Tag: covid-19

Long Covid: conceptualizing the challenges for public health

Abstract:

Background: Long Covid has caused significant disruption to public services, economies and population health worldwide, but no single public health approach has proven effective in its management. This essay was the winning entry for the Faculty of Public Health’s Sir John Brotherston Prize 2022.

Methods: In this essay, I synthesize existing literature on public health policy in long Covid, and discuss the challenges and opportunities posed by long Covid for the public health profession. The utility of specialist clinics and community care, in the UK and internationally, is examined, as well as key outstanding issues relating to evidence generation, health inequality and defining long Covid. I then use this information to inform a simple conceptual model.

Results: The generated conceptual model integrates community- and population-level interventions; key areas of identified policy need at both levels include ensuring equitable access to long Covid care, developing screening programmes for high-risk populations, co-production of research and clinical services with patients, and using interventions to generate evidence.

Conclusions: Significant challenges remain in the management of long Covid from a public health policy perspective. Multidisciplinary community-level and population-level interventions should be employed with a view to achieving an equitable and scalable model of care.

Source: Prashar J. Long Covid: conceptualizing the challenges for public health. J Public Health (Oxf). 2023 May 2:fdac153. doi: 10.1093/pubmed/fdac153. Epub ahead of print. PMID: 37132023. https://academic.oup.com/jpubhealth/advance-article/doi/10.1093/pubmed/fdac153/7147865 (Full text)

COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences

Abstract:

Worldwide there have been over 760 million confirmed coronavirus disease 2019 (COVID-19) cases, and over 13 billion COVID-19 vaccine doses have been administered as of April 2023, according to the World Health Organization. An infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can lead to an acute disease, i.e. COVID-19, but also to a post-acute COVID-19 syndrome (PACS, “long COVID”). Currently, the side effects of COVID-19 vaccines are increasingly being noted and studied.

Here, we summarise the currently available indications and discuss our conclusions that (i) these side effects have specific similarities and differences to acute COVID-19 and PACS, that (ii) a new term should be used to refer to these side effects (post-COVID-19 vaccination syndrome, PCVS, colloquially “post-COVIDvac-syndrome”), and that (iii) there is a need to distinguish between acute COVID-19 vaccination syndrome (ACVS) and post-acute COVID-19 vaccination syndrome (PACVS) – in analogy to acute COVID-19 and PACS (“long COVID”). Moreover, we address mixed forms of disease caused by natural SARS-CoV-2 infection and COVID-19 vaccination.

We explain why it is important for medical diagnosis, care and research to use the new terms (PCVS, ACVS and PACVS) in order to avoid confusion and misinterpretation of the underlying causes of disease and to enable optimal medical therapy. We do not recommend to use the term “Post-Vac-Syndrome” as it is imprecise. The article also serves to address the current problem of “medical gaslighting” in relation to PACS and PCVS by raising awareness among the medical professionals and supplying appropriate terminology for disease.

Source: Scholkmann F, May CA. COVID-19, post-acute COVID-19 syndrome (PACS, “long COVID”) and post-COVID-19 vaccination syndrome (PCVS, “post-COVIDvac-syndrome”): Similarities and differences. Pathol Res Pract. 2023 May 3;246:154497. doi: 10.1016/j.prp.2023.154497. Epub ahead of print. PMID: 37192595; PMCID: PMC10154064. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10154064/ (Full text)

‘I’m still here, I’m alive and breathing’: The experience of Black Americans with long COVID

Abstract:

Aims and objectives: In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults.

Background: As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients.

Design: We employed an interpretive description study design.

Methods: We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines.

Results: We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships.

Conclusion: Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management.

Relevance to clinical practice: Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue.

No patient or public contribution: While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.

Source: Bergmans RS, Chambers-Peeple K, Yu C, Xiao LZ, Wegryn-Jones R, Martin A, Dell’Imperio S, Aboul-Hassan D, Williams DA, Clauw DJ, DeJonckheere M. ‘I’m still here, I’m alive and breathing’: The experience of Black Americans with long COVID. J Clin Nurs. 2023 May 4. doi: 10.1111/jocn.16733. Epub ahead of print. PMID: 37140186. https://onlinelibrary.wiley.com/doi/10.1111/jocn.16733 (Full text)

Long-COVID and its Physical and Neurological Symptoms in Adults: A Systematic Review

Abstract:

This review was carried out with the objective to study patterns of neurological, psychological and other physical consequences of COVID-19 in the long term. The guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) had been followed; 22 articles, published during January 2020 to September 2021, were selected. Original research, review articles, editorial and viewpoints were included. Google Scholar, Medline, and PubMed were searched through 2020 till 2021.

Data collection in selected studies was performed mainly through the online survey, telephone survey, use of medical records, and patient interviews. This systematic review contains the studies conducted in the American, Asian and European countries. The major outcomes identified were the neurological, psychological, and other long-term chronic manifestations of COVID‐19.

This review demonstrates that long-COVID has started to bring a huge wave of patients, the count of them being millions now, who can enter a phase of disability due to neurological damages if not treated during the early course of illness. Though more disabling than lethal, long-COVID patients with a neurological deficit is expected to overburden the healthcare system globally which is already been struggling to handle acute COVID-19 patients in this once-in-a-lifetime pandemic.

Source: Abdul Mannan Baig, Sameera Rizvi, Shahla Pardhan, Joachim Gerlach, Tazeen Saeed Ali. Long-COVID and its Physical and Neurological Symptoms in Adults: A Systematic Review. Vol. 17 No. 04 (2023): Pakistan Journal of Medical & Health Sciences. https://pjmhsonline.com/index.php/pjmhs/article/view/4549/4498 (Full text)

Long COVID: a review and proposed visualization of the complexity of long COVID

Abstract:

Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus – 2 (SARS-CoV-2) infection, or Long COVID, is a prevailing second pandemic with nearly 100 million affected individuals globally and counting. We propose a visual description of the complexity of Long COVID and its pathogenesis that can be used by researchers, clinicians, and public health officials to guide the global effort toward an improved understanding of Long COVID and the eventual mechanism-based provision of care to afflicted patients. The proposed visualization or framework for Long COVID should be an evidence-based, dynamic, modular, and systems-level approach to the condition.

Furthermore, with further research such a framework could establish the strength of the relationships between pre-existing conditions (or risk factors), biological mechanisms, and resulting clinical phenotypes and outcomes of Long COVID. Notwithstanding the significant contribution that disparities in access to care and social determinants of health have on outcomes and disease course of long COVID, our model focuses primarily on biological mechanisms. Accordingly, the proposed visualization sets out to guide scientific, clinical, and public health efforts to better understand and abrogate the health burden imposed by long COVID.

Source: Perumal R, Shunmugam L, Naidoo K, Abdool Karim SS, Wilkins D, Garzino-Demo A, Brechot C, Parthasarathy S, Vahlne A, Nikolich JŽ. Long COVID: a review and proposed visualization of the complexity of long COVID. Front Immunol. 2023 Apr 20;14:1117464. doi: 10.3389/fimmu.2023.1117464. PMID: 37153597; PMCID: PMC10157068. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10157068/ (Full text)

Intrinsic factors behind long-COVID: I. Prevalence of the extracellular vesicles

Abstract:

It can be argued that the severity of COVID-19 has decreased in many countries. This could be a result of the broad coverage of the population by vaccination campaigns, which often reached an almost compulsory status in many places. Furthermore, significant roles were played by the multiple mutations in the body of the virus, which led to the emergence of several new SARS-CoV-2 variants with enhanced infectivity but dramatically reduced pathogenicity.

However, the challenges associated with the development of various side effects and their persistence for long periods exceeding 20 months as a result of the SARS-CoV-2 infection, or taking available vaccines against it, are spreading horizontally and vertically in number and repercussions. For example, the World Health Organization announced that there are more than 17 million registered cases of long-COVID (also known as post-COVID syndrome) in the European Union countries alone. Furthermore, by using the PubMed search engine, one can find that more than 10 000 articles have been published focusing exclusively on long-COVID.

In light of these enormous and ever-increasing numbers of cases and published articles, most of which are descriptive of the various long-COVID symptoms, the need to know the reasons behind this phenomenon raises several important questions. Is long-COVID caused by the continued presence of the virus or one/several of its components in the recovering individual body for long periods of time, which urges the body to respond in a way that leads to long-COVID development? Or are there some latent and limited reasons related to the recovering patients themselves? Or is it a sum of both?

Many observations support a positive answer to the first question, whereas others back the second question but typically without releasing a fundamental reason/signal behind it. Whatever the answer is, it seems that the real reasons behind this widespread phenomenon remain unclear. This report opens a series of articles, in which we will try to shed light on the underlying causes that could be behind the long-COVID phenomenon.

Source: El-Maradny YA, Rubio-Casillas A, Uversky VN, Redwan EM. Intrinsic factors behind long-COVID: I. Prevalence of the extracellular vesicles. J Cell Biochem. 2023 May;124(5):656-673. doi: 10.1002/jcb.30415. Epub 2023 May 1. PMID: 37126363. https://pubmed.ncbi.nlm.nih.gov/37126363/

Netosis -A double-edged sword in the Pathogenesis of LONG COVID

Abstract:

The emergence of COVID-19 as a global pandemic has had far-reaching effects on the health of individuals worldwide. Although there has been a decrease in the severity of the disease, there is a growing concern about the long-term impact of COVID-19 on the health of individuals, particularly cardiovascular complications, known as Long-COVID, which can significantly increase morbidity and mortality rates in people recovering from COVID-19 in the recent past.
The severity of COVID-19 has been linked to various factors, including the role of neutrophils and neutrophil extracellular traps (NET). These extracellular webs, composed of chromatin, microbicidal proteins, and oxidant enzymes, are released by neutrophils to fight infections. However, if not properly regulated, NETs can lead to thrombo-inflammatory states and microangiopathy in the body, resulting in complications such as sepsis, thrombosis, and respiratory failure.
Understanding the detailed pathophysiology and association of NETs with the prognosis of COVID-19 infection is crucial for future implications and management. The purpose of this review is to analyze the potential contribution of NETosis in the pathophysiology of COVID-19 and its subsequent complications apart from its beneficial effect. This may provide insight into potential therapeutic interventions for COVID-19 patients.
Source: Durre Aden, vagisha sharma, sufian zaheer, et al. Netosis -A double-edged sword in the Pathogenesis of LONG COVID. Authorea. April 28, 2023. https://www.authorea.com/users/570888/articles/640398-netosis-a-double-edged-sword-in-the-pathogenesis-of-long-covid (Full text available as PDF file)

Antihistamines as an early treatment for Covid-19

Abstract:

Infection with SARs-COV-2 results in COVID-19 disease. Between March 2020 and August 2021, 468 COVID-19 patients confirmed by PCR or antigen test, in Yepes, Spain, received early treatment with antihistamines, adding azithromycin in selected cases. The primary endpoint is the hospitalization rate of COVID-19 patients, and the secondary endpoints are ICU admission and mortality rates. All endpoints are compared with the official Spanish rates during the time period of the study.

There were 20 hospital admissions (hospitalization rate 4,3%), 5 ICU admissions (ICU admission rate 1,1%) and 3 deaths (fatality rate of 0,6%). No patients in the study required follow up treatment, which suggest they did not develop long COVID. Results from this retrospective trail indicate that early treatment of SARS-COV-2 positive patients with antihistamines may reduce the odds of hospitalization (OR: 0.490, CI: 0.313-0.767, p-value: 0.001). Randomized controlled clinical trials are needed to further evaluate the effects of early antihistamine treatment of SARS-CoV-2 patients to prevent hospitalization, ICU admission, mortality and long-covid.

Source: Morán Blanco JI, Alvarenga Bonilla JA, Fremont-Smith P, Villar Gómez de Las Heras K. Antihistamines as an early treatment for Covid-19. Heliyon. 2023 May;9(5):e15772. doi: 10.1016/j.heliyon.2023.e15772. Epub 2023 Apr 25. PMID: 37128299; PMCID: PMC10129342. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10129342/ (Full text)

Long-COVID, is a New Syndrome?

Abstract:

The ongoing or developing new symptoms after acute coronavirus disease-2019 (COVID-19) infection has emerged as a new clinical problem. This has become a problem facing the globally infected population and health systems. “Long-COVID” can be defined as patients with laboratory-confirmed or clinically present COVID-19 whose symptoms persist for four weeks after diagnosis. Symptoms are remarkably heterogeneous, as seen in acute COVID-19. These symptoms may remain stable or fluctuate. Controversy over its definition complicates accurate diagnosis and management of the disease. The most prominent symptoms were fatigue, sleep disturbances, chest pain, and shortness of breath. Recent reports also highlight the risk of long-term sequelae in those recovering from acute COVID-19, affecting almost all organs such as the skin, respiratory system, cardiovascular system, neuropsychiatric system, and renal system. The long-term effects of COVID-19, in hospitalized and non-hospitalized individuals, across all age groups, should be a priority for future research with standardized and controlled studies.

Source: Özlem Alıcı. Long-COVID, is a New Syndrome?. Cam Sakura Med J. 2023; 3(1): 1-5 https://jag.journalagent.com/csmedj/pdfs/CSM_3_1_1_5.pdf (Full text available as PDF file)

Battling the unknown: Using composite vignettes to portray lived experiences of COVID-19 and long-COVID

Abstract:

Understanding the day-to-day lived experiences of individuals who have had or are still recovering from Coronavirus Disease-19 (COVID-19), whilst a complex challenge, presents the opportunity to listen and learn. Composite vignettes provide a novel approach to explore and present descriptive portrayals of the most commonly derived experiences and recovery journeys.

The thematic analysis of 47 shared accounts (semi-structured interviews with adults aged ≥18 years; 40 females; 6-11 months post-COVID-19 infection) produced a series of four intricate character stories written through the lens of a single individual. Each vignette gives a voice to and captures a different experience trajectory.

From the point of initial symptom development onwards, the vignettes depict how COVID-19 has affected everyday lives, focusing on the secondary non-biological socio-psychological effects and implications. The vignettes highlight in participants’ own words: i) the potential negative implications of not addressing the psychological effects of COVID-19; ii) the lack of symptom and recovery linearity; iii) the ongoing ‘lottery’ of access to healthcare services; and iv) the highly variable, yet generally devastating, impacts that COVID-19 and consequent long-COVID has had across multiple facets of daily living.

Source: Knight RL, Mackintosh KA, Hudson J, Shelley J, Saynor ZL, McNarry MA. Battling the unknown: Using composite vignettes to portray lived experiences of COVID-19 and long-COVID. PLoS One. 2023 Apr 26;18(4):e0284710. doi: 10.1371/journal.pone.0284710. PMID: 37099534; PMCID: PMC10132598. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10132598/ (Full text)