Attributes and predictors of long COVID

Nature Medicine, Год журнала: 2021, Номер 27(4), С. 626 - 631

Опубликована: Март 10, 2021

Язык: Английский

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Management of post-acute covid-19 in primary care

BMJ, Год журнала: 2020, Номер unknown, С. m3026 - m3026

Опубликована: Авг. 11, 2020

What you need to know• Management of covid-19 after the first three weeks is currently based on limited evidence • Approximately 10% people experience prolonged illness Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity Home pulse oximetry can be helpful monitoring breathlessness Indications for specialist assessment include clinical concern along respiratory, cardiac, or neurological symptoms that are new, persistent, progressive

Язык: Английский

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Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

PLoS ONE, Год журнала: 2021, Номер 16(3), С. e0247461 - e0247461

Опубликована: Март 4, 2021

Aim COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating risk factors for infection, low sample size and heterogeneity in study design impacted consolidation findings. There pressing need identify the which predispose patients cases COVID-19. For rapid widespread stratification, these should be easily obtainable, inexpensive, avoid invasive procedures. The aim our fill this knowledge gap by systematically mapping all available evidence on association various clinical, demographic, lifestyle variables with specific adverse outcomes Methods systematic review was conducted using standardized methodology, searching two electronic databases (PubMed SCOPUS) relevant literature published between 1 st January 2020 9 th July 2020. Included studies reported characteristics while reporting disease severity. In case sufficient comparable data, meta-analyses were estimate each variable. Results Seventy-six identified, total 17,860,001 across 14 countries. highly heterogeneous terms under study, outcomes, measures reported. A large presented Commonly outcome comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81–3.90), male sex 2.05, 1.39–3.04) obesity 2.57, 1.31–5.05). Active cancer 1.46, 1.04–2.04) associated increased outcome. common symptoms vital (respiratory rate SpO2) also suggested elevated profiles. Conclusions Based findings range assessed parameters valuable predict illness mortality as result COVID-19, detailed comorbidities, alongside novel inclusion real-time measurements.

Язык: Английский

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Considering the potential for an increase in chronic pain after the COVID-19 pandemic

Pain, Год журнала: 2020, Номер 161(8), С. 1694 - 1697

Опубликована: Июнь 3, 2020

1. Introduction The COVID-19 pandemic has impacted the lives and health of persons worldwide, with potential for further effects in future. experience living within this disrupted daily life across all sectors, including those chronic pain (CP), infected coronavirus Severe Acute Respiratory Syndrome (SARS)-CoV2, healthcare providers essential workers, as well who remained physically healthy. toll extends beyond physical illness, important psychosocial stressors that include prolonged periods limited interpersonal contact, isolation, fear future uncertainty, financial strain. Uncertainty is fuelled by constant media coverage, often conflicting information, differing recommendations public authorities different jurisdictions, unknown duration likelihood resurgence pandemic. In context, we will examine consequences germane to CP, which might be nociplastic, neuropathic, or nociceptive. Specific possibilities include: (1) CP part a postviral syndrome result viral-associated organ damage; (2) worsening due exacerbation preexisting mental complaints; (3) newly triggered individuals not COVID risk factors (poor sleep, inactivity, fear, anxiety, depression). Chronic must considered context biopsychosocial model, views symptoms complex dynamic interaction between biological, psychological, social factors.36,39 Underlying predisposing mechanisms genetic factors, previous experience, traumatic events could emotional.2 conditions can organ-specific biological may preferentially occur fragile stress response system.8,10,24,40,47 many characteristics potentially increase prevalence especially extending over months. worldwide community invited consider possible downstream COVID-19, only patients surviving infection, but also wider experienced social, economic effects. Although address these issues from perspective physicians practicing developed countries, discussed particularly relevant people other call colleagues Asia, Africa, South America enter into dialogue. 2. Infections trigger viral illnesses present myalgia fatigue, symptoms, seen influenza, noted H1N1 pandemics 1918 2009, infection during SARS epidemic.4,17 Outcomes related infections are almost always focused on immediate acute little attention long-term outcomes. small study 22 subjects (21 whom were workers) epidemic, post-SARS consisting diffuse myalgia, depression, nonrestorative sleep persisted 2 years.27 Similarly, some widespread report onset after perceived illness. cause specific postinfectious syndromes, there common stereotypical any type observed. For example, up 12% 3 pathogens, ie, Ross River virus (the epidemic polyarthritis), Coxiella burnetii (cause Q fever), Epstein–Barr virus, pain, memory difficulties 12 months infection.15 have markedly disparate presentations, occurred at remarkably similar rates was predicted demographic, psychological/psychiatric measures, microbiological factors.15 presence severity somatic closely correlated subsequent development fatigue pain. regional follow types infection. meta-analysis, Halvorson et al. approximately 10% develop irritable bowel an episode bacterial gastroenteritis, premorbid psychological problems and/or recognized factors.7,13 On note, urinary tract evident substantial proportion women interstitial cystitis/painful bladder syndrome.43 Collectively, findings imply various capable triggering both CP. evidence suggests inciting sufficient disrupt normal activities.44 Current estimates 80% laboratory-confirmed mild moderate disease, pneumonia nonpneumonia cases, 13.8% severe 6.1% critical illness requiring intensive care unit (ICU) admission.42 3. Potential health-related 3.1. consequence disease Persons exhibit broad range beginning asymptomatic full-blown respiratory distress syndrome. Nonspecific constitutional myalgias, chills, headaches. Most 1 weeks complete resolution, although require hospitalization. mortality rate order 1% according published Centre Evidence-Based Medicine.37 Whether more susceptible thereof unknown. Theoretically, diminished immune system observed even suppressed such poor opioid use, susceptibility SARS-CoV2.19,41 Many need ICU care, admission increased long-lasting functional limitations, distress, Surveys reported persistent 38% 56% survivors when evaluated 4 years admission.18,34 Quality affected periods. evaluating 575 6 11 discharge, difficulty mobility (52%), self-care (19%), activities pain/discomfort (57%), cognition (43%).38 Mental frequently Between 41% 65% symptoms.20,23 25% 44% Hong Kong residents survived diagnosed posttraumatic disorder (PTSD), 15% depression least 30 illness.16,22 Posttraumatic 40.7% SARS-infected workers.22 3.2. Exacerbation absence actual Some resulting personal issues. Regular medical compromised lockdown ensuing months.9 Routine clinics less accessible closed, professionals diverted COVID-19-related activities, waiting times prolonged, nonurgent. Patients able willing travel fearful exposure setting. There delays timely access medications reduced prescribing, management procedures lesser importance than urgent illnesses. Reduced clinical encounters interdisciplinary team members (eg, physiotherapists, psychologists, self-help groups) adverse consequences. Access logistical true drug shortages analgesic emergency causing turn alcohol nonmedically prescribed substances desperate measure relieve poorly managed rapid evolution telehealth presents new challenges fully comfortable without digital technology. impact working lost jobs insurance contend insecurity poverty. Another factor vital strategy distancing closure group activity programs gyms pools.21 Limited support contribute health.12 heightened awareness accompanied indication These numerous exacerbate Given wisdom suggest catastrophic stressful inevitably lead However, studies performed United States just before 9/11 terrorist attacks indicate Pain complaints did change among New York Jersey had been surveyed World Trade Center.32 fibromyalgia Washington, D.C. region same period.32 Daily "hassles" personally seem likely major do individual.30 Therefore, (ie, current pandemic), vocational uncertainty loss jobs, adversely affecting Reviews highlight role number intensity "stressor" predicting Female sex, concerns about expectation chronicity, inactivity time off work symptoms.26 Naturally occurring earthquakes, floods, fires similarly "man-made" chemical spills war.6 Exposure multitude simultaneously, time, pose significant later sequelae.14,33 military personnel, multiple deployments significantly PTSD psychiatric conditions, highly coprevalent CP.46 3.3. It currently known whether new-onset population large. Risk longitudinal studied temporomandibular disorders.11,25,29 thought consistently shown high baseline levels modestly (OR 1.5-2).25 Regional female low socioeconomic status strongest predictors pain.11,25 Other activity. Sleep deprivation virtually indistinguishable tenderness.28 Furthermore, attenuated remain active sensitive disruption).1 Healthcare workers recent Israeli study, 9.7% cohort 206 nurses fulfilled criteria fibromyalgia, strongly work-related PTSD-related symptoms.3 Numerous geographic boundaries. Nearly everyone exposed relentless coverage messages, contracting SARS-CoV2, routine family, pervasive. Those underlying particular exacerbation. Further relate distancing, isolation quarantine, some, grieving death usual system. Persistent extreme suicide rate. preliminary anxiety (16%-28%), self-reported (8%), disturbances reactions pandemic.31 During outbreak 2003, historically 18.6 per 100,000 Kong.5 annual older adults return preepidemic levels, suggesting 4. Immediate strategies mitigate Recovery life-threatening expected affect health. Rehabilitation services should mobilized inpatient outpatient paid staffing ensure services, physiotherapy, occupational therapy.35 resume most patients, flexible adapt methods delivery, regard telemedicine.9 communicating emphasis virtual learning teaching. attuned hardship, substance abuse, domestic violence, suicide. Providers low- middle-income countries disadvantaged resources shortage workers.45 Developed recognize crises underdeveloped constrained artificial boundaries continue participate efforts led international organizations Health Organization International Red Cross. suggestions implemented if governments legislators partnership accordance experts. 5. Conclusion unprecedented crisis, directed towards containment patient care. manifested spared nevertheless disruptions wide array physical, stressors. Based past postulate scenarios collectively possibly Amidst uncertainties, research urged devise, implement aimed mitigating pain-related establishment registries (including concomitant CP), designated follow-up persons, examination means delivering surveys gather information COVID-19. Epidemiological data used inform policies seek reduce magnitude epidemics their myriad diseases. recognition exacerbations prompt targeted treatment, encouraged. Conflict interest statement D.J. Clauw consulting Pfizer, Tonix, Samumed, Lilly, Aptinyx, received funding Aptinyx. S.P. Cohen supported grant U.S. Dept. Defense, Uniformed Services University, Department Physical Medicine & Rehabilitation, Musculoskeletal Injury Research Operational Readiness (MIRROR) (HU00011920011). remaining authors no conflicts declare.

Язык: Английский

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Body Localization of ACE-2: On the Trail of the Keyhole of SARS-CoV-2

Frontiers in Medicine, Год журнала: 2020, Номер 7

Опубликована: Дек. 3, 2020

The explosion of the new coronavirus (SARS-CoV-2) pandemic has brought role angiotensin converting enzyme 2 (ACE2) back into scientific limelight. Since SARS-CoV-2 must bind ACE2 for entering host cells in humans, its expression and body localization are critical to track potential target organ this infection outline disease progression clinical outcomes. Here, we mapped physiological distribution, expression, activities discussed correlations mutal interactions with disparate symptoms present patients at level different organs. We highlighted that despite during ACE2-expressing organs may become direct targets, leading severe pathological manifestations, subsequent multiple failures, exact mechanism through which acts these is still heavily debated. Further efforts, also considering a personalized approach aimed consider specific patient differences mutual ACE2-SARS-CoV-2 long-term health effects associated COVID-19 currently mandatory.

Язык: Английский

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Attributes and predictors of Long-COVID: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App

medRxiv (Cold Spring Harbor Laboratory), Год журнала: 2020, Номер unknown

Опубликована: Окт. 21, 2020

Reports of “Long-COVID”, are rising but little is known about prevalence, risk factors, or whether it possible to predict a protracted course early in the disease. We analysed data from 4182 incident cases COVID-19 who logged their symptoms prospectively COVID Symptom Study app. 558 (13.3%) had lasting >=28 days, 189 (4.5%) for >=8 weeks and 95 (2.3%) >=12 weeks. Long-COVID was characterised by fatigue, headache, dyspnoea anosmia more likely with increasing age, BMI female sex. Experiencing than five during first week illness associated Long-COVID, OR=3.53 [2.76;4.50]. A simple model distinguish between short long-COVID at 7 which gained ROC-AUC 76%, replicated an independent sample 2472 antibody positive individuals. This could be used identify individuals clinical trials reduce long-term target education rehabilitation services.

Язык: Английский

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Post–COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at Mayo Clinic and Characteristics of the Initial Patient Cohort

Mayo Clinic Proceedings, Год журнала: 2021, Номер 96(7), С. 1782 - 1791

Опубликована: Май 11, 2021

Язык: Английский

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Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review

Journal of Infection, Год журнала: 2021, Номер 83(1), С. 1 - 16

Опубликована: Май 14, 2021

"Long COVID", a term coined by COVID-19 survivors, describes persistent or new symptoms in subset of patients who have recovered from acute illness. Globally, the population people infected with SARS-CoV-2 continues to expand rapidly, necessitating need for more thorough understanding array potential sequelae COVID-19. The multisystemic aspects been subject intense investigation, but long-term complications remain poorly understood. Emerging data lay press, social media, commentaries, and emerging scientific reports suggest that some survivors experience organ impairment and/or debilitating chronic symptoms, at times protean nature, which impact their quality life.

Язык: Английский

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Long COVID-19 Syndrome: A Comprehensive Review of Its Effect on Various Organ Systems and Recommendation on Rehabilitation Plans

Biomedicines, Год журнала: 2021, Номер 9(8), С. 966 - 966

Опубликована: Авг. 5, 2021

The majority of people infected with SARS-CoV-2 fully recovered within a few weeks. However, considerable number patients different ages still suffer from long-lasting problems similar to the multi-organ damage in its acute phase infection, or experience symptoms continuously for longer term after recovery. severity primary infection seems not be associated possibility and long-term symptoms. Various unresolved have been reported COVID-19 survivors months hospital discharge. Long Syndrome refers 4 initial onset. It is important understand systemic effects Syndrome, presentations, need rehabilitations restore functional recovery survivors. Government, healthcare workers, survivor groups should collaborate establish self-sustaining system facilitate follow-up rehabilitations, prioritization resources more severely This review looks into various aspects: respiratory, cardiovascular, hematological, renal, gastrointestinal, neurological, metabolic Syndromes. Recommendations details explored cope tremendous patients.

Язык: Английский

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Long COVID and Health Inequities: The Role of Primary Care

Milbank Quarterly, Год журнала: 2021, Номер 99(2), С. 519 - 541

Опубликована: Март 30, 2021

Policy Points An estimated 700,000 people in the United States have "long COVID," that is, symptoms of COVID-19 persisting beyond three weeks. and its long-term sequelae are strongly influenced by social determinants such as poverty structural inequalities racism discrimination. Primary care providers a unique position to provide coordinate for vulnerable patients with long COVID. measures should include strengthening primary care, optimizing data quality, addressing multiple nested domains inequity.

Язык: Английский

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