Tag: covid-19

Aging and long COVID-19 syndrome: what’s new in 2023?

Abstract:

Since 2019 that saw the onset of the COVID-19 pandemic, its ongoing impact on many older adults remains a persistent public health concern, especially among those who report suffering from long or post-acute COVID-19 disease health challenges. This report presents data published largely since January 1 2023 on this topic and concerning: Long COVID or COVID-19, Older Adults, Post-Acute COVID-19 Outcomes, and Prevention.

Data show that even though long COVID-19 was discussed in 2021 at some length, it still remains a relatively unchartered poorly understood topic in which a sizeable percentage of older adult COVID-19 survivors may experience delayed features of breathing, movement, cognitive and mental health challenges. What causes the observed and perceived problems, what may help to identify who is at risk, and what will reduce these remains unknown, but may benefit from insightful research and extended observations and possible multi pronged efforts that target those symptoms of most concern.

Source: Marks R. Aging and long COVID-19 syndrome: what’s new in 2023? MOJ Gerontol Ger. 2023;8(1):9-14. DOI: 10.15406/mojgg.2023.08.00302 (Full text)

Quality of life and ability to work of patients with Post-COVID syndrome in relation to the number of existing symptoms and the duration since infection up to 12 months: a cross-sectional study

Abstract:

Purpose: Following SARS-CoV-2 virus infection, patients may suffer from long-lasting symptoms regardless of disease severity. Preliminary results show limitations in health-related quality of life (HRQoL). The aim of this study is to show a possible change depending on the duration since infection and the accumulation of symptoms. Additionally, other possible influencing factors will be analyzed.

Methods: The study population consisted of patients (18-65 years) presenting to the Post-COVID outpatient clinic of the University Hospital Jena, Germany, between March and October 2021. The HRQoL was assessed by the use of the RehabNeQ and the SF-36. Data analysis was descriptive with frequencies, means, and/or percentages. In addition, a univariate analysis of variance was performed to show the dependence of physical and psychological HRQoL on specific factors. This was finally tested for significance at an alpha level of 5%.

Results: Data from 318 patients were analyzed, most of whom had 3-6 months of infection (56%) and 5-10 symptoms persisted (60.4%). Both mental (MCS) and physical sum score (PCS) of HRQoL were significantly lower than those of the German normal population (p < .001). The number of remaining symptoms (MCS p = .0034, PCS p = .000) as well as the perceived ability to work (MCS p = .007, PCS p = .000) influenced the HRQoL.

Conclusion: The HRQoL of patients with Post-COVID-syndrome is still reduced months after infection and so is their occupational performance. In particular, the number of symptoms could have an influence on this deficit, which would need to be further investigated. Further research is needed to detect other factors influencing HRQoL and to implement appropriate therapeutic interventions.

Source: Lemhöfer C, Sturm C, Loudovici-Krug D, Guntenbrunner C, Bülow M, Reuken P, Quickert S, Best N. Quality of life and ability to work of patients with Post-COVID syndrome in relation to the number of existing symptoms and the duration since infection up to 12 months: a cross-sectional study. Qual Life Res. 2023 Mar 3:1–12. doi: 10.1007/s11136-023-03369-2. Epub ahead of print. PMID: 36869248; PMCID: PMC9984128. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9984128/ (Full text)

Conceptualising the episodic nature of disability among adults living with Long COVID: a qualitative study

Abstract:

Introduction: Our aim was to describe episodic nature of disability among adults living with Long COVID.

Methods: We conducted a community-engaged qualitative descriptive study involving online semistructured interviews and participant visual illustrations. We recruited participants via collaborator community organisations in Canada, Ireland, UK and USA. We recruited adults who self-identified as living with Long COVID with diversity in age, gender, race/ethnicity, sexual orientation and duration since initial COVID infection between December 2021 and May 2022. We used a semistructured interview guide to explore experiences of disability living with Long COVID, specifically health-related challenges and how they were experienced over time. We asked participants to draw their health trajectory and conducted a group-based content analysis.

Results: Among the 40 participants, the median age was 39 years (IQR: 32-49); majority were women (63%), white (73%), heterosexual (75%) and living with Long COVID for ≥1 year (83%). Participants described their disability experiences as episodic in nature, characterised by fluctuations in presence and severity of health-related challenges (disability) that may occur both within a day and over the long-term living with Long COVID. They described living with ‘ups and downs’, ‘flare-ups’ and ‘peaks’ followed by ‘crashes’, ‘troughs’ and ‘valleys’, likened to a ‘yo-yo’, ‘rolling hills’ and ‘rollercoaster ride’ with ‘relapsing/remitting’, ‘waxing/waning’, ‘fluctuations’ in health. Drawn illustrations demonstrated variety of trajectories across health dimensions, some more episodic than others. Uncertainty intersected with the episodic nature of disability, characterised as unpredictability of episodes, their length, severity and triggers, and process of long-term trajectory, which had implications on broader health.

Conclusion: Among this sample of adults living with Long COVID, experiences of disability were described as episodic, characterised by fluctuating health challenges, which may be unpredictable in nature. Results can help to better understand experiences of disability among adults living with Long COVID to inform healthcare and rehabilitation.

Source: O’Brien KK, Brown DA, McDuff K, St Clair-Sullivan N, Solomon P, Chan Carusone S, McCorkell L, Wei H, Goulding S, O’Hara M, Thomson C, Roche N, Stokes R, Vera JH, Erlandson KM, Bergin C, Robinson L, Cheung AM, Torres B, Avery L, Bannan C, Harding R. Conceptualising the episodic nature of disability among adults living with Long COVID: a qualitative study. BMJ Glob Health. 2023 Mar;8(3):e011276. doi: 10.1136/bmjgh-2022-011276. PMID: 36863719; PMCID: PMC9979585. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9979585/ (Full text)

Effect of Repetitive Transcranial Magnetic Stimulation on Long Coronavirus Disease 2019 with Fatigue and Cognitive Dysfunction

Abstract:

Objectives: There is no established treatment for chronic fatigue and various cognitive dysfunctions (brain fog) caused by long coronavirus disease 2019 (COVID-19). We aimed to clarify the effectiveness of repetitive transcranial magnetic stimulation (rTMS) for treating these symptoms.

Methods: High-frequency rTMS was applied to occipital and frontal lobes in 12 patients with chronic fatigue and cognitive dysfunction 3 months after severe acute respiratory syndrome coronavirus 2 infection. Before and after ten sessions of rTMS, Brief Fatigue Inventory (BFI), Apathy Scale (AS), and Wechsler Adult Intelligence Scale-fourth edition (WAIS4) were determined and N-isopropyl-p-[123I]iodoamphetamine single photon emission computed tomography (SPECT) was performed.

Results: Twelve subjects completed ten sessions of rTMS without adverse events. The mean age of the subjects was 44.3 ± 10.7 years, and the mean duration of illness was 202.4 ± 114.5 days. BFI, which was 5.7 ± 2.3 before the intervention, decreased significantly to 1.9 ± 1.8 after the intervention. The AS was significantly decreased after the intervention from 19.2 ± 8.7 to 10.3 ± 7.2. All WAIS4 sub-items were significantly improved after rTMS intervention, and the full-scale intelligence quotient increased from 94.6 ± 10.9 to 104.4 ± 13.0. Hypoperfusion in the bilateral occipital and frontal lobes observed on SPECT improved in extent and severity after ten sessions of rTMS.

Conclusions: Although we are still in the early stages of exploring the effects of rTMS, the procedure has the potential for use as a new non-invasive treatment for the symptoms of long COVID.

Source: Sasaki N, Yamatoku M, Tsuchida T, Sato H, Yamaguchi K. Effect of Repetitive Transcranial Magnetic Stimulation on Long Coronavirus Disease 2019 with Fatigue and Cognitive Dysfunction. Prog Rehabil Med. 2023 Feb 28;8:20230004. doi: 10.2490/prm.20230004. PMID: 36861061; PMCID: PMC9968785. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9968785/ (Full text)

Could the fibromyalgia syndrome be triggered or enhanced by COVID-19?

Abstract:

Fibromyalgia (FM) is a complex disease with an uncertain aetiology and intricate pathophysiology. Although its genesis is not fully explained, potential environmental factors, such as viral infections might trigger FM or worsen patients’ clinical outcomes.

The SARS-CoV-2 virus may affect central and peripheral nervous systems, leading to musculoskeletal, neurological, and psychological disturbances. These symptoms might persist at least 12 months beyond the recovery, often referred to as post-COVID syndrome, which resembles FM syndrome. In this sense, we argued the potential consequences of COVID-19 exclusively on FM syndrome.

First, we have described post-COVID syndrome and its painful symptoms. Afterwards, we argued whether FM syndrome could be triggered or enhanced by COVID-19 infection or by numerous and persistent stressors imposed daily by the pandemic setting (isolation, uncertainty, depression, mental stress, generalized anxiety, and fear of the virus). In addition, we have demonstrated similarities between pathophysiological mechanisms and cardinal symptoms of FM and COVID-19, speculating that SARS-CoV-2 might represent a critical mediator of FM or an exacerbator of its symptoms once both syndromes share similar mechanisms and complaints.

Therefore, pharmacologic and non-pharmacological approaches commonly used to treat FM could serve as strategic therapies to attenuate painful and neurological manifestations of post-COVID syndrome. Although it is still theoretical, clinicians and researchers should be alert of patients who develop symptoms similar to FM or those who had their FM symptoms increased post-COVID to manage them better.

Source: Fialho MFP, Brum ES, Oliveira SM. Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? Inflammopharmacology. 2023 Feb 27:1–19. doi: 10.1007/s10787-023-01160-w. Epub ahead of print. PMID: 36849853; PMCID: PMC9970139. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9970139/ (Full text)

COVID-19 long-term sequelae: Omicron versus Alpha and Delta variants

Abstract:

Background: The study aimed to assess the association between three predominant SARS-CoV-2 variants (Alpha, Delta, and Omicron) and the risk of developing long COVID (persistence of physical, medical, and cognitive symptoms more than 4 weeks after infection), post-COVID-19 syndrome (symptoms extending beyond 12 weeks), and viral persistence (testing positive beyond 4 weeks despite clinical resolution).

Methods: Retrospective study of 325 patients hospitalized for COVID-19 with genomic sequencing information. For each SARS-CoV-2 variant, sample characteristics, frequency of symptoms, and long-term sequelae were compared using Chi-squared test, Fisher’s exact test, Kruskal-Wallis test, and Dunn’s test as appropriate. Odds ratios (OR) were calculated using logistic regression models to assess the association of risk factors and sequelae.

Results: The adjusted model showed that the Omicron (vs Alpha) variant (OR, 0.30; 95% CI0.16-0.56), admission to ICU (OR, 1.14; 95% CI 1.05-1.23), and being treated with antiviral or immunomodulatory drugs (OR, 2.01; 95% CI 1.23-3.27) predicted long COVID and post-COVID-19 syndrome. Viral persistence showed no difference between variants.

Conclusions: The Omicron variant was associated with significantly lower odds of developing long-term sequelae from COVID-19 compared with previous variants, while severity of illness indicators increased the risk. Vaccination status, age, sex, and comorbidities were not found to predict sequelae development. This information has implications for both health managers and clinicians when deciding on the appropriate clinical management and subsequent outpatient follow-up of these patients. More studies with non-hospitalized patients are still necessary.

Source: Hernández-Aceituno A, García-Hernández A, Larumbe-Zabala E. COVID-19 long-term sequelae: Omicron versus Alpha and Delta variants. Infect Dis Now. 2023 Feb 27:104688. doi: 10.1016/j.idnow.2023.104688. Epub ahead of print. PMID: 36858287; PMCID: PMC9970656. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9970656/ (Full text)

Is exposure to Epstein-Barr virus a risk factor for long-covid?

Abstract:

Background: A viral etiology to chronic fatigue syndrome (CFS) has long been postulated, and Epstein-Barr Virus (EBV) was the first CFS associated virus. CFS and Long-COVID share features, potentially implicating a similar etiology. This study evaluated if EBV exposure is associated with post-COVID syndrome (Long-COVID)

Methods: Intermountain Healthcare electronic health records were queried to identify patients diagnosed with COVID-19 and tested for EBV between March 6, 2020 and April 13, 2022. A subsequent diagnosis of Long-COVID (ICD-10 U09.9) was evaluated using survival methods.

Results: Overall, 296,959 patients had COVID-19 and 590 had concurrent EBV test results [207 (35.1%) were EBV positive]. Subjects averaged 27.4±18.4 years of age (range: 0-86); 57.6% were female. Hospitalization occurred in 61 subjects (10.3%) within 30 days of COVID-19 diagnosis, with 17 (2.9%) requiring intensive care. Long-COVID was found in 29 (4.9%) subjects (just 10 were among the 61 hospitalized for COVID-19), with 15 (7.2%) EBV positive (Figure) and 14 (3.7%) EBV negative (HR=2.09, 95% CI=1.01, 4.34; p=0.042). EBV risk remained in multivariable analyses. Race, hyperlipidemia, and tobacco use also predicted Long-COVID, with histories of anticoagulant and vitamin D use were protective.

Conclusion: In a large prospectively-collected registry, EBV positivity was associated with an elevated risk of Long-COVID. This suggests that EBV may be a predisposing risk factor for or co-precipitant of Long-COVID.

Source: Horne B, Knowlton K, Le V, et al. IS EXPOSURE TO EPSTEIN-BARR VIRUS A RISK FACTOR FOR LONG-COVID?. J Am Coll Cardiol. 2023 Mar, 81 (8_Supplement) 1784. https://doi.org/10.1016/S0735-1097(23)02228-3 (Full text)

Effect of covid-19 vaccination on long covid: systematic review

Abstract:

Objective To determine the effect of covid-19 vaccination, given before and after acute infection with the SARS-CoV-2 virus, or after a diagnosis of long covid, on the rates and symptoms of long covid.

Design Systematic review.

Data sources PubMed, Embase, and Cochrane covid-19 trials, and Europe PubMed Central (Europe PMC) for preprints, from 1 January 2020 to 3 August 2022.

Eligibility criteria for selecting studies Trials, cohort studies, and case-control studies reporting on patients with long covid and symptoms of long covid, with vaccination before and after infection with the SARS-CoV-2 virus, or after a diagnosis of long covid. Risk of bias was assessed with the ROBINS-I tool.

Results 1645 articles were screened but no randomised controlled trials were found. 16 observational studies from five countries (USA, UK, France, Italy, and the Netherlands) were identified that reported on 614 392 patients. The most common symptoms of long covid that were studied were fatigue, cough, loss of sense of smell, shortness of breath, loss of taste, headache, muscle ache, difficulty sleeping, difficulty concentrating, worry or anxiety, and memory loss or confusion. 12 studies reported data on vaccination before infection with the SARS-CoV-2 virus, and 10 showed a significant reduction in the incidence of long covid: the odds ratio of developing long covid with one dose of vaccine ranged from 0.22 to 1.03; with two doses, odds ratios were 0.25-1; with three doses, 0.16; and with any dose, 0.48-1.01. Five studies reported on vaccination after infection, with odds ratios of 0.38-0.91. The high heterogeneity between studies precluded any meaningful meta-analysis. The studies failed to adjust for potential confounders, such as other protective behaviours and missing data, thus increasing the risk of bias and decreasing the certainty of evidence to low.

Conclusions Current studies suggest that covid-19 vaccines might have protective and therapeutic effects on long covid. More robust comparative observational studies and trials are needed, however, to clearly determine the effectiveness of vaccines in preventing and treating long covid.

Source: Byambasuren O, Stehlik P, Clark J, et al. Effect of covid-19 vaccination on long covid: systematic review BMJ Medicine 2023;2:e000385. doi: 10.1136/bmjmed-2022-000385. https://bmjmedicine.bmj.com/content/2/1/e000385?s=08 (Full text)

Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort

Abstract:

Objective To evaluate the effect of covid-19 vaccination on the severity of symptoms in patients with long covid.

Design Target trial emulation based on ComPaRe e-cohort.

Data source ComPaRe long covid cohort, a nationwide e-cohort (ie, a cohort where recruitment and follow-up are performed online) of patients with long covid, in France.

Methods Adult patients (aged ≥18 years) enrolled in the ComPaRe cohort before 1 May 2021 were included in the study if they reported a confirmed or suspected SARS-CoV-2 infection, symptoms persistent for >3 weeks after onset, and at least one symptom attributable to long covid at baseline. Patients who received a first covid-19 vaccine injection were matched with an unvaccinated control group in a 1:1 ratio according to their propensity scores. Number of long covid symptoms, rate of complete remission of long covid, and proportion of patients reporting an unacceptable symptom state at 120 days were recorded.

Results 910 patients were included in the analyses (455 in the vaccinated group and 455 in the control group). By 120 days, vaccination had reduced the number of long covid symptoms (mean 13.0 (standard deviation 9.4) in the vaccinated group v 14.8 (9.8) in the control group; mean difference −1.8, 95% confidence interval −3.0 to −0.5) and doubled the rate of patients in remission (16.6% v 7.5%, hazard ratio 1.93, 95% confidence interval 1.18 to 3.14). Vaccination reduced the effect of long covid on patients’ lives (mean score on the impact tool 24.3 (standard deviation 16.7) v 27.6 (16.7); mean difference −3.3, 95% confidence interval −5.7 to −1.0) and the proportion of patients with an unacceptable symptom state (38.9% v 46.4%, risk difference −7.4%, 95% confidence interval −14.5% to −0.3%). In the vaccinated group, two (0.4%) patients reported serious adverse events requiring admission to hospital.

Conclusion In this study, covid-19 vaccination reduced the severity of symptoms and the effect of long covid on patients’ social, professional, and family lives at 120 days in those with persistent symptoms of infection.

Source: Tran V, Perrodeau E, Saldanha J, et al. Efficacy of first dose of covid-19 vaccine versus no vaccination on symptoms of patients with long covid: target trial emulation based on ComPaRe e-cohort. BMJ Medicine 2023;2:e000229. doi: 10.1136/bmjmed-2022-000229 https://bmjmedicine.bmj.com/content/2/1/e000229 (Full text)

Assessment of microbiota in the gut and upper respiratory tract associated with SARS-CoV-2 infection

Abstract:

Background: The human microbiome plays an important role in modulating the host metabolism and immune system. Connections and interactions have been found between the microbiome of the gut and oral pharynx in the context of SARS-CoV-2 and other viral infections; hence, to broaden our understanding of host-viral responses in general and to deepen our knowledge of COVID-19, we performed a large-scale, systematic evaluation of the effect of SARS-CoV-2 infection on human microbiota in patients with varying disease severity.

Results: We processed 521 samples from 203 COVID-19 patients with varying disease severity and 94 samples from 31 healthy donors, consisting of 213 pharyngeal swabs, 250 sputa, and 152 fecal samples, and obtained meta-transcriptomes as well as SARS-CoV-2 sequences from each sample. Detailed assessment of these samples revealed altered microbial composition and function in the upper respiratory tract (URT) and gut of COVID-19 patients, and these changes are significantly associated with disease severity. Moreover, URT and gut microbiota show different patterns of alteration, where gut microbiome seems to be more variable and in direct correlation with viral load; and microbial community in the upper respiratory tract renders a high risk of antibiotic resistance. Longitudinally, the microbial composition remains relatively stable during the study period.

Conclusions: Our study has revealed different trends and the relative sensitivity of microbiome in different body sites to SARS-CoV-2 infection. Furthermore, while the use of antibiotics is often essential for the prevention and treatment of secondary infections, our results indicate a need to evaluate potential antibiotic resistance in the management of COVID-19 patients in the ongoing pandemic. Moreover, a longitudinal follow-up to monitor the restoration of the microbiome could enhance our understanding of the long-term effects of COVID-19.

Source: Li J, Jing Q, Li J, Hua M, Di L, Song C, Huang Y, Wang J, Chen C, Wu AR. Assessment of microbiota in the gut and upper respiratory tract associated with SARS-CoV-2 infection. Microbiome. 2023 Mar 3;11(1):38. doi: 10.1186/s40168-022-01447-0. PMID: 36869345; PMCID: PMC9982190. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9982190/ (Full text)