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Long COVID and Post-COVID-19 Syndromes

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (30 June 2023) | Viewed by 61812

Special Issue Editors


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Guest Editor
Center for Global Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Interests: gender disparity; Long COVID; global health

E-Mail Website
Guest Editor
1. Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
2. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", 00168 Roma, Italy
Interests: pediatrics; Long COVID; global health
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Center for Global Health Research and Studies, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
2. Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario "A. Gemelli", 00168 Roma, Italy
Interests: occupational and urban health; Long COVID; global health

E-Mail Website
Guest Editor
1. Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
2. National Institute for Health, Migration and Poverty, 00153 Rome, Italy
Interests: global health; Long COVID; health inequalities; mental health

Special Issue Information

Dear Colleagues,

With more than 186 million cases and 4 million deaths worldwide, the coronavirus pandemic has disrupted global healthcare as well as social and economic scenarios. Even if vaccination campaigns are progressing fast, some concerns remain, such as the emerging spread of SARS-CoV-2 variants and the threats they could pose on vaccine effectiveness.

Despite the prolific COVID-19 scientific production of the last year, many aspects of SARS-CoV-2 infection still remain to be explored. In this regard, the persistence of symptoms in COVID-19 symptomatic cases or even the onset of symptoms in asymptomatic COVID-19 cases and the long-term complications beyond 4 weeks or even 8–12 weeks after the coronavirus infection is attracting increasing interest in the scientific community as well as among patients, organizations, and societies.

The chances of having long-term symptoms (e.g., fatigue, respiratory symptoms, “brain fog”, neurological and psychiatric symptoms, autonomic dysfunction such as tachycardia and fever, gastrointestinal discomforts, tinnitus, earaches, changes to sense of smell or taste, rash, and post-acute sequelae of COVID-19 (PASC)), a condition generally known as Long COVID or, most properly, post-acute COVID-19 and persistent post-COVID-19 syndrome, do not seem to be related to the intensity of COVID-19 manifestation. 

It has been reported in both symptomatic and asymptomatic cases, in both mild–moderate and severe clinical presentations, in hospitalized as well as in not hospitalized cases, in both adults and children, in which the PIMS-TS (pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2) has been observed in 8% to 50% of cases.

Long COVID that has clearly shown a multi-organ impact that involves body systems including heart, lung, kidney, skin, and brain functions with a broad spectrum of manifestation is currently estimated in 10% up to 30% of cases.

In this regard, literature on epidemiology as well as pathophysiology, treatment proposals, and care models is still scarce. Moreover, it is unavoidable not to pay attention to the quality of life and the lived experiences of Long COVID patients as well as on health professionals’ training needs and the impact of Long COVID on occupational health and society.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) focuses on the current state of knowledge on the Long COVID/post-COVID-19 syndrome.

Papers on the epidemiology and etiology—with particular regard to risk and protective factors—as well as physiology and pathophysiology, diagnostic tools, clinical manifestation and organ-specific sequelae, multi-interdisciplinary and integrated care models, and therapeutic and rehabilitation proposals both in primary and in secondary and tertiary care are welcomed. Moreover, contributions on the perception, needs, quality of life, and social protection of long-haulers as well as on the occupational, economic, and social implications of the increasing burden of Long COVID will be highly appreciated.

Qualitative as well as quantitative research papers, reviews, case reports and guidelines will be considered for this Special Issue, but other types of contributions will also be taken into consideration for publication.

We look forward to your participation in this Special Issue to increase and share our Long COVID knowledge, committing, all together, to better meeting our patients’ needs.

Prof. Dr. Walter Malorni
Dr. Danilo Buonsenso
Dr. Leuconoe Grazia Sisti
Prof. Dr. Umberto Moscato
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Long COVID/post-COVID-19 syndrome
  • epidemiology
  • pathophysiology
  • clinical practice
  • therapy
  • integrated care models
  • patients’ perception
  • pediatrics
  • mental health
  • occupational, social and economic impact

Published Papers (20 papers)

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14 pages, 870 KiB  
Article
Physical Activity in Long COVID: A Comparative Study of Exercise Rehabilitation Benefits in Patients with Long COVID, Coronary Artery Disease and Fibromyalgia
by Claire Colas, Yann Le Berre, Marie Fanget, Angélique Savall, Martin Killian, Ivan Goujon, Pierre Labeix, Manon Bayle, Léonard Féasson, Frederic Roche and David Hupin
Int. J. Environ. Res. Public Health 2023, 20(15), 6513; https://doi.org/10.3390/ijerph20156513 - 3 Aug 2023
Cited by 4 | Viewed by 2351
Abstract
Exercise in long COVID is poorly studied. Nevertheless, exerciserehabilitation could improve cardiorespiratory, muscular and autonomic functions. We aimed to investigate improvement in physical and autonomic performances of long COVID patients (n = 38) after a 4-week exercise rehabilitation program (3 sessions/week) compared [...] Read more.
Exercise in long COVID is poorly studied. Nevertheless, exerciserehabilitation could improve cardiorespiratory, muscular and autonomic functions. We aimed to investigate improvement in physical and autonomic performances of long COVID patients (n = 38) after a 4-week exercise rehabilitation program (3 sessions/week) compared to two control groups composed of coronary artery disease (n = 38) and fibromyalgia patients (n = 38), two populations for whom exercise benefits are well known. Efficacy of exercise training was assessed by a cardiopulmonary exercise test, a handgrip force test, and a supine heart rate variability recording at rest before and after the rehabilitation program. Cardiorespiratory and muscular parameters were enhanced after exercise rehabilitation in the three groups (p < 0.001). No significant difference was observed for the autonomic variables. Through this comparative study with control groups, we confirm and reinforce the interest of caring for long COVID patients without post-exertional symptom exacerbation by exercise rehabilitation of both strength and endurance training, by personalizing the program to the patient and symptoms. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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14 pages, 1447 KiB  
Article
Incidence, Risk Factors, and Consequences of Post-Traumatic Stress Disorder Symptoms in Survivors of COVID-19-Related ARDS
by Sara Miori, Andrea Sanna, Sergio Lassola, Erica Cicolini, Roberto Zanella, Sandra Magnoni, Silvia De Rosa, Giacomo Bellani and Michele Umbrello
Int. J. Environ. Res. Public Health 2023, 20(8), 5504; https://doi.org/10.3390/ijerph20085504 - 13 Apr 2023
Cited by 2 | Viewed by 1784
Abstract
Purpose: To assess the prevalence of symptoms of Post-Traumatic Stress Disorder (PTSD) in survivors of COVID-19 Acute Respiratory Distress Syndrome that needed ICU care; to investigate risk factors and their impact on the Health-Related Quality of life (HR-QoL). Materials and Methods: This multicenter, [...] Read more.
Purpose: To assess the prevalence of symptoms of Post-Traumatic Stress Disorder (PTSD) in survivors of COVID-19 Acute Respiratory Distress Syndrome that needed ICU care; to investigate risk factors and their impact on the Health-Related Quality of life (HR-QoL). Materials and Methods: This multicenter, prospective, observational study included all patients who were discharged from the ICU. Patients were administered the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) questionnaire, the Short-Form Health Survey 36Version 2 (SF-36v2), a socioeconomic question set and the Impact of Event Scale—Revised (IES-R) to assess PTSD. Results: The multivariate logistic regression model found that an International Standard Classification of Education Score (ISCED) higher than 2 (OR 3.42 (95% CI 1.28–9.85)), monthly income less than EUR 1500 (OR 0.36 (95% CI 0.13–0.97)), and more than two comorbidities (OR 4.62 (95% CI 1.33–16.88)) are risk factors for developing PTSD symptoms. Patients with PTSD symptoms are more likely to present a worsening in their quality of life as assessed by EQ-5D-5L and SF-36 scales. Conclusion: The main factors associated with the development of PTSD-related symptoms were a higher education level, a lower monthly income, and more than two comorbidities. Patients who developed symptoms of PTSD reported a significantly lower Health-Related Quality of life as compared to patients without PTSD. Future research areas should be oriented toward recognizing potential psychosocial and psychopathological variables capable of influencing the quality of life of patients discharged from the intensive care unit to better recognize the prognosis and longtime effects of diseases. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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18 pages, 2711 KiB  
Article
Association of Lung Fibrotic Changes and Cardiological Dysfunction with Comorbidities in Long COVID-19 Cohort
by Ainur T. Tauekelova, Zhanar Kalila, Akerke Bakhtiyar, Zarina Sautbayeva, Polina Len, Aliya Sailybayeva, Sadyk Khamitov, Nazira Kadroldinova, Natasha S. Barteneva and Makhabbat S. Bekbossynova
Int. J. Environ. Res. Public Health 2023, 20(3), 2567; https://doi.org/10.3390/ijerph20032567 - 31 Jan 2023
Viewed by 2236
Abstract
Background. Long COVID-19 symptoms appeared in many COVID-19 survivors. However, the prevalence and symptoms associated with long COVID-19 and its comorbidities have not been established. Methods. In total, 312 patients with long COVID-19 from 21 primary care centers were included in [...] Read more.
Background. Long COVID-19 symptoms appeared in many COVID-19 survivors. However, the prevalence and symptoms associated with long COVID-19 and its comorbidities have not been established. Methods. In total, 312 patients with long COVID-19 from 21 primary care centers were included in the study. At the six-month follow-up, their lung function was assessed by computerized tomography (CT) and spirometry, whereas cardiac function was assessed by electrocardiogram, Holter ECG, echocardiography, 24 h blood pressure monitoring, and a six-minute walk test (6MWT). Results. Of the 312 persons investigated, significantly higher systolic and diastolic blood pressure, left ventricular hypertrophy, and elevated NT-proBNP were revealed in participants with hypertension or type 2 diabetes. Left ventricular diastolic dysfunction was more frequently present in patients with hypertension. The most common registered CT abnormalities were fibrotic changes (83, 36.6%) and mediastinal lymphadenopathy (23, 10.1%). Among the tested biochemical parameters, three associations were found in long COVID-19 patients with hypertension but not diabetes: increased hemoglobin, fibrinogen, and ferritin. Nine patients had persisting IgM antibodies to SARS-CoV-2. Conclusions. We demonstrated a strong association between signs of cardiac dysfunction and lung fibrotic changes with comorbidities in a cohort of long COVID-19 subjects. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 1430 KiB  
Article
Prevalence, Patterns, and Clinical Severity of Long COVID among Chinese Medicine Telemedicine Service Users: Preliminary Results from a Cross-Sectional Study
by Fai Fai Ho, Shanshan Xu, Talos Ming Hong Kwong, Angus Siu-cheong Li, Eun Hae Ha, Heyu Hua, Ching Liong, Kwan Chi Leung, Ting Hung Leung, Zhixiu Lin, Samuel Yeung-Shan Wong, Faming Pan and Vincent Chi Ho Chung
Int. J. Environ. Res. Public Health 2023, 20(3), 1827; https://doi.org/10.3390/ijerph20031827 - 19 Jan 2023
Cited by 4 | Viewed by 2498
Abstract
Introduction: The emergence and persistence of symptoms after acute COVID-19 is expected to become a major burden on healthcare systems. We assessed the features of the post-COVID-19 Syndrome (Long COVID) burden in a cohort of COVID-19 patients during the fifth major wave in [...] Read more.
Introduction: The emergence and persistence of symptoms after acute COVID-19 is expected to become a major burden on healthcare systems. We assessed the features of the post-COVID-19 Syndrome (Long COVID) burden in a cohort of COVID-19 patients during the fifth major wave in Hong Kong. Methods: A cross-sectional study of 135 patients with confirmed COVID-19 from Feb to Apr 2022 who utilized traditional Chinese medicine telemedicine services was conducted. The COVID-19 Yorkshire Rehabilitation Scale was administered using an online survey 12 weeks after the COVID-19 infection. Prevalence of symptom severity and functional impairments were assessed to identify burdens and patterns. The correlation between symptom severity, functional impairments, patient characteristics, and overall health was evaluated. Results: The mean age was 46.8 years, with 46 (34.1%) males. Symptoms, functional impairments, and overall health worsened significantly when compared to the status prior to the infection. More than 50% reported the following sequelae 12 weeks after the acute infection: breathlessness, laryngeal or airway complications, fatigue, weakness, sleep, cognition, and anxiety. The presence of a single symptom or functional impairment significantly correlated with at least seven other problems positively, except for pain. Severity tended to be higher among vulnerable groups, including those who were chronic disease patients, older, less well educated, female, or had incomplete COVID-19 vaccinations. Conclusions: Long COVID is a significant healthcare burden among telemedicine users in Hong Kong, with complex needs for symptom and functional impairment management. Designing relevant health and rehabilitation services tailored to the needs of these patients is warranted. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 639 KiB  
Article
Prevalence and Associated Factors of Post-COVID-19 Syndrome in a Brazilian Cohort after 3 and 6 Months of Hospital Discharge
by Juliana Lapa, Davi Rosa, João Pedro Lima Mendes, Rodolfo Deusdará and Gustavo Adolfo Sierra Romero
Int. J. Environ. Res. Public Health 2023, 20(1), 848; https://doi.org/10.3390/ijerph20010848 - 2 Jan 2023
Cited by 13 | Viewed by 1988
Abstract
(1) Objectives: To evaluate the frequency and factors associated with the Post-COVID-19 Syndrome (PCS) in COVID-19 survivors after 3 and 6 months of hospital discharge; (2) Methods: We conducted a cohort study with patients who were hospitalized with COVID-19 in a referral public [...] Read more.
(1) Objectives: To evaluate the frequency and factors associated with the Post-COVID-19 Syndrome (PCS) in COVID-19 survivors after 3 and 6 months of hospital discharge; (2) Methods: We conducted a cohort study with patients who were hospitalized with COVID-19 in a referral public hospital in Brasília, Federal District, Brazil. After 3 and 6 months of discharge, patients answered a questionnaire about PCS symptoms. Poisson regression with robust variance was used to estimate the crude and adjusted prevalence ratios (PR and aPR) of PCS. (3) Results: The prevalence of PCS was 81% and 61% after 3 and 6 months of hospital discharge, respectively. The main symptoms after 3 months of discharge were hair loss (44%), fatigue (42%), and memory loss (39%); while after 6 months, they were memory loss (29%) and fatigue (27%). In the multivariate analysis, the main factor associated with PCS was female gender (aPR): 1.28 (1.16–1.41) and 1.60 (1.34–1.90), 3 and 6 months after hospital discharge, respectively. Hypercholesterolemia was also associated with PCS after 3 months aPR of 1.15 (1.04–1.27). After 6 months of discharge, obesity [aPR: 1.22 (1.03–1.45)] and pronation [aPR: 1.15 (1.06–1.25)] were relevant associated factors. (4) Conclusions: The prevalence of PCS was high in COVID-19 survivors who had the moderate and severe forms of the disease. Memory loss was the most persistent symptom. Our data pointed to female gender, hypercholesterolemia, obesity, and pronation during hospitalization as relevant PCS-associated risk factors. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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13 pages, 1209 KiB  
Article
Deep Dive into the Long Haul: Analysis of Symptom Clusters and Risk Factors for Post-Acute Sequelae of COVID-19 to Inform Clinical Care
by Nicole H. Goldhaber, Jordan N. Kohn, William Scott Ogan, Amy Sitapati, Christopher A. Longhurst, Angela Wang, Susan Lee, Suzi Hong and Lucy E. Horton
Int. J. Environ. Res. Public Health 2022, 19(24), 16841; https://doi.org/10.3390/ijerph192416841 - 15 Dec 2022
Cited by 17 | Viewed by 2247
Abstract
Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about [...] Read more.
Long COVID is a chronic condition characterized by symptoms such as fatigue, dyspnea, and cognitive impairment that persist or relapse months after an acute infection with the SARS-CoV-2 virus. Many distinct symptoms have been attributed to Long COVID; however, little is known about the potential clustering of these symptoms and risk factors that may predispose patients to certain clusters. In this study, an electronic survey was sent to patients in the UC San Diego Health (UCSDH) system who tested positive for COVID-19, querying if patients were experiencing symptoms consistent with Long COVID. Based on survey results, along with patient demographics reported in the electronic health record (EHR), linear and logistic regression models were used to examine putative risk factors, and exploratory factor analysis was performed to determine symptom clusters. Among 999 survey respondents, increased odds of Long COVID (n = 421; 42%) and greater Long COVID symptom burden were associated with female sex (OR = 1.73, 99% CI: 1.16–2.58; β = 0.48, 0.22–0.75), COVID-19 hospitalization (OR = 4.51, 2.50–8.43; β = 0.48, 0.17–0.78), and poorer pre-COVID self-rated health (OR = 0.75, 0.57–0.97; β = −0.19, −0.32–−0.07). Over one-fifth of Long COVID patients screened positive for depression and/or anxiety, the latter of which was associated with younger age (OR = 0.96, 0.94–0.99). Factor analysis of 16 self-reported symptoms suggested five symptom clusters—gastrointestinal (GI), musculoskeletal (MSK), neurocognitive (NC), airway (AW), and cardiopulmonary (CP), with older age (β = 0.21, 0.11–0.30) and mixed race (β = 0.27, 0.04–0.51) being associated with greater MSK symptom burden. Greater NC symptom burden was associated with increased odds of depression (OR = 5.86, 2.71–13.8) and anxiety (OR = 2.83, 1.36–6.14). These results can inform clinicians in identifying patients at increased risk for Long COVID-related medical issues, particularly neurocognitive symptoms and symptom clusters, as well as informing health systems to manage operational expectations on a population-health level. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 570 KiB  
Article
Is Purchase Behavior Different for Consumers with Long COVID?
by Alicia Blanco-Gonzalez, Gabriel Cachón-Rodríguez, Cristina Del-Castillo-Feito and Ana Cruz-Suarez
Int. J. Environ. Res. Public Health 2022, 19(24), 16658; https://doi.org/10.3390/ijerph192416658 - 11 Dec 2022
Cited by 3 | Viewed by 1534
Abstract
COVID-19 has generated an uncertain environment, which has motivated changes in consumers’ behavior globally. However, previous studies have not clarified if these effects are equally strong throughout the population. In this research, we want to analyze if there are behavioral differences between long-COVID [...] Read more.
COVID-19 has generated an uncertain environment, which has motivated changes in consumers’ behavior globally. However, previous studies have not clarified if these effects are equally strong throughout the population. In this research, we want to analyze if there are behavioral differences between long-COVID consumers and others. For this purpose, we analyzed a sample of 522 consumers divided into three groups depending on their type of exposure to the disease: those with long COVID; ones that had recovered from COVID-19; and those that had never had COVID-19. The results show that the effect that COVID-19 has on purchase behavior differs depending on the type of exposure to the disease. In fact, those with long COVID experienced more pleasure when purchasing than other people, but they needed higher trust levels in the enterprises to purchase from them, since that reduces their perception of uncertainty. Furthermore, for long-COVID individuals, an organization’s legitimacy level is even more important than for other consumer groups with less contact with the disease. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 2804 KiB  
Article
Factors Associated with Self-Reported Post/Long-COVID—A Real-World Data Study
by Anja Thronicke, Maximilian Hinse, Stefanie Weinert, Alexandra Jakubowski, Gerrit Grieb and Harald Matthes
Int. J. Environ. Res. Public Health 2022, 19(23), 16124; https://doi.org/10.3390/ijerph192316124 - 2 Dec 2022
Cited by 2 | Viewed by 2117
Abstract
Evidence suggests that Post/Long-COVID (PLC) is associated with a reduced health-related quality of life, however little knowledge exists on the risk factors that contribute to PLC. The objective of this prospective real-world data study was to evaluate factors associated with PLC using national [...] Read more.
Evidence suggests that Post/Long-COVID (PLC) is associated with a reduced health-related quality of life, however little knowledge exists on the risk factors that contribute to PLC. The objective of this prospective real-world data study was to evaluate factors associated with PLC using national online survey data. Adjusted multivariable regression analyses were performed using the software R. Between 14 April and 15 June 2021, 99 registered individuals reported to have suffered from PLC symptoms and the most common PLC symptoms reported were fatigue, dyspnoea, decreased strength, hyposmia, and memory loss. The odds of individuals suffering from COVID-19-associated anxiety, hyposmia, or heart palpitations developing PLC were eight times (OR 8.28, 95% CI 1.43–47.85, p < 0.01), five times (OR 4.74, 95% CI 1.59–14.12, p < 0.005), or three times (OR 2.62, 95% CI 1.72–3.99, p < 0.01) higher, respectively, than of those who had not experienced these symptoms. Individuals who experienced fatigue while having COVID-19 were seven times more likely to develop PLC fatigue than those who had not (OR 6.52, 95% CI: 4.29–9.91, p < 0.0001). Our findings revealed that 13% of the individuals who had previously suffered from COVID-19 subsequently reported having PLC. Furthermore, COVID-19-associated anxiety, hyposmia, heart palpitations, and fatigue were, among others, significant determinants for the development of PLC symptoms. Hyposmia has not previously been reported as an independent predictive factor for PLC. We suggest closely monitoring patients with COVID-19-induced fatigue, heart palpitations, and anxiety, as these symptoms may be predictors of PLC symptoms, including fatigue. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 328 KiB  
Article
Brain Fog and Fatigue following COVID-19 Infection: An Exploratory Study of Patient Experiences of Long COVID
by Emily E. Chasco, Kimberly Dukes, DeShauna Jones, Alejandro P. Comellas, Richard M. Hoffman and Alpana Garg
Int. J. Environ. Res. Public Health 2022, 19(23), 15499; https://doi.org/10.3390/ijerph192315499 - 23 Nov 2022
Cited by 20 | Viewed by 5865
Abstract
Post-acute sequelae of SARS-CoV-2 (PASC) is a poorly understood condition with significant impact on quality of life. We aimed to better understand the lived experiences of patients with PASC, focusing on the impact of cognitive complaints (“brain fog”) and fatigue on (1) daily [...] Read more.
Post-acute sequelae of SARS-CoV-2 (PASC) is a poorly understood condition with significant impact on quality of life. We aimed to better understand the lived experiences of patients with PASC, focusing on the impact of cognitive complaints (“brain fog”) and fatigue on (1) daily activities, (2) work/employment, and (3) interpersonal relationships. We conducted semi-structured qualitative interviews with 15 patients of a Midwestern academic hospital’s post-COVID-19 clinic. We audio-recorded, transcribed, and analyzed interviews thematically using a combined deductive-inductive approach and collected participants’ characteristics from chart review. Participants frequently used descriptive and metaphorical language to describe symptoms that were relapsing-remitting and unpredictable. Fatigue and brain fog affected all domains and identified subthemes included symptoms’ synergistic effects, difficulty with multitasking, lack of support, poor self-perception, and fear of loss of income and employment. Personal relationships were affected with change of responsibilities, difficulty parenting, social isolation, and guilt due to the burdens placed on family. Furthermore, underlying social stigma contributed to negative emotions, which significantly affected emotional and mental health. Our findings highlight PASC’s negative impact on patients’ daily lives. Providers can better support COVID-19 survivors during their recovery by identifying their needs in a sensitive and timely manner. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
15 pages, 1433 KiB  
Article
Mental Fatigue, Activities of Daily Living, Sick Leave and Functional Status among Patients with Long COVID: A Cross-Sectional Study
by Trine Brøns Nielsen, Steffen Leth, Mathilde Pedersen, Helle Dahl Harbo, Claus Vinther Nielsen, Cecilia Hee Laursen, Berit Schiøttz-Christensen and Lisa Gregersen Oestergaard
Int. J. Environ. Res. Public Health 2022, 19(22), 14739; https://doi.org/10.3390/ijerph192214739 - 9 Nov 2022
Cited by 8 | Viewed by 3272
Abstract
Studies suggest that persistent symptoms after COVID-19 (long COVID) influence functioning and activities of daily living (ADL). However, it is still uncertain how and to what extent. This study aimed to describe patient-reported mental fatigue, ADL problems, ADL ability, sick leave and functional [...] Read more.
Studies suggest that persistent symptoms after COVID-19 (long COVID) influence functioning and activities of daily living (ADL). However, it is still uncertain how and to what extent. This study aimed to describe patient-reported mental fatigue, ADL problems, ADL ability, sick leave and functional status among patients with long COVID. In this cross-sectional study, 448 patients, ≥18 years old and referred to occupational therapy at a Danish Post-COVID-19 Clinic, were included. Mental fatigue was measured by the Mental Fatigue Scale, ADL problems and ability were measured by the Canadian Occupational Performance Measure, sick leave was self-reported and functional status was evaluated by the Post-COVID-19 Functional Status Scale. Mean age was 46.8 years, 73% of the patients were female, and 75% suffered from moderate to severe mental fatigue. The majority reported difficulties performing productive and leisure activities. The median performance and satisfaction scores were 4.8 and 3, respectively. In total, 56% of the patients were on sick leave, and 94% were referred to rehabilitation. A decrease in functional status was found between pre-COVID-19 and assessment. Conclusively, the patients were highly affected in their everyday life and had distinct rehabilitation needs. Future research is needed to address causalities and rehabilitation for this patient group. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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20 pages, 3932 KiB  
Article
Long COVID at Different Altitudes: A Countrywide Epidemiological Analysis
by Juan S. Izquierdo-Condoy, Raul Fernandez-Naranjo, Eduardo Vasconez-González, Simone Cordovez, Andrea Tello-De-la-Torre, Clara Paz, Karen Delgado-Moreira, Sarah Carrington, Ginés Viscor and Esteban Ortiz-Prado
Int. J. Environ. Res. Public Health 2022, 19(22), 14673; https://doi.org/10.3390/ijerph192214673 - 8 Nov 2022
Cited by 12 | Viewed by 5300
Abstract
Background: Several reports from around the world have reported that some patients who have recovered from COVID-19 have experienced a range of persistent or new clinical symptoms after a SARS-CoV-2 infection. These symptoms can last from weeks to months, impacting everyday functioning to [...] Read more.
Background: Several reports from around the world have reported that some patients who have recovered from COVID-19 have experienced a range of persistent or new clinical symptoms after a SARS-CoV-2 infection. These symptoms can last from weeks to months, impacting everyday functioning to a significant number of patients. Methods: A cross-sectional analysis based on an online, self-reporting questionnaire was conducted in Ecuador from April to July 2022. Participants were invited by social media, radio, and TV to voluntarily participate in our study. A total of 2103 surveys were included in this study. We compared socio-demographic variables and long-term persisting symptoms at low (<2500 m) and high altitude (>2500 m). Results: Overall, 1100 (52.3%) responders claimed to have Long-COVID symptoms after SARS-CoV-2 infection. Most of these were reported by women (64.0%); the most affected group was young adults between 21 to 40 years (68.5%), and most long-haulers were mestizos (91.6%). We found that high altitude residents were more likely to report persisting symptoms (71.7%) versus those living at lower altitudes (29.3%). The most common symptoms were fatigue or tiredness (8.4%), hair loss (5.1%) and difficulty concentrating (5.0%). The highest proportion of symptoms was observed in the group that received less than 2 doses. Conclusions: This is the first study describing post-COVID symptoms’ persistence in low and high-altitude residents. Our findings demonstrate that women, especially those aging between 21–40, are more likely to describe Long-COVID. We also found that living at a high altitude was associated with higher reports of mood changes, tachycardia, decreased libido, insomnia, and palpitations compared to lowlanders. Finally, we found a greater risk to report Long-COVID symptoms among women, those with previous comorbidities and those who had a severer acute SARS-CoV-2 infection. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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9 pages, 349 KiB  
Article
Fatigue and Cognitive Dysfunction Are Associated with Occupational Status in Post-COVID Syndrome
by Cristina Delgado-Alonso, Constanza Cuevas, Silvia Oliver-Mas, María Díez-Cirarda, Alfonso Delgado-Álvarez, María José Gil-Moreno, Jorge Matías-Guiu and Jordi A. Matias-Guiu
Int. J. Environ. Res. Public Health 2022, 19(20), 13368; https://doi.org/10.3390/ijerph192013368 - 16 Oct 2022
Cited by 17 | Viewed by 2674
Abstract
Post-COVID syndrome (PCS) is a medical condition characterized by the persistence of a wide range of symptoms after acute infection by SARS-CoV-2. The work capacity consequences of this disorder have scarcely been studied. We aimed to analyze the factors associated with occupational status [...] Read more.
Post-COVID syndrome (PCS) is a medical condition characterized by the persistence of a wide range of symptoms after acute infection by SARS-CoV-2. The work capacity consequences of this disorder have scarcely been studied. We aimed to analyze the factors associated with occupational status in patients with PCS. This cross-sectional study involved 77 patients with PCS on active work before SARS-CoV-2 infection. Patients were evaluated 20.71 ± 6.50 months after clinical onset. We conducted a survey on occupational activity and cognitive and clinical symptoms. The association between occupational activity and fatigue, depression, anxiety, sleep quality, and cognitive testing was analyzed. Thirty-eight (49.4%) patients were working, and thirty-nine (50.6%) patients were not. Of those not working at the moment of the assessment, 36 (92.3%) patients were on sick leave. In 63 patients (81.8% of the sample), sick leave was needed at some point due to PCS. The mean duration of sick leave was 12.07 ± 8.07 months. According to the patient’s perspective, the most disabling symptoms were cognitive complaints (46.8%) and fatigue (31.2%). Not working at the moment of the assessment was associated with higher levels of fatigue and lower cognitive performance in the Stroop test. No association was found between occupational status with depression and anxiety questionnaires. Our study found an influence of PCS on work capacity. Fatigue and cognitive issues were the most frequent symptoms associated with loss of work capacity. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
13 pages, 2958 KiB  
Article
Cardiopulmonary Exercise Testing Distinguishes between Post-COVID-19 as a Dysfunctional Syndrome and Organ Pathologies
by Johannes Kersten, Luis Hoyo, Alexander Wolf, Elina Hüll, Samuel Nunn, Marijana Tadic, Dominik Scharnbeck, Wolfgang Rottbauer and Dominik Buckert
Int. J. Environ. Res. Public Health 2022, 19(18), 11421; https://doi.org/10.3390/ijerph191811421 - 10 Sep 2022
Cited by 9 | Viewed by 2139
Abstract
(1) Background: Dyspnea is one of the most frequent symptoms among post-COVID-19 patients. Cardiopulmonary exercise testing (CPET) is key to a differential diagnosis of dyspnea. This study aimed to describe and classify patterns of cardiopulmonary dysfunction in post-COVID-19 patients, using CPET. (2) Methods: [...] Read more.
(1) Background: Dyspnea is one of the most frequent symptoms among post-COVID-19 patients. Cardiopulmonary exercise testing (CPET) is key to a differential diagnosis of dyspnea. This study aimed to describe and classify patterns of cardiopulmonary dysfunction in post-COVID-19 patients, using CPET. (2) Methods: A total of 143 symptomatic post-COVID-19 patients were included in the study. All patients underwent CPET, including oxygen consumption, slope of minute ventilation to CO2 production, and capillary blood gas testing, and were evaluated for signs of limitation by two experienced examiners. In total, 120 patients reached a satisfactory level of exertion and were included in further analyses. (3) Results: Using CPET, cardiovascular diseases such as venous thromboembolism or ischemic and nonischemic heart disease were identified as either cardiac (4.2%) or pulmonary vascular (5.8%) limitations. Some patients also exhibited dysfunctional states, such as deconditioning (15.8%) or pulmonary mechanical limitation (9.2%), mostly resulting from dysfunctional breathing patterns. Most (65%) patients showed no signs of limitation. (4) Conclusions: CPET can identify patients with distinct limitation patterns, and potentially guide further therapy and rehabilitation. Dysfunctional breathing and deconditioning are crucial factors for the evaluation of post-COVID-19 patients, as they can differentiate these dysfunctional syndromes from organic diseases. This highlights the importance of dynamic (as opposed to static) investigations in the post-COVID-19 context. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 352 KiB  
Article
Post-Acute COVID-19 Sequelae in a Working Population at One Year Follow-Up: A Wide Range of Impacts from an Italian Sample
by Danilo Buonsenso, Maria Rosaria Gualano, Maria Francesca Rossi, Angelica Valz Gris, Leuconoe Grazia Sisti, Ivan Borrelli, Paolo Emilio Santoro, Antonio Tumminello, Carolina Gentili, Walter Malorni, Piero Valentini, Walter Ricciardi and Umberto Moscato
Int. J. Environ. Res. Public Health 2022, 19(17), 11093; https://doi.org/10.3390/ijerph191711093 - 5 Sep 2022
Cited by 24 | Viewed by 2883
Abstract
Long COVID-19 is a term used to describe the symptomatic sequelae that develop after suffering from COVID-19. Very few studies have investigated the impact of COVID-19 sequelae on employment status. The aim of this research was to characterise sequelae of COVID-19 in a [...] Read more.
Long COVID-19 is a term used to describe the symptomatic sequelae that develop after suffering from COVID-19. Very few studies have investigated the impact of COVID-19 sequelae on employment status. The aim of this research was to characterise sequelae of COVID-19 in a population of workers who tested positive for COVID-19, with a follow-up within one year of the acute illness, and to analyse the possible association between this and changes in the workers’ occupational status. In this retrospective cohort study, a questionnaire was administered to 155 workers; descriptive, univariate (chi-square tests), and multivariate (logistic regression model) analyses were carried out. The mean age was 46.48 years (SD ± 7.302); 76 participants were males (49.7%), and 33 participants reported being current smokers (21.3%). Overall, 19.0% of patients reported not feeling fully recovered at follow-up, and 13.7% reported a change in their job status after COVID-19. A change in occupational status was associated with being a smoker (OR 4.106, CI [1.406–11.990], p = 0.010); hospital stay was associated with age > 46 years in a statistically significant way (p = 0.025) and with not feeling fully recovered at follow-up (p = 0.003). A persistent worsening in anxiety was more common in women (p = 0.028). This study identifies smoking as a risk factor for workers not able to resume their job; furthermore, occupational physicians should monitor mental health more closely after COVID-19, particularly in female workers. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
15 pages, 727 KiB  
Article
Social Life of Females with Persistent COVID-19 Symptoms: A Qualitative Study
by Atefeh Aghaei, Ran Zhang, Slone Taylor, Cheuk-Chi Tam, Chih-Hsiang Yang, Xiaoming Li and Shan Qiao
Int. J. Environ. Res. Public Health 2022, 19(15), 9076; https://doi.org/10.3390/ijerph19159076 - 26 Jul 2022
Cited by 9 | Viewed by 2426
Abstract
Persistent COVID-19 symptoms (long COVID) may bring challenges to long haulers’ social lives. Females may endure more profound impacts given their special social roles and existing structural inequality. This study explores the effects of long COVID on the social life of female long [...] Read more.
Persistent COVID-19 symptoms (long COVID) may bring challenges to long haulers’ social lives. Females may endure more profound impacts given their special social roles and existing structural inequality. This study explores the effects of long COVID on the social life of female long haulers. We conducted semi-structured interviews via Zoom between April and June 2021 with 15 female long haulers in the United States, purposely recruited from Facebook and Slack groups and organization websites related to long COVID. Interviews were audio-recorded and transcribed verbatim with consent. The interview data were managed using MAXQDA and examined by thematic analysis. Long COVID negatively affected female long haulers’ social lives by causing physical limitations, economic issues, altered social relationships, social roles’ conflicts, and social stigma. Long COVID prevented female long haulers’ recovery process. Physical limitations altered their perceptions on body, and family–work conflicts caused tremendous stress. They also experienced internalized stigma and job insecurities. This study provides insights into challenges that COVID-19 female long haulers could face in their return to normal social life, underscoring the vulnerability of females affected by long COVID due to significant alterations in their social lives. Shifting to new methods of communication, especially social media, diminished the adverse effects of long COVID (e.g., social isolation). Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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10 pages, 905 KiB  
Article
State Health Department Communication about Long COVID in the United States on Facebook: Risks, Prevention, and Support
by Linnea I. Laestadius, Jeanine P. D. Guidry, Andrea Bishop and Celeste Campos-Castillo
Int. J. Environ. Res. Public Health 2022, 19(10), 5973; https://doi.org/10.3390/ijerph19105973 - 14 May 2022
Cited by 6 | Viewed by 4764
Abstract
Greater public awareness of long COVID severity and susceptibility is needed to support those with long COVID and encourage preventive behaviors. It is not yet known to what extent health departments have informed the public about long COVID risks or offered guidance and [...] Read more.
Greater public awareness of long COVID severity and susceptibility is needed to support those with long COVID and encourage preventive behaviors. It is not yet known to what extent health departments have informed the public about long COVID risks or offered guidance and support for those with long COVID. The objective of this research was to determine how and to what extent US state health departments have communicated with the public about long COVID via Facebook. Facebook posts with COVID-19 and long COVID terms made by 50 US state health departments plus Washington, DC, from 1 January 2020 to 31 January 2022, were collected using CrowdTangle. The first long COVID post appeared on 15 July 2020. From 15 July 2020 to 31 January 2022, state health departments made 49,310 COVID-19 posts and 137 long COVID posts. Using quantitative content analysis methods, long COVID posts were coded for health belief model constructs. Among long COVID posts, 75.18% included language about susceptibility, 64.96% severity, and 64.23% benefits of prevention. Cues to preventive action appeared in 54.01% of posts. 19.71% of posts provided guidance for those with long COVID. While health departments posted extensively about COVID-19, posts about long COVID were rare. This represents a missed opportunity to bolster arguments for preventive behaviors and support those experiencing long COVID. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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12 pages, 1613 KiB  
Article
Telemonitoring in Long-COVID Patients—Preliminary Findings
by Anna Romaszko-Wojtowicz, Stanisław Maksymowicz, Andrzej Jarynowski, Łukasz Jaśkiewicz, Łukasz Czekaj and Anna Doboszyńska
Int. J. Environ. Res. Public Health 2022, 19(9), 5268; https://doi.org/10.3390/ijerph19095268 - 26 Apr 2022
Cited by 6 | Viewed by 1979
Abstract
The COVID-19 pandemic has revealed the high usefulness of telemedicine. To date, no uniform recommendations or diagnostic protocols for long-COVID patients have been developed. This article presents the preliminary results of the examination of patients after SARS-CoV-2 infection who were provided with medical [...] Read more.
The COVID-19 pandemic has revealed the high usefulness of telemedicine. To date, no uniform recommendations or diagnostic protocols for long-COVID patients have been developed. This article presents the preliminary results of the examination of patients after SARS-CoV-2 infection who were provided with medical telemonitoring devices in order to oversee their pulmonological and cardiological health. Three cases have been analyzed. Each patient underwent a 10-day registration of basic vital signs, in three 15-min sessions daily: RR (respiratory rate), ECG (electrocardiogram), HR (pulse), SPO2 (saturation), body temperature and cough. Rule methods and machine learning were employed to automatically detect events. As a result, serious disorders of all the three patients were detected: cardiological and respiratory disorders that required extended diagnostics. Furthermore, average values of the selected parameters (RR, HR, SPO2) were calculated for every patient, including an indication of how often they exceeded the alarm thresholds. In conclusion, monitoring parameters in patients using telemedicine, especially in a time of limited access to the healthcare system, is a valuable clinical instrument. It enables medical professionals to recognize conditions which may endanger a patient’s health or life. Telemedicine provides a reliable assessment of a patient’s health status made over a distance, which can alleviate a patient’s stress caused by long-COVID syndrome. Telemedicine allows identification of disorders and performing further diagnosis, which is possible owing to the implementation of advanced analysis. Telemedicine, however, requires flexibility and the engagement of a multidisciplinary team, who will respond to patients’ problems on an ongoing basis. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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Review

Jump to: Research, Other

10 pages, 328 KiB  
Review
New-Onset Diabetes Mellitus, Hypertension, Dyslipidaemia as Sequelae of COVID-19 Infection—Systematic Review
by Marysia Wrona and Damian Skrypnik
Int. J. Environ. Res. Public Health 2022, 19(20), 13280; https://doi.org/10.3390/ijerph192013280 - 14 Oct 2022
Cited by 23 | Viewed by 4799
Abstract
As the population recovers from the coronavirus disease 2019 (COVID-19) pandemic, a subset of individuals is emerging as post-coronavirus disease (post-COVID) patients who experience multifactorial long-term symptoms several weeks after the initial recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The [...] Read more.
As the population recovers from the coronavirus disease 2019 (COVID-19) pandemic, a subset of individuals is emerging as post-coronavirus disease (post-COVID) patients who experience multifactorial long-term symptoms several weeks after the initial recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this systematic review is to present the latest scientific reports that evaluate changes in glucose levels, blood pressure readings and lipid profiles after recovery from COVID-19 to verify the hypothesis that new-onset diabetes mellitus, arterial hypertension and dyslipidaemia are a possible sequela of a COVID-19 infection. The open access databases PubMed and Google Scholar were searched. Articles investigating patients with residual clinical signs and biochemical alteration indicating diabetes, hypertension and dyslipidaemia at least a month after recovering from COVID-19 were included. It has been shown that a select number of patients were diagnosed with new-onset diabetes, arterial hypertension and dyslipidaemia after COVID-19 infection. Alterations in glucose levels, blood pressure and lipid profiles months after initial infection shows the importance of considering diabetes mellitus, arterial hypertension and dyslipidaemia as part of the multifactorial diagnostic criteria post-COVID to better provide evidence-based clinical care. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)

Other

Jump to: Research, Review

10 pages, 683 KiB  
Brief Report
Long COVID Classification: Findings from a Clustering Analysis in the Predi-COVID Cohort Study
by Aurélie Fischer, Nolwenn Badier, Lu Zhang, Abir Elbéji, Paul Wilmes, Pauline Oustric, Charles Benoy, Markus Ollert and Guy Fagherazzi
Int. J. Environ. Res. Public Health 2022, 19(23), 16018; https://doi.org/10.3390/ijerph192316018 - 30 Nov 2022
Cited by 15 | Viewed by 2037
Abstract
The increasing number of people living with Long COVID requires the development of more personalized care; currently, limited treatment options and rehabilitation programs adapted to the variety of Long COVID presentations are available. Our objective was to design an easy-to-use Long COVID classification [...] Read more.
The increasing number of people living with Long COVID requires the development of more personalized care; currently, limited treatment options and rehabilitation programs adapted to the variety of Long COVID presentations are available. Our objective was to design an easy-to-use Long COVID classification to help stratify people with Long COVID. Individual characteristics and a detailed set of 62 self-reported persisting symptoms together with quality of life indexes 12 months after initial COVID-19 infection were collected in a cohort of SARS-CoV-2 infected people in Luxembourg. A hierarchical ascendant classification (HAC) was used to identify clusters of people. We identified three patterns of Long COVID symptoms with a gradient in disease severity. Cluster-Mild encompassed almost 50% of the study population and was composed of participants with less severe initial infection, fewer comorbidities, and fewer persisting symptoms (mean = 2.9). Cluster-Moderate was characterized by a mean of 11 persisting symptoms and poor sleep and respiratory quality of life. Compared to the other clusters, Cluster-Severe was characterized by a higher proportion of women and smokers with a higher number of Long COVID symptoms, in particular vascular, urinary, and skin symptoms. Our study evidenced that Long COVID can be stratified into three subcategories in terms of severity. If replicated in other populations, this simple classification will help clinicians improve the care of people with Long COVID. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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14 pages, 360 KiB  
Protocol
Water-Based and Land-Based Exercise for Children with Post-COVID-19 Condition (postCOVIDkids)—Protocol for a Randomized Controlled Trial
by Anna Ogonowska-Slodownik, Marta Kinga Labecka, Katarzyna Kaczmarczyk, Renae J. McNamara, Michał Starczewski, Jan Gajewski, Agnieszka Maciejewska-Skrendo and Natalia Morgulec-Adamowicz
Int. J. Environ. Res. Public Health 2022, 19(21), 14476; https://doi.org/10.3390/ijerph192114476 - 4 Nov 2022
Cited by 3 | Viewed by 3128
Abstract
The most common symptoms of post-COVID-19 condition in children are fatigue, shortness of breath, exercise intolerance, and weakness. The post-COVID-19 condition in children can be very debilitating and lead to prolonged school absences, high morbidity, and limitations in daily functioning. The aim of [...] Read more.
The most common symptoms of post-COVID-19 condition in children are fatigue, shortness of breath, exercise intolerance, and weakness. The post-COVID-19 condition in children can be very debilitating and lead to prolonged school absences, high morbidity, and limitations in daily functioning. The aim of this research project is to determine the effectiveness of land-based and water-based exercise interventions on exercise capacity, fatigue, health-related quality of life, and pulmonary function in children with post-COVID-19 condition. This study is a prospective randomized controlled study with pre- and post-intervention assessment. Participants will be recruited from Warsaw’s primary schools and primary healthcare units according to the inclusion criteria: (i) symptoms of post-COVID-19 condition lasting more than one month following initial COVID-19 infection confirmed by the diagnosis by general practitioner (including obligatory fatigue and shortness of breath/respiratory problems); (ii) age 10–12 years old. Participants meeting the inclusion criteria will be randomized to one of three groups: water-based exercise, land-based exercise, or control (no exercise). We hope this study will provide guidance for long-COVID-19 rehabilitation in children. Full article
(This article belongs to the Special Issue Long COVID and Post-COVID-19 Syndromes)
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