Long COVID science, research and policy

Nature Medicine, Год журнала: 2024, Номер 30(8), С. 2148 - 2164

Опубликована: Авг. 1, 2024

Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system be severely disabling. The cumulative global incidence long around 400 million individuals, which estimated to have an annual economic impact approximately $1 trillion-equivalent about 1% economy. Several mechanistic pathways are implicated in COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement endothelial inflammation microbiome dysbiosis. devastating impacts on individual lives and, due its complexity prevalence, also has major ramifications for systems economies, even threatening progress toward achieving Sustainable Development Goals. Addressing challenge requires ambitious coordinated-but so far absent-global research policy response strategy. In this interdisciplinary review, we provide synthesis state scientific evidence assess human health, systems, economy metrics, forward-looking roadmap.

Язык: Английский

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Long COVID: a clinical update

The Lancet, Год журнала: 2024, Номер 404(10453), С. 707 - 724

Опубликована: Июль 31, 2024

Язык: Английский

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Laboratory Findings and Biomarkers in Long COVID: What Do We Know So Far? Insights into Epidemiology, Pathogenesis, Therapeutic Perspectives and Challenges

International Journal of Molecular Sciences, Год журнала: 2023, Номер 24(13), С. 10458 - 10458

Опубликована: Июнь 21, 2023

Long COVID (LC) encompasses a constellation of long-term symptoms experienced by at least 10% people after the initial SARS-CoV-2 infection, and so far it has affected about 65 million people. The etiology LC remains unclear; however, many pathophysiological pathways may be involved, including viral persistence; chronic, low-grade inflammatory response; immune dysregulation defective reactivation latent viruses; autoimmunity; persistent endothelial dysfunction coagulopathy; gut dysbiosis; hormonal metabolic dysregulation; mitochondrial dysfunction; autonomic nervous system dysfunction. There are no specific tests for diagnosis LC, clinical features laboratory findings biomarkers not specifically relate to LC. Therefore, is paramount importance develop validate that can employed prediction, prognosis its therapeutic response, although this effort hampered challenges pertaining non-specific nature majority manifestations in spectrum, small sample sizes relevant studies other methodological issues. Promising candidate found some patients markers systemic inflammation, acute phase proteins, cytokines chemokines; reflecting persistence, herpesviruses endotheliopathy, coagulation fibrinolysis; microbiota alterations; diverse proteins metabolites; biomarkers; cerebrospinal fluid biomarkers. At present, there only two reviews summarizing they do cover entire umbrella current biomarkers, their link etiopathogenetic mechanisms or diagnostic work-up comprehensive manner. Herein, we aim appraise synopsize available evidence on typical classification based pathogenetic main symptomatology frame epidemiological aspects syndrome furthermore assess limitations as well potential implications interventions.

Язык: Английский

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Cognitive dysfunction after covid-19

BMJ, Год журнала: 2024, Номер unknown, С. e075387 - e075387

Опубликована: Фев. 1, 2024

Язык: Английский

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Pathophysiological Mechanisms in Long COVID: A Mixed Method Systematic Review

International Journal of Environmental Research and Public Health, Год журнала: 2024, Номер 21(4), С. 473 - 473

Опубликована: Апрель 12, 2024

Introduction: Long COVID (LC) is a global public health crisis affecting more than 70 million people. There emerging evidence of different pathophysiological mechanisms driving the wide array symptoms in LC. Understanding relationships between and helps guiding clinical management identifying potential treatment targets. Methods: This was mixed-methods systematic review with two stages: Stage one (Review 1) included only existing reviews (meta-review) 2) all primary studies. The search strategy involved Medline, Embase, Emcare, CINAHL databases to identify studies that described statistical analysis and/or discussion plausible causal symptoms. Only control arm for comparison were included. Studies assessed quality using National Heart, Lung, Blood Institute assessment tools. Results: 19 Review 1 46 2. Overall, reporting across this second moderate poor. strong immune system dysregulation, cerebral hypoperfusion, impaired gas transfer lungs. Other weak endothelial damage hypercoagulation, mast cell activation, auto-immunity vascular receptors. Conclusions: LC complex condition multiple organs diverse presentations (or traits) underpinned by mechanisms. A ‘treatable trait’ approach may help certain groups target specific interventions. Future research must include understanding response intervention based on these mechanism-based traits.

Язык: Английский

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What is quality in long covid care? Lessons from a national quality improvement collaborative and multi-site ethnography

BMC Medicine, Год журнала: 2024, Номер 22(1)

Опубликована: Апрель 15, 2024

Abstract Background Long covid (post covid-19 condition) is a complex condition with diverse manifestations, uncertain prognosis and wide variation in current approaches to management. There have been calls for formal quality standards reduce so-called “postcode lottery” of care. The original aim this study—to examine the nature long care unwarranted services—evolved focus on examining reasons why standardizing was so challenging condition. Methods In 2021–2023, we ran improvement collaborative across 10 UK sites. dataset reported here mostly but not entirely qualitative. It included data origins context each clinic, interviews staff patients, ethnographic observations at 13 clinics (50 consultations) 45 multidisciplinary team (MDT) meetings (244 patient cases). Data collection analysis were informed by relevant lenses from clinical (e.g. evidence-based guidelines), science cycles) philosophy knowledge. Results Participating made progress towards assessment management some topics; remained could usually be explained. Clinics had different histories path dependencies, occupied place their healthcare ecosystem served varied caseload including high proportion patients comorbidities. A key mechanism achieving high-quality when local MDTs deliberated unusual, or cases which guidelines provided no easy answers. such cases, collective learning occurred through idiographic (case-based) reasoning , practitioners build lessons particular general. This contrasts nomothetic implicit guidelines, assumed go general findings trials) (management individual patients). Conclusion Not all services unwarranted. Largely because covid’s manifestations are comorbidities common, generic “evidence-based” require much adaptation. condition, resources may productively spent supporting optimise case-based interdisciplinary discussion. Quality service should include review sample assess how interpreted personalized meet patients’ unique needs. Study registration NCT05057260, ISRCTN15022307.

Язык: Английский

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Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study

Journal of Medical Virology, Год журнала: 2024, Номер 96(3)

Опубликована: Март 1, 2024

Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and hypotension (OH), are often reported in long covid, but published studies small with inconsistent results. We sought to estimate the prevalence of objective OI patients attending covid clinics healthy volunteers associations symptoms comorbidities. Participants a diagnosis were recruited from eight UK clinics, general population. All undertook standardized National Aeronautics Space Administration Lean Test (NLT). Participants' history typical (e.g., dizziness, palpitations) before during NLT recorded. Two hundred seventy-seven 50 frequency-matched tested. Healthy had no or PoTS, 10% asymptomatic OH. One thirty (47%) previous 144 (52%) developed NLT. Forty-one (15%) an abnormal NLT, 20 (7%) met criteria for 21 (8%) Of 45% prior OI. Relaxing diagnostic thresholds PoTS two consecutive readings one reading resulted 11% participants (an additional 4%) meeting not volunteers. More than half experienced more 10 either OH, whom did report symptoms. therefore recommend all offered appropriate management commenced.

Язык: Английский

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High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study

Frontiers in Medicine, Год журнала: 2023, Номер 10

Опубликована: Дек. 15, 2023

Exercise-based treatments can worsen/exacerbate symptoms in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM OI are not routinely assessed by clinicians. We estimated proportions PL-PCC, as well PCC (PnL-PCC) negatives (i.e., never reported a test), identified associated factors.

Язык: Английский

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Breathing difficulties after covid-19: a guide for primary care

BMJ, Год журнала: 2023, Номер unknown, С. e074937 - e074937

Опубликована: Июнь 14, 2023

What you need to know• Breathing difficulties are common sequelae of covid-19 • Typically there multiple contributing factors breathing within an individual pattern disorder can be positively diagnosed from the history and clinical examination, but parallel investigations rule out other causes may necessary Self management support tools help some patients regain a normal Further investigation specialist respiratory physiotherapy should considered when symptoms not improvingAround one in four adults who were hospitalised with six experience persistent beyond weeks after SARS-CoV-2 infection, 1 2 cohort study China demonstrated that breathlessness persist two years. 3 In long covid (defined as 4 ) predominant feature or part multisystem presentation. 5Cardiorespiratory complications include thromboembolic disease, interstitial lung heart failure excluded.This article predominantly focuses on other, more post-covid treated often less well understood. 6finitive, evidence based protocols treatment for currently lacking.Until they exist, pragmatic approach outlined here, including careful examination appropriate use investigations, identify treatable conditions improve symptoms.In particular, positive diagnosis (box 2) made general practice.Self resources 3) offered early.Timely referral services is needed whose severe progressive. Presentation difficultiesBreathing present several ways, pressure, tightness, soreness, pain burning chest.These associated considerable distress.The tends similar despite interval between healthcare presentation infection.Although natural recovery persisting 12 weeks, it difficult predict at level, early needed. 7Box describes typical patient narrative.

Язык: Английский

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Work and vocational rehabilitation for people living with long covid

BMJ, Год журнала: 2024, Номер unknown, С. e076508 - e076508

Опубликована: Май 10, 2024

Язык: Английский

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