Category: Covid-19

A newstudy of 73 adults recovering from COVID-19 finds that those who lost their sense of smell showed behavioral, functional, and structural brain changes.

Researchers in Chile conducted cognitive screening, performance on a decision-making task, functional testing, and magnetic resonance imaging (MRI) results with 73 patients after mild to moderate COVID-19 infection and 27 COVID-nave patients with infections from other pathogens.Two follow-up sessions were conducted 15 days apart.

The patients were recruited from public and private hospitals in Santiago an average of 9 months after diagnosis from February 2020 to May 2023. The average age was 40.1 years. The team used loss of smell and need for hospitalization as proxies for potential markers of neurologic involvement and disease severity, respectively.

The results were published late last week in Scientific Reports.

"Given the significant global incidence of COVID-19, identifying factors that can distinguish individuals at risk of developing brain alterations is crucial for prioritizing follow-up care," the study authors wrote.

Twenty-two of 73 COVID-19 patients (30.1%) reported having differing degrees of attention and memory problems. Seven patients said they had headaches, six reported fatigue, and four had a persistently impaired sense of smell lasting, on average, 1.3 months. Of these patients, 68% experienced a total loss of smell, while the rest had an altered sense of smell.

Given the significant global incidence of COVID-19, identifying factors that can distinguish individuals at risk of developing brain alterations is crucial for prioritizing follow-up care.

In addition to self-reported changes in smell, 6 of 43 patients who lost their sense of smell during the acute infection could identify at most four of six odors on olfactory testing, suggesting persistent dysfunction.

The COVID and non-COVID groups were similar in age and cognitive performance, but patients with a loss of smell showed more impulsivity and were more likely to make different a choice given a negative result when performing a behavioral task (game), while those who were hospitalized displayed less strategic thinking and made the same wrong choice repeatedly.

On MRI conducted during the game, loss of smell was associated with decreased functional activity during decision-making, loss of white-matter integrity, and thinning of the outer layer of the cerebrum in the parietal regions (responsible for processing sensory input, understanding spatial relationships, and how to navigate).

"Only six patients present indicators of persistent olfactory deficit; thus, our results are not due to actual deficit," the study authors wrote. "Hence, anosmia could serve as both a potential marker of virus-induced damage to neuronal tissues and a marker for individuals susceptible to brain damage."

Research is needed into the extent that loss of smell reflects COVID-related brain damage, whether it is a marker of patient susceptibility to different neuropathologic mechanisms, the mechanism of the link between loss of smell and brain changes, and treatment targets, the researchers concluded.

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COVID-related loss of smell tied to changes in the brain - University of Minnesota Twin Cities

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PermiaCare talked about the effects of COVID-19 trauma they've noticed in children who lived through the pandemic.

Author: newswest9.com

Published: 10:08 PM CDT August 21, 2024

Updated: 10:08 PM CDT August 21, 2024

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The long-lasting effects of 'COVID-19 trauma' in children, teens - NewsWest9.com

Now scientists in the U.K. have uncovered a new piece of the puzzle: COVID vaccination may mitigate the viruss adverse effects on mental health. The team, including researchers from the universities of Bristol, Cambridge, Oxford, and Swansea, as well as University College London, showed higher rates of mental illnesses among unvaccinated people, up to a year after severe COVID infection. Their findings were published Wednesday in JAMA Psychiatry.

Our findings have important implications for public health and mental health service provision, as serious mental illnesses are associated with more intensive health care needs and longer-term health and other adverse effects, Venexia Walker, PhD, a senior research fellow in epidemiology at Bristol Medical School and one of the studys lead authors, said in a news release. Our results highlight the importance of COVID-19 vaccination in the general population and particularly among those with mental illnesses, who may be at higher risk of both SARS-CoV-2 infection and adverse outcomes following COVID-19.

The observational study assessed the medical records of more than 18.6 million adults ages 18 to 110 (50% female; median age 49) who were registered with a general practitioner in England. In this first cohort, which centered on the pandemics early days before a vaccine was available, about 5% of patients had been diagnosed with COVID. Two other cohorts represented the vaccination era from June through December 2021:

In each of the three cohorts, researchers compared incidence of the following mental illnesses before and after a confirmed COVID diagnosis:

Compared to before or without COVID, the prevalence of most of these conditions increased one to four weeks following COVID diagnosis. This trend primarily applied to severe infections that had required hospitalization and among unvaccinated people, incidence remained elevated for up to a year.

Mental illness incidence increased slightly in COVID patients who endured milder infection. Depression rates, for example, spiked 16-fold among hospitalized patients but did so by just 1.2 times among nonhospitalized patients. While no vaccine is 100% effective, COVID immunization is intended to prevent severe illness and death. Researchers noted that the vaccinated cohort showed little variation in depression prevalence before/without or after nonhospitalized infection.

The link between COVID and mental illness didnt change significantly between racial and ethnic groups. It did, however, vary by age and biological sex. For instance, this association was stronger among men and older age groups.

Despite boasting a large sample size, the study has its limitations. The millions of participants hailed from a single nation, and the vast majority were white. Researchers also stressed that they analyzed only confirmed infections recorded in electronic health records, meaning COVID-positive individuals who hadnt sought medical care werent included. In addition, researchers couldnt rule out that viruses besides SARS-CoV-2 hadnt contributed to the mental illnesses studied.

We have already identified associations of COVID-19 with cardiovascular disease, diabetes, and now mental illnesses, Jonathan Sterne, PhD, study coauthor and professor of medical statistics and epidemiology at Bristol Medical School, said in the news release. We are continuing to explore the consequences of COVID-19 with ongoing projects looking at associations of COVID-19 with renal, autoimmune, and neurodegenerative conditions.

Updated 20242025 COVID vaccines likely will be available in the early fall. Vaccines manufactured by Pfizer, Moderna, and Novavax will arrive later this year, the Centers for Disease Control and Prevention (CDC) announced in June. Last years version launched in mid-September.

When the new vaccines are available, the CDC recommends everyone aged 6 months and older get a dose to shield themselves from the latest Omicron subvariants. People with compromised immune systems and those 65 and older may be eligible for additional doses.

Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated, CDC Director Dr. Mandy Cohen said in a June news release. Make a plan now for you and your family to get both updated flu and COVID vaccines this fall, ahead of the respiratory virus season.

If you need immediate mental health support, contact the 988 Suicide & Crisis Lifeline.

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COVID is associated with mental illness. Its worse for unvaccinated people, shows study of 18.6 million adults - Fortune

Most people associate symptoms such as shaking or trembling movements with neuromuscular diseases, such as Parkinsons diseasebut now, some Long COVID patients have reported experiencing internal tremors and vibrations. These are described as movements or sensations inside the body, with or without visible external muscle movementa symptom previously undiscovered in the complex pathology of the illness and quite rare in and of itself.

In a new study published in The American Journal of Medicine, led by Yale School of Medicines Harlan Krumholz, MD, Harold H. Hines Jr. Professor of Medicine (Cardiology), and Akiko Iwasaki, PhD, Sterling Professor of Immunobiology, the researchers sought to learn more by comparing Long COVID patients who have internal tremors and vibrations to Long COVID patients without these symptoms.

Back in 2021, a qualitative study by Dr. Krumholz collected emails and comments from patients with Long COVID experiencing internal tremors. "People around the world reached out to us and shared stories about their Long COVID symptoms, including internal tremors and vibrations, which they described as burdensome and, in some cases, quite debilitating, says Tianna Zhou, MD, the first author of the paper and a recent graduate of Yale Medical School. When we looked in the scientific literature, very few studies described internal tremors or vibrations in either Long COVID or other conditions. We wanted to shed light on a set of symptoms that are important to patients but understudied."

The severity of the tremors varies widely. In some patients, they affect the arms and legs, while others report feeling them throughout their body; the tremors can range from a slight vibration to a feeling of near paralysis and can occur at a frequency of every few hours all the way to a near constant basis. This study helped establish internal tremors as a prolonged and debilitating symptom in some Long COVID patients.

Many patients with these symptoms have been dismissed, as this aspect of the syndrome has not been well described, says Dr. Krumholz. Others feel alone and wonder if they are the only ones experiencing it. This research informs the medical professionand helps people with the condition know that they are not alone."

In the new study, Yale researchers compared demographic and socioeconomic characteristics of Long COVID patients with internal tremor symptoms, the effect of having other medical conditions prior to COVID-19, and the onset of new conditions. Of 423 Long COVID study participants, 37% described having internal tremors or vibrations.

Gender was the only statistically significant demographic factor that was identifiedof the study group, 81% of female participants reported internal tremors as a symptom compared to 70% of male participants. Importantly, participants with internal tremors reported significantly worse Long COVID symptom severity and had higher rates of experiencing such additional wide-ranging symptoms as visual flashes of light, hair loss, tingling or numbness, chest pain, and ringing in the ears.

Participants with internal tremors reported higher rates of new-onset mast cell disorders, a group of diseases in which mast cells are abnormally active and typically cause symptoms such as itching, nausea, and abdominal pain. Participants also reported higher rates of new-onset neurological disorders and conditions, including seizures and dementia, as well as stress and anxiety disorders compared to Long COVID participants without internal tremors.

Currently, low-dose naltrexone (LDN), a drug that has been used to treat chronic pain and discomfort in fibromyalgia and other rheumatological disorders, is sometimes used to relieve internal tremors and vibrations in Long COVID patients with varying levels of success. When administered in a daily dose of 1 to 5 mg, naltrexone is thought to reduce inflammation, release endorphins, and normalize cortisol levels to alleviate discomfort. At its usual dose50 mg or greaternaltrexone is used to treat addiction.

In one study, 52 participants with Long COVID were treated with a two-month course of LDN. The researchers conducted a survey and found that the participants reported an improvement in Long COVID recovery, daily activity limitation, energy levels, pain levels, concentration levels, and sleep disturbance. The study concluded that LDN was safe to use in Long COVID patients but required additional randomized control trials to validate its therapeutic use.

Just recognizing these symptoms is important to patients, but the real need is for targeted therapies," says Dr. Krumholz. By deepening our understanding of the mechanisms of Long COVID, we aim to identify potential treatments that can alleviate the burden of this condition. The Krumholz lab, in collaboration with Iwasaki and her lab, aims to continue advancing knowledge of Long COVID and hopes to develop targeted therapies for patients affected by Long COVID.

Kenny Cheng is an undergraduate majoring in molecular, cellular, and developmental biology at Yale University.

Internal tremor was one of the first unusual symptoms I heard about from my patients when I started the Long COVID Care Center at Yale in January of 2023. My patient, a young man from New York City, described a strange shaking or vibration in his internal organsthe way you might feel when standing next to a rapidly spinning motor or when attending a concert where the subwoofer is turned all the way up and the sound of the bass seems to travel through the body. He found low-dose naltrexone useful for this disquieting symptom. Since then, Ive seen many people who share this unusual symptom. Sometimes its reported as mild and annoyingas it was for that first patient I saw. For others, it can contribute to a cacophony of symptoms that make even getting out of bed daunting.

The recent observation by Zhou et al. (The American Journal of Medicine study mentioned above) that this tremor is often seen in those most dramatically and devastatingly affected by Long COVID has changed my approach to patients, and I now routinely ask about this specific symptom. I continue to try low-dose naltrexone but eagerly await studies to support the efficacy of this and other medications to treat these unusual tremors. As is said far too often with this disordermore research is desperately needed.

Read other installments of Long COVID Dispatches here.

If youd like to share your experience with Long COVID for possible use in this blog (under a pseudonym), write to us at: LongCovidDispatches@yale.edu. It may appear, space permitting, in a future post.

Information provided in Yale Medicine content is for general informational purposes only. It should never be used as a substitute for medical advice from your doctor or other qualified clinician. Always seek the individual advice of your health care provider for any questions you have regarding a medical condition.

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Long COVID Symptoms: Internal Tremors and Vibrations - Yale Medicine

Researchers at Tel Aviv University say that smartwatches with biomarkers that provide early detection of contagious diseases can prevent the spread of infections and even preempt global pandemics in the future.

Early diagnosis can be critical for inducing behavioral changes, such as reduced social contacts, when the disease is most infectious, said Prof. Dan Yamin, head of the Lab for Digital Epidemiology and Health Analytics, and Prof. Erez Shmueli, head of the Big Data Lab, both at Tel Avivs industrial engineering school, who led the team of researchers in Israel and at Stanford University.

The two-year study, which focused on three infectious diseases COVID-19, influenza, and group A streptococcus (GAS) was published last month in the prestigious peer-reviewed scientific journal Lancet Regional Health Europe.

The researchers also discovered that even after people reported their first symptoms, they postponed testing. During this critical period, they were spreading the disease to others.

The findings highlight a significant gap in timely disease management, the researchers said, and can help improve public health strategies.

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The researchers likened the spread of infectious diseases to controlling the spread of wildfires, as in both cases early detection is crucial.

Prof. Dan Yamin, head of the lab for Digital Epidemiology and Health Analytics at Tel Aviv University. (Tel Aviv University)

Nearly all infectious diseases begin silently and progressively worsen until clinical symptoms appear. During this period, people decide how to modify their social activities and when to seek diagnostic tests and treatment.

During the study, 4,795 Israelis over 18 years of age wore a smartwatch that continuously monitored key physiological parameters, including pulse and heart rate.

These biomarkers reveal information about our bodys two most important systems: the heart and the brain, said Yamin.

When a person becomes ill, most of the focus goes to the immune system that is battling the disease, he said. Our brain constantly consumes energy, burning oxygen provided by the cardiovascular system, and consequently, any change in our activity or condition is immediately reflected in a change in our heart rate.

In addition to wearing the smartwatches, the participants answered a daily series of questions about how they felt physically and mentally, including if they felt any specific symptoms.

A community outreach doula holds a home COVID-19 test kit, on February 3, 2022, while picking up supplies at Open Arms Perinatal Services before going out to visit some of her clients in Seattle. (AP Photo/Ted S. Warren)

They also received home test kits for the three diseases, which they used at their discretion.

Over the two years, the researchers collected 800,000 questionnaires; this data was compared with parallel data from the smartwatch.

Altogether, the data included 490 episodes of influenza, 2,206 episodes of COVID-19, and 320 episodes of GAS.

The researchers then built special models that identified the three points in time following exposure to an infectious disease.

With COVID-19, for example, the patients heart rate changed 96 hours after exposure, yet it took another 34 hours for the person to notice symptoms. Then, it took 64 more hours for them to use the home test confirming the disease.

Prof. Erez Shmueli, head of the Big Data Lab, Tel Aviv University, Dept. of Industrial Engineering. (Tel Aviv University)

Consequently, for quite a long interval, from exposure to testing, they did not change their social behavior, spreading the disease to others, said Shmueli.

We found that on average, people performed the test and changed their behavior when the disease was already past its peak and the chance of infecting others was lower, Shmueli said.

The subjects also waited 68 hours on average before they tested themselves for influenza and 58 hours for GAS.

The delay between digital diagnosis and testing is thus extremely crucial, Shmueli said.

Using digital diagnosis can significantly reduce the spread of infectious diseases because people might change their social behavior at a much earlier stage of the disease, Yamin said.

If this happens, then people with COVID, who normally infect an average of three people, would infect less than one other person.

If every sick individual transmits the disease to less than one other person, the disease soon dies out, he said,effectively eliminating the next pandemic.

Early diagnosis is also critical for effective treatment, the researchers said.

Existing treatments for COVID-19, for instance, are very effective only when given early on, preventing severe illness, hospitalization, and even death.

Infectious diseases pose the greatest threat for a global catastrophe, Yamin said. People travel all over the world and potentially spread new diseases.

Modern technology can help us combat this danger and devise more effective public health strategies, the researchers said.

Smartwatches are a relatively new technology, with enormous potential, said Yamin. There are ever more sensitive and accurate wearable sensors constantly being developed. Ultimately, this can be a high-impact tool for preempting future pandemics.

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Israeli researchers say wearable sensors could cut spread of contagious disease - The Times of Israel

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Updated 4 hours ago

Peaty missed out on a third consecutive gold medal by 0.02 seconds on Sunday and afterwards said he had been slightly unwell with a little bit on my throat.

A Team GB statement said the 29-year-olds condition worsened overnight and he has now tested positive for coronavirus.

Unlike the last Games in Tokyo, there are no strict protocols around the disease in Paris which could prevent him from competing.

It is viewed as a general illness by organisers, although Team GB have straightforward protocols including hand hygiene and keeping space from other competitors.

Peaty was expected be part of the British relay teams later in the Olympics, with a possible return to action as soon as Friday. Team GB said he is hopeful to be back in competition.

As in any case of illness, the situation is being managed appropriately, with all usual precautions being taken to keep the wider delegation healthy, the statement added.

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Peaty could compete in either the men's or mixed 4x100m medley relay competitions in Paris, and was part of the squad that won gold in the mixed event in Tokyo.

Their title defence begins on Friday morning in the heats with a potential final, should Britain qualify, on Saturday evening.

The men's medley relay begins on Saturday morning, with the heats on Sunday night.

Following his positive Covid test, Peaty said: "Ill now be focusing on a fast, full recovery to give my best in the team relays later in the week.

"Ive had so many messages and Ill get back to you all, thank you for your support as it has truly been an unforgettable journey."

The Team GB coaches would pick Peaty for whichever event they viewed as the best chance of a medal, possibly both if he felt fit enough, and he would be crucial to their hopes.

There are other breaststrokers in the GB squad who could take his place if required.

Peaty was targeting a third consecutive 100m Olympic title on Sunday, which would have meant he joined Michael Phelps as the only man to have won the same Olympic swimming event three times in a row.

He was well placed in the final 25m but Italian Nicolo Martinenghi came through to win gold.

Peaty gave emotional interviews afterwards when he discussed his difficulties since his last gold in Tokyo, which included problems with alcohol and his mental health.

He almost walked away from the sport before returning last year.

The Englishman is not the first aquatics athlete at these Games to test positive for Covid-19.

Five members of Australia's water polo squad, which takes place at a different venue to the swimming, contracted the disease days before the Games.

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Adam Peaty: GB swimmer tests positive for Covid-19 after winning Olympic silver medal - BBC.com

Great Britain Olympic swimmer Adam Peaty tested positive for COVID-19 on Monday, less than 24 hours after he won the silver medal in the mens 100-m breaststroke.

Peaty, 29, began feeling unwell before the final on Sunday, Team Great Britain said in a statement. In the hours after the race, his symptoms worsened, and he tested positive for COVID-19 early on Monday morning.

He is hopeful to be back in competition for the relay events later in the swimming programme, Team Great Britain said. As in any case of illness, the situation is being managed appropriately, with all usual precautions being taken to keep the wider delegation healthy.

Peaty confirmed his COVID-19 diagnosis in an Instagram post on Monday. Ill now be focusing on a fast, full recovery to give my best in the team relays later in the week, Peaty wrote in the caption of the post.

The mixed 4x100-m medley relay final is set to take place on Aug. 3, and the mens 4x100-m medley relay final will be held on Aug. 4. Peaty previously competed in the Tokyo and Rio de Janeiro Olympics.

Team Great Britain declined to specify what precautions Peaty and the team were taking or what treatment, if any, Peaty was receiving.

The Paris Games have significantly less stringent COVID-19 restrictions compared to the Tokyo Games in 2021; there are no mask mandates or isolation periods. The International Olympic Committee (IOC) did not respond to a request for comment about its guidelines or Peatys positive test. When five players on the Australian womens water polo team tested positive for the virus last week, the countrys Olympic team chief told Le Monde that affected players would be cleared for practice when they feel well enough to train, adding that affected athletes would be wearing masks and isolating from other team members outside of training.

Read More: Leon Marchands First Olympic Gold Will Only Fuel Michael Phelps Comparisons

Peaty shared a step on the podium with Team USA swimmer Nic Fink on Sunday night, after the two athletes tied for silver in the mens 100-m breaststroke.

Video footage also showed Peaty kissing Italian swimmer Nicolo Martinenghi, who won the gold medal for the race on Sunday, on the cheek that same night.

People who test positive for COVID-19 can continue to test positive for the virus for days or even weeks after, according to the U.S. Centers for Disease Control and Prevention.

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Great Britain Olympic Swimmer Adam Peaty Tests Positive for COVID-19 After Winning Silver - TIME

Data sources and study cohorts

UK Biobank is a large-scale population-based prospective cohort study with deep phenotyping and genomic data, as detailed elsewhere51. Briefly, between 2006 and 2010, over 500,000 individuals aged 4069 years were recruited from 22 assessment centers across the United Kingdom at baseline, with collection of socio-demographic, lifestyle and health-related factors, a range of physical measures, and blood samples51. Follow-up information is obtained by linking health and medical records, including national primary and secondary care, disease and mortality registries52, with validated reliability, accuracy and completeness53. To identify cases of SARS-CoV-2 infection, polymerase chain reaction (PCR)-based test results were obtained by linking all participants to the Public Health Englands Second Generation Surveillance System, with dates of specimen collection and healthcare settings of testing54. Outbreak dynamics were validated to be broadly similar between UK Biobank participants and the general population of England54.

In this study, we included participants who were alive by March 1, 2020 and had a positive SARS-CoV-2 PCR test result between March 1, 2020 (date of the first recorded case in the UK Biobank), and March 1, 2022, with the date of first infection considered as index date (T0). For those diagnosed with COVID-19 in hospital, we defined T0 as the date of hospital admission minus a random number of 7 days. The major prevalent variants during the study period included wildtype, Alpha (B.1.1.7), Delta (B.1.617.2), and Omicron (B.1.1.529 BA.1). The calendar periods of dominant variants in the UK were based on pandemic data from the Office for National Statistics26. Participants with missing data on study exposures at baseline were excluded. We addressed missing data on covariates using the following approaches: (1) participants with missing values in age and sex (<0.1%) were excluded. (2) participants with missing values in ethnicity were classified as other ethnic groups. (3) participants with missing values in education level (0.9%) were classified as category I, which includes none of the above and prefer not to answer. (4) missing values in IMD (13.8%) were imputed with the mean value of the entire UK Biobank cohort. All participants included in this study provided written informed consent at recruitment. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines and received ethical approval from the UKBB ethics advisory committee. Study design, cohort construction, and timeline are provided in Supplementary Fig.1. All participants provided written informed consent at the UK Biobank cohort recruitment. This study received ethical approval from UK Biobank Ethics Advisory Committee (EAC) and was performed under the application of 65397.

Ten prespecified potentially modifiable lifestyle factors were assessed, including smoking, alcohol consumption, body mass index (BMI), physical activity, sedentary time, sleep duration, intake of fruit and vegetable, intake of oily fish, intake of red meat, and intake of processed meat. Selection and categorization of lifestyle factors was based on literature review, previous knowledge, and UK national health service guidelines55,56. Multiple lifestyle factors were measured by validated questionnaire for all participants at baseline recruitment. Detailed definitions on measurement and classification of lifestyle factors are provided in Supplementary Table1. Briefly, healthy lifestyle components including past or never smoker, moderate alcohol intake (4 times week), BMI<30kg/m2, at least 150min of moderate or 75min of vigorous physical activity per week, less sedentary time (<4h per day), healthy sleep duration (79h per day), adequate intake of fruit and vegetables (400g/day), adequate oily fish intake (1 portion/week), moderate intake of red meat (4 portion week) and processed meat (4 portion week) were defined, in accordance with previous evidence or UK national health service guidelines55,56.

A binary variable was created for each of the 10 factors, with 1 point assigned for those meeting the healthy criteria and 0 otherwise. A composite lifestyle score was then calculated for each participant by summing the total number of healthy lifestyle factors, ranging from 0 to 10. Based on the composite score, participants were classified into three lifestyle categories: unfavorable (05), intermediate (67), and favorable (810). The lifestyle score was also used as a continuous variable of number of healthy lifestyle factors. Similar methods of defining lifestyle score have been used in the same UK Biobank cohort57 as well as external cohorts16,28. Distributions of lifestyle score and categories are provided in Supplementary Table2.

The median [IQR] duration between baseline assessment of lifestyle factors and the date of infection was 12.5 [11.813.3] years. Part of participants took part in up to two further touchscreen interviews with lifestyle and health-related factors similarly measured. There were generally stable responses to lifestyle factors between baseline assessment and the latest repeat assessment (median time difference from baseline, 8 years) as shown in Supplementary Fig.2. 34.9% of participants with an unfavorable lifestyle, 48.6% with an intermediate lifestyle, and 73.7% with a favorable lifestyle at baseline remained in the same corresponding lifestyle category at the latest repeat assessment following a median of 8 years. Overall, the proportion of stable lifestyle categories is 60.6%.

The outcomes after COVID-19 were prespecified, including a set of multisystem sequelae, death, and hospital admission following the SARS-CoV-2 infection. The multisystem sequelae were selected and defined based on previous evidence of the long COVID, including 75 systemic diseases or symptoms in 10 organ systems: cardiovascular46, coagulation and hematologic46, metabolic and endocrine44, gastrointestinal48, kidney43, mental health45, musculoskeletal47, neurologic47, and respiratory disorders10,13,14, and general symptoms of fatigue and malaise3,4,42,49. Detailed definitions of multisystem sequelae are listed in the Supplementary Table3. Outcomes were identified as follows: individual sequela from the hospital inpatient ICD-10 (International Classification of Diseases 10th Revision) diagnosis codes, deaths from the records of national death registry, and hospital admission from hospital inpatient data from the Hospital Episode Statistics. Incident outcomes were assessed in participants with no history of the related outcome within one year before the date of the first infection.

As SARS-CoV-2 infection has been associated with both multisystem manifestations during its acute phase and with sequelae during its post-acute phase7,49, we conducted analyses stratified by phase of infection. We reported risk of each outcome during the acute phase (T0 to T0+30d), post-acute phase (T0+30d to T0+210d), and overall period following infection (T0 to T0+210d) to reflect the full spectrum of post-COVID conditions. The end of follow-up for the overall cohort was September 30, 2022, with the maximum follow-up period censored to 210 days.

We prespecified a list of covariates for adjustment or stratification based on literature review and prior knowledge: socio-demographic characteristics including age, sex, education level (mapped to the international standard for classification of education), index of multiple deprivation (IMD, a summary measure of crime, education, employment, health, housing, income, and living environment)58, and race and ethnicity; and infection related factors including healthcare settings of the testing (community/outpatient vs inpatient setting as proxy of severity of infection), COVID-19 vaccination status, and SARS-CoV-2 variants.

Baseline characteristics of the overall cohort of participants with SARS-CoV-2 infection and by composite healthy lifestyle categories were reported as mean and standard deviation or frequency and percentage, when appropriate. Multivariable cox proportional hazard (PH) model was used to assess the association between composite healthy lifestyle and risk of multisystem sequelae (composite or by organ systems), death, and hospital admission, with adjustment for age, sex, ethnicity, education level, and IMD. PH assumption across lifestyle categories was tested by Schoenfeld residuals with no violations observed for outcomes. Hazard ratio (HR) and absolute risk reduction (ARR, difference in incidence rate between lifestyle groups per 100 persons during the corresponding follow-up period) were estimated from the Cox model. We also assessed the association between individual lifestyle factor instead of composite categories (each component as a categorical variable with or without mutual adjustment for others, or the number of factors as continuous variables) and risk of outcomes.

We conducted causal mediation analysis59,60 to quantify the extent to which the habitual healthy lifestyle may affect COVID-19 sequelae through the potential pathway of relevant pre-infection medical conditions (mediator), with the proportion of direct and indirect effects estimated by quasi-Bayesian Monte Carlo methods with 1000 simulations for each. Detailed modeling procedures and a directed acyclic graph are provided in Supplementary Methods.

We examined the association between composite healthy lifestyle and the overall risk of multisystem sequelae in prespecified clinical subgroups by demographic and infection-related factors. The demographic factors included age (65 and >65 years), sex (male and female), and ethnicity (White and other ethnic groups). As the risk profile of COVID sequelae was related to vaccination and severity of infection, and may change with the evolving pandemic, infection-related factors including vaccine status (no or one-dose partial vaccination and two-dose full vaccination), test setting (inpatient and outpatient or community), dominant variants during the study period (wildtype, Alpha, Delta, and Omicron BA.1) were assessed. Multiplicative interactions between the composite healthy lifestyle and the stratification variables were tested, with P-value reported.

We conducted multiple sensitivity analyses to assess the robustness of primary findings. First, to reflect the multisystem and potentially comorbid nature of COVID sequelae, accounting for both the number of sequelae by an individual and the relative health impact of each sequela. Weights based on Global Burden of Disease study data and methodologies for general diseases and long COVID were assigned to each sequela (Supplementary Table1)61,62. The weighted score was calculated for each participant by summing the weights of all incident sequelae during the follow-up period. Zero inflated Poisson regression was then used to calculate relative risk (RR), with follow-up time set as the offset of the model and adjustment for covariates. Second, to further account for potential reverse causality and more accurately define incident cases, extending the washout period for outcomes from one year to two years. Third, defining events of post-acute sequelae 90 days after infection (follow-up period T0+90d to T0+210d), instead of 30 days in the main analyses. The adjustment was made as there is no uniform definition for long COVID, which is currently described as conditions occurring 3090 days after infection in existing guidelines27. Fourth, restricting the identification of outcomes to the first three ICD diagnoses, which are the main causes for each hospital admission. Fifth, reconstructing a composite lifestyle index without BMI and assessed its association with outcomes. Finally, we conducted quantitative sensitivity analysis to adjust for changes in lifestyle factors over time since the baseline assessment. We used odds ratios to quantify associations and assumed a sensitivity and specificity of 90% for each lifestyle component (Supplementary Methods).

As a healthy lifestyle is associated with a lower risk of chronic diseases and mortality among the general population predated pandemic, we conduct exploratory analysis to compare the effects of healthy lifestyle on adverse outcomes following COVID-19 with the effects among participants without infection. A random index date was assigned to the participants without infection based on the distribution of T0 among those with infection, and we repeated the main analyses with the maximum follow-up period censored to 210 days.

Statistical significance was determined by a 95% confidence interval (CI) that excluded 1 for ratios and 0 for rate differences. All analyses and data visualizations were conducted using R statistical software (version 4.2.2).

Further information on research design is available in theNature Portfolio Reporting Summary linked to this article.

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Modifiable lifestyle factors and the risk of post-COVID-19 multisystem sequelae, hospitalization, and death - Nature.com

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Diabetes is a chronic disease affecting hundreds of millions worldwide and has multiple risk factors. The more the risk factors present, the higher the likelihood of developing diabetes. Understanding these factors is essential for prevention. A new study published inThe Lancet Diabetes and Endocrinologydescribes a link between COVID-19 and diabetes.

From databases of tens of millions of people in England registered with their general practitioners, researchers examined the risk of developing diabetes following COVID-19. They found a four-fold increase in risk during the first month post-infection. The risk remained elevated in two-thirds of these individuals in the second year.

Early indications came in 2020 when doctors across the world noted a surprisingly high occurrence of diabetes in previously healthy individuals following a diagnosis of COVID-19. Some required high doses of insulin. A paper published in theJournal of Family Medicine and Primary Carein October 2022 from Telangana reported similar findings.

However, observations based on small numbers of patients are not always definitive. For instance, steroid use for COVID-19 raises blood sugar levels on its own. Besides, in any population, diabetes exists undetected in a significant proportion of individuals. This might have been unearthed only because of the medical attention they received after contracting COVID. A reverse causality has also been implicated, with people with diabetes being at greater risk for severe COVID-19. It was also unclear whether the rise in blood sugars would settle down after the immediate stress of COVID passed. Thus, the link remained a matter of debate, necessitating larger studies over an extended period of time.

The new study also examined health records from before and after the vaccine rollout, enabling researchers to investigate the impact of vaccination on diabetes risk. With a follow-up period exceeding a year, they could assess the persistence of newly diagnosed diabetes. Since the study relied on well-maintained databases from before the pandemic, the findings are unlikely to be due to increased testing alone. The persistence of diabetes into the second year indicates that steroid use alone was not responsible.

Two key observations linked the severity of COVID-19 to an increased risk of diabetes. Firstly, the risk was significantly higher among hospitalised patients. Secondly, vaccinated individuals, who experienced less severe COVID-19, had a lower risk of developing diabetes.

When comparing vaccinated and unvaccinated populations, it is important to address demographic differences. For instance, unvaccinated people in England tended to be younger, healthier, and more likely to be of South Asian or Black ethnicity. Although South Asians have a higher baseline risk of diabetes, younger age lowers the overall risk in a population. To ensure accurate conclusions, the researchers adjusted for these factors, eliminating any inaccuracies from comparing unequal populations.

The increased diabetes risk following COVID-19 is believed to involve at least two mechanisms. The receptors used by the virus to attach and enter human cells are also found in the insulin-producing beta cells in the pancreas. Therefore it is possible the virus might have damaged these cells. Additionally, the widespread inflammation caused by COVID-19 leads to insulin resistance. Besides adding to the body of evidence connecting chronic diseases and viral infections, the study enhances our understanding of the various mechanisms involved in the development of diabetes. In summary, COVID-19 has increased the burden of chronic diseases among survivors in several ways, with diabetes being one of them.

(RajeevJayadevanisco-chairmanof the National IMA COVID task Force)

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Long-term study finds COVID-19 increases diabetes risk - The Hindu