseases.

The severity of pediatric COVID-19 during hospitalization is not associated with mortality within six months of discharge

BACKGROUND

COVID-19 has become a global pandemic. However, studies examining the outcomes for pediatric patients after hospital discharge, post-COVID-19, and the predictive factors influencing their high mortality rates, are still limited, especially in Indonesia. Therefore, this study aimed to determine the predictor that predict mortality six months after hospitalization for COVID-19.

METHODS

A retrospective cohort study was performed. The participants were children who were admitted to Dr. Sardjito General Hospital from February-April 2022. The inclusion criteria were pediatric patients who were hospitalized in the pediatric ward and discharged after recovering or completing isolation. COVID-19 hospitalization deaths and incomplete medical records were omitted from the study. Bivariate analysis was performed with chi-square log rank test. Kaplan-Meier method was used for calculating the cumulative survival between comparison groups of the predictor variables. Multivariate analysis was performed with a Cox regression. The relationships between the variables are presented as the Hazard ratios (HRs), confidence intervals of 95% (95%CI), and statistical significance levels, with p < 0.05.

RESULTS

Among the 114 patients studied, the mortality rate during the six months after COVID-19 was 29.8%. The multivariate analysis revealed that mortality was correlated with comorbidities (p < 0.021; HR 11.415; CI 95% 1.449-89.912) and obesity (p = 0.032; HR 4.617; CI 95% 1.139-18.721).

CONCLUSION

The presence of comorbidities and obesity are significant predictors of mortality in pediatric patients with COVID-19 within six months following hospital discharge.

CLINICAL TRIAL NUMBER

Not applicable.

Risk prediction and early intervention strategies for persistent SARS-CoV-2 infection in patients with non-Hodgkin lymphoma: a retrospective cohort study

BACKGROUND

Patients with non-Hodgkin lymphoma (NHL) face heightened mortality and accelerated disease progression when persistently infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This critical situation underscores the urgent need to identify risk factors and establish early intervention strategies tailored to this vulnerable population. The primary aim of this study was to investigate the risk factors associated with persistent SARS-CoV-2 infection in NHL patients during the COVID-19 pandemic.

METHODS

A retrospective cohort study was conducted using data from January 2020 to June 2024, obtained from the Aerospace Center Hospital's database, electronic health records, and laboratory archives. Inclusion criteria comprised patients with confirmed NHL and SARS-CoV-2 infection, with persistence defined as positive viral test results beyond 14 days after initial diagnosis. Patients with incomplete medical records or loss of follow-up were excluded. Predictive models were developed and refined using logistic regression and random forest algorithms. The models incorporated data on demographics, comorbidities, laboratory findings, and imaging results. Model performance was evaluated using accuracy, precision, and the area under the receiver operating characteristic curve (AUC-ROC). Validation was conducted on an independent dataset to ensure generalizability, and the best-performing model guided the development of a prediction tool for early risk assessment and intervention.

RESULTS

Key risk factors for persistent SARS-CoV-2 infection in NHL patients included advanced age, hypertension, diabetes, immunosuppressed status, low lymphocyte count, elevated C-reactive protein, high body mass index, anemia, reduced CD4 + cell count, and the presence of lung lesions. The random forest model demonstrated superior predictive performance, achieving an AUC of 0.93. The study further highlighted that prompt antiviral therapy, adjustments to immunosuppressive regimens, and enhanced monitoring significantly reduced infection persistence.

CONCLUSIONS

This study identifies critical risk factors for persistent SARS-CoV-2 infection in NHL patients and underscores the importance of early intervention strategies. These findings may guide clinical decision-making to improve outcomes in this high-risk population.

Precision phenotyping for curating research cohorts of patients with unexplained post-acute sequelae of COVID-19

BACKGROUND

Scalable identification of patients with post-acute sequelae of COVID-19 (PASC) is challenging due to a lack of reproducible precision phenotyping algorithms, which has led to suboptimal accuracy, demographic biases, and underestimation of the PASC.

METHODS

In a retrospective case-control study, we developed a precision phenotyping algorithm for identifying cohorts of patients with PASC. We used longitudinal electronic health records data from over 295,000 patients from 14 hospitals and 20 community health centers in Massachusetts. The algorithm employs an attention mechanism to simultaneously exclude sequelae that prior conditions can explain and include infection-associated chronic conditions. We performed independent chart reviews to tune and validate the algorithm.

FINDINGS

The PASC phenotyping algorithm improves precision and prevalence estimation and reduces bias in identifying PASC cohorts compared to the ICD-10-CM code U09.9. The algorithm identified a cohort of over 24,000 patients with 79.9% precision. Our estimated prevalence of PASC was 22.8%, which is close to the national estimates for the region. We also provide in-depth analyses, encompassing identified lingering effects by organ, comorbidity profiles, and temporal differences in the risk of PASC.

CONCLUSIONS

PASC precision phenotyping boasts superior precision and prevalence estimation while exhibiting less bias in identifying patients with PASC. The cohort derived from this algorithm will serve as a springboard for delving into the genetic, metabolomic, and clinical intricacies of PASC, surmounting the constraints of prior PASC cohort studies.

FUNDING

This research was funded by the US National Institute of Allergy and Infectious Diseases (NIAID).

A single-nucleus and spatial transcriptomic atlas of the COVID-19 liver reveals topological, functional, and regenerative organ disruption in patients

BACKGROUND

The molecular underpinnings of organ dysfunction in severe COVID-19 and its potential long-term sequelae are under intense investigation. To shed light on these in the context of liver function, we perform single-nucleus RNA-seq and spatial transcriptomic profiling of livers from 17 COVID-19 decedents.

RESULTS

We identify hepatocytes positive for SARS-CoV-2 RNA with an expression phenotype resembling infected lung epithelial cells, and a central role in a pro-fibrotic TGFβ signaling cell-cell communications network. Integrated analysis and comparisons with healthy controls reveal extensive changes in the cellular composition and expression states in COVID-19 liver, providing the underpinning of hepatocellular injury, ductular reaction, pathologic vascular expansion, and fibrogenesis characteristic of COVID-19 cholangiopathy. We also observe Kupffer cell proliferation and erythrocyte progenitors for the first time in a human liver single-cell atlas. Despite the absence of a clinical acute liver injury phenotype, endothelial cell composition is dramatically impacted in COVID-19, concomitantly with extensive alterations and profibrogenic activation of reactive cholangiocytes and mesenchymal cells.

CONCLUSIONS

Our atlas provides novel insights into liver physiology and pathology in COVID-19 and forms a foundational resource for its investigation and understanding.

Health-related quality of life in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Post COVID-19 Condition: a systematic review

PURPOSE

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Post COVID-19 Condition (PCC) are debilitating, chronic multi-systemic illnesses that require multidisciplinary care. However, people with ME/CFS (pwME/CFS) and people with PCC (pwPCC) are often precluded from accessing necessary disability and social support services. These unmet care needs exacerbate the existing illness burdens experienced by pwME/CFS and pwPCC. To deliver appropriate care and optimise health outcomes for pwME/CFS and pwPCC, the development of evidence-based healthcare policies that recognise the disabling impacts of these illnesses must be prioritised. This systematic review summarises the health-related quality of life (HRQoL) of pwME/CFS and pwPCC when compared with healthy controls (HCs) to elucidate the impacts of these illnesses and guide healthcare policy reform.

METHODS

CINAHL, Embase, MEDLINE, PubMed, PsycINFO and the Web of Science Core Collection were systematically searched from 1st January 2003 to 23rd July 2024. Eligible publications included observational studies capturing quantitative HRQoL data among pwME/CFS or pwPCC when compared with HCs. The use of validated patient-reported outcome measures (PROMs) was mandatory. Eligible studies were also required to employ the most stringent diagnostic criteria currently available, including the Canadian Consensus Criteria or International Consensus Criteria for ME/CFS and the World Health Organization case definition for PCC (PROSPERO ID: CRD42024501309).

RESULTS

This review captured 16 studies, including eight studies among pwME/CFS, seven studies among pwPCC and one study among both illness cohorts. Most participants were female and middle-aged. All pwPCC had experienced prolonged COVID-19 symptoms for at least three months. When compared with HCs, all HRQoL domains were significantly impaired among pwME/CFS and pwPCC. Both illnesses had a salient impact on physical health, including pain and ability to perform daily and work activities. While direct comparisons between pwME/CFS and pwPCC were limited by inconsistencies in the PROMs employed, comparable impact trends across HRQoL domain scores were observed.

CONCLUSION

ME/CFS and PCC have similar, profound impacts on HRQoL that warrant access to multidisciplinary disability and social support services. Future research must harmonise HRQoL data collection and prioritise longitudinal investigations among pwME/CFS and pwPCC to characterise PCC subgroups (including those fulfilling ME/CFS criteria) and predictors of prognosis.

Subtle changes on electrocardiogram in severe patients with COVID-19 may be predictors of treatment outcome

Background

Two years after the COVID-19 pandemic, it became known that one of the complications of this disease is myocardial injury. Electrocardiography (ECG) and cardiac biomarkers play a vital role in the early detection of cardiovascular complications and risk stratification. The study aimed to investigate the value of a new electrocardiographic metric for detecting minor myocardial injury in patients during COVID-19 treatment.

Methods

The study was conducted in 2021. A group of 26 patients with verified COVID-19 diagnosis admitted to the intensive care unit for infectious diseases was examined. The severity of a patient's condition was calculated using the NEWS score. The digital ECGs were repeatedly recorded (at the beginning and 2-4 times during the treatment). A total of 240 primary and composite ECG parameters were analyzed for each electrocardiogram. Among these patients, 6 patients died during treatment. Cluster analysis was used to identify subgroups of patients that differed significantly in terms of disease severity (NEWS), SрО2 and integral ECG index (an indicator of the state of the cardiovascular system).

Results

Using analysis of variance (ANOVA repeated measures), a statistical assessment of changes of indicators in subgroups at the end of treatment was given. These subgroup differences persisted at the end of the treatment. To identify potential predictors of mortality, critical clinical and ECG parameters of surviving (S) and non-surviving patients (D) were compared using parametric and non-parametric statistical tests. A decision tree model to classify survival in patients with COVID-19 was constructed based on partial ECG parameters and NEWS score.

Conclusion

A comparison of potential mortality predictors showed no significant differences in vital signs between survivors and non-survivors at the beginning of treatment. A set of ECG parameters was identified that were significantly associated with treatment outcomes and may be predictors of COVID-19 mortality: T-wave morphology (SVD), Q-wave amplitude, and R-wave amplitude (lead I).

Neuropsychiatric Manifestations of Long COVID-19: A Narrative Review of Clinical Aspects and Therapeutic Approaches

The COVID-19 (C-19) pandemic has highlighted the significance of understanding the long-term effects of this disease on the quality of life of those infected. Long COVID-19 (L-C19) presents as persistent symptoms that continue beyond the main illness period, usually lasting weeks to years. One of the lesser-known but significant aspects of L-C19 is its impact on neuropsychiatric manifestations, which can have a profound effect on an individual's quality of life. Research shows that L-C19 creates neuropsychiatric issues such as mental fog, emotional problems, and brain disease symptoms, along with sleep changes, extreme fatigue, severe head pain, tremors with seizures, and pain in nerves. People with cognitive problems plus fatigue and mood disorders experience great difficulty handling everyday activities, personal hygiene, and social interactions. Neuropsychiatric symptoms make people withdraw from social activity and hurt relationships, thus causing feelings of loneliness. The unpredictable state of L-C19 generates heavy psychological pressure through emotional suffering, including depression and anxiety. Neuropsychiatric changes such as cognitive impairment, fatigue, and mood swings make it hard for people to work or study effectively, which decreases their output at school or work and lowers their job contentment. The purpose of this narrative review is to summarize the clinical data present in the literature regarding the neuropsychiatric manifestations of L-C19, to identify current methods of diagnosis and treatment that lead to correct management of the condition, and to highlight the impact of these manifestations on patients' quality of life.

COVID-19 related complications

The COVID-19 pandemic has significantly impacted global healthcare systems, revealed vulnerabilities and prompted a re-evaluation of medical practices. Acute complications from the virus, including cardiovascular and neurological issues, have underscored the necessity for timely medical interventions. Advances in diagnostic methods and personalized therapies have been pivotal in mitigating severe outcomes. Additionally, Long COVID has emerged as a complex challenge, affecting various body systems and leading to respiratory, cardiovascular, neurological, psychological, and musculoskeletal problems. This broad spectrum of complications highlights the importance of multidisciplinary management approaches that prioritize therapy, rehabilitation, and patient-centered care. Vulnerable populations such as paediatric patients, pregnant women, and immunocompromised individuals face unique risks and complications, necessitating continuous monitoring and tailored management strategies to reduce morbidity and mortality associated with COVID-19.

Donepezil for Fatigue and Psychological Symptoms in Post-COVID-19 Condition: A Randomized Clinical Trial

Importance

Fatigue is the most commonly reported symptom of post-COVID-19 condition (also known as long COVID) and impairs various functions. One of the underlying mechanisms may be intracerebral inflammation due to decreases in acetylcholine levels.

Objective

To examine the effects of donepezil hydrochloride, an acetylcholinesterase inhibitor, on post-COVID-19 fatigue and psychological symptoms.

Design, Setting, and Participants

A multicenter, double-blind randomized clinical trial was performed in Japan. Between December 14, 2022, and March 31, 2024, adult patients within 52 weeks of the onset of COVID-19 and with a global binary fatigue score of 4 or greater on the Chalder Fatigue Scale were randomized into a donepezil or a placebo group.

Exposure

The intervention was conducted during a 3-week period, with donepezil hydrochloride being administered at a dosage of 3 mg/d for the first week and then 5 mg/d for 2 weeks.

Main Outcomes and Measures

The primary outcome was a change in the Chalder Fatigue Scale score and the absolute score 3 weeks after the initiation of treatment. Other outcomes at 3 and 8 weeks, such as psychological symptoms and quality of life, were evaluated as secondary outcomes.

Results

A total of 120 eligible patients were enrolled and 10 withdrew or were lost to follow-up; therefore, 110 patients (55 in each group) were included in the efficacy analysis (64 [58%] female; mean [SD] age, 43 [12] years). No significant differences were observed in baseline characteristics between the 2 groups. The baseline-adjusted estimating treatment effect of donepezil, measured as the mean difference on Chalder Fatigue Scale scores at 3 weeks, was 0.34 (95% CI, -2.23 to 2.91), showing no significant effect of the intervention (P = .79). Scores for the Hospital Anxiety and Depression Scale, Impact of Event Scale-Revised, EuroQol 5-Dimension 5-Level Version, Patient Health Questionnaire, and Daily Health Status at 3 and 8 weeks were similar. No serious adverse events occurred in either group.

Conclusions and Relevance

In this randomized clinical trial of donepezil to treat post-COVID-19 condition, the efficacy for fatigue and psychological symptoms was not confirmed in a general population. The development of effective therapeutics for post-COVID-19 symptoms is needed, and more clinical trials should be conducted in the future.

Trial Registration

Japan Registry of Clinical Trials Identifier: jRCT 2031220510.

Post-COVID metabolic enzyme alterations in K18-hACE2 mice exacerbate alcohol-induced liver injury through transcriptional regulation

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a significant threat to global public health. Despite reports of liver injury during viral disease, the occurrence and detailed mechanisms underlying the development of secondary exogenous liver injury, particularly in relation to changes in metabolic enzymes, remain to be fully elucidated. Therefore, this study was aimed to investigate the mechanisms underlying SARS-CoV-2-induced molecular alterations in hepatic metabolism and the consequent secondary liver injury resulting from alcohol exposure. We investigated the potential effects of SARS-CoV-2 infection on alcohol-induced liver injury in Keratin 18 promoter-human angiotensin converting enzyme 2 (K18-hACE2) transgenic mice. Mice were intranasally infected with 1 × 102 PFU of SARS-CoV-2. Following a 14 d recovery period from infection, the recovered mice were orally administered alcohol at 6 g/kg. Prior SARS-CoV-2 infection aggravated alcohol-induced liver injury based on increased alanine aminotransferase levels and cytoplasmic vacuolation. Interestingly, infected mice exhibited lower blood alcohol levels and higher levels of acetaldehyde, a toxic alcohol metabolite, compared to uninfected mice after the same period of alcohol consumption. Along with alterations of several metabolic process-related terms identified through RNA sequencing, notably, upregulation of cytochrome P450 2E1 (CYP2E1) and CYP1A2 was observed in infected mice compared to control value prior to alcohol exposure, with no significant impact of SARS-CoV-2 on intestinal damage. Tumor necrosis factor-alpha persistently showed upregulated expression in the infected mice; it also enhanced aryl hydrocarbon receptor and Sp1 expressions and their binding activity to Cyp1a2 and Cyp2e1 promoters, respectively, in hepatocytes, promoting the upregulation of their transcription. Our findings suggest that SARS-CoV-2 infection exacerbates alcohol-induced liver injury through the transcriptional activation of Cyp1a2 and Cyp2e1, providing valuable insights for the development of clinical recommendations on long COVID.

Characteristics and Prevalence of Sequelae after COVID-19: A Longitudinal Cohort Study

BACKGROUND

The World Health Organization has declared the end of the coronavirus disease 2019 (COVID-19) public health emergency. However, this did not indicate the end of COVID-19. Several months after the infection, numerous patients complain of respiratory or nonspecific symptoms; this condition is called long COVID. Even patients with mild COVID-19 can experience long COVID, thus the burden of long COVID remains considerable. Therefore, we conducted this study to comprehensively analyze the effects of long COVID using multi-faceted assessments.

MATERIALS AND METHODS

We conducted a prospective cohort study involving patients diagnosed with COVID-19 between February 2020 and September 2021 in six tertiary hospitals in Korea. Patients were followed up at 1, 3, 6, 12, 18, and 24 months after discharge. Long COVID was defined as the persistence of three or more COVID-19-related symptoms. The primary outcome of this study was the prevalence of long COVID after the period of COVID-19.

RESULTS

During the study period, 290 patients were enrolled. Among them, 54.5 and 34.6% experienced long COVID within 6 months and after more than 18 months, respectively. Several patients showed abnormal results when tested for post-traumatic stress disorder (17.4%) and anxiety (31.9%) after 18 months. In patients who underwent follow-up chest computed tomography 18 months after COVID-19, abnormal findings remained at 51.9%. Males (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.05-0.53; P=0.004) and elderly (OR, 1.04; 95% CI, 1.00-1.09; P=0.04) showed a significant association with long COVID after 12-18 months in a multivariable logistic regression analysis.

CONCLUSION

Many patients still showed long COVID after 18 months post SARS-CoV-2 infection. When managing these patients, the assessment of multiple aspects is necessary.

Post-COVID general health symptoms in patients with immune-mediated inflammatory diseases

BACKGROUND

Post-COVID entails persistent symptoms following a presumed or confirmed SARS-CoV-2 infection. This study aims to evaluate post-COVID general health symptoms reported by patients with IMIDs.

METHODS

An online questionnaire was distributed to IMID patients on systemic therapy at dermatology, rheumatology, and gastroenterology departments in the Netherlands. General health symptoms were compared between patients with and without prior SARS-CoV-2 infection. Multivariable logistic regression was used to adjust for disease-related factors and known post-COVID risk factors. Self-reported prevalence of post-COVID symptoms was assessed by asking patients if they linked their symptoms to the previous SARS-CoV-2 infection.

RESULTS

A total of 1518 patients were included, and 58% (n = 877) reported ≥1 SARS-CoV-2 infections. When assessing self-reported prevalence of post-COVID symptoms, 13.9% (122/877) linked their symptoms to a previous infection. Patients with a previous infection showed higher prevalence of symptoms than those without (56.2%, 43.9%; P < 0.001), and higher prevalence of fatigue (42%, 32%; P < 0.001). After adjusting for potential risk factors, previous infection was associated with symptoms (OR: 1.53; 95% CI: 1.23-1.91; P < 0.001), and fatigue (OR: 1.31; 95% CI: 1.04-1.64; P = 0.021). Subanalysis showed an association between self-reported COVID-19 severity and symptoms, while presumed SARS-CoV-2 variant (based on date of reported infection) and number of infections were not associated.

CONCLUSION

The self-reported prevalence of general health symptoms, particularly fatigue, is significantly higher in IMID patients with a previous SARS-CoV-2 infection. The cause of this increase requires further investigation and might provide insights into the pathogenesis of post-COVID, both relevant for IMID patients as well as the general population.

Impaired Endothelial Function in Individuals With Post-Acute Sequelae of COVID-19: Effects of Combined Exercise Training

PURPOSE

We investigated the presence of impaired endothelial function in individuals with post-acute sequelae of coronavirus disease-2019 (PASC) compared to healthy individuals and explored the efficacy of combined exercise training in restoring or improving endothelial function in those with PASC.

METHODS

Study I was a cross-sectional study which compared endothelial function between individuals with PASC (n = 29, mean age 22.9 ± 3.9 year) and healthy individuals (n = 42, mean age 21.7 ± 2.0 year). Study II, an intervention design, explored if combined exercise training (n = 14) could reverse the decline in endothelial function associated with PASC compared to controls (n = 14). The combined exercise program included aerobic, resistance, and inspiratory muscle training administered for 8 weeks. We measured endothelial function using flow-mediated dilation of the brachial artery and assessed peak oxygen uptake (VO2peak), dyspnea, and fatigue before and after the intervention.

RESULTS

Individuals with PASC exhibited significantly lower endothelial function compared to healthy controls (4.95 ± 2.0% vs 8.00 ± 2.4%, P < .001). The exercise group showed a significant increase in endothelial function (4.73 ± 1.5% to 7.98 ± 2.4%) as opposed to the control group (5.31 ± 2.5% to 6.30 ± 2.5%) (interaction effect: P = .008), reaching levels similar to those in healthy individuals. Additionally, the exercise group demonstrated improvement in VO2peak (38.3 ± 6.4 ml/min/kg to 42.8 ± 7.3 ml/min/kg, P < .001) and a reduction in dyspnea and fatigue compared to the control group (P < .001).

CONCLUSIONS

Having PASC is associated with impaired endothelial function, but combined exercise training effectively restores it, making it a promising lifestyle intervention for vascular function in PASC.

The interplay between frailty status and persistent critical illness on the outcomes of patients with critical COVID-19: A population-based retrospective cohort study

OBJECTIVES

Persistent critical illness (PerCI) occurs when the patient's prolonged intensive care unit (ICU) stay results in complications that become the primary drivers of their condition, rather than the initial reason for their admission. Patients with frailty have a higher risk of developing and dying from PerCI. We aimed to investigate the interplay of frailty and PerCI in critically ill patients with COVID-19.

METHOD

We conducted a retrospective multicentre cohort study including 103 Australian and New Zealand ICUs over the period of January 2020 to December 2021. We included all adult patients with COVID-19 and documented the Clinical Frailty Scale (frail ≥ 5). PerCI is defined as an ICU length of stay of ≥10 days. We aimed to investigate the hospital mortality with and without PerCI across varying degrees of frailty and examined the potential interaction effect between frailty status and PerCI.

RESULTS

The prevalence of PerCI was similar between patients with and without frailty (25.4% vs. 27.9%; p = 0.44). Hospital mortality was higher in patients with PerCI than in those without (28.8% vs. 9.3%; p < 0.001). Mortality in patients with PerCI also increased with increasing frailty (p < 0.001). Frailty independently predicted hospital mortality. When adjusted for Australia and New Zealand risk of death mortality prediction model and sex, the impact of frailty was no different in patients with and without PerCI (odds ratio = 1.30 [95% confidence interval: 1.14-1.49] vs. (odds ratio = 1.46 [95% confidence interval: 1.29-1.64]). Furthermore, increasing frailty did not influence mortality in patients with PerCI more (or less) than in those without PerCI (pinteraction = 0.82).

CONCLUSIONS

The presence of frailty independently predicted hospital mortality in patients with PerCI with COVID-19, but the impact of frailty on mortality was no different in those who developed PerCI from those without PerCI.

Objectifying persistent subjective cognitive impairment following COVID-19 infection: cross-sectional data from an outpatient memory-clinic in Germany

OBJECTIVE

Subjective cognitive impairment is frequently reported by patients experiencing Post-COVID symptoms. This study aims to assess objective impairment in attention, memory, and executive functions among these patients. Further, we investigated potential determinants of objective cognitive impairment.

METHODS

In this cross-sectional study, standardized neuropsychological testing (Vienna Testing System), assessment of cognitive symptom aggravation, psychiatric anamnesis, and psychometrics (BDI-II, Fatigue Severity Scale) were conducted in 229 patients who voluntarily presented to our outpatient memory-clinic due to subjective cognitive impairment following COVID-19. Blood-samples were collected to assess peripheral immune markers (IL-6, CRP) and APOE-ε4 genotype.

RESULTS

Objective cognitive impairment in at least one domain was present in 39% of the patients and 47% showed symptoms of moderate or severe depression. The APOE-ε4 allele was present in 32% of the patients. Higher rates of depressive symptoms (OR = 1.41, 95%-CI = 1.02-1.95) and higher burden of the APOE-ε4 allele (OR = 3.29, 95%-CI = 1.51-7.40) predicted objective cognitive impairment, regardless of age, sex, years of formal education, time since infection, and medication for diabetes or hypertension. Fatigue severity, acute COVID-19 severity or inflammation markers had no impact.

CONCLUSIONS

In our study, subjective cognitive impairment following COVID-19 was more likely associated with high rates of depression rather than relatively low rates of objective cognitive performance. Thus, the study emphasizes the necessity for extensive neuropsychological testing and evaluation of depression when examining Post-COVID patients in clinical practice. Further, the link between objective cognitive impairment, depression and APOE-ε4 does not appear to be specific to Post-COVID symptoms. Therefore, depression- and APOE-ε4-mediated neurodegenerative pathomechanisms might be a promising therapeutical target.

Three-Year Follow-Up of COVID-19 Cases in District of Constance, Germany. A Prospective, Controlled Cohort Study (FSC19-KN)

Background and Objectives: Long-term sequalae of viral diseases, especially after infections with SARS-CoV-2 (COVID-19), can induce multi-organ involvement, as around 65 million people worldwide report persistent symptoms that go far beyond the acute course. Studies indicate that early virus variants pose a higher risk of developing post-COVID-19 conditions. The primary aim of this study was to investigate the possible long-term effects based on the hospitalization rates and associated clinical events in patients infected with SARS-CoV-2 over an observational period of three years after the initial infection. Secondarily, an investigation of health-related quality of life and functional status was performed. Methods and Materials: The study presented was designed as a prospective, controlled cohort study to follow up on COVID-19 cases in the district of Konstanz, Germany (FSC19-KN). The positive group included subjects who had a primary infection with SARS-CoV-2 between March and December 2020. The control group included subjects who did not have a SARS-CoV-2 infection, as evidenced by a negative antibody test. As the primary endpoint, hospitalization rates and respective related admission diagnosis during the observational period of three years from January 2021 until July 2024 were analyzed. The health-related quality of life and functional outcomes were measured by the SF-36 questionnaire and Post-COVID-19 Functional Status (PCFS) as the secondary endpoint. Results: During the three years of observation after inclusion in the study, the hospitalization rate did not differ significantly between the two groups of initially infected and non-infected subjects (cumulative events, verum group 57 to control group 45, OR 1.24, CI 0.83; 1.85, p = 0.30). However, the health-related quality of life, measured by SF-36 sub scores of the SARS-CoV-2-positive subjects, achieved significantly lower results, except for the dimension 'energy and fatigue', in which subjects of the verum group still achieved significantly lower scores. Conclusions: Mild COVID-19 cases have no significant impact on hospitalization rates during an observational period of three years after initial infection. Yet, SARS-CoV-2-positive subjects reported a reduced health-related quality of life and functional outcomes. Ultimately, only the sub score quality 'energy and fatigue' still registered significant differences between both cohorts at the end of the three-year observational period.

Assessing the impact of Long COVID on healthcare workers' work - role functioning in tertiary hospitals in Singapore

BACKGROUND

Understanding Long COVID's impact on healthcare workers (HCWs) is vital for patient safety and care quality. However, research on its prevalence among HCWs in Singapore and its work impact is lacking.

OBJECTIVE

This study aims to assess Long COVID prevalence and its impact on work role functioning among HCWs in two Singapore tertiary hospitals, filling a critical gap in the literature.

METHODS

Conducted from January to April 2023, this study evaluated Long COVID prevalence and its impact on HCWs' work-role functioning in two Singapore tertiary hospitals. HCWs over 21, having experienced ≥1 COVID-19 infection, participated in an online survey. Long COVID, defined by NICE criteria, entailed symptoms persisting for 4 or more weeks. Work-related functioning was assessed using WRFQv2.0. Descriptive analyses were conducted using STATA software.

RESULTS

Out of 15,882 eligible participants, 573 responded (3.6% response rate). Long COVID prevalence (symptoms persisting for ≥4 weeks) was 47.5%, notably higher among younger HCWs (<40 years old), those with moderate/severe infections, and multiple infections. HCWs with Long COVID had significantly lower WRFQv2.0 mean scores compared to those without (85.1 vs. 74.3, p < 0.05). Additionally, HCWs with symptoms for ≥12 weeks had significantly lower scores than those without Long COVID (85.6 vs. 74.3, p < 0.05).

CONCLUSION

This study underscores Long COVID's potential impact on HCWs' work role functioning, especially among those with prolonged symptoms. Tailored work adjustments are crucial for their successful return to pre-illness levels, highlighting the importance of addressing Long COVID in healthcare settings.

The relationship between gut and nasopharyngeal microbiome composition can predict the severity of COVID-19

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that displays great variability in clinical phenotype. Many factors have been described to be correlated with its severity, and microbiota could play a key role in the infection, progression, and outcome of the disease. SARS-CoV-2 infection has been associated with nasopharyngeal and gut dysbiosis and higher abundance of opportunistic pathogens. To identify new prognostic markers for the disease, a multicentre prospective observational cohort study was carried out in COVID-19 patients divided into three cohorts based on symptomatology: mild (n = 24), moderate (n = 51), and severe/critical (n = 31). Faecal and nasopharyngeal samples were taken, and the microbiota was analysed. Linear discriminant analysis identified Mycoplasma salivarium, Prevotella dentalis, and Haemophilus parainfluenzae as biomarkers of severe COVID-19 in nasopharyngeal microbiota, while Prevotella bivia and Prevotella timonensis were defined in faecal microbiota. Additionally, a connection between faecal and nasopharyngeal microbiota was identified, with a significant ratio between P. timonensis (faeces) and P. dentalis and M. salivarium (nasopharyngeal) abundances found in critically ill patients. This ratio could serve as a novel prognostic tool for identifying severe COVID-19 cases.

Association between Mexican vaccination schemes and the duration of long COVID syndrome symptoms

The COVID-19 pandemic had a profound global impact, characterized by a high fatality rate and the emergence of enduring consequences known as Long COVID. Our study sought to gauge the prevalence of Long COVID syndrome in northeastern Mexico, correlating it with patients' comorbidities and vaccination records. We carried out an observational cross-sectional approach, by administering a comprehensive questionnaire covering patients' medical history, demographics, vaccination status, COVID-related symptoms, their duration, and any treatment received. Our participant cohort included 804 patients, averaging 41.5 (SD 13.6) years in age, with 59.3% being women. Notably, 168 individuals (20.9%) met Long COVID criteria. Our analysis of COVID-19 long lasting compared vaccination schemes, unveiling a significant difference between vaccinated and unvaccinated groups (p =  < 0.001). Through linear regression model, we found male gender (β = - 0.588, p < 0.001) and vaccination status (β = 0.221, p = 0.015) acted as protective factors against Long COVID symptom duration, while higher BMI was a risk factor (β = - 0.131, p = 0.026). We saw that the duration of Long COVID was different within vaccinated patients, and we did not find any association of comorbidities with an increase in the presence of symptoms. Even three years after the pandemic, a significant prevalence of Long COVID persists, and there is still a lack of standardized information and any possible treatment regarding this condition.

Assessment of psychosocial aspects in adults in post-COVID-19 condition: the EURONET-SOMA recommendations on core outcome domains for clinical and research use

BACKGROUND

Harmonizing core outcome domains allows for pooling data, comparing interventions, and streamlining research evaluation. At the same time clinicians require concise and feasible measures for routine practice. Considering the heterogeneity of post-COVID-19 condition, a biopsychosocial approach requires sufficient coverage of the psychosocial dimension with assessments. Previous recommendations for core outcome sets have serious limitations regarding the psychosocial aspects of post-COVID-19 condition. This paper specifically focuses on psychosocial outcomes for adults with post-COVID-19 condition, providing both a comprehensive set of outcome domains for research and a streamlined clinical core set tailored for routine clinical use.

METHODS

In a structured Consensus Development Approach, the European Network to improve diagnostic, treatment, and healthcare for patients with persistent somatic symptoms (EURONET-SOMA) developed psychosocial core outcome domains and assessments regarding post-COVID-19 condition. The experts identified variables and instruments which should be considered in studies on adults suffering from post-COVID-19 condition, and which are feasible in the clinical setting and relevant for research.

RESULTS

We identified three higher-order dimensions with each encompassing several domains: The first higher-order dimension, "outcomes", encompasses (1) the classification/ diagnostics of post-COVID-19 condition, (2) somatic symptoms (including fatigue), (3) the psychopathological status and mental comorbidities, (4) the physical status and somatic comorbidities, (5) neurocognitive symptoms, and (6) illness consequences. The second higher-order domain "mechanisms" encompasses (7) cognitive components, (8) affective components, (9) behavioral components, (10) social components, and (11) psychobiological bridge markers (e.g., neuroimmunological and psychoneuroendocrinological variables). The third higher-order domain, "risk factors", includes factors such as (12) socioeconomic status and sociocultural factors, (13) pre-existing mental and somatic health issues, (14) personality factors (e.g., neuroticism), (15) adverse childhood experiences, (16) ongoing disability or pension claim, and (17) social media use. For each domain, specific instruments are suggested for research purposes and clinical use.

CONCLUSIONS

The recommended core domains help to increase consistency in a biopsychosocial approach to post-COVID-19 condition across investigations, improve synergies, and facilitate decision-making when comparing different interventional approaches. It allows to better identify relevant subgroups in heterogeneous post-COVID-19 condition populations offering practical tools for routine clinical practice through the clinical core set.

Definitions and symptoms of the post-COVID syndrome: an updated systematic umbrella review

Post-COVID syndrome (PCS) describes a persistent complex of symptoms following a COVID-19 episode, lasting at least 4 to 12 weeks, depending on the specific criteria used for its definition. It is often associated with moderate to severe impairments of daily life and represents a major burden for many people worldwide. However, especially during the first two years of the COVID-19 pandemic, therapeutic and diagnostic uncertainties were prominent due to the novelty of the disease and non-specific definitions that overlooked functional deficits and lacked objective assessment. The present work comprehensively examines the status of PCS definitions as depicted in recent reviews and meta-analyses, alongside exploring associated symptoms and functional impairments. We searched the database Pubmed for reviews and meta-analysis evaluating PCS in the period between May 31, 2022, to December 31, 2023. Out of 95 studies, 33 were selected for inclusion in our analyses. Furthermore, we extended upon prior research by systematically recording the symptoms linked with PCS as identified in the studies. We found that fatigue, neurological complaints, and exercise intolerance were the most frequently reported symptoms. In conclusion, over the past eighteen months, there has been a notable increase in quantity and quality of research studies on PCS. However, there still remains a clear need for improvement, particularly with regard to the definition of the symptoms necessary for diagnosing this syndrome. Enhancing this aspect will render future research more comparable and precise, thereby advancing and understanding PCS.

Cognitive functions in COVID-19 survivors, approaches strategies, and impact on health systems: a qualitative systematic review

Post-COVID syndrome has been defined as signs and symptoms that develop after an infection consistent with COVID-19 and continue for more than 12 weeks, including neurocognitive signs and symptoms that have an impact on the functioning and quality of life of middle-aged adult and older survivors. This systematic review describes the current knowledge of long-term cognitive impairments in COVID-19 survivors, approaches strategies, and their impact on public and private health services worldwide. The systematic review was conducted under the criteria and flowchart established in the PRISMA statement, considering studies from the PubMed, Scopus, and Web of Science databases between 2020 and 2023. The included studies considered participants over 40 years of age, COVID-19 survivors. A total of 68 articles were included, most of which had high to excellent quality. The analysis showed the presence of heterogeneous cognitive symptoms in COVID survivors, persistent for at least 12 weeks from the onset of infection, mostly unsystematized and nonspecific approaches strategies, and a lack of methods for monitoring their effectiveness, with a significant economic and logistical impact on health systems. Specific protocols are required for the rehabilitation of persistent cognitive dysfunction in COVID-19 survivors, as well as longitudinal studies to evaluate the effectiveness of these interventions.