Long COVID study looks at why some can’t shake dizziness, fatigue and more

Authors: Helena Oliviero, The Atlanta Journal-Constitution

Georgia residents among thousands needed for a massive study to discover how the virus causes lingering symptoms.

Back in the summer of 2020, when the pandemic was still new and hospitals were overflowing, Emory Healthcare opened a facility to treat a perplexing group of COVID-19 survivors.

The patients had withstood the virus’s initial onslaught but couldn’t shake some of the symptoms.

At the time, Dr. Alex Truong thought the long COVID clinic might be needed for a year, maybe two.

But long COVID — a mysterious constellation of ailments that can go on for many weeks or months — has become a bigger problem than Truong could have ever imagined.

In the U.S. alone, 1 in 5 of the adults stricken with COVID-19 have developed conditions that could be considered long COVID, according to a recent study by the Centers for Disease Control and Prevention. Symptoms range from brain fog and unrelenting fatigue to gastric and cardiac issues. Among those 65 and older, the estimates are even higher — 1 in 4.

That translates into millions of Americans and more than 300,000 Georgians.

Other estimates vary wildly. There is no test for long COVID. No official statistics exist.

Clinicians at the Emory clinic have treated more than 1,000 COVID survivors. There’s now a four-month waiting list to be seen at the clinic.ExploreComplete coverage of COVID-19 in Georgia

“It’s been shocking,” said Truong, who is co-director of the clinic,located at Emory University Hospital Midtown. “I’ve never seen, with other infections, such widespread, all-over-the-body symptoms for this long.”

COVID can wreak havoc on a person’s body and damage organs – the lungs, heart, kidneys and liver. Experts worry that people who are infected multiple times have increased chances of developing long COVID.

How is long COVID defined?

A recent CDC study says that 1 in 5 of U.S. adults stricken with COVID-19 have developed conditions that could be considered long COVID, which the agency defines as symptoms lasting at least four weeks after infection.

The CDC says the following symptoms are the most common for this complex and poorly understood condition:

  • Tiredness or fatigue that interferes with daily life
  • Difficulty breathing, shortness of breath, chest pain
  • Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
  • Headache
  • Sleep problems
  • Anxiety
  • Digestive issues
  • Joint or muscle pain

“With COVID, we tend to think about the hospitalizations and deaths, and then we kind of stop there sometimes,” said Dr. Tiffany Walker, who has treated long COVID patients at Grady Memorial Hospital. “I don’t want to paint the picture of everybody’s debilitated, but some people are, and it’s people that don’t expect it. The times that people have cried in my office because they’re just so overwhelmed is like more than anything I’ve experienced before in clinical practice.”

Walker now leads a long COVID study at Grady, which is part of a massive National Institutes of Health effort to find the connection between seemingly unrelated symptoms that have afflicted patients and confounded physicians.

Scientists still do not know how the virus triggers such a wide range of problems, from minor to incapacitating, or why issues emerge in some patients but not in others, or what exactly the risk factors are for developing them.

What’s more, there is no specific treatment for longCOVID. Instead, the current approach is to deal with each symptom individually.

It’s often hard to offer satisfying answers to patients. “It’s just very upsetting and really challenging,” Walker said. “As a physician, you really want to be able to provide a prognosis at least, at a minimum to be able to express to them, this is what you can expect.”

But doctors “don’t know enough to know what the course is going to be and who’s going to get better and who isn’t, and you don’t know enough about how to treat those that aren’t getting better,” she said.

And the world’s leading health organizations don’t even have a standard definition of what constitutes long COVID, Truong said. The CDC defines long COVID, which it calls Post-COVID Conditions, as symptoms lasting four weeks or longer after infection. The World Health Organization says people cross over into long COVID after symptoms persist for at least three months.

In 2021, 60% of patients at the Emory and Grady long COVID clinics enrolled in a study aimed at gathering more information on the illness. At the time of their enrollment, patients had already been dealing with COVID symptoms for an average of 107 days.

Even people who have mild or asymptomatic COVID-19 infections can have new health problems crop up months after they’ve tested negative.

Remaining vigilant

The CDC’s study evaluated electronic medical records for nearly 2 million people. The agency compared those who had been infected with the coronavirus and those who had not. The analysis found 38% percent of the COVID patients developed one or more new health problems, compared to 16% percent of the non-COVID patients. The health problems of about 21% of the younger COVID patients in the study, those ages 18 to 64, and nearly 27% of the older people, 65 and up, could be attributed to long COVID. The study did not look at vaccination status.

A growing number of studies suggest that getting a COVID vaccine can reduce — though not eliminate — the risk of longer-term symptoms.

Some experts think that today’s omicron strains pose a lower risk for long COVID than previous variants. But they caution: Even if omicron is less likely to cause long-lasting symptoms, particularly for people who have been vaccinated, the actual number of long COVID sufferers will still grow due to the high infection rate.

It’s often hard to determine whether health problems that emerge after a case of COVID are truly triggered by the virus.

Lead Nurse Practitioner Lori Reed, who works at the Piedmont Pulmonary COVID Recovery clinic, said some patients dealing with preexisting conditions may be more aware of them after coronavirus infections. That means it’s important for clinicians to obtain thorough medical histories to pinpoint when symptoms, such as dizziness, memory loss and headaches, started and when they worsened, she said.

“One that comes up all the time is asthma because asthma can develop at any point in life,” Reed said. “We know, historically, viral illnesses can cause asthma onset, so COVID can cause asthma onset. But, with women, hormonal changes and menopause can also cause onset.”

Reed recommends patients see a doctor after a COVID infection to rule out COVID-related damage to the body, and she urges people to remain vigilant of any sign of new problems.ExploreFrom November: Georgia long-COVID patients fight for benefits, legitimacy

“Pay attention to subtle things that some people may write off,” she said. “Talk to your doctor about brain fog or things like, ‘I just forgot what I was going to make for dinner,’ or ‘You know, that bill came in, and I forgot to pay for it.’”

At long COVID clinics, a team of specialists — cardiologists, pulmonologists, neurologists, psychiatrists and others — work together to treat patients. Often, the patients undergo a comprehensive evaluation, including a series of lab tests and imaging tests, to rule out other undiagnosed medical conditions.

Lacking established therapies for long COVID symptoms, doctors often rely on approaches that have been used for other ailments with similar symptoms.

“It’s been shocking. I’ve never seen, with other infections, such widespread, all-over-the-body symptoms for this long.”

– Dr. Alex Truong, co-director of Emory Healthcare’s post-COVID clinic

Neurological stimulants such as Adderall have shown to be effective at improving energy and focus. Albuterol, an inhaled medicine frequently used to treat asthma, can improve breathing. Other medications, physical therapy and cognitive programs also can be helpful.

“I would say to people who get COVID, you didn’t ask to get COVID, and you don’t deserve to fall ill and not have answers,” said Reed. “Reach out to somebody to at least be seen and evaluated because we can do things to get you feeling better. If we can’t reverse the long-term consequences, we can at least improve your quality of life.”

A high-stakes undertaking

Close to 1,000 people in Georgia — and at least 17,000 adults across the country — are being recruited for the massive NIH study called Researching COVID to Enhance Recovery (RECOVER). Its goal is to answer fundamental questions about exactly how the virus causes long COVID, which ultimately could lead to better, more tailored treatments.

The study sites in Atlanta — Emory Hope Clinic, Grady, Morehouse School of Medicine, the Atlanta Veterans Affairs Healthcare System and Kaiser Permanente of Georgia — will work together and are slated to receive a total of about$20 million over four years for the high-stakes undertaking.

The NIH study

The Atlanta sites for the NIH are still actively recruiting patients who have had COVID-19 in the past 30 days, as well as those who have never been infected. Click here for more information.

Walker, from Grady, said clinicians have been working to recruit a diverse group of adults, and are seeking three categories of participants: those who have COVID right now, those with long COVID, and others who have never had COVID. Finding people who have never had the illness is getting increasingly difficult with an ever-changing virus and continued waves of infections.

Plenty of theories have formed around long COVID. Some researchers think people suffer prolonged symptoms because they have never really shaken COVID-19, though they think they have. Instead, the virus is still hiding in their bodies, damaging nerves and other organs. Other research suggeststhe virus may be gone, but it causes the immune system to go haywire and attack the body.

There’s also research that indicates certain medical conditions may play a role in who develops long COVID, such as Type 2 diabetes, or a reactivation of Epstein-Barr virus, which infects most people when they are young.

‘A monster’

In July 2020, Latoshia Allen Perrymond fell ill with COVID. Within a week, the 52-year-old Stone Mountain woman was struggling to catch her breath. She ended up hospitalized — for four months.

Though she survived, COVID damaged her heart and lungs. She said she’s been struggling mightily ever since. Dependent on oxygen around the clock, the former caregiver now relies on family members to help care for her.

She can no longer go on walks with her husband or cook big meals, or even sleep lying flat.

In late March, she eagerly joined the NIH study at Grady.

Like other participants in the NIH RECOVER study, she’s undergoing physical assessments.

“I feel good about the study because it means that I’m part of the answers,” she said. “I’m willing to do whatever they need because this COVID and long COVD is a monster and it’s still creepy. I’m learning to live with this new norm for me, but I hope that I can get better.”

Doctors are also eager for more answers.

“My hope is to find a pathology that unifies all of these symptoms,” said Truong. “My hope is, as the pandemic progresses, the variants become less virulent and less likely to cause long haul issues, and more and more patients are getting vaccinated. I hope we learn from this pandemic so that, when the next pandemic comes, we are a lot smarter, a lot more nimble in our approach, and more aware of the long haul issues.”

For now, the best way to try to avoid long COVID is to try to avoid the virus, Truong said. Get vaccinated and boosted and wear masks – especially indoors around crowds of people.

“It’s as simple as that,” he said. “But, unfortunately, I don’t think people want to hear it.”

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Risk of new‐onset psychiatric sequelae of COVID‐19 in the early and late post‐acute phase

Authors: Ben Coleman, 1 , 2 Elena Casiraghi, 3 , 4 Hannah Blau, 1 Lauren Chan, 5 Melissa A. Haendel, 6 Bryan Laraway, 6 Tiffany J. Callahan, 6 Rachel R. Deer, 7 Kenneth J. Wilkins, 8 Justin Reese, 9 and Peter N. Robinson 1 , 2 World Psychiatry. 2022 Jun; 21(2): 319–320 2022 May 7. doi: 10.1002/wps.20992 PMCID: PMC9077621 PMID: 35524622

Recent publications have documented that a proportion of COVID‐19 patients develop psychiatric symptoms during or after acute infection 1 . We investigated this risk in the context of the National COVID Cohort Collaborative (N3C) – a centralized, harmonized, high‐granularity electronic health record (EHR) repository 2 – using the largest retrospective cohort reported to date.

Two previous large‐scale EHR studies examined psychiatric sequelae 90 and 180 days after COVID‐19 diagnosis. A cohort of 44,779 individuals with COVID‐19 was propensity score‐matched to control cohorts with conditions such as influenza and other respiratory tract infections (RTI). In the 90 days following the initial presentation, the incidence proportion of new‐onset psychiatric conditions was 5.8% in the COVID‐19 group vs. 2.5% to 3.4% in the control groups 3 . A follow‐up study also included individuals with a prior history of mental illness and similarly showed an increased risk of psychiatric conditions in the six months following initial presentation 4 .

To validate these findings, we leveraged data from N3C, which at our cutoff date of October 20, 2021 had 1,834,913 COVID‐19 positive patients and 5,006,352 comparable controls. Our data set was drawn from 51 distinct clinical organizations. We included patients in the COVID‐19 cohort if they had a confirmed diagnosis of SARS‐CoV‐2 infection by polymerase chain reaction or antigen test after January 1, 2020. Controls were selected from patients with a diagnosis of a RTI other than COVID‐19. We excluded from this analysis patients with a history of any mental illness prior to 21 days after COVID‐19 diagnosis, as well as patients without a medical record extending back a year prior to COVID‐19. There were 245,027 COVID‐19 positive individuals available for propensity matching.

Each COVID‐19 patient was matched with a control patient from the same institution whose age differed by no more than 5 years. Propensity score matching was done on 34 factors using a logistic regression model including main effect terms, resulting in 46,610 matched patient pairs. Multivariable Cox regression was performed to compare the incidence of new‐onset mental illness for all psychiatric conditions, mood disorders and anxiety disorders for 21 to 365 days following initial presentation. We additionally considered dyspnea as a positive control.

We tested the Cox regression proportional hazard assumption for comparisons of COVID‐19 patients and controls 5 . Schoenfeld residual analysis yielded a significant p‐value and led us to reject the null hypothesis of a constant proportional hazard over the full time period of 21‐365 days. We therefore separated the cohort into two time intervals (before and after 120 days) in which the proportional hazard assumption was not violated.

We identified a statistically significant difference in the hazard rate of new‐onset psychiatric sequelae between COVID‐19 and RTI in the early post‐acute phase (from 21 to 120 days), but not in the late post‐acute phase (from 121 to 365 days). The estimated incidence proportion (as modeled on the log‐hazard scale over time) of a new‐onset psychiatric diagnosis in the early post‐acute phase for the COVID‐19 group was 3.8% (95% CI: 3.6‐4.0), significantly higher than the 3.0% (95% CI: 2.8‐3.2) for the RTI group, with a hazard ratio (HR) of 1.3 (95% CI: 1.2‐1.4). The HR for new‐onset mental illness in the late post‐acute phase was not significant in the COVID‐19 compared to the RTI group (HR: 1.0; 95% CI: 0.97‐1.1).

Similar findings were obtained for anxiety disorders, but not for mood disorders. The estimated incidence proportion of a new‐onset anxiety disorder diagnosis was significantly increased for COVID‐19 patients (2.0%; 95% CI: 1.8‐2.1) compared to RTI patients (1.6%; 95% CI: 1.5‐1.7) in the early post‐acute phase (HR: 1.3; 95% CI: 1.1‐1.4). However, the estimated incidence proportion of a new‐onset mood disorder diagnosis in the same period was not significantly increased for COVID‐19 patients (1.2%; 95% CI: 1.1‐1.3) in comparison to RTI patients (1.1%; 95% CI: 1.0‐1.2).

New‐onset anxiety and mood disorders were not significantly increased in the interval of 121‐365 days following initial presentation (HR: 1.0, 95% CI: 0.91‐1.1; and HR: 1.1, 95% CI: 0.97‐1.2, respectively). In contrast, the HR for dyspnea, a known post‐acute COVID‐19 sequela 1 , increased in both time periods (1.4, 95% CI: 1.2‐1.5; and 1.2, 95% CI: 1.0‐1.3, respectively).

We reasoned that patients might be followed more closely after COVID‐19 as compared with other RTIs, and that a higher visit frequency might increase the probability of a mental illness being recorded in the EHR. To assess this, we repeated our analysis but added the frequency of visits 21 days or more after initial presentation as a factor to the Cox regression. The HR for any mental illness in the early post‐acute phase was still significant (p<0.0001), but reduced to 1.2 (95% CI: 1.1‐1.3).

Our results confirm the conclusion of the above‐cited study 3 that patients are at significantly increased risk of psychiatric conditions after a COVID‐19 diagnosis. However, the degree of increased risk documented in our study is substantially lower than previously found.

There are several potential reasons for the differences between our results and those of the above‐mentioned study. The previous study included data from January 20, 2020 (first recorded COVID‐19 case in the US) to August 1, 2020, while our study includes data through October 20, 2021. It is conceivable that perceptions of COVID‐19 by patients have shifted or that clinical practice has changed in the intervening time. It is possible that improved treatment options available later in the pandemic have reduced the risk of psychiatric illness. Finally, COVID‐19 vaccination may reduce rates of anxiety and depression and alleviate symptoms in persons with post‐acute sequelae 6 . Thus, the increasing availability of vaccines might have reduced the rate of mental illness following COVID‐19. The data available in N3C do not include comprehensive information about vaccination status, so we could not test this hypothesis.

Many cohort studies have documented a high prevalence of mental illness in individuals with long COVID. For instance, in our recent analysis, the prevalence of depression was 21.1% (median reported percentage in 25 studies) and that of anxiety was 22.2% (median over 24 studies) 1 . However, it is possible that the reported prevalence of these and other conditions was in­flated by a sampling bias toward long COVID patients who joined support groups or chose to participate in cohort studies 8 . This, and the fact that inclusion criteria for long COVID studies vary, has made it difficult to characterize the natural history of psychiatric manifestations of long COVID. Our study did not fo­cus specifically on long COVID, but instead investigated a cohort of patients following a diagnosis of acute COVID‐19. It is difficult to know what proportion of these patients went on to develop long COVID; the recent introduction of ICD‐10 codes for long COVID 9 may enable studies on this topic in the future.

In summary, we support previously published reports of an increased risk of new‐onset psychiatric illness following acute COVID‐19 infection. In contrast to the nearly doubled risk identified by the earlier study, we found the relative risk to be increased by only about 25% (3.8% vs. 3.0% following other RTI). We did not find a significant difference in risk in the late post‐acute phase, suggesting that the increased risk of new‐onset psychiatric illness is concentrated in the early post‐acute phase.

Our results have important implications for understanding the natural history of psychiatric manifestations of COVID‐19. If confirmed by independent studies, our findings suggest that health services should consider mental health screening efforts early in the post‐COVID clinical course.

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NOTES

This work was supported by the US National Center for Advancing Translational Sciences (grant no. U24 TR002306).

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University Study Finds Higher Risk Of Psychiatric Diagnoses Among COVID-19 Patients

Authors: Naveen Athrappully via The Epoch Times  June 9,2022

A recent study published by Oregon State University discovered that COVID-19 infected individuals have a higher chance of developing psychiatric disorders within about four months of contracting the virus.

For the study, published in World Psychiatry on May 7, researchers used data from the National COVID Cohort Collaborative (N3C). They matched 46,610 patients infected with COVID-19, which can trigger a respiratory tract infection (RTI), with control patients diagnosed with a different RTI.

This allowed researchers to specifically look into how COVID-19 affected the mental health of infected individuals. No patients with any history of mental illness prior to 21 days after a COVID-19 diagnosis were included in the study. Those with a medical record extending a year prior to their COVID-19 diagnosis were also excluded.

Researchers looked at the rate of psychiatric diagnoses in the 46,610 COVID-19 patients for two time periods—the early post-acute phase between 21 and 120 days from the infection and the late post-acute phase between 121 and 365 days from the infection.

The study discovered that COVID-19 patients had a 3.8 percent rate of developing a psychiatric disorder in the early post-acute phase when compared to just 3 percent for other respiratory tract infections. This amounted to a nearly 25 percent higher risk for COVID-19 patients.

However, the researchers did not find such a “significant difference in risk” when they compared COVID-19 late post‐acute phase patients with individuals with other respiratory tract infections.

When researchers looked at anxiety disorders, they found the incidence proportion of a new‐onset anxiety disorder diagnosis was “significantly higher” for COVID-19 patients when compared to RTI patients. For mood disorders, such significant differences were not observed.

“For people that have had COVID, if you’re feeling anxiety, if you’re seeing some changes in how you’re going through life from a psychiatric standpoint, it’s totally appropriate for you to seek some help,” Lauren Chan, co-author of the study, said according to a June 6 news release by Eurekalert.

“And if you’re a care provider, you need to be on the proactive side and start to screen for those psychiatric conditions and then follow up with those patients.”

Chan stressed that not every COVID-19 infected individual is going to have such psychiatric problems. In the context of the health care infrastructure of the United States, an increase in the number of COVID-19 patients seeking psychiatric care could add more strain on the system, she warned.

Multiple other studies have also suggested that a segment of COVID-19 patients might end up facing psychological issues.

Research published in April 2021 found that 34 percent of the 236,379 COVID-19 survivors included in the study developed neurological and mental disorders in the six months after becoming infected, according to WebMD.

Anxiety was the most commonly found disorder, with 17 percent of subjects reporting it. This was followed by mood disorders at 14 percent, substance abuse disorders at 7 percent, and insomnia at 5 percent.

When it came to neurological problems, 0.6 percent reported brain hemorrhage, 2.1 percent reported ischemic strokes, and 0.7 percent reported dementia. Among patients diagnosed as seriously ill with COVID-19, these rates jumped. Of the patients admitted to the intensive care unit, 7 percent experienced a stroke while 2 percent were diagnosed with dementia.

In another study published on Feb. 16 at BMJ, researchers analyzed records of nearly 153,848 COVID-19 patients in the Veterans Health Administration (VHS) system, comparing them with individuals who had not contracted the virus.

Those who got infected were found to be 35 percent more likely to be diagnosed with anxiety following the infection than uninfected people, 38 percent were more likely to be diagnosed with adjustment and stress disorders, 39 percent were more likely to be diagnosed with depression, and 41 percent were more likely to be diagnosed with sleep disorders.

There appears to be a clear excess of mental health diagnoses in the months after Covid,” Paul Harrison, a professor of psychiatry at the University of Oxford who was not involved in the study, told The New York Times.

However, only 4.4 to 5.6 percent of individuals in the study were diagnosed with anxiety, depression, adjustment, and stress disorders.

“It’s not an epidemic of anxiety and depression, fortunately,” Harrison added. “But it’s not trivial.”

Warning to anyone who’s had Covid as scientists discover symptoms that can last for TWO YEARS

Authors: Vanessa Chalmers, Digital Health Reporter May 11 2022  May 12 2022

DOCTORS have discovered the symptoms of Covid that can last for two years or more. 

Their research has shown that half of patients admitted to hospital are still likely to have at least one persistent problem two years later.

The study, published in The Lancet Respiratory Medicine, has the longest follow-up period of patients to date. 

Researchers are only able to analyse what symptoms exist after two years given the coronavirus emerged in late 2019.

So it’s possible problems like fatigue and anxiety could stick around even longer.

Lead author Professor Bin Cao, of the China-Japan Friendship Hospital, China, said: “Our findings indicate that for a certain proportion of hospitalised Covid-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully from Covid-19.”

The study involved almost 1,200 patients, aged 57 on average, who were infected with the bug in the early phase of the pandemic.

They had all been treated in Wuhan, China, then assessed six months, 12 months and two years after discharge.

Researchers looked at their walking abilities, mental health, quality of life and more.

Covid patients were generally found to be in poorer health than those in the general population two years after infection.

They reported:

  • Fatigue or muscle weakness (31 per cent of Covid patients compared to five per cent in the general population)
  • Sleep difficulties (51 per cent compared with 14 per cent)
  • Pain or discomfort (23 per cent compared with five per cent)
  • Anxiety or depression (12 per cent compared with five per cent)

Joint pain, palpitations, dizziness, and headaches were also more common among previously hospitalised Covid patients.

Not all of those hospitalised were affected, however.

More than half (55 per cent) of participants had at least one symptom of Covid at two years, and were therefore considered “long Covid” patients.

The researchers then compared the long Covid group with the group of participants who had endured Covid, but gotten better. 

Those with long Covid had more pain (35 per cent vs 10 per cent), and mobility issues (five per cent vs one per cent) than their fully recovered counterparts.

Some 13 per cent showed symptoms of anxiety and 11 per cent depression, compared with three per cent and one per cent in non-long Covid patients, respectively. 

The researchers said it’s not possible to say whether problems like these are specific to Covid, or whether other hospital patients experience them.

Long Covid is defined as someone who still battles symptoms beyond four weeks in the UK.

It may be defined as ongoing Covid (four to 12 weeks), or post-Covid syndrome (more than 12 weeks) by medics.

The symptoms may include fatigue, a cough, breathlessness, muscle or joint pain, loss of taste of smell and brain fog.

Multiple Early Factors Anticipate Post-Acute COVID-19 Sequelae

Highlights

  • Longitudinal multiomics associate PASC with autoantibodies, viremia and comorbidities
  • Reactivation of latent viruses during initial infection may contribute to PASC
  • Subclinical autoantibodies negatively correlate with anti-SARS-CoV-2 antibodies
  • Gastrointestinal PASC uniquely present with post-acute expansion of cytotoxic T cells

SUMMARY

Post-acute sequelae of COVID-19 (PASC) represent an emerging global crisis. However, quantifiable risk-factors for PASC and their biological associations are poorly resolved. We executed a deep multi-omic, longitudinal investigation of 309 COVID-19 patients from initial diagnosis to convalescence (2-3 months later), integrated with clinical data, and patient-reported symptoms. We resolved four PASC-anticipating risk factors at the time of initial COVID-19 diagnosis: type 2 diabetes, SARS-CoV-2 RNAemia, Epstein-Barr virus viremia, and specific autoantibodies. In patients with gastrointestinal PASC, SARS-CoV-2-specific and CMV-specific CD8+ T cells exhibited unique dynamics during recovery from COVID-19. Analysis of symptom-associated immunological signatures revealed coordinated immunity polarization into four endotypes exhibiting divergent acute severity and PASC. We find that immunological associations between PASC factors diminish over time leading to distinct convalescent immune states. Detectability of most PASC factors at COVID-19 diagnosis emphasizes the importance of early disease measurements for understanding emergent chronic conditions and suggests PASC treatment strategies.

Article Info

Publication History

Accepted: January 19, 2022Received in revised form: December 14, 2021Received: September 29, 2021

Click on Link Below for Complete Study:

https://www.cell.com/cell/pdf/S0092-8674(22)00072-1.pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867422000721%3Fshowall%3Dtrue

Long COVID’s daunting toll seen in study of pandemic’s earliest patients

Authors: Melissa Healy   6 hrs ago

COVID-19 patients in Wuhan were among the pandemic’s first victims, and a comprehensive new study finds that a year after shaking the coronavirus, survivors were more likely than their uninfected peers to suffer from mobility problems, pain or discomfort, anxiety and depression.

detailed accounting of 1,276 people hospitalized for COVID-19 in the pandemic’s opening months reveals that a full year later, almost half continued to report at least one lingering health problem that is now considered a symptom of “long COVID.”

One out of five said they had continued fatigue and/or muscle weakness, and 17% said they were still experiencing sleep difficulties. Just over one in four said they were suffering anxiety or depression in the wake of their bout with the SARS-CoV-2 virus.

For the growing number of patients who identify themselves as COVID “long haulers,” the new accounting offers cause for optimism — and concern. The period from six to 12 months after infection brought improvement for many. But most patients struggling with symptoms at the six-month mark were not yet well six months later.

The findings, catalogued by a team of Chinese researchers, were published late Thursday in the medical journal Lancet.

“This is not good news,” said David Putrino, a rehabilitation specialist who works with COVID long haulers at Mount Sinai Hospital in New York. “If you run the numbers here, about one-third of the group that had persistent symptoms are getting better after 12 months, while two-thirds are not.”

Putrino also called the findings a “wake-up call” to public health officials that even when the pandemic is over — a distant enough prospect in the midst of a fourth wave of infections — its downstream consequences will not be.

“We’re going to need resources for many years to come to deal with these patients,” he said.

There will be a lot of them. More than 87,000 COVID-19 patients are being hospitalized each day in the United States, and 2.7 million have receiving hospital care in the past year alone.

The half who contend with persistent symptoms will show up in doctors’ offices with clusters of vague and perplexing complaints including brain fog, heart palpitations, pain and exhaustion. And despite emerging evidence that time and specialized treatment can help many to improve, few will have the wherewithal to spend months in intensive rehabilitation for their symptoms, Putrino said.

An editorial published alongside the new study noted that only 0.4% of COVID long haulers are receiving rehabilitative treatment for their symptoms.

Even as scientists puzzle over the common biological mechanisms of long COVID’s diverse symptoms, healthcare providers “must acknowledge and validate the toll of the persistent symptoms of long COVID on patients, and health systems need to be prepared to meet individualised, patient-oriented goals, with an appropriately trained workforce,” Lancet’s editors wrote.

The new research also offered some glimmers of hope.

When the study’s COVID-19 patients were examined at six months, 68% said they had at least one of 15 symptoms considered hallmarks of long COVID, which is also known as Post-Acute Sequelae of COVID, or PASC. At one year, 49% were still afflicted by at least one of those symptoms.

The proportion of patients with ongoing muscle weakness and fatigue dropped from 52% to 20% during that time. Patients experiencing loss of smell dropped from 11% to 4%, and those afflicted with sleep problems fell from 27% to 17%. The 22% who reported hair loss at six months dwindled to 11% a full year out.

At the same time, the numbers of patients reporting breathing difficulties saw a slight increase, rising from 26% at six months to 30% after a year. Likewise, patients who reported new depression or anxiety increased from 23% to 26% during that period.

Study co-author Xiaoying Gu from the China-Japan Friendship Hospital in Beijing said the slight uptick in anxiety and depression was, like all of long COVID’s symptoms, hard to explain.

The psychiatric symptoms “could be caused by a biological process linked to the virus infection itself, or the body’s immune response to it,” he said. “Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness.”

Patients who required mechanical ventilation were more likely than those with less severe illness to have measurable lung impairment and abnormal chest X-rays at both six and 12 months.

But in the tally of more subjective long COVID symptoms, the difference between the most severely ill and those who required no supplemental oxygen at all was very small.

That finding underscores the fact that even patients who are only mildly ill are at risk of developing a range of persistent symptoms.

Of the study population’s 479 patients who held jobs when the pandemic struck, 88% had returned to work a year after their illness. Most of the 57 who did not return said they either could not or were unwilling to do the tasks required of them.

The findings from the Wuhan patients also tracked with the widespread observation that persistent post-COVID infection symptoms are more common in women than in men. Women who had been hospitalized for COVID-19 were twice as likely as their male counterparts to report depression or anxiety 12 months later. In addition, they were close to three times as likely to show evidence of impaired lung function, and 43% more likely to report symptoms of fatigue and muscle weakness.

All of the study’s participants were treated at a single hospital in Wuhan, where reports of a mysterious new form of pneumonia first surfaced in December 2019. The researchers followed a large group of patients sickened in the first five months that the outbreak.

That makes the Lancet report one of the earliest and largest accounts of lingering COVID-19 symptoms to be tallied and vetted by other researchers, and the only one to compare such patients to a group of uninfected peers matched on a wide range of demographic and health attributes.

One thing is already clear, the journal editors noted: “Long COVID is a modern medical challenge of the first order.”

This story originally appeared in Los Angeles Times.

Some COVID-19 patients have brain complications, study suggests

Authors: Mary Van Beusekom | News Writer | CIDRAP News  | Jun 26, 2020

Some COVID-19 patients, including those younger than 60 years old, appear to develop neurologic and neuropsychiatric complications such as stroke, brain inflammation, psychosis, and dementia-like symptoms, according to a study published yesterday in The Lancet Psychiatry.

The early-stage study of 153 hospitalized patients with confirmed, probable, or possible COVID-19 in the United Kingdom (UK) from Apr 2 to 26 identified 125 patients with complete data, of whom 77 (62%) had a stroke.

Of 125 patients, 114 (92%) had confirmed coronavirus infection, 5 (4%) had probable infection, and 5 (4%) were classified as possibly infected.

Stroke, encephalopathy, psychiatric diagnoses

Fifty-seven of 77 stroke patients (74%) had an ischemic stroke caused by a blood clot in the brain, 9 (12%) had a stroke caused by a brain hemorrhage, and 1 (1%) had a stroke caused by inflammation in the brain’s blood vessels. Sixty-one of the 77 stroke patients for whom age was available (82%) were older than 60 years.

Thirty-nine of 125 patients (31%) had behavioral changes indicative of an altered mental state, of whom 9 (23%) had unspecified brain dysfunction known as encephalopathy, and 7 (18%) had brain inflammation, or encephalitis.

The remaining 23 patients with altered mental states had psychiatric diagnoses, including 10 with new-onset psychosis, 7 with depression or anxiety, and 6 with a dementia-like syndrome. Only 2 patients (9%) had exacerbations of a chronic mental illness, although the authors noted that they cannot exclude the possibility that cases classified as new were simply undiagnosed before the pandemic.

Of the 37 of 39 COVID-19 patients with an altered mental state for whom age was available, 18 (49%) were younger than 60 years, which could be because they were more likely to be referred to a psychiatrist or other specialist, while physicians may be likely to attribute confusion or behavioral changes in older patients to delirium without further investigation, the authors said.

Altered mental states in younger patients

While altered mental states are not uncommon in hospitalized patients with infections, especially those requiring intensive care, they occur most often in older patients.

“In this study, we observed a disproportionate number of neuropsychiatric presentations in younger patients and a predominance of cerebrovascular complications in older patients, which might reflect the state of health of the cerebral vasculature and associated risk factors, exacerbated by critical illness in older patients,” the authors said.

For More Information: https://www.cidrap.umn.edu/news-perspective/2020/06/some-covid-19-patients-have-brain-complications-study-suggests

Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic

Authors: Ram Lakhan1 Amit Agrawal2 Manoj Sharma3

Introduction

The outbreak of the third coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), also named coronavirus disease 2019 (COVID-19), has occurred more rapidly than people could have ever imagined from the experience of the past two SARS-CoV and Middle East respiratory syndrome coronavirus.1,2 To control the spread of this virus, the entire world acted fast and in collaboration, but the COVID-19 pandemic could not be controlled as it has rather impacted human lives across the globe. In 6 months, in 216 countries including territories, 13,876,441 people got confirmed for infection and 593,087 lost their lives.3 To reduce the risk of COVID-19 exposure, social distancing was suggested and enforced. People of all walks are required to stay in their homes and maintain physical distance in any given situation while they are out for any essential reason.4,5 This intervention has not only impacted all ongoing activities but has led to a tremendous negative effect on the mental health of people. The fear of contracting the virus, lack of treatment, higher mortality associated with the virus, and uncertainty about when the virus would be controlled and when a vaccine would be available are the major factors that were found to be highly responsible in increasing psychological distress, adjustment, and even more serious mental health problems. Economic loss, interrupted daily routine, the inability of engaging in social events, and constant news exposure are additional factors that affected mental health. The crisis became an unmanageable stressor. Incidences were even noticed where some people could not handle the mental pressure, and as an escape from traumatizing reality, they committed suicide.6,7 Editorials, scientific letters, perspectives, and commentaries in scientific literature and reports in print and visual media have pointed out an increase in mental health problems. Experts across the world expressed concerns for an increasing toll of mental health problems and urged for mental health support.8 The increase in mental health problems in every society and age group in every nation has turned out to be another important global public health concern during this pandemic. 9-16 Experts have suggested appropriate and cost-effective ways to address psychological distress and their resulted effects.17 A lot of attention has been given to this emerging situation with mental health concerns. However, we still lack quantifiable information about the increase in mental health problems due to the pandemic. Policy makers need to know the extent of the problem before making the appropriate arrangements for addressing this issue of increased mental health problems. This scoping review was conducted to provide an estimate of various mental health problems that occurred due to COVID-19. Objective The aim of this study was to review the prevalence of depression, anxiety, stress, and sleep problems during the first 7 months of COVID-19 pandemic.

For More Information: https://digitalscholarship.unlv.edu/cgi/viewcontent.cgi?article=1411&context=community_health_sciences_fac_articles

Prevalence of Depression, Anxiety, and Stress during COVID-19 Pandemic

Authors: Ram Lakhan 1Amit Agrawal 2Manoj Sharma 3

Abstract

The coronavirus disease 2019 (COVID-19) crisis has greatly affected human lives across the world. Uncertainty and quarantine have been affecting people’s mental health. Estimations of mental health problems are needed immediately for the better planning and management of these concerns at a global level. A rapid scoping review was conducted to get the estimation of mental health problems in the COVID-19 pandemic during the first 7 months. Peer-reviewed, data-based journal articles published in the English language were searched in the PubMed, Medline, and Google Scholar electronic databases from December 2019 to June 2020. Papers that met the inclusion criteria were analyzed and discussed in this review. A total of 16 studies were included. Eleven studies were from China, two from India, and one from Spain, Italy, and Iran. Prevalence of all forms of depression was 20%, anxiety 35%, and stress 53% in the combined study population of 113,285 individuals. The prevalence rate of all forms of depression, anxiety, stress, sleep problems, and psychological distress in general population was found to be higher during COVID-19 pandemic.

For More Information: https://pubmed.ncbi.nlm.nih.gov/33144785/

Psychological Impact of COVID-19 on Children and Adolescents: A Systematic Review

Authors: Nishtha Chawla,1Ashlyn Tom,1Mahadev Singh Sen,1 and Rajesh Sagar1

Abstract

Background and aims:

The outbreak of COVID-19 led to a significant psychological impact on individuals, particularly those belonging to vulnerable groups. This study aimed to synthesize literature on the psychological impact of COVID-19 among children and adolescents.

Methods:

Electronic search engines were used to identify studies till March 2021 that reported symptoms of psychological origin in children and adolescents. Information was extracted using a predefined template, and qualitative analysis was conducted using STROBE.

Results:

One hundred and two relevant papers were identified. Most of the studies were conducted online or telephonically. The study designs were primarily single group cross-sectional, though a few prospective/retrospective designs were also identified. Studies assessing emotional distress showed variable levels of anxiety and depressive symptoms in the study population, with greater severity of anxiety symptoms among females and older adolescents. Reduced physical activity; delayed sleep time; increased sleep duration, screen time, internet use, and sedentary habits, poor quality of life were other notable findings, often correlating with anxiety/depression. Efforts to address bias, discussion on generalizability of their results, and sample size calculation were not reported in most studies.

Conclusion:

Psychological impact on children/adolescents is significant, either due to the fear of the illness or social isolation related to COVID-19. One may focus on improving sleep habits and physical activity and regulating internet use for maintaining psychological well-being.

For More Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8327877/