1
|
Sugiyama A, Takafuta T, Sato T, Kitahara Y, Yoshinaga Y, Abe K, Chanroth C, Ataa AG, Phyo Z, Kurisu A, Ko K, Akita T, Kishita E, Kuwabara M, Tanaka J. Natural course of post-COVID symptoms in adults and children. Sci Rep 2024; 14:3884. [PMID: 38365846 PMCID: PMC10873293 DOI: 10.1038/s41598-024-54397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
More than 200 million COVID-19 survivors have lasting symptoms after recovering, but the duration and related risk factors remain uncertain. This study focused on all 6551 patients diagnosed with COVID-19 at a medical institution in Hiroshima from March 2020 to July 2022. In November 2022, a questionnaire survey was conducted regarding post-COVID symptoms and their duration. The prevalence and duration of post-COVID symptoms were illustrated using the Kaplan-Meier method. Risk factors for symptoms lasting over 3 months and interfering with daily life were assessed via multivariate logistic regression. A total of 2421 survivors responded: 1391 adults, 1030 children, median age 34 years (IQR 9-55), 51·2% male, 36·7% hospitalized, median time from infection to the survey was 295 days (IQR 201-538). Upon their initial recovery, the prevalence of post-COVID symptoms was 78·4% in adults and 34·6% in children. Three months later, the rates were 47·6% and 10·8%. After over one year, they were 31·0% and 6·8%. Regarding symptoms interfere with daily life, 304 people (12.6%) experienced symptoms lasting for over three months, with independent risk factors including age, being female, diabetes mellitus, infection during the Delta period, and current smoking. There was no significant association between vaccination history and post-COVID symptoms.
Collapse
Affiliation(s)
- Aya Sugiyama
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Toshiro Takafuta
- Hiroshima City Funairi Citizens Hospital, 14-11, Funairisaiwaicho, Naka-ku, Hiroshima-shi, Hiroshima-ken, 730-0844, Japan
| | - Tomoki Sato
- Hiroshima City Funairi Citizens Hospital, 14-11, Funairisaiwaicho, Naka-ku, Hiroshima-shi, Hiroshima-ken, 730-0844, Japan
| | - Yoshihiro Kitahara
- Hiroshima City Funairi Citizens Hospital, 14-11, Funairisaiwaicho, Naka-ku, Hiroshima-shi, Hiroshima-ken, 730-0844, Japan
| | - Yayoi Yoshinaga
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Kanon Abe
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Chhoung Chanroth
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Akuffo Golda Ataa
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Zayar Phyo
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Akemi Kurisu
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Ko Ko
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Tomoyuki Akita
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan
| | - Eisaku Kishita
- Ministry of Health, Labor and Welfare Health Insurance Bureau Medical Economics Division, 1-2-2, Kasumigaseki, Chiyoda-ku, Tokyo-to, Tokyo, 100-8916, Japan
| | - Masao Kuwabara
- Hiroshima Prefecture Center for Disease Control and Prevention, 10-52, Motomachi, Naka-ku, Hiroshima-shi, Hiroshima-ken, 730-8511, Japan
| | - Junko Tanaka
- Department of Epidemiology Infectious Disease Control and Prevention, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima-shi, Hiroshima-ken, 734-8551, Japan.
| |
Collapse
|
2
|
Brinkley E, Knuth K, Kwon T, Mack C, Leister-Tebbe H, Bao W, Reynolds MW, Dreyer N. Daily COVID-19 symptom assessment over 28 days - findings from a daily direct-to-patient registry of COVID-19 positive patients. J Patient Rep Outcomes 2023; 7:128. [PMID: 38060047 DOI: 10.1186/s41687-023-00668-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023] Open
Abstract
In January 2021, 999 COVID-19 positive adults in the US enrolled in an online, direct-to-patient registry to describe daily symptom severity and progression over 28 days. The most commonly reported and persistent symptoms were fatigue, headache, decreased sense of taste, decreased sense of smell, and cough. Fast resolving symptoms included gastrointestinal symptoms (nausea, vomiting, diarrhea) and those related to fever and chills. While more than half (56%) of patients reported overall symptom improvement during the 28-day study period, 60% of patients were still reporting at least 1 COVID-19 symptom at the end of 28 days. Risk factors for experiencing symptoms for longer duration included at least one of the following: older age (> 60 years), higher BMI, lung disease, and receiving medication for hypertension. The study demonstrates the value of patient-reported data to provide important and timely insights to COVID-19 disease and symptom progression and the potential of using real-world data to inform clinical trial design and endpoints.
Collapse
Affiliation(s)
| | | | - Tom Kwon
- IQVIA, 2400 Ellis Road, Durham, NC, 27703, USA
| | | | | | - Weihand Bao
- Pfizer Inc, 66 Hudson Boulevard West, New York, NY 10001, USA
| | | | | |
Collapse
|
3
|
Newlands F, Goddings AL, Juste M, Boyd H, Nugawela MD, Pinto Pereira SM, Whelan E, Whittaker E, Stephenson T, Heyman I, Chalder T, Dalrymple E, Segal T, Shafran R. Children and Young People with Long COVID-Comparing Those Seen in Post-COVID Services with a Non-Hospitalised National Cohort: A Descriptive Study. Children (Basel) 2023; 10:1750. [PMID: 38002841 PMCID: PMC10670307 DOI: 10.3390/children10111750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Post-COVID services have been set up in England to treat children with ongoing symptoms of Long COVID. To date, the characteristics of children seeking treatment from these services has not been described. PURPOSE (1) to describe the characteristics of children aged 11-17 referred to the Pan-London Post-COVID service and (2) to compare characteristics of these children with those taking part in the United Kingdom's largest research study of Long COVID in children (CLoCk). DESIGN Data from 95 children seeking treatment from the Post-COVID service between May 2021 and August 2022 were included in the study. Their demographic characteristics, symptom burden and the impact of infection are described and compared to children from CLoCk. RESULTS A high proportion of children from the Post-COVID service and CLoCk reported experiencing health problems prior to the pandemic. Almost all Post-COVID service children met the research Delphi definition of Long COVID (94.6%), having multiple symptoms that impacted their lives. Symptoms were notably more severe than the participants in CLoCk. CONCLUSIONS This study describes the characteristics of children seeking treatment for Long COVID compared to those identified in the largest longitudinal observational study to date. Post-COVID service children have more symptoms and are more severely affected by their symptoms following infection with COVID-19 than children in the CLoCk study. Research to understand predisposing factors for severity and prognostic indicators is essential to prevent this debilitating condition. Evaluation of short- and long-term outcomes of interventions by clinical services can help direct future therapy for this group.
Collapse
Affiliation(s)
- Fiona Newlands
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Anne-Lise Goddings
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Maude Juste
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Holly Boyd
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Manjula D. Nugawela
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Snehal M. Pinto Pereira
- Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London WC1E 6BT, UK
| | - Emily Whelan
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK
| | - Elizabeth Whittaker
- Department of Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Isobel Heyman
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Trudie Chalder
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Emma Dalrymple
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| | | | - Terry Segal
- University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Roz Shafran
- Great Ormond Street Institute of Child Health, University College London, London WC1N 1EH, UK
| |
Collapse
|
4
|
Augustin M, Stecher M, Wüstenberg H, Di Cristanziano V, Sandaradura de Silva U, Picard LK, Pracht E, Rauschning D, Gruell H, Klein F, Wenisch C, Hallek M, Schommers P, Lehmann C. 15-month post-COVID syndrome in outpatients: Attributes, risk factors, outcomes, and vaccination status - longitudinal, observational, case-control study. Front Immunol 2023; 14:1226622. [PMID: 37781408 PMCID: PMC10540070 DOI: 10.3389/fimmu.2023.1226622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023] Open
Abstract
Background While the short-term symptoms of post-COVID syndromes (PCS) are well-known, the long-term clinical characteristics, risk factors and outcomes of PCS remain unclear. Moreover, there is ongoing discussion about the effectiveness of post-infection vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) to aid in PCS recovery. Methods In this longitudinal and observational case-control study we aimed at identifying long-term PCS courses and evaluating the effects of post-infection vaccinations on PCS recovery. Individuals with initial mild COVID-19 were followed for a period of 15 months after primary infection. We assessed PCS outcomes, distinct symptom clusters (SC), and SARS-CoV-2 immunoglobulin G (IgG) levels in patients who received SARS-CoV-2 vaccination, as well as those who did not. To identify potential associating factors with PCS, we used binomial regression models and reported the results as odds ratios (OR) with 95% confidence intervals (95%CI). Results Out of 958 patients, follow-up data at 15 month after infection was obtained for 222 (23.2%) outpatients. Of those individuals, 36.5% (81/222) and 31.1% (69/222) were identified to have PCS at month 10 and 15, respectively. Fatigue and dyspnea (SC2) rather than anosmia and ageusia (SC1) constituted PCS at month 15. SARS-CoV-2 IgG levels were equally distributed over time among age groups, sex, and absence/presence of PCS. Of the 222 patients, 77.0% (171/222) were vaccinated between 10- and 15-months post-infection, but vaccination did not affect PCS recovery at month 15. 26.3% of unvaccinated and 25.8% of vaccinated outpatients improved from PCS (p= .9646). Baseline headache (SC4) and diarrhoea (SC5) were risk factors for PCS at months 10 and 15 (SC4: OR 1.85 (95%CI 1.04-3.26), p=.0390; SC5: OR 3.27(95%CI 1.54-6.64), p=.0009). Conclusion Based on the specific symptoms of PCS our findings show a shift in the pattern of recovery. We found no effect of SARS-CoV-2 vaccination on PCS recovery and recommend further studies to identify predicting biomarkers and targeted PCS therapeutics.
Collapse
Affiliation(s)
- Max Augustin
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research [Deutsches Zentrum für Infektionsforschung (DZIF)], Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research [Deutsches Zentrum für Infektionsforschung (DZIF)], Cologne, Germany
| | - Hauke Wüstenberg
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veronica Di Cristanziano
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Sandaradura de Silva
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research [Deutsches Zentrum für Infektionsforschung (DZIF)], Cologne, Germany
| | - Lea Katharina Picard
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elisabeth Pracht
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dominic Rauschning
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henning Gruell
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Florian Klein
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research [Deutsches Zentrum für Infektionsforschung (DZIF)], Cologne, Germany
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Wenisch
- Department IV of Internal Medicine, Klinik Favoriten, Vienna Healthcare Group, Vienna, Austria
| | - Michael Hallek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Schommers
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research [Deutsches Zentrum für Infektionsforschung (DZIF)], Cologne, Germany
- Institute of Virology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research [Deutsches Zentrum für Infektionsforschung (DZIF)], Cologne, Germany
| |
Collapse
|
5
|
Faria N, Oliveira T, Pinto P, Almeida V, Carvalho R, Fernandes MJ, Sucena M, Gomes J. Role of the one-minute sit-to-stand test in the diagnosis of post COVID-19 condition: a prospective cohort study. J Bras Pneumol 2023; 49:e20230027. [PMID: 37255165 PMCID: PMC10578920 DOI: 10.36416/1806-3756/e20230027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/23/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE To analyze the relationship between one-minute sit-to-stand test (1MSTST) parameters and a diagnosis of post COVID-19 condition in a cohort of patients who previously had COVID-19. METHODS This was a prospective cohort study of patients with post COVID-19 condition referred for body plethysmography at a tertiary university hospital. Post COVID-19 condition was defined in accordance with the current WHO criteria. RESULTS Fifty-three patients were analyzed. Of those, 25 (47.2%) met the clinical criteria for post COVID-19 condition. HR was lower in the patients with post COVID-19 condition than in those without it at 30 s after initiation of the 1MSTST (86.2 ± 14.3 bpm vs. 101.2 ± 14.7 bpm; p < 0.001) and at the end of the test (94.4 ± 18.2 bpm vs. 117.3 ± 15.3 bpm; p < 0.001). The ratio between HR at the end of the 1MSTST and age-predicted maximal HR (HRend/HRmax) was lower in the group of patients with post COVID-19 condition (p < 0.001). An HRend/HRmax of < 62.65% showed a sensitivity of 78.6% and a specificity of 82.0% for post COVID-19 condition. Mean SpO2 at the end of the 1MSTST was lower in the patients with post COVID-19 condition than in those without it (94.9 ± 3.6% vs. 96.8 ± 2.4%; p = 0.030). The former group of patients did fewer repetitions on the 1MSTST than did the latter (p = 0.020). CONCLUSIONS Lower SpO2 and HR at the end of the 1MSTST, as well as lower HR at 30 s after initiation of the test, were associated with post COVID-19 condition. In the appropriate clinical setting, an HRend/HRmax of < 62.65% should raise awareness for the possibility of post COVID-19 condition.
Collapse
Affiliation(s)
- Nuno Faria
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Tiago Oliveira
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
- . Serviço de Pneumologia, Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Paula Pinto
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Vânia Almeida
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Raquel Carvalho
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria José Fernandes
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria Sucena
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Joana Gomes
- . Serviço de Pneumologia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| |
Collapse
|
6
|
Chancharoenthana W, Kamolratanakul S, Leelahavanichkul A, Ariyanon W, Chinpraditsuk S, Saelim R, Vadcharavivad S, Phumratanaprapin W, Wilairatana P. Gastrointestinal manifestations of long-term effects after COVID-19 infection in patients with dialysis or kidney transplantation: An observational cohort study. World J Gastroenterol 2023; 29:3013-3026. [PMID: 37274795 PMCID: PMC10237091 DOI: 10.3748/wjg.v29.i19.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/13/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND Prolonged symptoms after corona virus disease 2019 (Long-COVID) in dialysis-dependent patients and kidney transplant (KT) recipients are important as a possible risk factor for organ dysfunctions, especially gastrointestinal (GI) problems, during immunosuppressive therapy.
AIM To identify the characteristics of GI manifestations of Long-COVID in patients with dialysis-dependent or KT status.
METHODS This observational, prospective study included patients with COVID-19 infection, confirmed by reverse transcription polymerase chain reaction, with the onset of symptoms between 1 January 2022 and 31 July 2022 which was explored at 3 mo after the onset, either through the out-patient follow-up or by telephone interviews.
RESULTS The 645 eligible participants consisted of 588 cases with hemodialysis (HD), 38 patients with peritoneal dialysis (PD), and 19 KT recipients who were hospitalized with COVID-19 infection during the observation. Of these, 577 (89.5%) cases agreed to the interviews, while 64 (10.9%) patients with HD and 4 (10.5%) cases of PD were excluded. The mean age was 52 ± 11 years with 52% women. The median dialysis duration was 7 ± 3 and 5 ± 1 years for HD and PD groups, respectively, and the median time post-transplantation was 6 ± 2 years. Long-COVID was identified in 293/524 (56%) and 21/34 (62%) in HD and PD, respectively, and 7/19 (37%) KT recipients. Fatigue was the most prevalent (96%) of the non-GI tract symptoms, whereas anorexia (90.9%), loss of taste (64.4%), and abdominal pain (62.5%) were the first three common GI manifestations of Long-COVID. Notably, there were 6 cases of mesenteric panniculitis from 19 patients with GI symptoms in the KT group.
CONCLUSION Different from patients with non-chronic kidney disease, there was a high prevalence of GI manifestations of Long-COVID in dialysis-dependent patients and KT recipients. An appropriate long-term follow-up in these vulnerable populations after COVID-19 infection is possibly necessary.
Collapse
Affiliation(s)
- Wiwat Chancharoenthana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Supitcha Kamolratanakul
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Asada Leelahavanichkul
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Wassawon Ariyanon
- Cardiometabolic Centre, Department of Medicine, Bangkok Nursing Hospital, Bangkok 10500, Thailand
| | - Sutatip Chinpraditsuk
- Dialysis Center, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Rattanaporn Saelim
- Dialysis Center, Hospital for Tropical Diseases, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Somratai Vadcharavivad
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand
| | - Weerapong Phumratanaprapin
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| |
Collapse
|
7
|
Sherif ZA, Gomez CR, Connors TJ, Henrich TJ, Reeves WB. Pathogenic mechanisms of post-acute sequelae of SARS-CoV-2 infection (PASC). eLife 2023; 12:e86002. [PMID: 36947108 PMCID: PMC10032659 DOI: 10.7554/elife.86002] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/10/2023] [Indexed: 03/23/2023] Open
Abstract
COVID-19, with persistent and new onset of symptoms such as fatigue, post-exertional malaise, and cognitive dysfunction that last for months and impact everyday functioning, is referred to as Long COVID under the general category of post-acute sequelae of SARS-CoV-2 infection (PASC). PASC is highly heterogenous and may be associated with multisystem tissue damage/dysfunction including acute encephalitis, cardiopulmonary syndromes, fibrosis, hepatobiliary damages, gastrointestinal dysregulation, myocardial infarction, neuromuscular syndromes, neuropsychiatric disorders, pulmonary damage, renal failure, stroke, and vascular endothelial dysregulation. A better understanding of the pathophysiologic mechanisms underlying PASC is essential to guide prevention and treatment. This review addresses potential mechanisms and hypotheses that connect SARS-CoV-2 infection to long-term health consequences. Comparisons between PASC and other virus-initiated chronic syndromes such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome will be addressed. Aligning symptoms with other chronic syndromes and identifying potentially regulated common underlining pathways may be necessary for understanding the true nature of PASC. The discussed contributors to PASC symptoms include sequelae from acute SARS-CoV-2 injury to one or more organs, persistent reservoirs of the replicating virus or its remnants in several tissues, re-activation of latent pathogens such as Epstein-Barr and herpes viruses in COVID-19 immune-dysregulated tissue environment, SARS-CoV-2 interactions with host microbiome/virome communities, clotting/coagulation dysregulation, dysfunctional brainstem/vagus nerve signaling, dysautonomia or autonomic dysfunction, ongoing activity of primed immune cells, and autoimmunity due to molecular mimicry between pathogen and host proteins. The individualized nature of PASC symptoms suggests that different therapeutic approaches may be required to best manage specific patients.
Collapse
Affiliation(s)
- Zaki A Sherif
- Department of Biochemistry & Molecular Biology, Howard University College of MedicineWashington, District of ColumbiaUnited States
| | - Christian R Gomez
- Division of Lung Diseases, National Institutes of Health (NIH), National Heart, Lung and Blood Institute (NHLBI)BethesdaUnited States
| | - Thomas J Connors
- Department of Pediatrics, Division of Critical Care, Columbia University Vagelos College of Physicians and Surgeons and New York - Presbyterian Morgan Stanley Children's HospitalNew YorkUnited States
| | - Timothy J Henrich
- Division of Experimental Medicine, University of CaliforniaSan FranciscoUnited States
| | - William Brian Reeves
- Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of TexasSan AntonioUnited States
| |
Collapse
|
8
|
Feltrin TD, Cielo CA, Pasqualoto AS. Relation between Orotracheal Intubation, Inflammatory Markers, Breathing and Voice in Post-COVID-19. J Voice 2023:S0892-1997(23)00070-X. [PMID: 37045738 PMCID: PMC9946891 DOI: 10.1016/j.jvoice.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION COVID-19, an infectious disease with a wide spectrum of clinical manifestations and intensities in the human body, it can cause respiratory and vocal disorders, with fatigue. OBJECTIVE To verify the relation between biological Inflammatory markers D-dimers and C-Reactive Protein, Forced Vital Capacity, Maximum Phonation Time, vocal performance and fatigue, length of hospitalization period and gender of people affected by COVID-19 who were hospitalized, but did not use orotracheal intubation and compare with a group of post-COVID-19 patients with orotracheal intubation. METHODS Data on D-dimers and C-Reactive Protein, spirometry, Maximum Phonation Time, performance and vocal fatigue were collected. The study included 42 adult people affected by COVID-19 who were hospitalized, 22 (52.4%) female and 20 (47.6%) male; 23 (54.8%) critical cases composing the group with orotracheal intubation (average age 48.9 years old) and 19 (45.24%) severe cases in the group without orotracheal intubation (average age 49.9 years old). RESULTS hospital length of stay was significantly longer for the group with orotracheal intubation; D-dimers were significantly altered in all groups; correlations between maximum phonation times were positive and significant; correlations between maximum phonation times, vocal performance and fatigue were both negative and significant. CONCLUSION Patients with orotracheal intubation had longer hospital internment and increased D-dimers and were amazed that, whenever maximum phonation times decreased performance and vocal fatigue increased.
Collapse
Affiliation(s)
- Thaís D Feltrin
- Department of Speech Therapy, Federal University of Santa Maria, Santa Maria, RS, Brazil.
| | - Carla A Cielo
- Department of Speech Therapy and Human Communication Disorders, Federal University of Santa Maria, Santa Maria RS, Brazil
| | - Adriane S Pasqualoto
- Department of Physiotherapy and Human Communication Disorders, Federal University of Santa Maria, Santa Maria, RS, Brazil
| |
Collapse
|
9
|
Danesh V, Arroliga AC, Bourgeois JA, Boehm LM, McNeal MJ, Widmer AJ, McNeal TM, Kesler SR. Symptom Clusters Seen in Adult COVID-19 Recovery Clinic Care Seekers. J Gen Intern Med 2023; 38:442-449. [PMID: 36376627 PMCID: PMC9663188 DOI: 10.1007/s11606-022-07908-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND COVID-19 symptom reports describe varying levels of disease severity with differing periods of recovery and symptom trajectories. Thus, there are a multitude of disease and symptom characteristics clinicians must navigate and interpret to guide care. OBJECTIVE To find natural groups of patients with similar constellations of post-acute sequelae of COVID-19 (PASC) symptoms. DESIGN Cohort SETTING: Outpatient COVID-19 recovery clinic with patient referrals from 160 primary care clinics serving 36 counties in Texas. PATIENTS Adult patients seeking COVID-19 recovery clinic care between November 15, 2020, and July 31, 2021, with laboratory-confirmed mild (not hospitalized), moderate (hospitalized), or severe (hospitalized with critical care) COVID-19. MAIN MEASURES Demographics, COVID illness onset, and duration of persistent PASC symptoms via semi-structured medical assessments. KEY RESULTS Four hundred forty-one patients (mean age 51.5 years; 295 [66.9%] women; 99 [22%] Hispanic, and 170 [38.5%] non-White, racial minority) met inclusion criteria. Using a k-medoids algorithm, we found that PASC symptoms cluster into two distinct groups: neuropsychiatric (N = 186) (e.g., subjective cognitive dysfunction) and pulmonary (N = 255) (e.g., dyspnea, cough). The neuropsychiatric cluster had significantly higher incidences of otolaryngologic (X2 = 14.3, p < 0.001), gastrointestinal (X2 = 6.90, p = 0.009), neurologic (X2 = 441, p < 0.001), and psychiatric sequelae (X2 = 40.6, p < 0.001) with more female (X2 = 5.44, p = 0.020) and younger age (t = 2.39, p = 0.017) patients experiencing longer durations of PASC symptoms before seeking care (t = 2.44, p = 0.015). Patients in the pulmonary cluster were more often hospitalized for COVID-19 (X2 = 3.98, p = 0.046) and had significantly higher comorbidity burden (U = 20800, p = 0.019) and pulmonary sequelae (X2 = 13.2, p < 0.001). CONCLUSIONS Health services clinic data from a large integrated health system offers insights into the post-COVID symptoms associated with care seeking for sequelae that are not adequately managed by usual care pathways (self-management and primary care clinic visits). These findings can inform machine learning algorithms, primary care management, and selection of patients for earlier COVID-19 recovery referral. TRIAL REGISTRATION N/A.
Collapse
Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, 3434 Live Oak St, Dallas, TX, 75204, USA.
- School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Alejandro C Arroliga
- Baylor Scott & White Health, Dallas, TX, USA
- College of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James A Bourgeois
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA
- Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael J McNeal
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Andrew J Widmer
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Tresa M McNeal
- Baylor Scott & White Health, Temple, TX, USA
- College of Medicine, Texas A&M University, College Station, TX, USA
| | - Shelli R Kesler
- School of Nursing, University of Texas at Austin, Austin, TX, USA
- Department of Diagnostic Medicine, Dell School of Medicine, University of Texas at Austin, Austin, TX, USA
| |
Collapse
|
10
|
Rodríguez Onieva A, Vallejo Basurte C, Fernández Bersabé A, Camacho Cerro L, Valverde Bascón B, Muriel Sanjuan N, Soto Castro CA, García Morales V, Piedra Ruiz F, Hidalgo Requena A. Clinical Characterization of the Persistent COVID-19 Symptoms: A Descriptive Observational Study in Primary Care. J Prim Care Community Health 2023; 14:21501319231208283. [PMID: 37947104 PMCID: PMC10638863 DOI: 10.1177/21501319231208283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Evidence and clinical experience suggest that there are a range of signs of health issues that affect patients who have recovered from acute COVID-19 infection. This condition is commonly referred to as "persistent COVID-19," which is not connected with the severity of the disease. We have identified the prevalence and clinical-epidemiological characteristics of patients with COVID-19 and persistent symptoms treated in primary care centers. This is a descriptive observational study conducted between December 2020 and May 2022, the data were collected from digitized medical records and interviewing 1542 individuals with laboratory-confirmed SARS-CoV-2 infection. These patients were clinically followed for up to 1 year, based on the prevalence of symptoms. When stratifying by the risk of developing persistent COVID-19, 37.09% of the patients exhibited risk factors, with age (over 60 years) and cardiovascular risk factors predominating. The obtained prevalence of persistent COVID-19 at 90 days was 12.39%, with a slight predominance in females (55%) and a mean age of 45.8 years. The most affected systems were the cardiovascular, respiratory, and psychoneurological systems, with predominant symptoms of fatigue (41.88%), dyspnea (32.46%), and headache (14.66%), among others. The average duration of persistent symptoms was 178 days, equivalent to 6 months. In conclusion, over 10% of patients who recover from acute SARS-CoV-2 infection developed long-term consequences. OBJECTIVE To measure the prevalence and clinical-epidemiological characteristics of individuals diagnosed with COVID-19 and persistent symptoms treated in primary care centers in Área Sanitaria Sur de Córdoba (Spain) between December 2020 and May 2022. METHODS A retrospective observational study of the population of Área Sanitaria Sur de Córdoba was developed between December 2020 and May 2022. The scope of the study was 1542 individuals, and the prevalence of patients diagnosed with COVID-19 and persistent symptoms was determined based on laboratory-confirmed cases, randomly selected from adults who had progressed beyond the acute phase of the disease. All data were managed by the Área Sanitaria Sur de Córdoba (Spain). RESULTS The risk factor of exhibiting one or more risk factors associated with developing persistent COVID-19 is 37.09%. The obtained prevalence of persistent COVID-19 at 90 days is 12.39%, it is higher in females (55%) than males and the mean age was 45.8 years. The most affected systems were the cardiovascular, respiratory, and psychoneurological systems, with predominant symptoms of fatigue (41.88%), dyspnea (32.46%), and headache (14.66%), among others. CONCLUSIONS Results confirm that more than 10% of individuals recovering from acute SARS-CoV-2 infection showed long-term consequences and the observed persistent symptom duration was 178 days on average.
Collapse
|
11
|
Doheny EP, Flood M, Ryan S, McCarthy C, O'Carroll O, O'Seaghdha C, Mallon PW, Feeney ER, Keatings VM, Wilson M, Kennedy N, Gannon A, Edwards C, Lowery MM. Prediction of low pulse oxygen saturation in COVID-19 using remote monitoring post hospital discharge. Int J Med Inform 2023; 169:104911. [PMID: 36347139 PMCID: PMC9625852 DOI: 10.1016/j.ijmedinf.2022.104911] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Monitoring systems have been developed during the COVID-19 pandemic enabling clinicians to remotely monitor physiological measures including pulse oxygen saturation (SpO2), heart rate (HR), and breathlessness in patients after discharge from hospital. These data may be leveraged to understand how symptoms vary over time in COVID-19 patients. There is also potential to use remote monitoring systems to predict clinical deterioration allowing early identification of patients in need of intervention. METHODS A remote monitoring system was used to monitor 209 patients diagnosed with COVID-19 in the period following hospital discharge. This system consisted of a patient-facing app paired with a Bluetooth-enabled pulse oximeter (measuring SpO2 and HR) linked to a secure portal where data were available for clinical review. Breathlessness score was entered manually to the app. Clinical teams were alerted automatically when SpO2 < 94 %. In this study, data recorded during the initial ten days of monitoring were retrospectively examined, and a random forest model was developed to predict SpO2 < 94 % on a given day using SpO2 and HR data from the two previous days and day of discharge. RESULTS Over the 10-day monitoring period, mean SpO2 and HR increased significantly, while breathlessness decreased. The coefficient of variation in SpO2, HR and breathlessness also decreased over the monitoring period. The model predicted SpO2 alerts (SpO2 < 94 %) with a mean cross-validated. sensitivity of 66 ± 18.57 %, specificity of 88.31 ± 10.97 % and area under the receiver operating characteristic of 0.80 ± 0.11. Patient age and sex were not significantly associated with the occurrence of asymptomatic SpO2 alerts. CONCLUSION Results indicate that SpO2 alerts (SpO2 < 94 %) on a given day can be predicted using SpO2 and heart rate data captured on the two preceding days via remote monitoring. The methods presented may help early identification of patients with COVID-19 at risk of clinical deterioration using remote monitoring.
Collapse
Affiliation(s)
- Emer P. Doheny
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland,Corresponding author
| | - Matthew Flood
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
| | - Silke Ryan
- School of Medicine, University College Dublin, Dublin, Ireland,St. Vincent’s University Hospital, Dublin, Ireland
| | - Cormac McCarthy
- School of Medicine, University College Dublin, Dublin, Ireland,St. Vincent’s University Hospital, Dublin, Ireland
| | | | | | | | - Eoin R. Feeney
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | | | - Avril Gannon
- Midland Regional Hospital at Tullamore, Tullamore, Ireland
| | | | - Madeleine M. Lowery
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland,Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| |
Collapse
|
12
|
Goldman M. Long Covid, a great imitator of the 21th century. Front Med (Lausanne) 2022; 9:1026425. [PMID: 36186771 PMCID: PMC9519984 DOI: 10.3389/fmed.2022.1026425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
|
13
|
Briller JE, Aggarwal NR, Davis MB, Hameed AB, Malhamé I, Mahmoud Z, McDonald EG, Moraes de Oliveira G, Quesada O, Scott NS, Sharma J. Cardiovascular Complications of Pregnancy-Associated COVID-19 Infections. JACC: Advances 2022; 1:100057. [PMID: 35967591 PMCID: PMC9364954 DOI: 10.1016/j.jacadv.2022.100057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/25/2022]
|
14
|
Kläser K, Molteni E, Graham M, Canas LS, Österdahl MF, Antonelli M, Chen L, Deng J, Murray B, Kerfoot E, Wolf J, May A, Fox B, Capdevila J, Modat M, Hammers A, Spector TD, Steves CJ, Sudre CH, Ourselin S, Duncan EL. COVID-19 due to the B.1.617.2 (Delta) variant compared to B.1.1.7 (Alpha) variant of SARS-CoV-2: a prospective observational cohort study. Sci Rep 2022; 12:10904. [PMID: 35764879 PMCID: PMC9240087 DOI: 10.1038/s41598-022-14016-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/31/2022] [Indexed: 01/07/2023] Open
Abstract
The Delta (B.1.617.2) variant was the predominant UK circulating SARS-CoV-2 strain between May and December 2021. How Delta infection compares with previous variants is unknown. This prospective observational cohort study assessed symptomatic adults participating in the app-based COVID Symptom Study who tested positive for SARS-CoV-2 from May 26 to July 1, 2021 (Delta overwhelmingly the predominant circulating UK variant), compared (1:1, age- and sex-matched) with individuals presenting from December 28, 2020 to May 6, 2021 (Alpha (B.1.1.7) the predominant variant). We assessed illness (symptoms, duration, presentation to hospital) during Alpha- and Delta-predominant timeframes; and transmission, reinfection, and vaccine effectiveness during the Delta-predominant period. 3581 individuals (aged 18 to 100 years) from each timeframe were assessed. The seven most frequent symptoms were common to both variants. Within the first 28 days of illness, some symptoms were more common with Delta versus Alpha infection (including fever, sore throat, and headache) and some vice versa (dyspnoea). Symptom burden in the first week was higher with Delta versus Alpha infection; however, the odds of any given symptom lasting ≥ 7 days was either lower or unchanged. Illness duration ≥ 28 days was lower with Delta versus Alpha infection, though unchanged in unvaccinated individuals. Hospitalisation for COVID-19 was unchanged. The Delta variant appeared more (1.49) transmissible than Alpha. Re-infections were low in all UK regions. Vaccination markedly reduced the risk of Delta infection (by 69-84%). We conclude that COVID-19 from Delta or Alpha infections is similar. The Delta variant is more transmissible than Alpha; however, current vaccines showed good efficacy against disease. This research framework can be useful for future comparisons with new emerging variants.
Collapse
Affiliation(s)
- Kerstin Kläser
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Erika Molteni
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Mark Graham
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liane S Canas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Marc F Österdahl
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Aging and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michela Antonelli
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Liyuan Chen
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Jie Deng
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Benjamin Murray
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | | | | | | | - Marc Modat
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- King's College London & Guy's and St Thomas' PET Centre, London, UK
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK
- Department of Aging and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Carole H Sudre
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- MRC Unit for Lifelong Health and Ageing, Department of Population Health Sciences, University College London, London, UK
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - Sebastien Ourselin
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, St Thomas' Hospital Campus, 3rd Floor South Wing Block D, Westminster Bridge Road, London, SE1 7EH, UK.
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| |
Collapse
|
15
|
Haroon S, Nirantharakumar K, Hughes SE, Subramanian A, Aiyegbusi OL, Davies EH, Myles P, Williams T, Turner G, Chandan JS, McMullan C, Lord J, Wraith DC, McGee K, Denniston AK, Taverner T, Jackson LJ, Sapey E, Gkoutos G, Gokhale K, Leggett E, Iles C, Frost C, McNamara G, Bamford A, Marshall T, Zemedikun DT, Price G, Marwaha S, Simms-Williams N, Brown K, Walker A, Jones K, Matthews K, Camaradou J, Saint-Cricq M, Kumar S, Alder Y, Stanton DE, Agyen L, Baber M, Blaize H, Calvert M. Therapies for Long COVID in non-hospitalised individuals: from symptoms, patient-reported outcomes and immunology to targeted therapies (The TLC Study). BMJ Open 2022; 12:e060413. [PMID: 35473737 PMCID: PMC9044550 DOI: 10.1136/bmjopen-2021-060413] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Individuals with COVID-19 frequently experience symptoms and impaired quality of life beyond 4-12 weeks, commonly referred to as Long COVID. Whether Long COVID is one or several distinct syndromes is unknown. Establishing the evidence base for appropriate therapies is needed. We aim to evaluate the symptom burden and underlying pathophysiology of Long COVID syndromes in non-hospitalised individuals and evaluate potential therapies. METHODS AND ANALYSIS A cohort of 4000 non-hospitalised individuals with a past COVID-19 diagnosis and 1000 matched controls will be selected from anonymised primary care records from the Clinical Practice Research Datalink, and invited by their general practitioners to participate on a digital platform (Atom5). Individuals will report symptoms, quality of life, work capability and patient-reported outcome measures. Data will be collected monthly for 1 year.Statistical clustering methods will be used to identify distinct Long COVID-19 symptom clusters. Individuals from the four most prevalent clusters and two control groups will be invited to participate in the BioWear substudy which will further phenotype Long COVID symptom clusters by measurement of immunological parameters and actigraphy.We will review existing evidence on interventions for postviral syndromes and Long COVID to map and prioritise interventions for each newly characterised Long COVID syndrome. Recommendations will be made using the cumulative evidence in an expert consensus workshop. A virtual supportive intervention will be coproduced with patients and health service providers for future evaluation.Individuals with lived experience of Long COVID will be involved throughout this programme through a patient and public involvement group. ETHICS AND DISSEMINATION Ethical approval was obtained from the Solihull Research Ethics Committee, West Midlands (21/WM/0203). Research findings will be presented at international conferences, in peer-reviewed journals, to Long COVID patient support groups and to policymakers. TRIAL REGISTRATION NUMBER 1567490.
Collapse
Affiliation(s)
- Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK (HDR UK) Midlands, Birmingham, UK
| | - Sarah E Hughes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
| | | | - Olalekan Lee Aiyegbusi
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Applied Research Centre West Midlands, Birmingham, UK
| | | | - Puja Myles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Tim Williams
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Grace Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christel McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Janet Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Kirsty McGee
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Thomas Taverner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Louise J Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Elizabeth Sapey
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - George Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Edward Leggett
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Clare Iles
- Clinical Practice Research Datalink, Medicines and Healthcare Products Regulatory Agency, London, UK
| | | | | | - Amy Bamford
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Steven Marwaha
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | | | - Kirsty Brown
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Anita Walker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karen Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | | | | | | | | | | | | | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Health Data Research UK (HDR UK) Midlands, Birmingham, UK
| |
Collapse
|
16
|
Righi E, Mirandola M, Mazzaferri F, Dossi G, Razzaboni E, Zaffagnini A, Ivaldi F, Visentin A, Lambertenghi L, Arena C, Micheletto C, Gibellini D, Tacconelli E. Determinants of persistence of symptoms and impact on physical and mental wellbeing in Long COVID: A prospective cohort study. J Infect 2022; 84:566-572. [PMID: 35150765 PMCID: PMC8828388 DOI: 10.1016/j.jinf.2022.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Residual symptoms can be detected for several months after COVID-19. To better understand the predictors and impact of symptom persistence we analyzed a prospective cohort of COVID-19 patients. METHODS Patients were followed for 9 months after COVID-19 onset. Duration and predictors of persistence of symptoms, physical health and psychological distress were assessed. RESULTS 465 patients (54% males, 51% hospitalized) were included; 37% presented with at least 4 symptoms and 42% complained of symptom lasting more than 28 days. At month 9, 20% of patients were still symptomatic, showing mainly fatigue (11%) and breathlessness (8%). Hospitalization and ICU stay vs. non-hospitalized status increased the median duration of fatigue of 8 weeks. Age > 50 years (OR 2.50), ICU stay (OR 2.35), and presentation with 4 or more symptoms (OR 2.04) were independent predictors of persistence of symptoms at month 9. A total of 18% of patients did not return to optimal pre-COVID physical health, while 19% showed psychological distress at month 9. Hospital admission (OR 2.28) and persistence of symptoms at day 28 (OR 2.21) and month 9 (OR 5.16) were independent predictors of suboptimal physical health, while female gender (OR 5.27) and persistence of symptoms at day 28 (OR 2.42) and month 9 (OR 2.48) were risk factors for psychological distress. CONCLUSIONS Patients with advanced age, ICU stay and multiple symptoms at onset were more likely to suffer from long-term symptoms, which had a negative impact on both physical and mental wellbeing. This study contributes to identify the target populations and Long COVID consequences for planning long-term recovery interventions.
Collapse
Affiliation(s)
- Elda Righi
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy.
| | - Massimo Mirandola
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Fulvia Mazzaferri
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Giuditta Dossi
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Elisa Razzaboni
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Amina Zaffagnini
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Federico Ivaldi
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Alessandro Visentin
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Lorenza Lambertenghi
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| | - Cinzia Arena
- Respiratory Unit, Verona University Hospital, Verona, Italy
| | | | - Davide Gibellini
- Diagnostics and Public Health Department, Microbiology Unit, University of Verona, Verona, Italy
| | - Evelina Tacconelli
- Diagnostics and Public Health Department, Infectious Diseases Division, University of Verona, P.le L.A. Scuro 10, Verona 37134, Italy
| |
Collapse
|
17
|
Callan C, Ladds E, Husain L, Pattinson K, Greenhalgh T. 'I can't cope with multiple inputs': a qualitative study of the lived experience of 'brain fog' after COVID-19. BMJ Open 2022; 12:e056366. [PMID: 35149572 PMCID: PMC8844964 DOI: 10.1136/bmjopen-2021-056366] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/26/2022] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To explore the lived experience of 'brain fog'-the wide variety of neurocognitive symptoms that can follow COVID-19. DESIGN AND SETTING A UK-wide longitudinal qualitative study comprising online focus groups with email follow-up. METHOD 50 participants were recruited from a previous qualitative study of the lived experience of long COVID-19 (n=23) and online support groups for people with persistent neurocognitive symptoms following COVID-19 (n=27). In remotely held focus groups, participants were invited to describe their neurocognitive symptoms and comment on others' accounts. Individuals were followed up by email 4-6 months later. Data were audiotaped, transcribed, anonymised and coded in NVIVO. They were analysed by an interdisciplinary team with expertise in general practice, clinical neuroscience, the sociology of chronic illness and service delivery, and checked by people with lived experience of brain fog. RESULTS Of the 50 participants, 42 were female and 32 white British. Most had never been hospitalised for COVID-19. Qualitative analysis revealed the following themes: mixed views on the appropriateness of the term 'brain fog'; rich descriptions of the experience of neurocognitive symptoms (especially executive function, attention, memory and language), accounts of how the illness fluctuated-and progressed over time; the profound psychosocial impact of the condition on relationships, personal and professional identity; self-perceptions of guilt, shame and stigma; strategies used for self-management; challenges accessing and navigating the healthcare system; and participants' search for physical mechanisms to explain their symptoms. CONCLUSION These qualitative findings complement research into the epidemiology and mechanisms of neurocognitive symptoms after COVID-19. Services for such patients should include: an ongoing therapeutic relationship with a clinician who engages with their experience of neurocognitive symptoms in its personal, social and occupational context as well as specialist services that include provision for neurocognitive symptoms, are accessible, easily navigable, comprehensive and interdisciplinary.
Collapse
Affiliation(s)
- Caitriona Callan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laiba Husain
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kyle Pattinson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
18
|
O'Boyle S, Nacul L, Nacul FE, Mudie K, Kingdon CC, Cliff JM, Clark TG, Dockrell HM, Lacerda EM. A Natural History of Disease Framework for Improving the Prevention, Management, and Research on Post-viral Fatigue Syndrome and Other Forms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Front Med (Lausanne) 2022; 8:688159. [PMID: 35155455 PMCID: PMC8835111 DOI: 10.3389/fmed.2021.688159] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 12/27/2021] [Indexed: 01/04/2023] Open
Abstract
We propose a framework for the treatment, rehabilitation, and research into Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) using a natural history of disease approach to outline the distinct disease stages, with an emphasis on cases following infection to provide insights into prevention. Moving away from the method of subtyping patients based on the various phenotypic presentations and instead reframing along the lines of disease progression could help with defining the distinct stages of disease, each of which would benefit from large prospective cohort studies to accurately describe the pathological mechanisms taking place therein. With a better understanding of these mechanisms, management and research can be tailored specifically for each disease stage. Pre-disease and early disease stages call for management strategies that may decrease the risk of long-term morbidity, by focusing on avoidance of further insults, adequate rest to enable recovery, and pacing of activities. Later disease stages require a more holistic and tailored management approach, with treatment-as this becomes available-targeting the alleviation of symptoms and multi-systemic dysfunction. More stringent and standardised use of case definitions in research is critical to improve generalisability of results and to create the strong evidence-based policies for management that are currently lacking in ME/CFS.
Collapse
Affiliation(s)
- Shennae O'Boyle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- UK Health Security Agency, London, United Kingdom
| | - Luis Nacul
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- B.C. Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Flavio E. Nacul
- Pro-cardiaco Hospital and Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kathleen Mudie
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Caroline C. Kingdon
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jacqueline M. Cliff
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Taane G. Clark
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hazel M. Dockrell
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eliana M. Lacerda
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
19
|
Cristillo V, Pilotto A, Cotti Piccinelli S, Bonzi G, Canale A, Gipponi S, Bezzi M, Leonardi M, Padovani A, Libri I, Giunta M, Cortinovis M, Locatelli M, Risi B, di Cola FS, Zoppi N. Premorbid vulnerability and disease severity impact on Long-COVID cognitive impairment. Aging Clin Exp Res 2022; 34:257-260. [PMID: 35014002 PMCID: PMC8747881 DOI: 10.1007/s40520-021-02042-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/21/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Cognitive deficits have been increasingly reported as possible long-term manifestations after SARS-CoV-2 infection. AIMS In this study we aimed at evaluating the factors associated with cognitive deficits 6 months after hospitalization for Coronavirus Disease 2019 (COVID-19). METHODS One hundred and six patients, discharged from a pneumology COVID-19 unit between March 1 and May 30 2020, accepted to be evaluated at 6 months according to an extensive neurological protocol, including the Montreal Cognitive Assessment (MoCA). RESULTS Abnormal MoCA scores at 6 months follow-up were associated with higher pre-hospitalization National Health System (NHS) score (Duca et al. in Emerg Med Pract 22:1-2, 2020) (OR 1.27; 95% CI 1.05-1.6; p = 0.029) and more severe pulmonary disease expressed by the Brescia-COVID Respiratory Severity Scale (Duca et al. in Emerg Med Pract 22:1-2, 2020) (BCRSS > 1OR 4.73; 95% CI 1.53-14.63; p = 0.003) during the acute phase of the disease. DISCUSSION This longitudinal study showed that the severity of COVID-19, indicated by BCRSS, and a complex score given by age and premorbid medical conditions, expressed by NHS, play a major role in modulating the long-term cognitive consequences of COVID-19 disease. CONCLUSIONS These findings indicate that the association of age and premorbid factors might identify people at risk for long-term neurological consequences of COVID-19 disease, thus deserving longer and proper follow-up.
Collapse
|
20
|
Mancuzo EV, Marinho CC, Machado-Coelho GLL, Batista AP, Oliveira JF, Andrade BH, Brandão ÁLT, Leite ASM, Ferreira PC, Roveda JRC, Leite AS, Augusto VM. Lung function of patients hospitalized with COVID-19 at 45 days after hospital discharge: first report of a prospective multicenter study in Brazil. J Bras Pneumol 2021; 47:e20210162. [PMID: 34932718 PMCID: PMC8836626 DOI: 10.36416/1806-3756/e20210162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Because SARS-CoV-2 infection can severely affect the lungs and persistent functional changes can occur after severe disease, we aimed to determine lung function parameters of COVID-19 patients at 45 days after hospital discharge and compare changes according to the severity of the disease. Methods: This was a prospective descriptive analytical multicenter study. The participants were allocated into three groups: ward admission (WA) group; ICU admission not on mechanical ventilation (ICU/MV−) group; and ICU admission on MV (ICU/MV+) group. Lung volumes, DLco, MIP, MEP, and six-minute walk distance (6MWD) were measured 45 days after discharge. Results: The sample comprised 242 patients (mean age = 59.4 ± 14.8 years; 52.1% of males), and 232 (96%) had altered lung function. In the total cohort, restrictive disorder was observed in 96%, as well as reductions in DLco (in 21.2% of the patients), FEV1/FVC (in 39.7%), and PEmax (in 95.8%), with no differences between the groups. Comparing the groups, the ICU/MV+ group had reduced DLco in 50% of the patients (p < 0.001) and a lower mean 6MWD % of the predicted value (p = 0.013). Oxygen desaturation in the six-minute walk test was observed in 32.3% of the cohort and was less frequent in the IE group. Conclusions: This is the first South American study involving severe COVID-19 survivors whose lung function was assessed 45 days after hospital discharge. Changes were frequent, especially in those on MV, which highlights the importance of lung function evaluation after severe COVID-19.
Collapse
|
21
|
Cassar MP, Tunnicliffe EM, Petousi N, Lewandowski AJ, Xie C, Mahmod M, Samat AHA, Evans RA, Brightling CE, Ho LP, Piechnik SK, Talbot NP, Holdsworth D, Ferreira VM, Neubauer S, Raman B. Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19. EClinicalMedicine 2021; 41:101159. [PMID: 34693230 PMCID: PMC8527025 DOI: 10.1016/j.eclinm.2021.101159] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19. METHODS Fifty-eight patients and thirty matched controls (single visit), recruited between 14th March - 25th May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months. FINDINGS At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T1 (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O2) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m2, P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O2, although better, were abnormal in patients versus controls. 31% had reduced pV̇O2 secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures. INTERPRETATION In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health. FUNDING The authors' work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.
Collapse
Affiliation(s)
- Mark Philip Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Elizabeth M. Tunnicliffe
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Nayia Petousi
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Adam J. Lewandowski
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Cheng Xie
- Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Masliza Mahmod
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Azlan Helmy Abd Samat
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Rachael A. Evans
- NIHR Biomedical Research Centre (Respiratory theme), University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Christopher E. Brightling
- NIHR Biomedical Research Centre (Respiratory theme), University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Ling-Pei Ho
- Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Weatherall Institute of Molecular Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan K. Piechnik
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Nick P. Talbot
- Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - David Holdsworth
- Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
| | - Vanessa M. Ferreira
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom
- Corresponding Author: Dr Betty Raman, Oxford Centre for Clinical Magnetic Resonance Research, Level 0, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom, Telephone number: 00441865234580
| |
Collapse
|
22
|
Wildi K, Li Bassi G, Barnett A, Panigada M, Colombo SM, Bandera A, Muscatello A, McNicholas B, Laffey JG, Battaglini D, Robba C, Torres A, Motos A, Luna CM, Rainieri F, Hodgson C, Burrell AJC, Buscher H, Dalton H, Cho SM, Choi HA, Thomson D, Suen J, Fraser JF. Design and Rationale of a Prospective International Follow-Up Study on Intensive Care Survivors of COVID-19: The Long-Term Impact in Intensive Care Survivors of Coronavirus Disease-19-AFTERCOR. Front Med (Lausanne) 2021; 8:738086. [PMID: 34568393 PMCID: PMC8455846 DOI: 10.3389/fmed.2021.738086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/09/2021] [Indexed: 01/16/2023] Open
Abstract
Background: In a disease that has only existed for 18 months, it is difficult to be fully informed of the long-term sequelae of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Evidence is growing that most organ systems can be affected by the virus, causing severe disabilities in survivors. The extent of the aftermath will declare itself over the next 5-10 years, but it is likely to be substantial with profound socio-economic impact on society. Methods: This is an international multi-center, prospective long-term follow-up study of patients who developed severe coronavirus disease-2019 (COVID-19) and were admitted to Intensive Care Units (ICUs). The study will be conducted at international tertiary hospitals. Patients will be monitored from time of ICU discharge up to 24 months. Information will be collected on demographics, co-existing illnesses before ICU admission, severity of illness during ICU admission and post-ICU quality of life as well as organ dysfunction and recovery. Statistical analysis will consist of patient trajectories over time for the key variables of quality of life and organ function. Using latent class analysis, we will determine if there are distinct patterns of patients in terms of recovery. Multivariable regression analyses will be used to examine associations between baseline characteristics and severity variables upon admission and discharge in the ICU, and how these impact outcomes at all follow-up time points up to 2 years. Ethics and Dissemination: The core study team and local principal investigators will ensure that the study adheres to all relevant national and local regulations, and that the necessary approvals are in place before a site may enroll patients. Clinical Trial Registration:anzctr.org.au: ACTRN12620000799954.
Collapse
Affiliation(s)
- Karin Wildi
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Gianluigi Li Bassi
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Adrian Barnett
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, Queensland University of Technology QUT, Brisbane, QLD, Australia
| | - Mauro Panigada
- Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Sebastiano M Colombo
- Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Antonio Muscatello
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Milan, Italy
| | - Bairbre McNicholas
- Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - John G Laffey
- Galway University Hospitals, National University of Ireland, Galway, Ireland
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Antoni Torres
- Servei de Pneumologia, Hospital Clinic, University of Barcelona, IDIBAPS, ICREA, CIBERESUCICOVID, Barcelona, Spain
| | - Ana Motos
- Servei de Pneumologia, Hospital Clinic, University of Barcelona, IDIBAPS, ICREA, CIBERESUCICOVID, Barcelona, Spain
| | | | | | - Carol Hodgson
- The Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | | | - Hergen Buscher
- St. Vincent's Hospital Sydney, University of New South Wales, Darlinghurst, NSW, Australia
| | - Heidi Dalton
- Inova Fairfax Hospital, Falls Church, VA, United States
| | - Sung-Min Cho
- Departments of Neurology, Neurosurgery, Anesthesia and Critical Care Medicine, John Hopkins Hospital, Baltimore, MD, United States
| | | | - David Thomson
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Jacky Suen
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John F Fraser
- Critical Care Research Group, Brisbane, QLD, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| |
Collapse
|
23
|
Dauletbaev N, Kuhn S, Holtz S, Waldmann S, Niekrenz L, Müller BS, Bellinghausen C, Dreher M, Rohde GGU, Vogelmeier C. Implementation and use of mHealth home telemonitoring in adults with acute COVID-19 infection: a scoping review protocol. BMJ Open 2021; 11:e053819. [PMID: 34580103 PMCID: PMC8478582 DOI: 10.1136/bmjopen-2021-053819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION mHealth refers to digital technologies that, via smartphones, mobile apps and specialised digital sensors, yield real-time assessments of patient's health status. In the context of the COVID-19 pandemic, these technologies enable remote patient monitoring, with the benefit of timely recognition of disease progression to convalescence, deterioration or postacute sequelae. This should enable appropriate medical interventions and facilitate recovery. Various barriers, both at patient and technology levels, have been reported, hindering implementation and use of mHealth telemonitoring. As systematised and synthesised evidence in this area is lacking, we developed this protocol for a scoping review on mHealth home telemonitoring of acute COVID-19. METHODS AND ANALYSIS We compiled a search strategy following the PICO (Population, Intervention, Comparator, Outcome) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for Scoping Reviews) guidelines. MEDLINE, Embase and Web of Science will be searched from 1 March 2020 to 31 August 2021. Following the title and abstract screening, we will identify, systematise and synthesise the available knowledge. Based on pilot searches, we preview three themes for descriptive evidence synthesis. The first theme relates to implementation and use of mHealth telemonitoring, including reported barriers. The second theme covers the interactions of the telemonitoring team within and between different levels of the healthcare system. The third theme addresses how this telemonitoring warrants the continuity of care, also during disease transition into deterioration or postacute sequelae. ETHICS AND DISSEMINATION The studied evidence is in the public domain, therefore, no specific ethics approval is required. Evidence dissemination will be via peer-reviewed publications, conference presentations and reports to the policy makers.
Collapse
Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
- Department of Pediatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada
| | - Sebastian Kuhn
- Department of Digital Medicine, Bielefeld University Faculty of Medicine, Bielefeld, Germany
| | - Svea Holtz
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Susanne Waldmann
- Central Medical Library, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| | - Lukas Niekrenz
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Beate S Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Gernot G U Rohde
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Claus Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| |
Collapse
|
24
|
Majolo F, da Silva GL, Vieira L, Anli C, Timmers LFSM, Laufer S, Goettert MI. Neuropsychiatric Disorders and COVID-19: What We Know So Far. Pharmaceuticals (Basel) 2021; 14:ph14090933. [PMID: 34577633 PMCID: PMC8465079 DOI: 10.3390/ph14090933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/02/2021] [Accepted: 09/08/2021] [Indexed: 01/09/2023] Open
Abstract
SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) affects the central nervous system (CNS), which is shown in a significant number of patients with neurological events. In this study, an updated literature review was carried out regarding neurological disorders in COVID-19. Neurological symptoms are more common in patients with severe infection according to their respiratory status and divided into three categories: (1) CNS manifestations; (2) cranial and peripheral nervous system manifestations; and (3) skeletal muscle injury manifestations. Patients with pre-existing cerebrovascular disease are at a higher risk of admission to the intensive care unit (ICU) and mortality. The neurological manifestations associated with COVID-19 are of great importance, but when life-threatening abnormal vital signs occur in severely ill COVID-19 patients, neurological problems are usually not considered. It is crucial to search for new treatments for brain damage, as well as for alternative therapies that recover the damaged brain and reduce the inflammatory response and its consequences for other organs. In addition, there is a need to diagnose these manifestations as early as possible to limit long-term consequences. Therefore, much research is needed to explain the involvement of SARS-CoV-2 causing these neurological symptoms because scientists know zero about it.
Collapse
Affiliation(s)
- Fernanda Majolo
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Guilherme Liberato da Silva
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Lucas Vieira
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Cetin Anli
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
| | - Luís Fernando Saraiva Macedo Timmers
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
| | - Stefan Laufer
- Department of Pharmaceutical and Medicinal Chemistry, Institute of Pharmacy, Eberhard Karls Universität Tübingen, 72076 Tübingen, Germany;
- Tübingen Center for Academic Drug Discovery (TüCAD2), 72076 Tübingen, Germany
| | - Márcia Inês Goettert
- Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (F.M.); (C.A.); (L.F.S.M.T.)
- Postgraduate Program in Medical Sciences Center, Universidade do Vale do Taquari-Univates, Lajeado 95914-014, Rio Grande do Sul, Brazil; (G.L.d.S.); (L.V.)
- Correspondence: ; Tel.: +55-5137147000
| |
Collapse
|
25
|
Zuo Y, Yalavarthi S, Navaz S, Hoy C, Harbaugh A, Gockman K, Zuo M, Madison JA, Shi H, Kanthi Y, Knight JS. Autoantibodies stabilize neutrophil extracellular traps in COVID-19. medRxiv 2021:2021.03.31.21254692. [PMID: 33851189 PMCID: PMC8043486 DOI: 10.1101/2021.03.31.21254692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The release of neutrophil extracellular traps ( NETs ) by hyperactive neutrophils is recognized to play an important role in the thromboinflammatory milieu inherent to severe presentations of COVID-19. At the same time, a variety of functional autoantibodies have been observed in individuals with severe COVID-19 where they likely contribute to immunopathology. Here, we aimed to determine the extent to which autoantibodies might target NETs in COVID-19 and, if detected, to elucidate their potential functions and clinical associations. We measured anti-NET antibodies in 328 individuals hospitalized with COVID-19 alongside 48 healthy controls. We found high anti-NET activity in the IgG and IgM fractions of 27% and 60% of patients, respectively. There was a strong correlation between anti-NET IgG and anti-NET IgM (r=0.4, p<0.0001). Both anti-NET IgG and IgM tracked with high levels of circulating NETs, impaired oxygenation efficiency, and high circulating D-dimer. Furthermore, patients who required mechanical ventilation had a greater burden of anti-NET antibodies than did those not requiring oxygen supplementation. Levels of anti-NET IgG (and to a lesser extent anti-NET IgM) demonstrated an inverse correlation with the efficiency of NET degradation by COVID sera. Furthermore, purified IgG from COVID sera with high levels of anti-NET antibodies impaired the ability of healthy control serum to degrade NETs. In summary, many individuals hospitalized with COVID-19 have anti-NET antibodies, which likely impair NET clearance and may potentiate SARS-CoV-2-mediated thromboinflammation.
Collapse
|
26
|
Abstract
Background Social media have in recent years challenged the way in which research questions are formulated in epidemiology and medicine, and in particular when it comes to women’s health. They have contributed to the emergence of ‘new’ public health topics (e.g. gynaecological and obstetric violence, long-Covid), the unearthing of testimonials of medical injustice, and in some cases, the creation of new evidence and changes in medical practice. Main text From a theoretical and methodological perspective, we observe two powerful mechanisms at play on social media, which can facilitate the implementation of feminist epidemiological research and address so-called anti-feminist bias: social media as a ‘third’ space and the power of groups. Social media posts can be seen as inhabiting a third space, akin to what is said off the record or in-between doors, at the end of a therapy session. Researchers somehow miss the opportunity to use the third spaces that people occupy. Similarly, another existing space that researchers are seldom interested in are peer-groups. Peer-groups are the ideal terrain to generate bottom-up research priorities. To some extent, their on-line versions provide a safe and emancipatory space, accessible, transnational, and inclusive. We would argue that this could bring feminist epidemiology to scale. Conclusion Given the emancipatory power of social media, we propose recommendations and practical implications for leveraging the potential of online-sourced feminist epidemiology at different stages of the research process (from design to dissemination), and for increasing synergies between researchers and the community. We emphasise that attention should be paid to patriarchal sociocultural contexts and power dynamics, the mitigation of risks for political recuperation and stigmatisation, and the co-production of respectful discourse on studied populations.
Collapse
Affiliation(s)
- Céline Miani
- School of Public Health, Bielefeld University, Universitätstraße 25, 33615, Bielefeld, Germany.
| | - Yudit Namer
- School of Public Health, Bielefeld University, Universitätstraße 25, 33615, Bielefeld, Germany
| |
Collapse
|