Category: Covid-19

The so-called Blue Economy of 10 marine- and ocean-sector industries continued to grow out of the Covid-19 pandemic despite massive disruptions to the broader economy, according to statistics recently released by NOAA and the Bureau of Economic Affairs.

Marine activities accounted for $476 billion in economic impact in 2022 and generated $777 billion in sales, according to the annual Marine Economy Satellite Account. Thats a 1.8 percent increase from 2021. Marine sector employment was up 5 percent over the previous year, to 2.4 million jobs, outpacing the national economy.

The marine living resources sector, which includes commercial seafood harvest, processing and sales, as well as aquaculture and marine-based pharmaceuticals, was down 6.7 percent from 2021, to $31 billion, but well above 2020 levels.

These figures show how essential the Blue Economy is to American prosperity, NOAA Administrator Rick Spinrad said in a statement Friday. The ocean and the Great Lakes are integral to the overall health of Americas economy, and they impact our lives in numerous ways.

Read more from the original source:

Marine economy sailed out of Covid-19 doldrums in 2022 - E&E News by POLITICO

Pediatric patients hospitalized with severe COVID-19 or the related multisystem inflammatory syndrome in children (MIS-C) experience new neurologic problems and/or impaired function at rates of 18.0% and 24.8%, respectively, an international group of researchers suggests inJAMA Network Open.

In a secondary analysis of the Global Consortium Study of Neurologic Dysfunction in COVID-19 study, investigatorsstudied the rates of newsevere neurologic conditions among 3,568 COVID-19 or MIS-C patients younger than 18 years hospitalized from January 2020 to July 2021 at 46 centers in 10 countries. The Pediatric Cerebral Performance Category scale was used to define new neurocognitive disorders, and the Functional Status Scale determined functional impairment.

The median patient age was 8 years, 45.6% were girls, 42.5% had no underlying condition, 23.0% were Black, 28.7% were Hispanic, 63.6% were non-Hispanic, 54.0% were White, and 24.9% were another race.

"Children with the SARS-CoV-2related condition multisystem inflammatory syndrome in children (MIS-C) often require critical care due to multisystem organ dysfunction, with high survival rates but with risk of postcritical illness sequelae," the researchers wrote. "In particular, neurological manifestations of pediatric SARS-CoV-2related conditions have been associated with morbidity and mortality in prior studies."

Most patients (83.5%) had severe COVID-19, and 16.5% had MIS-C.Of the patients hospitalized with severe COVID-19, 18% had a serious neurologic condition, as did 24.8% of those with MIS-C. COVID-19 patients with serious neurologic disease were more likely than those without such a condition to have new neurocognitive disease or functional impairment at hospital release (27.7% vs 14.6%).

The most common new neurocognitive disorders or functional impairments in COVID-19 patients were acute encephalopathy (brain dysfunction; 61.9%), seizures or status epilepticus (40.7%), and delirium and coma (7.5%). Among MIS-C patients,acute encephalopathy (76.0%), delirium (11.6%), dysautonomia (disrupted autonomic nervous system;10.9%), and seizures or status epilepticus (9.6%) were most common.

A total of 28.0% of MIS-C patients with severe neurologic illness or functional impairment at hospital release had new neurocognitive manifestations and/or impaired function, compared with 15.5% without serious neurologic problems.

Future studies should aim to better understand the pathophysiology behind the severe neurological manifestations and to investigate the role of surveillance, treatment, and follow-up of these patients with high risk of neurocognitive and/or functional morbidities.

COVID-19 patients with severe neurologic disorders were less likely to be Hispanic (26.7% vs 30.4%), more likely to have at least one chronic condition (46.6% vs 32.5%), and more likely to have a preexisting neurologic condition (45.7% vs 16.3%) than those without a severe neurologic disorder. Similarly, patients with MIS-C and a severe neurologic condition were more likely to have a preexisting neurologic condition than those without severe neurologic manifestations (11.6% vs 5.9%).

After adjustment, among patients with severe neurologic problems, those with acute COVID-19 infection and those with MIS-C were more likely to have new neurocognitive and/or functional impairment at hospital release (odds ratios, 1.85 and 2.18, respectively).

Of COVID-19 patients with severe neurologic conditions, 4.8% died in the hospital, compared with 0.3% of those without such conditions.Similarly, among MIS-C patients, those with severe neurologic disorders had a much higher in-hospital death rate (4.9%) than those without such a disorder (0.5%). COVID-19 and MIS-C survivors with severe neurologic problems were also more likely to need physical and occupational therapy and rehabilitation consultations.

"The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery," the study authors wrote."Future studies should aim to better understand the pathophysiology behind the severe neurological manifestations and to investigate the role of surveillance, treatment, and follow-up of these patients with high risk of neurocognitive and/or functional morbidities."

In a relatedcommentary, Michael Wolf, MD, of Vanderbilt University Medical Center, said the study highlights the critical need for neurologic monitoring in hospitalized children with COVID-19 or MIS-C.

"As Francoeur et alobserve and emphasize, patients younger than 18 years with new functional and neurocognitive impairments require resource-intensive multidisciplinary care before and after hospital discharge," he wrote. "While programs for structured follow-up are uncommon, there exists a growing focus on long-term, patient-centered outcomes for children recovering from critical illness."

"Lessons learned from large cohorts of patients with sepsis, acute SARS-CoV-2 infection, MIS-C, and other systemic illnesses should deepen clinicians' appreciation of the links between short-term disease manifestations and long-term consequences for the most vulnerable pediatric patients," he added.

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Severe neurologic conditions common in hospitalized kids with COVID, MIS-C, data suggest - University of Minnesota Twin Cities

Cuomo says New Yorkers 'should be very proud' on COVID-19, but 'federal government failed'

Former Gov. Andrew Cuomo, D-N.Y., said there are "two very different opinions on what happened during COVID," June 11, 2024. (Pool via CNN Newsource)

WASHINGTON (WSTM-WTVH)

Former New York Gov. Andrew Cuomo spent Tuesday on Capitol Hill, testifying about how he handled the COVID-19 pandemic. He has been accused of misrepresenting the number of deaths reported inside state nursing homes during the pandemic.

Cuomo was peppered with questions from reporters as he walked into the closed interview with the Oversight Select Subcommittee on the coronavirus pandemic. Cuomo maintains New York committed no wrongdoing following investigations by the Department of Justice.

Cuomo was the face of New York's response to the pandemic at its height in the spring of 2020 when the virus ravaged the country and hit New York particularly hard.

Tuesday, Congressional Republicans grilled Cuomo about the March 2020 advisory which barred New York nursing homes from rejecting patients who tested positive for COVID-19. Some people say they lost family members because of the policy.

Cuomo aimed to defend himself from accusations the nursing home directive led to the needless death of nursing home patients.

The former governor insists the state followed directives issued by the Trump administration and the Centers for Disease Control and Prevention.

Former%20Gov.%20Andrew%20Cuomo,%20D-N.Y.:%20%E2%80%9CNew%20Yorkers%20did%20a,%20in%20my%20opinion,%20a%20great%20job%20should%20be%20very%20proud%20of%20what%20they%20did%20because%20the%20results%20matter,%E2%80%9D%20June%2011,%202024.%20(Pool%20via%20CNN%20Newsource)

"CMS [Centers for Medicare and Medicaid Services] and CDC did very extensive instructive guidance," he said, "and the investigations say New York followed the federal guidance."

Former%20Gov.%20Andrew%20Cuomo,%20D-N.Y.:%20%E2%80%9CI%20think%20the%20federal%20government%20failed%20this%20nation%20and%20it%20was%20abysmal,%E2%80%9D%20June%2011,%202024.%20(Pool%20via%20CNN%20Newsource)

Cuomo also claimed there are "two very different opinions on what happened during COVID," saying New York performed well, but not the federal government.

Former%20Gov.%20Andrew%20Cuomo,%20D-N.Y.:%20%E2%80%9CWe%20needed%20the%20federal%20government%20to%20actually%20act,%E2%80%9D%20June%2011,%202024.%20(Pool%20via%20CNN%20Newsource)

The former governor called the criticism purely political, saying only blue states were investigated and not red states, which issued the same directives.

"It's ironic today that you hear complaints about the weaponization of the justice system, when they nuclearized the justice system against Democratic states," he insisted.

Republican representatives Claudia Tenney and Elise Stefanik of New York criticized Cuomo on social media on the eve of his testimony.

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The rest is here:

Cuomo says New Yorkers 'should be very proud' on COVID-19, but 'federal government failed' - WGME

Early in the COVID-19 pandemic, some states allowed COVID-19 patients to be discharged from hospitals to skilled nursing facilities (SNFs), and even offered financial incentives to SNFs to take in patients to deal with hospital bed shortages.

"The potential human cost of these policies continues to be controversial," the authors wrote. "Some observers have argued that the policies had little impact, while other observers have blamed admissions for seeding or worsening COVID-19 outbreaks in SNFs."

The potential human cost of these policies continues to be controversial

Now a study in JAMA Internal Medicine shows this practice led to preventable COVID-19 cases in the SNFs and increased death rates. Furthermore, SNFs that reported staff and personal protective equipment (PPE) shortages saw bigger increases in COVID-19 morbidity and mortality.

The study was conducted by comparing matched groupings of 264 SNFs with initial admission of COVID-19positive patients (exposed facilities) and 518 comparator SNFs without initial admission (control facilities) from June 2020 to March 2021. Outcomes were assessed during a 15-week follow-up period.

The authors found that exposed SNFs had a cumulative increase of 6.94 (95% confidence interval [CI], 2.91 to 10.98) additional COVID-19 cases per 100 residents compared with control SNFs, a 31.3% increase.

Exposed facilities saw 2.31 (95% CI, 1.39-3.24) additional cumulative COVID-19related deaths per 100 residents compared with control facilities, representing a 72.4% increase compared with the sample mean (SD) of 3.19.

The authors defined PPE shortage as less than a 7-day supply of N95 respirators or surgical masks. Facilities with PPE shortages had an additional 14.81 [95% CI, 2.38 to 27.25] cases per 100 residents compared with those without such shortages.

In an invited commentary, James S. Goodwin, MD, and Huiwen Xu, PhD, said the findings of the study should result in outrage. Even in the earliest days of the pandemic, state public health leaders knew SNFs were unprepared to quarantine patients with COVID-19, they said, with inadequate staff, space, PPE, training, and protocols.

Also the earliest and deadliest outbreaks in the United States were occurring in nursing facilities, they wrote. In the first months of the pandemic, half of the nation's deaths occurred in nursing homes, even though they housed only 0.4% of US citizens.

"To the question, 'What else could we have done?' the answer is anything but this, anything but a move that fed the flames of the pandemic, creating more infections, more hospitalizations, and more deaths," Goodwin and Xu wrote.

The rest is here:

Placing COVID patients in skilled nursing facilities led to increased cases, deaths, study finds - University of Minnesota Twin Cities

Whats the issue?

Following the peak of the COVID-19 pandemic, researchers continue to investigate the factors related to the spread of diseaseand how city leaders can better respond before, during, and after such crises. Housing conditions, for example, can play a role in infectious disease risk. Substandard housingwhich might feature poor ventilation, overcrowding, and dampnesscan create an environment favorable to respiratory disease.

So, did poor housing conditions lead to moreand more severecases of COVID-19 infection during the pandemic?

Researchers from the Bloomberg Center for Cities at Harvard University and the MGH Institute of Health Professions studied the connections between poor housing conditions and COVID-19 infection and severity during the first year of the pandemic. They combined city housing data with healthcare data for residents of Chelsea, Massachusettsa densely populated city with high levels of substandard housing.

The researchers found that:

They conclude, The results demonstrate the value of combining cross-sector datasets to yield new insights and solutions. Existing city data can be leveraged to identify and prioritize 1) high-risk areas for future pandemic response activities, and 2) for longer-term solutions that address social determinants of health through safe and affordable housing.

See more here:

The link between poor housing conditions and COVID-19 infection - Harvard Kennedy School

Today a new report from the National Academies of Sciences, Engineering, and Medicine presents a number of conclusions about long-COVID diagnosis, symptoms, and impact on daily function, including that the condition can cause more than 200 symptoms, and that a positive COVID-19 test is not necessary to make a long-COVID diagnosis.

The findings are meant to guide the Social Security Administration (SSA) and are published one week before the National Academies of Sciences, Engineering, and Medicine is set to offer a new single definition of long COVID that can be used across US governmental groups as a way to streamline treating the condition in the years to come.

"This report offers a comprehensive review of the evidence base for how Long COVID may impact a patient's ability to engage in normal activities, such as going to work, attending school, or taking care of their families," said Victor J. Dzau, MD, president of the National Academy of Medicine, in a National Academies press release. "Its findings will be useful to anyone attempting to understand how Long COVID may affect the millions of people in the U.S. who have reported symptoms."

According to the Centers for Disease Control and Prevention, 5.3% of Americans currently have long COVID, with a significant proportion of those experiencing disability from the condition.

In today's report, more than 200 symptoms are formally listed as possible signs of long COVID, affecting every organ system. Women are twice as likely to men to experience long COVID, but people who have never received a diagnosis or even a positive COVID-19 test may be experiencing symptoms of the condition.

Though people with mild or even asymptomatic cases of acute COVID can develop long COVID, the report recognizes that people whose infection required hospitalization are two to three times more likely to experience long COVID than are those who were not hospitalized.

Emphasized throughout the report is the similarity long COVID has to other chronic conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, and postural orthostatic tachycardia syndrome (POTS).

Like those conditions there is no current way to treat long COVID, though long COVID does have a better prognosis than does ME/CFS.

While there is evidence that many people with Long COVID symptoms have improved by 12 months, data beyond that time frame is limited but suggestive that recovery might plateau.

"While there is evidence that many people with Long COVID symptoms have improved by 12 months, data beyond that time frame is limited but suggestive that recovery might plateau or progress at a slower rate," the authors wrote.

Children and teens with long COVID are also more likely than adults are to make a full recovery.

Long COVID can impair a person's ability to work or attend school for 6 months to 2 years or more after COVID-19 infection, the authors said.

Disability from long COVID is associated with acute disease severity, female sex, and baseline comorbidities, the authors said. Though some people with long COVID applying for disability with the SSA will qualify under the SSA's current listing of impairments, many will not.

"Three frequently reported health effects that can significantly interfere with the ability to perform work or school activities and may not be captured in the SSA Listings are chronic fatigue and post-exertional malaise, post-COVID-19 cognitive impairment, and autonomic dysfunction, all of which can be difficult to assess clinically in terms of their severity and effects on a persons functioning," the authors said.

Excerpt from:

Report: More than 200 symptoms tied to long COVID - University of Minnesota Twin Cities

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The Class of 2024 had a normal senior year with in-person classes, prom, and graduation.

But this years seniors started high school in fall of 2020 anything but normally. Classes were virtual, they had lunch at home, and they didnt get a chance to make friends when COVID-19 kept school buildings closed.

Chalkbeat spoke to 10 graduating seniors about what it was like to start high school during the pandemic. The Class of 2024 didnt have the usual hallmarks of freshman year like getting lost on the first day of school while trying to find classes, meeting new teachers for the first time, or the awkwardness of making new friends, all while going through the awfulness of puberty.

Even though these graduating seniors had a rocky start, they were resilient. Many students took Advanced Placement classes, dual-credit courses, and participated in many extracurricular activities.

Chicago Public Schools announced in a press release that this years graduating class received over 84,000 acceptance letters from institutions like Northwestern, Howard, and Harvard universities. Over 140 students have already earned associate degrees, more than 2,200 students are graduating from International Baccalaureate programs, and students took more than 49,000 Advanced Placement exams as of May 21, according to the press release.

But the Class of 2024 is also graduating during a contentious time in history. In November, the Chicago Board of Education will transition from an all-appointed board to a hybrid school board with some elected members and some appointed. In the United States, the country will once again vote for president, choosing between incumbent Joseph Biden, a Democrat, and the presumptive Republican candidate, former President Donald Trump, who has been convicted on 34 felony counts of falsifying financial documents. Across the country, college students are protesting the Israel-Hamas War, which has seen over 35,000 Palestinians killed after Hamas killed over 1,000 Israeli citizens during the October 7 attack.

In their own words, Chicagos high school seniors talk about their time in high school, post-secondary education plans, and how they feel about graduating during a presidential election and conflicts happening around the globe.

These interviews have been lightly edited for clarity and length.

Chase Jones, Gwendolyn Brooks College Preparatory Academy, plans to attend Yale University to study biology.

My mother and my eighth grade history teacher, Miss Clark. Brooks is an academic center, so Ive been there since seventh grade. Ive had Miss Clark as my history teacher for eighth grade, ninth grade and 11th grade. She single-handedly has been my support for helping me maintain balance academically. My mother has always been there to support me mentally, socially, and emotionally.

Xamiya Walton, Butler College Prep, a Noble school, will attend Northwestern University on a basketball scholarship to major in journalism with a minor in statistics toward a career as a sports journalist.

I would definitely say my parents and my sisters. Without them I wouldnt have been able to accomplish all the things I did and be where I am now.

Fernando Gonzalez, Marine Leadership Academy, will attend Stanford University and plans to major in computer science and cybersecurity.

It was hard to meet new people through a computer and I struggled in class. I wasnt challenging myself in class. I asked to be switched to AP classes during my freshman year. At first, the administration was hesitant about it because I didnt take any pre-courses to get into AP courses, but they made an exception. I worked so hard with these AP courses, but I still struggled because working through the computer made me feel like I wasnt in the class. I feel like I was in my room the whole time. When we went to lunch, I was like, Okay, Im gonna shut my computer off and lay down.

Raymarreon Polk, Crane Medical Prep High School, will attend DePauw University in the fall and plans to major in computer science.

For me, starting high school during COVID was a little weird. You cant really see many peoples faces because they rarely turned their cameras on, so the teacher saw a bunch of pictures. Also, nobody was really collaborative, because it was so awkward.

Melina Sandoval, Carl Schurz High School, will attend North Park University where she will pursue elementary education.

I had a lot of great opportunities. One of them was meeting the mayor. Another one was when my art teacher, some friends, and I were in class having fun and eating. That was a great memory and I wish I could go back to it. Also, I went to prom. I won duchess but I didnt win queen. It was a good experience still.

Andrew Espinoza, North-Grand High School, will attend Harold Washington College in the fall.

When we came back to school after virtual learning during COVID and seeing friends. It was a great moment because I saw all the people who were on the computer in person.

Guadalupe Miranda, Advantage Academy of DeVry University, will attend Stanford University in the fall to study human biology on a pre-med track.

With the upcoming election, its really nerve-wracking because its the first time for those of us who are 18. It was my first time voting in the primaries. When it comes to things happening in other countries, its really sad and devastating. But seeing how young people are getting involved and using their voice to try to make an impact gives me hope. I hope that young people can continue to use their voices.

Nyla Jackson, Gwendolyn Brooks College Preparatory Academy, will attend Illinois State University and plans to major in marketing analytics.

I hope that the Class of 2024 continues to break barriers and push through in the face of adversity.

Jayveon Edmonds, Al Raby High School for Community and Environment, will head to Southern Illinois University-Carbondale this fall to study zoology.

I didnt feel like my school set me up for greatness. I feel like our creativity was taken away because we didnt have many options and we were underpopulated. My graduating class was only about 20. My school didnt have funding to bring in new teachers or different sports programs. My high school experience was mediocre because of the lack of opportunity. Luckily, I was able to take college classes because I was able to network. But when I talked to other high school students, I realized that we didnt have a lot of options for classes. CPS should have more ways for students to be creative and check on the students in underpopulated schools.

Duchara Moody, Morgan Park High School, will attend the University Of Illinois Urbana - Champaign in the fall and major in secondary education.

What I would like to change or improve about Chicago Public Schools is the teachers. I feel we need more motivating, encouraging, and respectful teachers. I have had different experiences with teachers and noticed that some teachers arent doing their job, especially once I got in high school. I noticed some teachers just dont care and are only there for the pay. This is why I plan to make a difference and become a teacher. Teaching will be such a joyful moment for me and Ill be the best teacher ever. My goal is to instill as much wisdom as I can into kids, be a safe space for them if they need someone to talk to, be the one to cheer them up and let them know that they are the future and that they can be bright.

Samantha Smylie is the state education reporter for Chalkbeat Chicago covering school districts across the state, legislation, special education and the state board of education. Contact Samantha at ssmylie@chalkbeat.org.

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Class of 2024: These Chicago students started high school during COVID-19 - Chalkbeat

In the present study, we conducted a comprehensive cross-sectional and longitudinal assessment of individuals with PACS regarding their cognition, mental health status, neuroimaging, and fluid biomarker profile. This approach offers a broad view of PACS patients, which is particularly valuable considering the limited previous research in this area. We evaluated PACS patients with subjective cognitive complaints and their evolution over a 6-month period. Our findings revealed cognitive impairment affecting executive function in more than two-thirds of participants and verbal memory in over one-third. Additionally, prevalent mental health issues included apathy (64%), moderate-severe anxiety (57%), and severe fatigue (35%). Visual memory impairment correlated with total gray matter and subcortical gray matter volume, as well as regional GM reductions in the hippocampus and thalamus. Notably, markers of neuronal damage and inflammation were within normal limits. Importantly, overall health and cognitive evaluations showed no significant change over time. Furthermore, altered executive function and verbal memory, common in PACS, persisted in most subjects without any link to alterations in their biomarker and imaging profiles.

Our study stands out for three main reasons: First, it assesses cognitive deficits through comprehensive neuropsychological evaluations. Whereas the literature on PACS is replete with studies on cognition using screening tools like the Mini-Mental State Examination or the Montreal Cognitive Assessment53,54, our research incorporates detailed neuropsychological evaluations conducted by an experienced neuropsychologist. Second, our study is distinguished by its longitudinal design. Beyond describing the alterations in patients suffering from PACS, we repeated the same analyses six months later to assess their progression and track the evolution of these key health indicators over time. Third, our study is notable for the breadth of areas evaluated: it meticulously examines cognition, mental health, brain structure, and markers of inflammation and neuronal damage concurrently, tracking their longitudinal evolution.

Cognitive evaluations in PACS showed that attention-executive and verbal memory were the most affected domains (Fig.1), which has been described in previous published works; however, the pattern of alterations was broader and more heterogeneous between patients4,5,6,7,52,53. The sample had a high premorbid intelligence and would not be expected to perform below average on cognitive testing. Despite their cognitive reserve, known as a protective mechanism against neurological impairments, these individuals nonetheless experience cognitive deficits. This would likely lead to difficulties in effectively managing daily work and life responsibilities, adversely affecting their quality of life. At a 6-month follow-up, we determined that only the FCSRTDelayed Free Recall of verbal memory scores improved significantly from baseline, using LME models. Nevertheless, if we consider the percentage of normal evaluations (defined as the proportion of tests within clinical limits of normality), there was a significant improvement with time. Considering that most participants with abnormal results were close to the threshold for normal performance, even a slight improvement in these tests could lead to reaching normal threshold values. The improvement in verbal memory and the achievement of normality in the neuropsychological tests indicate a positive trajectory toward normal cognitive functioning. Conversely, high levels of anxiety, apathy, and fatigue present at the beginning of the study remained unchanged. The slight improvements observed in cognition did not strongly affect participants' clinical outcomes or quality of life. It is plausible that the persistence of executive function deficits, ongoing psychological symptoms, and chronic fatigue significantly influenced the overall lack of enhancement in participants' well-being.

Our results are in line with previous published works showing both improvements and persisting cognitive deficits in PACS55,56. Previous research has also documented a decline in executive functions among participants who initially presented with severe cognitive impairment57. The repeated administration of a cognitive test four times over a six-month period in our study raises concerns about the potential influence of a learning effect on the results. To mitigate the learning effect, participants received standardized instructions and practice trials during the baseline assessment to familiarize themselves with the cognitive test procedures, potentially minimizing the influence of initial unfamiliarity or anxiety on test performance. In future research, it is advisable to schedule evaluations at more significant intervals to allow for a more comprehensive study of PACS.

Participants also reported depressive symptoms, anxiety, apathy, fatigue, and low scores in general health. These symptoms did not improve during this 6-month study (Table 2). Given that our analysis demonstrated a significant relationship between one memory test and stratification in anxiety scores, we believe that the coexistence of cognitive and mental health symptoms could not be interpreted as causality. Additionally, the modest sample size in our study may have limited our ability to detect subtle differences in other categories. Recent literature has reported mixed findings regarding the associations between psychiatric comorbidities and cognitive impairment in individuals with PACS. For instance, one recent study identified a significant association between depression symptom severity and cognitive impairment severity among PACS patients58, while findings for post-traumatic stress disorder and anxiety were inconclusive. Conversely, another study found no association between depression, anxiety, total general health status, fatigue, and cognitive profiles59.

In our study of PACS participants, we observed a complex interplay between cognitive and mental health symptoms, with prevalent cognitive impairment alongside high levels of anxiety, apathy, and fatigue. This underscores the intertwined nature of cognitive and mental health domains in PACS, where cognitive deficits may coexist with psychiatric symptoms. We next sought to stratify participants by levels of anxiety, depression, apathy, fatigue, or quality of life scores according to their questionnaire scores. Participants displaying moderate or severe anxiety showed lower results in the ROCFT Recall subtest (adjusted p-value=0.0014). No significant differences were observed in cognitive tests between participants with normal and abnormal values of the other stratification categories. No associations were detected between longitudinal changes in cognitive and mental health measures. Conversely, a previously published work found that changes in executive functions were significantly associated with changes in depressive symptoms57.

While we can hypothesize that mental health issues may impede cognitive symptom improvement, it is worth noting that these mental health issues could be a consequence of the cognitive impairment as described elsewhere60. Understanding this relationship is crucial for informing treatment approaches; interventions targeting cognitive rehabilitation should consider the impact of comorbid psychiatric symptoms. Integrated interventions addressing both cognitive and psychiatric symptoms concurrently may optimize patient outcomes in PACS. Furthermore, both types of symptoms may be influenced by fatigue, which was nearly universal and severe in 35% of participants.

Fatigue has been implicated in various aspects of cognitive function, including attention, processing speed, and executive function, and has been associated with cognitive impairment in other medical conditions such as fibromyalgia and chronic fatigue syndrome. Moreover, fatigue often coexists with psychiatric symptoms such as anxiety and depression, contributing to the complex interplay between cognitive and mental health domains. In a recent study by Delgado-Alonso et al.61 investigated the relationship between subjective cognitive complaints, cognitive function, fatigue, and neuropsychiatric symptoms using various analytical methods. The study found that fatigue played a central role as the main mediator between objective and subjective cognition, while the impact of depression was indirect and mediated through fatigue. The lack of symptom improvement in PACS during the study suggests complex underlying factors. Possible reasons include the chronic nature of PACS, ongoing inflammation, and the interplay between cognitive and mental health symptoms. This highlights the need for personalized, multidisciplinary treatment approaches. Strategies may include pharmacological interventions, cognitive rehabilitation, psychotherapy, and lifestyle modifications.

Our study revealed a specific connection between cognitive deficits and brain changes in individuals with PACS. The ROCFT Recall test, a measure of memory and visual-spatial abilities, was the only cognitive test that showed abnormalities. These abnormalities were connected to both overall and specific areas of brain volume loss, specifically in the GM and WM globally, and in particular regions like the hippocampus and thalamus. This finding is significant because it identifies a direct relationship between certain cognitive deficits and changes in brain structure among individuals with PACS. The fact that these links were observed globally in GM and WM volumes, as well as in specific regions critical for memory and cognition (the hippocampus and thalamus), underscores the potential impact of COVID-19 on brain health. However, the fact that these associations were limited to certain brain regions and were only detected with the ROCFT Recall test suggests that the structural brain changes in PACS might be more nuanced than previously understood. While other studies, such as the one by Dez-Ciranda et al.5, have also found connections between cognitive deficits and MRI results, the limited scope of these associations in our study points to a potential gap in the literature. Specifically, it raises questions about the extent and significance of brain structural changes in PACS. Although it was beyond the scope of our study, it's noteworthy that some researchers have investigated the utility of functional neuroimaging to deepen our understanding of PACS pathophysiology. Bungenberg et al., in a cross-sectional study, used resting-state functional MRI (fMRI) to examine participants with PACS. They discovered changes in several brain regionsincluding the brainstem, olfactory cortex, cingulate cortex, thalamus, and cerebellumon average seven months after SARS-CoV-2 infection. These alterations were associated with the severity of fatigue and cognitive functioning54. While structural MRI delineates the brain anatomy, fMRI sheds light on the brains dynamic functions. By revealing changes in brain activity and connectivity, fMRI could reveal underlying neural mechanisms of PACS that are not apparent in structural changes alone.

Our next approach in this study was to correlate clinical and neuroimaging features of this PACS cohort longitudinally. While a previous study has included both cognitive and neuroimaging assessment of PACS62, to our knowledge, this is the first study to include longitudinal analysis of both cognitive and neuroimaging tests. We found significant positive correlations between both global and focal measures of brain volume/thickness and visual memory scores, but not with other cognitive tests. This correlation indicated that worse visual memory was associated with lower total and subcortical GM volume together with left cerebral WM volume. Furthermore, subcortical GM volumes, especially the hippocampus and thalamus, significantly corresponded with worse visual memory performance. Previous studies also explored the association between GM volume and cognitive symptoms; it has been reported that worse memory and visuospatial test performance is associated with a loss of GM volume5,20. In line with previous studies, our longitudinal analyses revealed no evidence of volume gain in a 6-month period, nor did we find evidence of progressive volume loss broadly. However, we did observe significant gray matter loss in the left pallidum and left transverse cortical thickness. Despite these findings, we do not believe that they hold clinical significance. The observed changes in the left pallidum and left transverse cortical thickness were not associated with any clinical symptoms or functional impairments in our study population. Therefore, we do not interpret these findings as clinically meaningful54.

The majority of previous studies13,14,16,63,64,65,66, have reported high levels of plasma and/or CSF cytokines, NfL and GFAP in the acute or subacute phase of COVID-19 infection that normalize at follow-up, albeit using differing follow-up intervals64,67,68. Some of these studies related these biochemical changes with the severity of the infection or the gravity of neurological symptoms; however, there is no consensus on how fluid biomarkers relate to acute COVID-19 symptom severity, PASC symptoms, or PASC progression/resolution. In our study, the levels of plasma and CSF cytokines, NfL and GFAP were within pre-specified normal limits. Similar results were observed by Boesl et al.69, they found that NfL levels were normal in participants with self-reported cognitive complaints, and GFAP was altered in only 4%. They compared participants with subjective cognitive decline, single domain or multi-domain impairment and found no association between persistent neuronal or astrocytic damage and cognitive impairment. We observed slight differences in some cytokine levels between PACS and control participants, with variations of small magnitude. Furthermore, cytokine levels were either elevated or reduced compared to controls. Given the proximity of all values, even minimal differences in a subset of measurements could potentially lead to clinically significant results. Despite achieving statistical significance, we find this difficult to interpret and potentially inconclusive, and in our opinion, without clinical significance. However, it is worth mentioning that other studies in neurocognitive disorders show relationships between select cytokines with measures of cognitive function, and this warrants further examination. We did not observe significant differences in either GFAP or NfL levels between PACS participants relative to controls. Previous studies14,15,16,70,71 have inconsistent results regarding the association of fluid biomarkers with the severity of infection or neurological symptoms. This variability in findings from past studies may arise from methodological differences, diverse patient populations, and the dynamic nature of the post-acute phase of COVID-19. All the samples were negative for antineuronal antibodies. The absence of antineuronal antibodies in all samples holds clinical significance, suggesting that autoimmunity involving these specific antibodies may not be a predominant factor in the pathophysiology of PACS. This finding implies that cognitive impairment and neurological symptoms observed in PACS may be driven by mechanisms other than direct autoimmune responses targeting neurons.

We next sought to clarify whether these biochemical markers related to neuropsychological test results in PACS patients, as previous studies have inconsistent results regarding the association of inflammatory marker levels and neuropsychological tests. Results have ranged from no association72 to an association between cytokine levels and fatigue or executive functions (Stroop Color Word test)73, or TNF- levels and memory74. In our research, we discovered a surprising positive correlation between higher GFAP levels and enhanced Stroop Word test performance. Despite observing impairment in Stroop Word test results among participants, GFAP levels stayed within normal ranges, suggesting these levels might not substantially affect cognitive performance or act as a cognitive function marker. Contrary to the expected negative correlation between GFAP and cognitive testing, stemming from inflammation's assumed detrimental effects on cognition, our findings suggest otherwise. This could indicate a compensatory or specific role of glial cell activation in supporting cognitive functions, or potentially represent a Type I error. This intriguing result encourages further investigation to confirm these findings and uncover the mechanisms involved. No association was observed between cytokines, NfL, or GFAP levels and global or regional MRI measures after adjusting for multiple comparisons. Finally, we found that patients serum or CSF samples did not immunoreact with brain tissue or live neurons, suggesting that brain autoantibodies are not involved in PACS symptoms. While our study did not reveal any significant abnormalities in markers of neuronal damage, inflammation, or neuroimaging among individuals experiencing cognitive manifestations following COVID-19 infection, several potential pathophysiological mechanisms warrant consideration. It is plausible that subtle, yet to be identified systemic or central dysregulated immune responses or diffuse microvascular or barrier changes could contribute to cognitive manifestations. We might also consider the central role of fatigue in cognitive manifestations. Future research exploring these mechanisms in depth is crucial for a comprehensive understanding of the neurological sequelae of COVID-19 infection.

An interesting finding elucidated by this work is the breakdown of PACS amongst sex. Whereas COVID-19 infects women and men equally, related publications indicate that there is a higher prevalence of females with PACS, with percentages ranging from 63 to 74%13,16,75, in line with these observations, 79% of participants in this study were women. Interestingly, in a study including 377 patients with COVID-19 infection, the female sex was independently associated with PACS within the multivariable analysis75. The higher prevalence of PACS in females suggests multifaceted influences across biological, psychological, and social dimensions. Hormonal differences may affect immune responses and neuroinflammation, contributing to gender-based variations in susceptibility and outcomes. Psychologically, gender-specific stressors and coping mechanisms could impact symptom manifestation, requiring exploration of psychosocial aspects in the post-acute phase. Social disparities, including healthcare-seeking behavior and societal expectations, may further influence the identification and reporting of PACS symptoms. Acknowledging these complexities highlights the importance of customized research and treatment approaches for effectively addressing PACS in females.

A significant limitation of our study is the small sample size, which included only 49 participants at baseline and 46 at the 6-month follow-up visit. This limitation is particularly pronounced concerning CSF samples. The lumbar puncture procedure was designated as optional. Consequently, CSF samples were obtained from only 12 participants. As a result, the interpretation of our findings must be approached cautiously; a larger number of CSF samples would have provided a more robust basis for identifying differences compared to controls, if any. The statistical analyses have been adapted to the reduced data. Thus, it could be generalized our results. However, the unicentric nature of the study, even if limited in the sample size, also provided homogeneity to the data acquisition. Secondly, the present study neither has healthy participant controls nor participants with COVID-19 infection without cognitive complaints for neuropsychological or neuroimaging analyses. This was due to the review of the local Ethics Committee, which considered the inclusion of controls as too high of a demand. This study may face referral bias, as participants were referred by healthcare providers, potentially overrepresenting severe cases. Additionally, considering the heightened fear and anxiety surrounding COVID-19, some participants actively sought assistance and self-referred due to concerns about cognitive symptoms related to the virus. Further research should consider a more diverse and randomized sample to mitigate potential biases in interpreting the severity and prevalence of cognitive symptoms in PACS. Another limitation of the study lies in the absence of baseline cognitive assessments prior to COVID-19 infection, which could have offered valuable insights into pre- and post-infection cognitive changes. However, participants with previous cognitive impairment were excluded. Finally, we believe the current duration of this study was limited and that including a longer endpoint with greater distance between measurement intervals may be more suitable for studying PACS cognitive symptoms. However, the study was designed during the last quarter of 2020, even before the formal definition of PACS, and most studies then were designed with short follow-up periods20,64.

In conclusion, our study showed cognitive impairment, mainly affecting attention/executive and verbal memory functions lasting for at least 6months in individuals with PACS. Cognitive impairment was accompanied by depressive symptoms, apathy, anxiety, fatigue, and low health status. These findings (except for visual memory loss) were not associated with brain structural abnormalities, elevated cytokines, markers of neuronal damage, or neuronal antibodies. Given these findings, a tailored and multidisciplinary approach involving cognitive and mental health interventions is recommended for patient care. Future research is essential for understanding the enduring cognitive trajectory of PACS and the associated biological mechanisms. Longitudinal studies of extended duration will provide insights into the long-term cognitive impact. Addressing the gaps identified by our study's limitations, ongoing research endeavors are crucial to guide clinical interventions and enhance the overall management of PACS.

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Cognitive profile, neuroimaging and fluid biomarkers in post-acute COVID-19 syndrome | Scientific Reports - Nature.com

Remember the rush to get a COVID-19 shot when the vaccines first arrived? Hundreds of millions of people rolled up their sleeves and got jabbed to protect themselves and others from the virus.

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Today, of course, the pandemic is over, but COVID-19 continues to circulate and infect people around the world. Its not gone.

Thats why being up to date on COVID-19 vaccinations remains a global health priority, says infectious disease specialist Kristin Englund, MD. Heres what you need to be considered fully vaccinated for COVID-19.

COVID-19 continues to evolve with new variants and subvariants emerging. Dozens of different strains have been reported since 2020. Today, omicron and its offshoots are the predominant variants circulating.

As the virus goes through these changes, your bodys defense against these new attackers needs to be reinforced. Mutations to the virus go well beyond what the initial vaccines covered, says Dr. Englund.

Thats why the U.S. Centers for Disease Control and Prevention (CDC) recommends getting an updated 20232024 COVID-19 vaccine to better protect yourself against newer variants and serious illness.

Three updated 20232024 vaccines are available: Pfizer-BioNTech, Moderna and Novavax.

COVID-19 vaccination guidance from the CDC varies by a persons age, vaccination record and health condition. Heres a rundown:

Recommendations for this age group are:

One updated Moderna or Pfizer-BioNTech vaccine is recommended for children in this age group who are either unvaccinated or previously got a vaccine before September 12, 2023.

Recommendations for this age group are:

For this age group, an additional dose of any updated COVID-19 vaccine is recommended at least four months following the first updated dose.

Those who are moderately or severely immunocompromised may benefit from additional doses of an updated COVID-19 vaccine. Talk to your healthcare provider about your specific timing needs.

Vaccines train your immune system to recognize and destroy harmful invaders (such as COVID-19). They teach your body to protect itself by giving intel on potential threats. (Basically, its a biological cheat sheet.)

It takes about two weeks after getting a COVID-19 vaccination for your body to build up immunity against the virus, says Dr. Englund. After that, youre considered fully vaccinated against COVID-19.

Data from the CDC shows the effectiveness of COVID-19 vaccines. A 2024 report shows that people who received an updated vaccine were 54% less likely to get COVID-19. (The findings focus on the four months from mid-September 2023 to January 2024.)

But that protective power naturally declines over time. Dr. Englund says COVID-19 vaccines generally hold firm against the virus for about a year. After that, the shielding effect loses some oomph.

New COVID-19 variants also can lessen the effectiveness of vaccines over time.

As the virus mutates and changes the vaccine loses some of its efficacy in addition to waning over time, explains Dr. Englund. Getting an updated vaccine is important to protect yourself and those around you.

Getting COVID-19 also educates your immune system on the virus and offers some security against future infection. But like vaccines, that immunity lessens over time and doesnt cover new variants.

The CDC recommends getting an updated COVID-19 vaccine even if you have had the virus. (The suggested wait time is 90 days after infection.)

Research shows that people who dont get vaccinated after recovering from COVID-19 are more likely to get reinfected than those who get an updated vaccine to boost their natural immunity.

More than 98% of the population in the United States has some protective immunity against COVID-19 through vaccination, prior infection or some combination of the two, according to the CDC.

But CDC data shows that a much smaller percentage has received an updated COVID-19 vaccine.

Looking ahead, Dr. Englund envisions vaccination against COVID-19 following a similar pattern as whats done for influenza (aka, the flu). In other words, an annual shot to guard against infection and serious illness.

Theres even work underway on a combined flu/COVID-19 vaccine.

This all falls under the concept of public health, says Dr. Englund. Getting vaccinated is part of our moral obligation to make sure were doing everything we can to lower the spread of these viruses and protect those around us.

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What Does It Mean To Be Fully Vaccinated for COVID-19? - Health Essentials