Tag: covid-19

A model framework for projecting the prevalence and impact of Long-COVID in the UK

Abstract:

The objective of this paper is to model lost Quality Adjusted Life Years (QALYs) from symptoms arising from COVID-19 disease in the UK population, including symptoms of ‘long-COVID’. The scope includes QALYs lost to symptoms, but not deaths, due to acute COVID-19 and long-COVID. The prevalence of symptomatic COVID-19, encompassing acute symptoms and long-COVID symptoms, was modelled using a decay function. Permanent injury as a result of COVID-19 infection, was modelled as a fixed prevalence. Both parts were combined to calculate QALY loss due to COVID-19 symptoms. Assuming a 60% final attack rate for SARS-CoV-2 infection in the population, we modelled 299,730 QALYs lost within 1 year of infection (90% due to symptomatic COVID-19 and 10% permanent injury) and 557,764 QALYs lost within 10 years of infection (49% due to symptomatic COVID-19 and 51% due to permanent injury). The UK Government willingness-to-pay to avoid these QALY losses would be £17.9 billion and £32.2 billion, respectively.

Additionally, 90,143 people were subject to permanent injury from COVID-19 (0.14% of the population). Given the ongoing development in information in this area, we present a model framework for calculating the health economic impacts of symptoms following SARS-CoV-2 infection. This model framework can aid in quantifying the adverse health impact of COVID-19, long-COVID and permanent injury following COVID-19 in society and assist the proactive management of risk posed to health. Further research is needed using standardised measures of patient reported outcomes relevant to long-COVID and applied at a population level.

Source: Martin C, Luteijn M, Letton W, Robertson J, McDonald S. A model framework for projecting the prevalence and impact of Long-COVID in the UK. PLoS One. 2021 Dec 2;16(12):e0260843. doi: 10.1371/journal.pone.0260843. PMID: 34855874; PMCID: PMC8639065. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8639065/ (Full text)

Long term predictors of breathlessness, exercise intolerance, chronic fatigue and well-being in hospitalized patients with COVID-19: A cohort study with 4 months median follow-up

Abstract:

Background: Post-acute COVID-19 syndrome (PACS) is an emerging healthcare burden. We therefore aimed to determine predictors of different functional outcomes after hospital discharge in patients with COVID-19.

Methods: An ambidirectional cohort study was conducted between May and July 2020, in which PCR-confirmed COVID-19 patients underwent a standardized telephone assessment between 6 weeks and 6 months post discharge. We excluded patients who died, had a mental illness or failed to respond to two follow-up phone calls. The medical research council (MRC) dyspnea scale, metabolic equivalent of task (MET) score for exercise tolerance, chronic fatigability syndrome (CFS) scale and World Health Organization-five well-being index (WHO-5) for mental health were used to evaluate symptoms at follow-up.

Results: 375 patients were contacted and 153 failed to respond. The median timing for the follow-up assessment was 122 days (IQR, 109-158). On multivariate analyses, female gender, pre-existing lung disease, headache at presentation, intensive care unit (ICU) admission, critical COVID-19 and post-discharge ER visit were predictors of higher MRC scores at follow-up. Female gender, older age >67 years, arterial hypertension and emergency room (ER) visit were associated with lower MET exercise tolerance scores. Female gender, pre-existing lung disease, and ER visit were associated with higher risk of CFS. Age, dyslipidemia, hypertension, pre-existing lung disease and duration of symptoms were negatively associated with WHO-5 score.

Conclusions: Several risk factors were associated with an increased risk of PACS. Hospitalized patients with COVID-19 who are at risk for PACS may benefit from a targeted pre-emptive follow-up and rehabilitation programs.

Source: Tleyjeh IM, Saddik B, Ramakrishnan RK, AlSwaidan N, AlAnazi A, Alhazmi D, Aloufi A, AlSumait F, Berbari EF, Halwani R. Long term predictors of breathlessness, exercise intolerance, chronic fatigue and well-being in hospitalized patients with COVID-19: A cohort study with 4 months median follow-up. J Infect Public Health. 2021 Nov 18;15(1):21-28. doi: 10.1016/j.jiph.2021.11.016. Epub ahead of print. PMID: 34861604; PMCID: PMC8600938. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600938/ (Full text)

SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases

Abstract:

Coronavirus disease-2019 (COVID-19) is asymptomatic in most cases, but it is impartible and fatal in fragile and elderly people. Heretofore, more than four million people succumbed to COVID-19, while it spreads to every part of the globe. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) induces various dysfunctions in many vital organs including the thyroid by utilizing ACE2 as a receptor for cellular entry. Emerging reports clearly show the involvement of SARS-CoV-2 in diverse thyroid disorders. Thus, this review article aims to review comprehensively all the recent developments in SARS-CoV-2-induced pathogenesis of thyroid diseases.

The review briefly summarizes the recent key findings on the mechanism of SARS-CoV-2 infection, the role of ACE2 receptor in viral entry, SARS-CoV-2-activated molecular signaling in host cells, ACE2 expression in the thyroid, cytokine storm, and its vital role in thyroid dysfunction and long-COVID in relation to thyroid and autoimmunity.

Further, it extensively discusses rapidly evolving knowledge on the potential part of SARS-CoV-2 in emerging various thyroid dysfunctions during and post-COVID-19 conditions which include subacute thyroiditis, Graves’ diseases, Hashimoto’s thyroiditis, thyrotoxicosis, and other recent advances in further discerning the implications of this virus within thyroid dysfunction. Unraveling the pathophysiology of SARS-CoV-2-triggered thyroid dysfunctions may aid pertinent therapeutic options and management of these patients in both during and post-COVID-19 scenarios.

Source: Murugan AK, Alzahrani AS. SARS-CoV-2: Emerging Role in the Pathogenesis of Various Thyroid Diseases. J Inflamm Res. 2021 Nov 24;14:6191-6221. doi: 10.2147/JIR.S332705. PMID: 34853527; PMCID: PMC8628126. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8628126/ (Full text)

COVID-19 Induced Immunosuppression resulting in Pulmonary Mucormycosis : A Long COVID sequalae

Abstract:

With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS -CoV -2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis.

We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVID19 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3weeks, followed by oral Posaconazole.

Source: Dhruv Talwar1,Sunil Kumar,Sourya Acharya,Sparsh Madaan,Vidyashree Hulkoti. COVID-19 Induced Immunosuppression resulting in Pulmonary Mucormycosis : A Long COVID sequalae. J MEDICINE 2021; 22: 150-154 https://www.researchgate.net/publication/356692787_COVID-19_Induced_Immunosuppression_resulting_in_Pulmonary_Mucormycosis_A_Long_COVID_sequalae (Full text)

Risk Factors Associated with Development and Persistence of Long COVID: A Cross-Sectional Study

Abstract:

Background: Long coronavirus disease (COVID) has been a social concern. Though patient characteristics associated with the
development of long COVID are partially known, those associated with its persistence have not been identified.

Methods: We conducted a cross-sectional questionnaire survey of patients after COVID-19 recovery who visited the National
Center for Global Health and Medicine between February 2020 and March 2021. Demographic and clinical data and
data regarding the presence and duration of long COVID were obtained. We identified factors associated with the
development and persistence of long COVID using multivariate logistic and linear regression analysis, respectively.

Results: We analyzed 457 of 526 responses (response rate, 86.9%). The median age was 47 years, and 378 patients (84.4%)
had mild disease in the acute phase. The number of patients with any symptoms after 6 and 12 months after onset or
diagnosis were 120 (26.3%) and 40 (8.8%), respectively. Women were at risk for development of fatigue (odds ratio
[OR]: 2.03, 95% confidence interval [CI]: 1.31-3.14), dysosmia (OR: 1.91, 95% CI: 1.24-2.93), dysgeusia (OR: 1.56, 95% CI:
1.02-2.39), and hair loss (OR: 3.00, 95% CI: 1.77-5.09) and for persistence of any symptoms (coefficient: 38.0, 95% CI:
13.3-62.8). Younger age and low body mass index were risk factors for developing dysosmia (OR: 0.96, 95% CI: 0.94-
0.98 and OR: 0.94, 95% CI: 0.89-0.99, respectively) and dysgeusia (OR: 0.98, 95% CI: 0.96-1.00 and OR: 0.93, 95% CI:
0.88-0.98, respectively).

Conclusion: We identified risk factors for the development and persistence of long COVID. Many patients suffer from long-term
residual symptoms, even in mild cases.

Source: Yusuke Miyazato, Shinya Tsuzuki, Shinichiro Morioka, Mari Terda, Satoshi Kutsuna, Sho Saito, Yumiko Shimanishi, Kozue Takahashi, Mio Sanada, Masako Akashi, Chika Kuge, Yasuyo Osanai, Keiko Tanaka, Michiyo Suzuki, Kayoko Hayakawa, Norio Ohmagari. Risk Factors Associated with Development and Persistence of Long COVID: A Cross-Sectional Study.
doi: https://doi.org/10.1101/2021.09.22.21263998 https://www.medrxiv.org/content/10.1101/2021.09.22.21263998v1.full-text (Full text)

Who has long-COVID? A big data approach

Abstract:

Background Post-acute sequelae of SARS-CoV-2 infection (PASC), otherwise known as long-COVID, have severely impacted recovery from the pandemic for patients and society alike. This new disease is characterized by evolving, heterogeneous symptoms, making it challenging to derive an unambiguous long-COVID definition. Electronic health record (EHR) studies are a critical element of the NIH Researching COVID to Enhance Recovery (RECOVER) Initiative, which is addressing the urgent need to understand PASC, accurately identify who has PASC, and identify treatments.

Methods Using the National COVID Cohort Collaborative’s (N3C) EHR repository, we developed XGBoost machine learning (ML) models to identify potential long-COVID patients. We examined demographics, healthcare utilization, diagnoses, and medications for 97,995 adult COVID-19 patients. We used these features and 597 long-COVID clinic patients to train three ML models to identify potential long-COVID patients among (1) all COVID-19 patients, (2) patients hospitalized with COVID-19, and (3) patients who had COVID-19 but were not hospitalized.

Findings Our models identified potential long-COVID patients with high accuracy, achieving areas under the receiver operator characteristic curve of 0.91 (all patients), 0.90 (hospitalized); and 0.85 (non-hospitalized). Important features include rate of healthcare utilization, patient age, dyspnea, and other diagnosis and medication information available within the EHR. Applying the “all patients” model to the larger N3C cohort identified 100,263 potential long-COVID patients.

Interpretation Patients flagged by our models can be interpreted as “patients likely to be referred to or seek care at a long-COVID specialty clinic,” an essential proxy for long-COVID diagnosis in the current absence of a definition. We also achieve the urgent goal of identifying potential long-COVID patients for clinical trials. As more data sources are identified, the models can be retrained and tuned based on study needs.

Source: Pfaff ER, Girvin AT, Bennett TD, Bhatia A, Brooks IM, Deer RR, Dekermanjian JP, Jolley SE, Kahn MG, Kostka K, McMurry JA, Moffitt R, Walden A, Chute CG, Haendel MA, The N3C Consortium. (2021). Who has long-COVID? A big data approach [preprint]. UMass Center for Clinical and Translational Science Supported Publications. https://doi.org/10.1101/2021.10.18.21265168. Retrieved from https://escholarship.umassmed.edu/umccts_pubs/253

Viral diseases and the brain: Long COVID puts the spotlight on how viral infections affect the brain

Abstract:

Various viruses can affect the brain directly or indirectly. The specter of Long COVID has focused research on how respiratory viruses can cause infection and inflammation of brain cells.

Source: Hunter P. Viral diseases and the brain: Long COVID puts the spotlight on how viral infections affect the brain. EMBO Rep. 2021 Nov 29:e54342. doi: 10.15252/embr.202154342. Epub ahead of print. PMID: 34842325. https://pubmed.ncbi.nlm.nih.gov/34842325/

Long COVID from rheumatology perspective – a narrative review

Abstract:

Long-term sequel of acute COVID-19, commonly referred to as long COVID, has affected millions of patients worldwide. Long COVID patients display persistent or relapsing and remitting symptoms that include fatigue, breathlessness, cough, myalgia, arthralgia, sleep disturbance, cognitive impairment and skin rashes. Due to the shared clinical features, laboratory and imaging findings, long COVID could mimic rheumatic disease posing a diagnostic challenge. Our comprehensive literature review will help rheumatologist to be aware of long COVID manifestations and differentiating features from rheumatic diseases to ensure a timely and correct diagnosis is reached.

Source: Sapkota HR, Nune A. Long COVID from rheumatology perspective – a narrative review. Clin Rheumatol. 2021 Nov 30:1–12. doi: 10.1007/s10067-021-06001-1. Epub ahead of print. PMID: 34845562; PMCID: PMC8629735. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629735/ (Full text)

Neurological, Psychological, and Cognitive Manifestations of Long-COVID

Abstract:

The terms “Post-COVID” or “Long-COVID” refer to a variety of physical and psychological symptoms that continue for weeks or months beyond the initial illness or develop as new-onset clinical manifestations after resolving of the acute phase. Moreover, these signs and symptoms are collectively referred to as post-acute sequelae of SARS-CoV-2 infection (PASC). Although the construction of solid epidemiological data is ongoing, the literature suggests that this phenomenon is a heterogeneous condition that can affect multiple organs and systems, with a potentially great impact on the quality of life. Furthermore, considering the millions of COVID-19 cases worldwide, these sequelae could have a high impact on health care systems.

In the context of long-COVID, many questions need to be answered. For example, it needs to be checked whether middle-aged women are at increased risk of developing debilitating long-term symptoms. To implement preventive and/or curative strategies, the data must be confirmed and the causes must be sought.

Neurological symptoms such as fatigue and muscle weakness, psychological conditions, including sleep disorders, anxiety, and depression, as well as neurocognitive problems can persist for months and can range from mild issues to serious and debilitating disorders. In particular, fatigue is one of the most common symptoms reported in the post-COVID-19 disease. It can affect up to 70% of patients and can last 6 months or more. Other neurological sequelae include smell and taste disorders (loss of smell or taste, altered sense of smell, and phantom smells), as well as dizziness, myalgia, joint pain, headache, blurred vision, and tinnitus. The incidence of each symptom and its duration after the acute phase vary greatly according to the type of study carried out, the timing, and the setting investigated.

About psychological consequences, if during the acute phase of the illness, fear, and the sense of abandonment, due to isolation at home or during hospitalization, are the most important psychological aspects of the disease, several problems of psychological distress may emerge after healing. Symptoms such as fear, mood changes, states of anxiety, depression, sleep disorders can occur alone or in combination by structuring, in turn, syndromes. Post-traumatic stress disorder and post-intensive care syndrome should not be underestimated. Likewise, potential neurocognitive sequelae need attention. What is the causal link between symptoms of cognitive impairment and the infection? The impact of the disease on mental health and cognitive performance will be well-elucidated in the coming years. To date, we can only speculate by referring to what has been observed about previous epidemics.

Taken together, data from the literature underline the need for longer follow-up studies and the organization of proper post-discharge care. In the meanwhile, the long-COVID issue requires a multiprofessional approach that involves neurologists, pain therapists, neurologists, nutritionists, neuroradiologists, physical therapists, otolaryngologists, and others. Follow-ups must be carefully scheduled in those who have suffered from the more severe forms of the disease and in individuals who have had mild or moderate COVID-19 acute manifestations. It is mandatory as, given the numbers of the pandemic, the public health implications could be considerable and the crashing wave of neurological and/or neuropsychiatric sequelae of COVID can have the effect of a tsunami.

Source:

Boosting Health Recovery by Food Supplements: The Case of ME/CFS versus Post-Covid-19 Syndrome

Abstract:

Background and objectives: Other than the direct impact of cardiopulmonary sequelae, COVID-19 disease may cause persistent signs and symptoms describes as post-COVID syndrome or long COVID. The clinical presentation and neuroimaging aspects of patients suffering from this condition are remarkably similar to those seen in patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Inflammation, immune disorder and oxidative damage have been documented to cause metabolic deregulation with decreased glycolysis and impaired mitochondrial function.

Purpose of the study: It is suggested that these alterations may be improved by the oral administration of a nutraceutical, Meldonium and sodium dichloroacetate (group designated as “oral treatment”; n=79) or intermittent intravenous infusions of magnesium sulphate together with multivitamins and essential amino acids (group designated as “infusion treatment”, n=18).

Materials and methods: 97 patients suffering from ME/CFS (n=79) or post-COVID syndrome (n=9) were included in a pragmatic prospective open-label trial using either oral or infusion therapy for 1 month, and the effect of treatment was assessed by the Fatigue Severity Scale (FSS).

Results: Upon interim analysis of 97 cases of ME/CFS and/or Post-COVID-19 syndrome therapeutic approach by either the oral or the infusion therapy was found to result in a reduction of the Fatigue Severity Scale (FSS) in two thirds of patients. The quotient of FSS after treatment divided by the FSS before treatment decreased by an average for all 97 cases by 14% within one month, with no difference between oral and infusion therapy (P=0.70), nor between the ME/CFS patient (mean quotient: 0.85, SD: 0.16) and the post-COVID cases (quotient: 0.87, SD: 0.16). Among the successful cases the FSS decreased by an average of 31%.

Conclusion: Preliminary results of the oral and the infusion therapy suggest a similar beneficial effect on fatigue in a substantial proportion of patients suffering from ME/CFS or Post-COVID syndrome. The result should be confirmed in a controlled trial, while the long-term efficacy is presently being investigated in a larger group of patients.

Source: Frank Comhaire and Jan Pen. Boosting Health Recovery by Food Supplements: The Case of ME/CFS versus Post-Covid-19 Syndrome. J Clin Pharmacol Ther. 2021;2(3):JCPT-02-1022. http://www.medtextpublications.com/open-access/boosting-health-recovery-by-food-supplements-the-case-of-me-947.pdf (Full text)