We’re four years into the COVID-19 pandemic, and by this point, most Americans have had the coronavirus at least once. But when the virus comes for us (again), it can still feel just as alarming as our first bouts.

Here’s a guide to what COVID looks like now and how to treat it.

Symptoms

The most common COVID symptoms haven’t changed much since the start of the pandemic, and they remain consistent for the latest dominant variant, JN.1, said Dr. Soniya Gandhi, the associate chief medical officer at Cedars-Sinai Medical Center in Los Angeles. They include fatigue, sore throat, congestion, runny nose, headache, body aches and cough.

“All or any of those in isolation can still be COVID,” Gandhi said.

Some people may develop conjunctivitis, also known as pinkeye, or experience gastrointestinal issues, like nausea, vomiting and diarrhea, but those symptoms are rarer. Anecdotally, experts said, one of the most notable symptoms early in the pandemic — the loss of taste and smell — appears to be less common these days.

“The biggest change is that people are having milder symptoms overall,” said Dr. Amanda Casto, an acting assistant professor of allergy and infectious diseases at the University of Washington. That’s because virtually everyone has some preexisting immunity through vaccines, a prior infection or both.

While COVID is mild for most people, it can be dangerous and even fatal for some. Data from the Centers for Disease Control and Prevention indicated that, as of mid-February, more than 21,000 people were hospitalized with COVID, and there had been roughly 10,000 COVID-related deaths in 2024.

Severe illness is a lot less prevalent now than during the first few years of the pandemic, “but we’re still seeing it,” said Dr. Stuart Ray, a professor in the division of infectious diseases at Johns Hopkins Medicine in Baltimore. The people who are getting sickest tend to be those with compromised immune systems and underlying health conditions, such as heart disease, diabetes or lung problems. Adults over age 65 are also at higher risk for severe infections.

Since mild COVID can look like a cold or the flu, it’s important to test yourself if you have symptoms or have had a known exposure, Gandhi said. Knowing what you have can affect your treatment and how long you isolate from others. The CDC currently recommends isolating for five days after a positive test and wearing a mask for five days after that.

Treatment

The antiviral pill Paxlovid is very effective against severe COVID, reducing the risk of death by 73% if taken within the first five days of an infection, according to a preliminary study conducted by the National Institutes of Health. Experts urged people who are high-risk to contact their doctors about getting a prescription as soon as they have symptoms or test positive.

“If you’re elderly or you have comorbidities, before you even get worse, you should already seek medical care,” said Dr. Bernard Camins, the medical director for infection prevention at the Mount Sinai Health System in New York. “Your health care provider will then evaluate you if you’re a candidate for antivirals.”

Paxlovid isn’t recommended for everyone. It can interact with several medications, including common ones used to lower blood pressure or prevent blood clots, and it’s also not advised for people with severe kidney disease. If you can’t take Paxlovid, the drug remdesivir could be an option, but it has to be delivered intravenously, so it’s less convenient and harder to obtain.

Paxlovid also doesn’t appear to provide much benefit to young, healthy adults whose risk of severe infection is low, so it isn’t broadly recommended for those groups.

For most people, COVID symptoms can be managed at home and treated like any other respiratory illness, with an emphasis on rest and staying hydrated. “If you have congestion or cough, you’re losing more fluids than you normally would,” Casto said. “So I would definitely recommend that people stay on top of fluid.”

If you have a fever or body aches, take acetaminophen (Tylenol) or ibuprofen (Advil or Motrin). You can also take over-the-counter cold and flu medicines with decongestants or cough suppressants, though the experts didn’t recommend them strongly because they don’t work for everybody and can cause drowsiness.

When to seek medical care

If you’re experiencing shortness of breath — meaning you can’t catch your breath or are taking quick and shallow breaths — it’s important to seek medical attention right away.

“The thing that I worry most about is the breathing,” Casto said. “That’s the most concerning sign, because people can get” worse really quickly. If you’re having trouble breathing, she advised going to the emergency room rather than to your doctor or an urgent care clinic. Experts also said you should see a provider if you experience confusion or chest pain.

If your symptoms don’t improve after several days, or improve and then regress, it could be a sign you have a secondary infection such as pneumonia, Casto said. In that case, or if you’re concerned about your symptoms at all, don’t hesitate to call your doctor.

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Individuals who have tested positive for COVID-19 or believe they have contracted the virus but have yet to test for it are still being advised by the CDC to isolate − but for a shorter period.

These are the current guidelines from federal and local Arizona health agencies regarding the coronavirus.

This could change as the Washington Post first reported in early February about plans from the Centers for Disease Control and Prevention to drop the five-day isolation period that has been in place since 2021. The proposed new guidelines would mean that individuals would no longer be advised to isolate before returning to school or work. The proposal would rather align COVID-19 with the isolation recommendations for influenza or other respiratory viruses.

California and Oregon have already made similar changes to their guidelines in January 2024.

However, the agency has yet to confirm the report and no changes to current guidelines have been made.

If an individual believes that they may have COVID-19 or has tested positive for the virus, here is what they are advised to do:

What are the CDC's COVID-19 isolation guidelines?

The CDC's COVID-19 isolation recommendations have been unchanged since 2021 when the agency scaled down the recommended isolation period length.

The agency advises individuals who test positive for the disease to stay home for at least five days to reduce the chances of being contagious and spreading the virus to others. For individuals who have yet to test positive, the agency also recommends isolating.

The CDC's website makes note that individuals are in their most infectious period in the first five days and lists some ways to prevent spread:

  • Wear a high-quality mask if you must be around others at home and in public.
  • Do not go places where you are unable to wear a mask. For travel guidance, see CDC’s Travelers' webpage.
  • Do not travel.
  • Stay home and separate from others as much as possible.
  • Use a separate bathroom, if possible.
  • Take steps to improve ventilation at home, if possible.
  • Don’t share personal household items, like cups, towels and utensils.
  • Monitor your symptoms. If you have an emergency warning sign (like trouble breathing), seek emergency medical care immediately.
  • Learn more about what to do if you have COVID-19.

It's a 'tripledemic': What to do if you have COVID, the flu or RSV

What are Arizona’s isolation guidelines for people with COVID-19?

Arizona’s Department of Health Services released guidance for when individuals may be released from a quarantine or isolation period after exposure to COVID-19. They advise that precautions should be made based on “a person’s symptoms and clinical testing.”

The Maricopa County of Public Health released a document with guidance on isolation. It was last revised in January 2022. The county includes a flow chart in the document that may help individuals best make decisions based on their symptoms and test results. 

The document notes, “Isolation is for people who have tested positive or have symptoms consistent with COVID-19 and are waiting to be tested or diagnosed.”

Raphael Romero Ruiz, engagement reporter, wrote this newsletter. Reach him at [email protected] or on Twitter at @raphaeldelag.

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Cases of “broken heart syndrome” have increased during the COVID-19 pandemic, according to a new, small study.

The syndrome, more formally known as takotsubo or stress cardiomyopathy, produces symptoms that feel like a heart attack — weakened heart muscles, shortness of breath and chest pain. But it is instead caused by physical or emotional stress that leads the heart muscles to dysfunction, and it is far less deadly. Most patients recover in a few days.

Researchers from the Cleveland Clinic say that they have “found a significant increase” in patients with broken heart syndrome over the last four months, compared to previous years. Between March 1 and April 30, cardiologists saw 258 patients with acute coronary syndrome, and of those, 7.8 percent had broken heart syndrome, compared to 1.7 percent prior to the pandemic.

RELATED: Coronavirus Infects More Than Just the Lungs: Studies Show It Hits Heart, Liver and Other Organs

The researchers also said that the patients needed longer recovery time in the hospital compared to pre-COVID-19 cases, though the mortality rate remained the same. And none of the patients tested positive for COVID-19.

“The COVID-19 pandemic has brought about multiple levels of stress in people’s lives across the country and world. People are not only worried about themselves or their families becoming ill, they are dealing with economic and emotional issues, societal problems and potential loneliness and isolation,” said Dr. Ankur Kalra, a cardiologist at Cleveland Clinic who led the study, published in JAMA Network Open on Thursday, in a press release. “The stress can have physical effects on our bodies and our hearts, as evidenced by the increasing diagnoses of stress cardiomyopathy we are experiencing.”

RELATED: Florida Dad Recovers From COVID-19 One Month After Heart and Kidney Transplants: 'I'm a Survivor'

The study, however, was small, and the researchers acknowledged that the topic should be studied in other parts of the country to get a better sense of how COVID-19 is affecting people's well-being. And a takotsubo expert, who was not involved with the study, told CNN that he questioned the design of the study, which only included people who already had acute coronary syndrome.

"It's well-known that patients quite frequently get takotsubo syndrome at times of extreme stress or during natural disasters," Dr. John Horowitz, an emeritus cardiology professor at the University of Adelaide, told the outlet. "But there are problems with the way the study was designed. I don't believe all of these cases are Takotsubo. It's as simple as that."

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Horowitz added, though, that he agreed with the hypothesis that takotsubo cases have increased during COVID-19.

The researchers said that their finding show that the pandemic has been unhealthy for everyone, even those who have not contracted COVID-19.

“While the pandemic continues to evolve, self-care during this difficult time is critical to our heart health, and our overall health,” said Dr. Grant Reed, senior author on the study, said in the press release. “For those who feel overwhelmed by stress, it’s important to reach out to your health care provider. Exercise, meditation and connecting with family and friends, while maintaining physical distance and safety measures, can also help relieve anxiety.”

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Study design and population

The CLSA is a large, national, long-term study with 51,338 respondents between the ages of 45 and 85 years at baseline who will be followed longitudinally. Baseline data were collected between 2011 and 2015. A large subset referred to as the Comprehensive Cohort (n = 30,097) provided detailed sociodemographic, lifestyle, and medical data, as well as genome-wide genotyping33. The details of the CLSA are provided elsewhere34. In rapid response to the pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the CLSA initiated three COVID-19 studies between 2020 and 2021 to explore the impacts of the pandemic on older adults (COVID-19 Questionnaire Study, COVID-19 Seroprevalence (Antibody) Study, and COVID-19 Brain Health Study)35. The current investigation utilized data from both the COVID-19 Questionnaire Study (comprised of self-reported data collected by questionnaires) and COVID-19 Seroprevalence (Antibody) Study (comprised of self-reported data collected by a separate questionnaire and serology from a blood sample). Genetic data from the CLSA Comprehensive Cohort were merged with these COVID-19 data sources to evaluate TAS2R38 diplotypes in analyses. Two common single nucleotide polymorphisms (SNPs) from TAS2R38 were available from the genome-wide assays: rs1726866 (V262A) and rs10246939 (I296V). Participants were categorized into three TAS2R38 diplotypes based on these SNPs: [P]AV/[P]AV (subsequently referred to as “[P]AV homozygotes”), [P]AV/[A]VI (subsequently referred to as “heterozygotes”), and [A]VI/[A]VI (subsequently referred to as “[A]VI homozygotes”). The bracketed letter indicates the inferred variant that was not available from the genetic data, and thus in the present study, [P]AV is analogous to the PAV haplotype and [A]VI is analogous to the AVI haplotype.

CLSA COVID-19 questionnaire study and seroprevalence study

A series of questionnaires were collected as part of the COVID-19 Questionnaire Study over a 9-month period (April 15, 2020 to December 29, 2020) with frequencies varying from weekly, biweekly, and monthly. Questionnaires were completed online or via telephone interview. The present investigation utilized data from the final COVID-19 questionnaire (Exit Questionnaire, n = 24,114), collected between September 29, 2020 to December 29, 2020. The Exit Questionnaire took approximately 30 min to complete and captured self-reported information on COVID-19 outcomes that occurred since the start of the pandemic (March 1, 2020), including participant infection status and symptoms, healthcare use, health behaviours, and psychosocial and economic impacts of the pandemic. In addition to the Exit Questionnaire, n = 19,334 CLSA participants participated in the CLSA COVID-19 Seroprevalence (Antibody) Study. These participants completed a separate questionnaire between November 2020 to July 2021 (internet-based or telephone interview) that collected self-reported information on COVID-19 infection status and symptoms, healthcare use, health behaviours, psychosocial and economic impacts of the pandemic since it began on March 1, 2020. In addition, these participants provided a blood sample either at a CLSA data collection site or using a self-collection kit at home. Blood samples were used to test for the presence of antibodies against SARS-CoV-2. Informed consent was obtained from all CLSA participants at baseline and prior to data collection for the COVID sub-studies. All methods conducted in this investigation were carried out in accordance with the principles outlined in the Declaration of Helsinki.

For the present investigation, data from the CLSA COVID-19 Questionnaire Study and the CLSA COVID-19 Seroprevalence (Antibody) Study were analyzed separately given that the samples were not identical, but also contained substantial overlap. Upon merging with genetic data for TAS2R38 diplotypes, a total of n = 13,825 respondents from the CLSA COVID-19 Questionnaire Study and n = 8791 respondents from the CLSA COVID-19 Seroprevalence (Antibody) Study were included in the current analyses (Supplementary Fig. S1 and S2). Ethics approval was obtained from the McGill University Faculty of Agricultural and Environmental Sciences Research Ethics Board.

Outcome measures

CLSA COVID-19 questionnaire study

Participants were considered to be cases of COVID-19 infection based on their responses to two questions in the self-reported Exit Questionnaire: “Have you ever had a positive test result?” and “Have you ever been told by a health care provider that you have COVID-19, but you did NOT have a test to confirm this?” Of the 13,825 participants with a response available, n = 42 reported a positive test result for COVID-19 and an additional n = 34 reported being told they had COVID-19 by a health care provider, providing a total of n = 76 respondents considered as COVID-19 cases for analysis.

The experiences of COVID-19 symptomatology were determined based on 12 questions in the Exit Questionnaire (detailed wording of the questions are presented in Supplementary Table S1). Common symptoms included fever, dry cough (no phlegm or mucus), wet cough (with phlegm or mucus), shortness of breath or difficulty breathing, decreased sense of smell, fatigue, sore/scratchy throat, muscle and/or joint aches/pains, headache, runny or stuffy nose, sinus pain and feeling generally unwell. For each symptom, participants self-reported the degree to which they experienced it: no symptom, mild, moderate, or severe. Due to the limited sample size of cases available, mild, moderate and severe responses were combined, and a binary outcome was analyzed for each symptom representing yes/no presence of the symptom.

CLSA COVID-19 seroprevalence (Antibody) study

From this study, participants with COVID-19 infection were determined based on the results of the serology variable: COVID-19 antibody result interpretation. Four groups were available based on antibody result: (1) results suggest prior SARS-CoV-2 infection (n = 177); (2) results suggest prior SARS-CoV-2 infection and/or vaccination (n = 4065); (3) results suggest prior SARS-CoV-2 infection OR prior SARS-CoV-2 infection and vaccination (n = 259); (4) no antibodies to SARS-CoV-2 detected (n = 4290). Only the first group was able to be considered as COVID-19 cases, as their results did not include the uncertainty in infection status due to vaccination.

The experiences of COVID-19 symptomatology were determined based on seven questions in the seroprevalence study questionnaire (detailed wording of the questions are presented in Supplementary Table S1). Common symptoms included fever, cough, shortness of breath, decreased sense of smell, sore throat, sore muscles and headache. The questionnaire asked only about the presence of the symptoms without severity level, so a binary outcome was analyzed for each symptom representing yes/no presence of the symptom.

Statistical analyses

Statistical analyses were conducted using SAS software (version 9.4, SAS Institute, Cary, North Caroline, USA). Sample means and frequencies for characteristics of the CLSA respondents according to TAS2R38 diplotypes were evaluated with analysis of variance and Pearson Chi-square tests to compare continuous and categorical characteristics, respectively. Characteristics of CLSA participants with data available vs. unavailable for the present investigation were also compared using the same statistical approach to assess the potential for attrition bias (Supplementary Table S2). Some variables assessed at CLSA’s baseline assessment were not reassessed in the COVID-19 Questionnaire Study (body mass index, self-reported ethnicity and highest level of education). In these cases, baseline data were used in these comparisons. Pearson Chi-square tests (or Fisher’s Exact test where appropriate) were used to assess differences in COVID-19 infection status, comorbidities, and symptomatology according to TAS2R38 diplotypes, with assessment of pairwise comparisons when overall exploratory (uncorrected) significant differences were observed. Furthermore, multivariable logistic regression analyses were used to assess associations between TAS2R38 diplotypes and COVID-19 infection status, as well as associations between TAS2R38 diplotypes and experiences of common COVID-19 symptomatology. The regression models were adjusted for age, sex, and the first five principal components of ancestry to account for population stratification. p-values are two-sided and due to multiple testing statistical significance was set at FDR corrected P < 0.0536. However, given the exploratory nature of this investigation, both uncorrected (i.e. exploratory) and FDR corrected p-values are reported.

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The peak of the COVID-19 pandemic may be behind us, but for many people, long COVID continues to cause symptoms weeks, months, or even years after the initial illness. Among the more than 200 symptoms reported for long COVID, brain fog — problems with thinking, understanding, focus and memory — is one of the most widespread and long-lasting.

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What does the latest research tell us about brain fog in long COVID? Image credit: davit85/Getty Images.

The World Health Organization (WHO) declared COVID-19 a pandemic on March 11, 2020. Since then, the WHO has recorded almost 775 million confirmed cases worldwide. But there have, almost certainly, been many more that have not been confirmed, particularly with the decline in testing in most countries.

According to the Centers for Disease Control and Infection (CDC), infection with SARS-CoV-2, the virus that causes COVID-19, leads to an illness with some, or all, of the following symptoms, which may be mild or severe:

  • fever or chills
  • cough
  • shortness of breath or difficulty breathing
  • fatigue
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea.

For most people, these symptoms resolve within 1 to 2 weeks. However, for some people, the acute illness is followed by lingering symptoms, a condition termed long COVID, or post-acute sequelae of COVID-19 (PASC).

Long COVID can occur in anyone infected by SARS-CoV-2, whether their initial infection was severe, mild, or even asymptomatic.

One study, published in Nature Reviews Microbiology in January 2023, suggests that around 10% of people experience long COVID following acute infection, with 50–70% of people who are hospitalized with COVID-19 experiencing lasting symptoms.

According to the United Kingdom’s Office of National Statistics Coronavirus (COVID-19) Infection Survey self-reported data, almost 3% of the U.K. population was experiencing long COVID in March 2023. Of these, 41% were still experiencing symptoms 2 years after initial infection with SARS-CoV-2.

In the United States, the CDC notes that 6.4% of adults have, at some time, reported long COVID symptoms.

These may be a continuation of those experienced in the acute infection, or may change, and can affect almost any part of the body, with one study — published ineClinicalMedicine in 2021 — finding that symptoms “affect multiple organ systems, with significant impacts on morbidity, mortality, and quality of life”.

The study from Nature Reviews Microbiology outlines lasting impacts on the heart, lungs, immune system, pancreas, gastrointestinal tract, kidneys, spleen, liver, blood vessels, reproductive system and neurological system.

Of course, a person with long COVID will not experience all of the 203 symptoms recorded by the wide-ranging international study from eClinicalMedicine. In this study, 91.8% of the cohort reported symptoms that lasted more than 35 weeks after initial infection, the most common and debilitating of which were fatigue, breathing issues and cognitive dysfunction, or brain fog.

This “classic” long COVID, characterized by brain fog, fatigue, dysautonomia, and postexertional malaise, is more common in younger adults and in females. Older people and those with comorbidities are more likely to experience cardiovascular and metabolic effects.

Reports of COVID-19’s effects on the central nervous system (CNS) started early in the pandemic, and evidence has accumulated since then.

Those who have had more severe COVID-19, with hypoxia, a need for ventilation, and psychological trauma, are at higher risk of lasting psychological effects or cognitive dysfunction.

But anyone who has had COVID-19 has a greater risk of neurological or psychiatric symptoms following their initial illness than someone who has not had a SARS-CoV-2 infection.

Some symptoms, such as mood and anxiety disorders, increase for a short time after infection, but then reduce back to baseline levels. However, others continue for much longer. And one of these is brain fog, which a recent study published in Scientific Reports found in 89% of people with long COVID.

In this study, 89% of participants also reported fatigue, and 77% difficulty concentrating. When researchers assessed them using the Montreal Cognitive Assessment, they found that 46% had mild cognitive dysfunction.

Often the result of, among other things, inflammation, concussion, hormonal changes, or medication, brain fog is one of the most common symptoms reported by people with long COVID.

A person with brain fog may have problems with memory, focus, thinking and understanding, as well as often experiencing stress and fatigue.

Prof. Stephen Griffin, virologist at the University of Leeds School of Medicine, and co-chair of Independent SAGE told Medical News Today:

“Symptoms can vary, but some of the major issues include a lack of recall for things like names, places, events, etc., as well as a general inability to process complex tasks, hold concentration over time and multi-task.”

“In some instances, general alertness can be affected as well which, when combined with the intense fatigue experienced by many, can be extremely debilitating in terms of interacting socially or functioning at school or work,” he added.

The study from eClinicalMedicine, which looked into the lasting effects of COVID-19, recorded brain fog, cognitive dysfunction and memory impairment in 85.1% of respondents. And almost 90% of those who worked reported that brain fog impaired their ability to work to some extent.

Research has suggested several potential causes for brain fog in COVID-19, including:

  • persistence of the virus in tissue reservoirs
  • a dysregulated immune response
  • mitochondrial dysfunction
  • vascular (endothelial) and/or neuronal inflammation
  • microbiome dysbiosis.

One theory is that SARS-CoV-2 can cross the blood-brain barrier (BBB) and directly affect cells in the CNS, but this has only been demonstrated in vitro, in isolated cells.

This study found that two SARS-CoV-2 variants, the original wild type and Omicron, were best able to induce cell stress and damage components of the BBB.

However, Dr. Giovanni Schifitto, professor of neurology at the University of Rochester Medical Center, NY, believes that the cause of long covid is likely to be multifactorial.

“The physical presence of SARS-CoV-2 in the brain, especially in the chronic phase, is unlikely to be the culprit. However, systemic virus persistence can create a more chronic systemic inflammatory status and that can contribute to multi-organ dysfunction,” he told us.

There is more support for the suggestion that brain fog in long COVID may result from immune dysfunction and inflammation.

One recent study, which appeared in Nature Communications, showed that people with COVID had raised levels of four brain injury biomarkers, and that two of these persisted long after the initial infection, particularly in those who experienced neurological complications during the acute infection.

The authors of this research suggest these abnormal immune responses may be causing ongoing inflammation. And inflammation can lead to brain fog.

They believe that if they can find out why these immune responses are triggered, treatments could be developed to target them.

Whether the effects are due to viral invasion or immune dysfunction, research has found that SARS-CoV-2 infection can lead to changes in the brain.

A study — published in Nature in March 2022 — using data from the UK Biobank compared brain scans conducted on people before and after they had COVID-19.

Those who had had SARS-CoV-2 infection had a reduction in grey matter thickness, markers of tissue damage in olfactory regions, and changes in brain volume, as well as slightly lower cognitive abilities than those who had not.

Prof. Griffin explained:

“As with many issues around long COVID, brain fog is likely a combination of persistent infection by SARS-CoV-2 [as reported in a new study published in 2023] and host immune/metabolic changes that occur either concomitantly or as a follow-on. Worryingly, changes to the brain, including reductions in grey matter, have been noted even in patients that aren’t necessarily associated with neurological symptoms.”

Research reported in Nature Neuroscience, which used dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on people with long COVID with or without reported brain fog, has backed up these findings. The researchers found not only significantly increased BBB permeability in the group with brain fog, but also reduced global brain volume and white matter volume.

The researchers suggest that “long COVID-derived brain fog is associated with BBB disruption and sustained systemic inflammation,” adding that their “data suggest that BBB disruption occurs during acute infection and long COVID, where it is strongly associated with cognitive impairment.”

General advice for coping with brain fog, from any cause, includes:

  • following a healthy diet, rich in fresh fruits and vegetables and limiting processed food
  • doing regular exercise
  • having good sleep hygiene
  • managing stress.

Dr. Schifitto advised that:

“General principals are avoid deconditioning, thus keep routine physical activity although [this] will need to be titrated to tolerance. Be aware of mental fatigue so spread intellectual work throughout the day. Because often there are also depressive symptoms present, maintain social connections.”

And Prof. Griffin warned that anyone with long COVID brain fog should “ensure that you pace yourself when experiencing this or other long COVID symptoms. Over-exertion can sometimes exacerbate things.”

He suggested that using tech, and setting reminders and alarms can help people cope with the brain fog and fatigue of long COVID.

As has become increasingly clear, COVID, like many other viral diseases, can have effects long beyond the initial infection, and research is only now starting to discover why.

Avoiding infection is, of course, the best way to avoid long-term effects, but there is increasing evidence that vaccination and antiviral treatment in the early stages of infection reduces the risk of long COVID.

But Prof. Griffin is frustrated about the lack of action taken to prevent infection and counter the long-term effects of COVID-19.

“Like a lot of aspects of SARS-CoV-2 infection, because it [brain fog] doesn’t necessarily manifest during acute disease it tends to be overlooked. This, to me, is another reason why the reluctance of western governments to suppress prevalence of this virus is […] mind-bogglingly negligent,” he told us.

“There are already record numbers of people out of work due to chronic illness, also many that struggle on, plus cognitive impairment on this scale makes for a less productive population as a whole,“ said Prof Griffin.

Adding brain fog to the already staggering list of longer term problems caused by COVID must surely make us question what we’re allowing to happen to those being exposed to multiple infections with this virus, including our children,” he emphasized.

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Although the symptoms may be similar, they can be distinguished. (Illustrative Image Library)

It has been 3 years and 10 months since the first case COVID-19 in Mexico February 28, 2020. Since then, the virus has been like a see-saw, however, and concerns about a new wave of coronavirus are growing as some hospitals are stretched to the limits of their capacity in the face of apparent outbreaks. Increased infections.

During this period winterPeople tend to get sicker due to several factors that coincide with this time of year. Cold temperatures cause us to spend more time indoors, which increases the likelihood of being in close contact with other people and making it easier to spread infections. respiratory viruses Examples include the flu, the common cold, or COVID-19.

Additionally, cold, dry air weakens the natural defenses of the respiratory mucosa, making them more susceptible to infection. Lower sun exposure can also lead to lower vitamin D levels and negatively impact the immune system.

Some viruses, e.g. influenzaIn the cold, dry air of winter, their ability to survive and spread is greater, so the incidence of respiratory diseases tends to increase, which is why authorities usually carry out vaccination campaigns to reduce the incidence, especially among minors and the elderly people.

Both tend to rebound in the winter. (Illustrative Image Library)

some characteristic diseases winter They often have similarities, which makes us sometimes confused whether it’s a simple allergy, the flu, or a more serious virus.

Influenza and the illnesses caused by coronaviruses have similarities and differences. Both are contagious respiratory diseases that can spread from person to person, but they are caused by different viruses.

Influenza is caused by influenza virus Type A and Type Bwhile coronaviruses cover a broader family of viruses that can cause illnesses ranging from the common cold to more severe illnesses such as MERS (Middle East Respiratory Syndrome) and SARS (Severe Acute Respiratory Syndrome), including COVID-19.19 Virus SARS-CoV-2.

In terms of symptoms, both conditions share common symptoms such as Fever, cough, and fatigue. Other symptoms may include Body aches, sore throat, congestion, and runny nose.

However, COVID-19 can be distinguished by certain characteristic symptoms (albeit dependent on the strain), e.g. Loss of taste or smell. Additionally, it often leads to more serious complications, including respiratory distress and the potential for the development of multisystem inflammatory syndromes.

In terms of transmissibility, the SARS-CoV-2 coronavirus, especially its newer variants, has proven to be more contagious than the influenza virus; this turned into a pandemic at the time. Influenza is generally considered a seasonal epidemic.

this vaccine Vaccines exist for both diseases, and while flu vaccines are developed each year to combat the most prevalent strains of the virus that year, COVID-19 vaccines are being developed at a rapid pace due to the global health emergency and are being adapted to respond to new variant.

Recovery times also vary. (Illustrative Image Library)

As for treatment, antiviral medications are available for both conditions, but specific treatment Developed for COVID-19 or adapted in response to the virus.

he Recovery Time The flu lasts 3 to 7 days and can last up to two weeks in severe cases; in the case of the new coronavirus, its latest Pirola variant can lie dormant for two to seven days after exposure, but recovery time can vary from days to weeks. wait. The Centers for Disease Control and Prevention (CDC) recommends ending isolation until you no longer have any symptoms.

Compared to influenza, past public health measures in response to COVID-19 have been far greater in scale and scope, including border closures, quarantines, and the implementation of strict health measures such as the use of masks and social distancing. Influenza, on the other hand, is mostly dealt with by: Annual vaccination campaign and standard personal hygiene measures.

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Donald Trump has officially been discharged from Walter Reed Medical Center following his Coronavirus diagnosis and he is back at the White House. Although he tweeted that he was feeling “better” than he did 20 years ago, video has surfaced of the president appearing to gasp for air.

The president arrived to the White House on Monday (Oct. 5) a little before 7 pm ET. Before entering, he stopped and faced the media and immediately took off his mask — although he tested positive for Coronavirus a few days ago.

Before giving a salute and thumbs up, Trump was seen on video gasping for air and looking like he was in pain.

Earlier Monday, the president took to Twitter to say that he was feeling “really good” before he was scheduled to be discharged from the hospital.

“I will be leaving the great Walter Reed Medical Center today at 6:30 P.M,” he tweeted. “Feeling really good! Don’t be afraid of Covid[-19]. Don’t let it dominate your life. We have developed, under the Trump Administration, some really great drugs & knowledge. I feel better than I did 20 years ago!”

During his short stay at the center, White House physician Dr. Sean Conley says Trump was given a Regeneron polyclonal antibody cocktail, aspirin, vitamin D, zinc, famotidine and melatonin.

On Sunday (Oct. 4), Conley told reporters that the president would be discharged and his condition monitored. “There are frequent ups and downs… particularly when a patient is being so closely watched 24 hours a day,” he said. “If he continues to look and feel as well as he does today, our hope is that we can plan for a discharge as early as tomorrow to the White House where he can continue his treatment course.”

“Gasping” is now a trending topic on Twitter as many Americans believe the president’s condition is worse than he wants people to believe.

Check out the videos of Trump arriving back at the White House below.

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(CNN) — Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention (CDC), said respiratory illnesses are spreading. He singled out the rise of three viruses in particular: influenza, coronavirus and respiratory syncytial virus, better known as RSV.

Hospitalizations from the three viruses continue to increase, according to the Centers for Disease Control and Prevention. As more people develop symptoms such as coughing, sneezing and fever, they may be wondering whether they should get tested to find out what virus is causing their symptoms. Which symptoms can be treated at home, and which symptoms should prompt people to seek medical care? Does it matter if you go to a doctor’s office or go to an urgent care or emergency room? If people haven’t been vaccinated yet, is it too late?

To help us answer these questions, I spoke with CNN health expert Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.

CNN: Is it important for everyone with a runny nose, cough or fever to get tested to find out what exactly is causing their symptoms?

Dr. Wen Lina: No, this is neither practical nor necessary. In addition to the oft-mentioned “big three”: influenza, coronavirus, and respiratory syncytial virus, there are many other viruses that cause respiratory illness, such as adenovirus, rhinovirus, and parainfluenza virus. It is estimated that there are more than 200 viruses that cause the common cold and produce the symptoms of runny nose, cough, or fever mentioned above. Most people don’t need a test to determine which virus is causing their symptoms.

There are three situations in which viral testing may be recommended. First, people who are susceptible to severe illness may want to get tested for both influenza and Covid-19. There are several antiviral treatments approved for people with the flu, including Tamiflu. According to the CDC, priority groups for flu treatment include people who are at higher risk for severe illness or complications from the flu.

Likewise, Paxlovid is an oral antiviral treatment that has been approved to treat patients in the early stages of Covid-19 disease who meet the eligibility criteria. Other treatments for Covid-19 include monopiravir pills and remdesivir injections or infusions. People at risk for severe illness from coronavirus should get tested if they develop symptoms of the virus so that antiviral treatment can be started as soon as possible if confirmed.

Second, if someone lives in a household with someone who is susceptible to severe illness from either pathogen, they may want to get tested for either flu or Covid-19. For example, a healthy child attending day care may not need to be tested every time he catches a cold. However, if they live in a household where a grandparent takes immunosuppressive drugs after a kidney transplant, they should be tested more frequently if they develop symptoms of the virus.

That’s because if a child has the flu, the grandparent may be eligible to take preventive antiviral medications to reduce the chance of getting the flu. There are currently no such precautions for Covid-19, but grandparents should be aware of symptoms and take antiviral treatment if infected with coronavirus. Of course, a child showing symptoms of the virus should be isolated from his or her grandparents to reduce the chance of spreading the infection.

Third, if a person is seriously ill or has been ill for some time, they can be tested for influenza, Covid-19, RSV and other viruses. This will be part of the evaluation to find out what is causing these long-lasting, severe and/or progressive symptoms. For example, people who are seriously ill and require hospitalization may receive comprehensive viral testing as part of the hospital’s evaluation.

CNN: Is it possible for a person to test positive for multiple viruses?

arts: Yes. In a 2019 study, researchers examined more than 44,000 cases of respiratory illness in Scotland and tested for 11 viruses, including rhinovirus, coronavirus, influenza and RSV. Of all patients who tested positive for the virus, 11% were co-infected with one or more different viruses. Some patients carry as many as five viruses at the same time.

Likewise, for most people, it’s not important to know exactly what’s causing their symptoms. Treatment is generally the same and is called supportive care. This means there is no specific antiviral treatment, but rather addressing symptoms to help patients feel better. So if someone has a fever, they can take a fever-reducing medicine like Tylenol or ibuprofen. They can drink plenty of fluids to prevent dehydration. They can rest to relieve fatigue. For influenza and Covid-19, the situation is different for specific patients who qualify for antiviral treatment; for these people, testing is most important.

CNN: Which symptoms can be treated at home, and which symptoms should prompt people to seek medical care?

arts: Most people recover fully with supportive care at home. Note that this may take some time; cold symptoms may last for more than a week, and a cough may last for several months.

Symptoms that should seek immediate medical attention include difficulty breathing, severe chest pain, severe vomiting, inability to control fluids, and persistent fever. Parents of young children should watch for symptoms of difficulty breathing, such as flaring noses, wheezing, increased respiratory rate, and blue lips. Babies are particularly susceptible to dehydration, and parents and caregivers should contact a medical professional if their child is not getting enough wet diapers.

Others who should contact their doctor early in their illness include those who are older and have serious underlying medical conditions, such as heart and lung disease. For these patients, a viral illness that may be mild in most people may exacerbate existing conditions and lead to hospitalization or more serious illness, so early and proactive follow-up is critical.

CNN: When should you go to a doctor’s office instead of an urgent care or emergency room?

arts: Urgent symptoms require urgent care in the emergency room. These include sudden, severe symptoms such as chest pain, difficulty breathing, and seizures. On the other hand, symptoms that last for several days can usually begin with an evaluation at the doctor’s office. In these cases, you can start by calling your doctor’s office. They may be able to tell you if they can see you urgently in the office or via a telemedicine visit. They may also recommend whether you should go to an urgent care or emergency room.

CNN: Can you remind us what steps people can take to avoid contracting the virus? Also, if they haven’t been vaccinated yet, is it too late?

arts: It’s not too late to get vaccinated. People who haven’t received this year’s flu vaccine or the latest Covid-19 vaccine can still get one now, as can those who are eligible for the RSV vaccine. These vaccines can reduce your chances of getting the virus and, more importantly, your chance of getting serious illness if you do get infected.

Other measures to prevent infection include washing hands frequently, staying away from people with cold symptoms and wearing a mask in crowded indoor spaces.

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Europe Respiratory Monitoring Market Industry Number Of People Over The Age Of 65 Years In Percentage By Country Eu

Europe Respiratory Monitoring Market Industry Number Of People Over The Age Of 65 Years In Percentage By Country EuEurope Respiratory Monitoring Market Industry Number Of People Over The Age Of 65 Years In Percentage By Country Eu

Europe Respiratory Monitoring Market Industry Number Of People Over The Age Of 65 Years In Percentage By Country Eu

Dublin, Feb. 23, 2024 (GLOBE NEWSWIRE) -- The "Europe Respiratory Monitoring - Market Share Analysis, Industry Trends & Statistics, Growth Forecasts 2021 - 2029" report has been added to ResearchAndMarkets.com's offering.

The Europe Respiratory Monitoring Market size is estimated at USD 1.16 billion in 2024, and is expected to reach USD 1.75 billion by 2029, growing at a CAGR of 8.60% during the forecast period (2024-2029).

The COVID-19 pandemic had a significant impact on the market initially as respiratory monitoring was widely used to monitor the conditions of coronavirus-infected patients. The ECDC in its October 2021 report on COVID-19 surveillance guidance indicated that the severity of the respiratory infection was to be monitored and reported weekly to ECDC. Such activities added to the growth of the studied market in the initial phase of the pandemic. However, currently, as the pandemic has subsided and fewer people are getting infected with the virus, the studied market is expected to have stable growth during the forecast period of the study.

The increasing prevalence of respiratory diseases, technological advancements, and the growing geriatric population are expected to drive market growth over the forecast period. Chronic obstructive pulmonary disease (COPD) is a life-threatening lung disease that interferes with normal breathing. According to an article published by the European Respiratory Journal in September 2021, it is estimated that 49,453,852 people will have COPD with a prevalence of 9.3% by the end of 2050. The article also stated that by 2050, there will be approximately 7.6 million, 7 million, and 4.8 million people affected with COPD in Germany, the United Kingdom, and Spain respectively. Thus, the high prevalence of COPD is anticipated to drive the respiratory monitoring market in Europe.

Additionally, factors such as a rise in the number of smokers, urbanization, growing pollution levels, and the development of advanced technologies will increase the demand for respiratory devices in healthcare facilities. Also, the recent product launches by the key market players in the region are expected to boost market growth. For instance, in April 2022, SCHILLER France SAS launched the MRI-compatible patient monitor MAGLIFE RT-1 with the ability to monitor respiratory mechanics through its spirometry option. Such product launches in the region are expected to significantly add to the growth of the studied market over the forecast period.

However, the high price associated with the devices is expected to hinder the growth of the market to a certain extent over the forecast period.

A selection of companies mentioned in this report includes

  • Draegerwerk AG

  • GE Healthcare

  • Koninklijke Philips N.V.

  • Maquet (Getinge AB)

  • Medtronic

  • COSMED srl

  • Resmed

  • Koko PFT

  • Vitalograph Ltd

  • Siemens Healthcare GmbH

For more information about this report visit www.researchandmarkets.com/r/7fbydw

About ResearchAndMarkets.com
ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

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As coronavirus disease 2019 (COVID-19) public health restrictions are relaxed, the circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) alongside other respiratory viruses may lead to an increased likelihood of coinfection (1). Older patients face a higher risk of severe outcomes, when infected with multiple respiratory viruses (2). This study highlights the successful recovery of the oldest older adult (≥80 years) from pneumonia caused by the dual infection of human respiratory syncytial virus (HRSV) and SARS-CoV-2.







On May 18, 2023, an 86-year-old male patient with a medical history of hypertension, prostate cancer, and prior SARS-CoV-2 vaccination was admitted to the single ward of the Department of Geriatrics, First Affiliated Hospital, Zhejiang University School of Medicine. The patient presented with symptoms of cough and shortness of breath that started three days prior to admission. On May 19, a chest computed tomography (CT) scan revealed acute inflammation in both lungs (Supplementary Figure S1A). On May 20 (Admission day 2), the patient developed a fever. Real-time polymerase chain reaction (RT-PCR) and metagenomic next-generation sequencing (mNGS) confirmed the patient’s positive status for the HRSV-B subtype and SARS-CoV-2 (reinfection). The patient received treatment including high-flow nasal cannula oxygen therapy, aerosol inhalation of ipratropium bromide, budesonide, acetylcysteine, and other symptomatic care and excellent nursing service. His respiratory symptoms significantly improved, and a positron emission tomography/CT (PET/CT) scan on May 24 a showed notable reduction in lung inflammation (Supplementary Figure S1B). The patient fully recovered after a 13-day hospital stay. Table 1 displays all the clinical symptoms and signs.










Table 1. 
Symptoms and results of pathogenic testing in the case of an elderly man with dual infection of HRSV and SARS-CoV-2 virus in Hangzhou, Zhejiang Province in May 2023.




The patient’s sputum was collected on May 20 at the hospital and a respiratory viral panel using RT-PCR confirmed the presence of HRSV, while influenza A and B viruses were not detected. Several swab samples and sputum were collected from May 20 to May 30, and sent to Zhejiang Provincial Center for Disease Control and Prevention. The median duration of HRSV shedding was found to be 11 days (Supplementary Figure S2). The HRSV strain identified in this patient was identified as HRSV-B. Sputum collected on May 24 tested negative for SARS-CoV-2, while samples collected on May 26, 28, and 29 tested positive (Supplementary Figure S2). A follow-up RT-PCR test for COVID-19 conducted on June 10 yielded a negative result. A sputum sample collected on May 29 was subjected to mNGS analysis. The results revealed the presence of 85 reads for HRSV, 13,471 reads for SARS-CoV-2, and 60 reads for Aspergillus fumigatus (Table 1).







To further investigate the transmission of HRSV in this elderly case, we collected throat swabs from two medical workers, one bedside caregiver, and 40 inpatients on the same floor. All 43 samples tested negative for HRSV using RT-PCR, except for the sample from the bedside caregiver. The caregiver, a 23-year-old woman without symptoms and no personal protective equipment (PPE), tested positive for HRSV-B on May 24 (Ct value =32.0) (Supplementary Figure S3). She had received a SARS-CoV-2 vaccination and tested negative for SARS-CoV-2.







We also took five swabs from the ward environment on May 20, and one swab collected from the bathroom tested positive for HRSV (Ct value =36.8) (Supplementary Figure S3).







We obtained the second hypervariable region (HVR2) sequences of the HRSV G gene from the elderly patient, the bedside caregiver, and one positive environmental sample. Phylogenetic analysis revealed that all three sequences belonged to the HRSV B/BA9 genotype, with 99.68% amino acid sequence similarity.







Previous studies have shown that older patients with multiple respiratory pathogens are at a higher risk of experiencing worse outcomes (24). However, this case report describes a rare coinfection of HRSV-B/BA9 and SARS-CoV-2 in the oldest known patient, which did not necessarily increase the clinical severity, but instead prolonged the hospital stay (13 days vs. 7 days) (5). This finding can be explained by several factors. First, the patient in this case was diagnosed with HRSV infection two days after admission, enabling early initiation of proper treatment and receiving excellent healthcare services from a highly skilled professional team. Second, infections with HRSV-B genotype typically have lower disease severity scores compared to HRSV-A infections (67). Lastly, the patient in this case experienced a reinfection with SARS-CoV-2 six months after the initial natural infection and vaccination against SARS-CoV-2, which can provide protection against severe SARS-CoV-2 infection and COVID-19-related death (89).







This study has important implications for public health policies. First, older patients should take precautions to reduce their risk of exposure to respiratory viruses and prevent the spread of respiratory infections. This includes measures such as isolation in a single room, adherence to hand hygiene and PPE by healthcare workers, and caregivers. Second, early and accurate multi-etiologic diagnosis, along with prompt antiviral and symptomatic treatment, should be prioritized in order to improve clinical outcomes in older patients. Lastly, our study highlights the need to increase vaccination coverage for preventable respiratory infections, including influenza, SARS-CoV-2, HRSV, etc., in order to reduce morbidity and mortality among the elderly population.





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Jul. 5—As COVID-19 cases waned in Eastern Washington, influenza made its return.

Seven people died from influenza in Spokane County during this most recent flu season, typically from early October through the end of May.

Spokane Regional Health District reported on June 14 that there were 77 confirmed influenza hospitalizations within Spokane County during the recent flu season. This time last year, the report had one hospitalization in the county during the prior season, and no one had died from influenza.

"We definitely have seen a return of flu season as people have begun to transition into a more pre-COVID lifestyle," said SRHD spokeswoman Kelli Hawkins.

"However, numbers are far from reaching pre-pandemic levels."

Six long-term care facilities in Spokane County had outbreaks of the flu in the 2021-22 period.

Public health officials attribute such factors as mask-wearing, social distancing, better hand hygiene and children not in school during the coronavirus pandemic as key reasons that flu rates were so low for 2020-21.

Hawkins said that based on information from regional epidemiologists, public health officials don't know a lot about asymptomatic flu cases, mainly because only tested cases are reported.

"What we do know, and what people should be aware of, is that you can be contagious one day before symptoms develop and up to five to seven days after becoming sick," Hawkins said. "So, if you are exposed to someone who had the flu, you should be aware that you could be contagious before you actually experience symptoms and could potentially expose others who are at risk of severe symptoms."

Those people at risk include pregnant women, those older than 50, young children and those with chronic medical conditions.

"This does make getting vaccinated for the flu every year important not only for your own well-being, but for those who may be potentially exposed before you realize you're contagious," Hawkins said.

Influenza cases were much higher during the 2017-19 periods. Statewide, 296 laboratory-confirmed influenza deaths were reported for the 2017-18 season, and 245 in 2018-19, reported the state Department of Health.

Most deaths occurred in people with underlying health conditions, or in people with no pre-existing conditions but who were elderly.

People who have the flu often feel some or all of certain symptoms that can include fever or chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and extreme fatigue.

During this recent season, the district was aware of many cases of respiratory syncytial virus, or RSV, among children. However, RSV is not a reportable virus, so SRHD doesn't have county-level data for it.

"Anecdotally, we have received reports of increased respiratory illnesses, including RSV, that we typically see this time of year among children," Hawkins said.

The CDC does have some data at the state level for RSV.

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Infants born to coronavirus-infected mothers have a much higher chance of health issues such as difficulty breathing compared with the newborns of moms without COVID-19, a new study shows.

The study, published in the Journal of Maternal-Fetal and Neonatal Medicine, adds to mounting evidence that COVID-19 complications can be especially hard on pregnant people and babies.

“There were significant differences between the COVID-19-positive and healthy controls,” lead author Dr. Elior Eliasi wrote.

That included higher rates of gestational diabetes, significantly lower white blood count, increased bleeding during birth, and “neonatal respiratory complications,” he wrote.

“We found that COVID-19-positive parturients had higher rates of composite adverse outcomes than healthy parturients, with symptomatic women having higher rates of adverse outcomes than asymptomatic women,” the study authors said.

While some pregnant women are forgoing vaccination for fear it could affect their babies, the opposite appears to be true, as ABC News reported in an extensive Q&A about pregnancy and COVID-19. Pregnant people are more prone to severe illness, hospitalization and even death if they contract COVID-19, and the U.S. Centers for Disease Control and Prevention has been strongly urging them since the summer to get the jab.

The CDC has been joined by the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine in advocating that pregnant people get the shot.

Pregnant people not only avoid severe illness by getting vaccinated but they also pass high levels of antibodies on to their babies, researchers led by New York University’s Grossman School of Medicine found in a study published last month in the American Journal of Obstetrics & Gynecology—Maternal–Fetal Medicine.

Pregnant women are twice as likely to end up in the hospital with COVID-19 complications, according to the CDC, and have a 70% higher risk of death. Add to that the findings of another study, published last month in the American Journal of Obstetrics and Gynecology, which found that the delta variant added to the severity. Preterm birth and stillbirth are also on the list of risks to the fetus, the CDC said.

———

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Josie Norton for NPR

We regularly answer frequently asked questions about the coronavirus. If you have a question you'd like us to consider for a future post, email us at [email protected] with the subject line: "Weekly Coronavirus Questions." See an archive of our FAQs here.

As a physician and infectious disease epidemiologist, I've seen a lot of COVID-19 patients during the course of the pandemic, and there's a question I hear over and over:

How is it possible that my partner – or child or sibling or roommate – tested positive for COVID, and even though I slept in the same room or lived in the same house, I didn't come down with the virus?

Weren't they breathing out infectious particles for days on end? And I assume I was breathing them in.

There is an answer to this question. But it's a bit complicated.

First: Let's review how SARS-CoV-2, the virus that causes COVID-19, spreads. While some viruses are primarily passed through contact with the bodily fluids (Ebola) or skin (mpox) of someone who's infected, SARS-CoV-2 is easier to catch. It's spread mainly through the air in invisible aerosols (and to a lesser extent in large droplets) that the infected person emits while breathing, talking, sneezing, coughing, laughing or snoring. The aerosols can hang around in the air for hours, and others can inhale them.

So yes, if someone in your house is exhaling SARS-CoV-2-viral particles, you could breathe them in and become infected. But ... here's why that does not always happen.

There are two points to ponder. One: The person with COVID is not contagious at all times. Two: Different factors can reduce the risk of getting infected from a housemate.

The incubation period

For starters, someone who is sick with COVID-19 is not infectious from the moment they catch the virus to the moment they test negative (or their symptoms go away). Viruses like SARS CoV-2 have different stages.

It all starts when you're first exposed.

If you breathe in enough viral particles and your immune system doesn't vanquish the pathogens you've inhaled, the timer starts for your case of COVID. The virus will incubate in your body until symptoms begin to appear.

And when do you become contagious – marking the transition from the "latent" stage to the "infectious" stage? There's no way to know the exact moment this happens. It's a complex biological process, and for everyone it will be a little different.

But we can make certain inferences.

For example, many people wonder: Can you be contagious before symptoms of COVID appear?

Early on in the pandemic, the answer was definitely yes – and that's one reason why it was so hard to control COVID. We knew this from studies that showed transmission happening before the sick person had any symptoms. You would not necessarily know when you were exposed to someone who was contagious because they may have been "pre-symptomatic."

But things have changed since 2020. Now, most of our immune systems are able to recognize the virus – a result of previous exposures and/or being vaccinated. And the immune system's reaction to even a small amount of virus could be symptoms like coughing, sore throat, running nose, a fever. With our immune systems primed, the body's response comes much more quickly than it would have back in 2020 when SARS-CoV-2 was a novel pathogen. So those symptoms could appear early on after exposure — even before we're infectious. This was shown in a study published in Clinical Infectious Disease that examined people's symptoms compared to how much virus they were carrying across the days of their infection.

The infectious window

The infectious window – the period during which you're contagious — varies from person to person.

For some, it may only be a couple of days, whereas for others it can be a week or even longer (especially in people who are immunocompromised and can't easily clear the virus).

If you're lucky, your housemate will have a short window.

And then there's the matter of quantity.

Many if not most people will transmit only small amounts of SARS-CoV-2 after getting infected.

In fact, most of the spread of SARS-CoV-2 actually happens from a relatively small number of highly infectious people — called superspreaders. Research on transmission has shown a wide variation in how many people get infected by one person.

Some superspreaders are just biologically capable of shedding a lot of virus. One study published in November 2023 found an association between higher BMI in men and higher viral loads. Other superspreaders could have a big network of people they come into contact with – for example, infecting on a bus or in a choir setting.

You can reduce the amount of pathogen you're exposed to

Just breathing in a pathogen doesn't mean you'll get sick. This is the difference between exposure versus actual infection.

For a pathogen to cause disease, you must be exposed to enough of it – the minimum infectious dose — so it can overcome your immune defenses. Some pathogens can do their work with a tiny infectious dose, meaning even just a few microbes or viral particles are sufficient to infect you, while others require a much heftier exposure. That's why you're unlikely to catch COVID from, say, dashing into a grocery store for a quick shop and perhaps breathing in a very small amount of virus. The duration of exposure and the concentration of the pathogen in its preferred route (air, for this virus) affect your chance of getting sick.

We are exposed to small amounts of pathogens all the time, but usually it is not enough to cause disease. Sometimes, however, it is. A more sinister example of these principles is Coxiella burnetti, the bacteria that causes "Q Fever." It can spread to people from animals, including farm animals, and is on the list of "select agents" for bioterrorism concern. The bacteria has a very low infectious dose, is stable in the environment and can spread so effectively that even living miles downwind of a farm is a risk factor.

Reducing the dose you are exposed to is one way to avoid infection. For SARS-CoV-2, opening windows can dilute the cloud of aerosols by bringing in fresh air.

If your home has a fan with an air filter or you're using a HEPA air purifier, the infectious aerosol particles can become trapped in the filter rather than in your lungs.

To reiterate: the cumulative dose you inhale depends on the time you spend in a place and the concentration of viral particles there.

Masks that are worn correctly and consistently will also reduce that dose. If your housemate is infected and you wear an effective mask (a well-fitting N95, for example), the mask will trap most of the viral particles, reducing the amount you inhale. If the person with COVID masks up, that will decrease the quantity of pathogens they're emitting into the air as well.

Your immune system (or medications) could save you

If you've been vaccinated or had a prior infection, your immune system could be able to knock out the pathogen. The older you get, the less effective your immune system will be. And if you have a medical condition that makes your immune system weaker – like cancer or chronic diseases like diabetes – that could also play a role in whether exposure to viral particles will lead to infection.

For healthy people exposed to a sick person, antiviral drugs (or antibiotics for bacteria) can often avert infection after exposure — this is called post-exposure prophylaxis and is used for many infections already, including HIV, gonorrhea, chlamydia and syphilis.

In one study, researchers looked at whether those living at home with someone infected with COVID-19 were less likely to get sick if they used the antiviral paxlovid. The study found a signal — a 32% reduced risk of getting sick compared to placebo — but did not meet statistical significance.

So in conclusion: Yes, you can live with someone with COVID and not catch it. Because infectious disease transmission is complicated.

And remember, we do see weird things happening with infectious diseases every single day. So yes, in theory you could catch, say, mpox from dust particles on a patient's blanket. This actually happened in a famous case from the U.K., but it is exceedingly rare.

But don't fall for the trap of thinking that your single example represents the general trend.

When it comes to COVID, let me assure you: It is contagious – but remember, that doesn't mean everyone who is in contact with someone who's infected will catch it.

I was infected a few weeks ago. My mother and sister were both in the car with me hours before I felt sick and tested positive. My sister got COVID days later. But my mother never got it.

Abraar Karan is an infectious disease physician and researcher at Stanford University. He worked on the COVID-19 pandemic for the Massachusetts Department of Public Health and the mpox outbreak for the Los Angeles County Department of Public Health. He posts on Instagram @abraarkaran

Copyright 2024 NPR. To see more, visit www.npr.org.



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New research suggests that brain fog experienced by individuals with long Covid may be linked to leaky blood vessels. Scientists suggest that coronavirus disrupts a person's blood-brain barrier, which could be a potential cause of the cognitive issues seen in those with long Covid.

The research

A team from Trinity College Dublin and FutureNeuro, a research centre, examined serum and plasma samples from 76 individuals hospitalised with COVID-19 in March or April 2020. In addition, they analysed the samples from 25 people before the pandemic.

Their findings, which have been published in Nature Neuroscience, revealed that individuals with long COVID who exhibited blood-brain barrier leaks experienced brain fog. On the other hand, those without the said disruptions did not.

Professor Matthew Campbell, a geneticist and head of genetics at Trinity, who contributed to the study said that "for the first time...we have been able to show that leaky blood vessels in the human brain, in tandem with a hyperactive immune system, may be the key drivers of brain fog associated with long COVID."

"This is critically important, as understanding the underlying cause of these conditions will allow us to develop targeted therapies for patients in the future," he added, as quoted by Sky News.

In their report, the researchers highlighted that "disruption" is apparent during "acute infection and in patients with long COVID with cognitive impairment." Still, they noted that it remains unclear how function is affected in these conditions.

Previously, a study from University College London noted that blood vessel leakage into surrounding tissues is common in numerous inflammatory diseases.

Professor Colin Doherty, a neurology expert and head of the school of medicine at Trinity, who was not part of the study, suggests that the study results will "now likely change the landscape of how we understand and treat post-viral neurological conditions".

"It also confirms that the neurological symptoms of long COVID are measurable with real and demonstrable metabolic and vascular changes in the brain," he added.

Watch | Covid study: Indians suffer more lung damage post recovery, worst-hit by Covid after-effects

What is long covid?

Individuals with persistent symptoms such as tiredness, difficulty breathing, memory and cognitive issues, as well as joint and muscle pain lasting more than 12 weeks after infection, can be classified as having long COVID.

According to the Office for National Statistics, as of March last year, an estimated 1.9 million people in the UK living in private households, accounting for 2.9 per cent of the population, were experiencing self-reported long COVID.

(With inputs from agencies)

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Persistent COVID-19 Infections: A Closer Look

A recent study led by the University of Oxford has shed light on the nature of SARS-CoV-2 infections, revealing that a significant proportion of these infections in the general population may persist for a month or more. The data, sourced from the Office for National Statistics COVID Infection Survey, revealed that between 0.1 and 0.5% of all infections could potentially persist for at least 60 days or more.

This research spanned from November 2020 to August 2022 and included more than 90,000 participants. Out of these, 3,603 individuals provided two or more positive samples, indicating a persistent infection. The findings of this study underscore the importance of understanding the nature and implications of these persistent infections.

Long COVID and Persistent Infections

Individuals with persistent COVID-19 infections were found to be 55% more likely to report having symptoms of long COVID more than 12 weeks since the onset of the infection. Long COVID refers to a range of symptoms that can last weeks or even months after the initial recovery from the illness. Some of the common long COVID symptoms include fatigue, shortness of breath, and cognitive issues, often referred to as ‘brain fog’.

However, the study also highlighted that the relationship between viral persistence and long COVID may not be causal. There is still much to be learned about the pathophysiology of long COVID, and further research is needed to fully understand this complex relationship.

Implications for Genomic Surveillance

One of the significant findings from this study was the detection of an extremely high number of mutations in certain individuals. These mutations included those that define new coronavirus variants, alter target sites for monoclonal antibodies, and introduce changes to the coronavirus spike protein. This has serious implications for the virus’s ability to evade prior immunity and heightens the need for robust genomic surveillance.

Community-based genomic surveillance is crucial to monitor the emergence and spread of new variants. It provides a fundamental understanding of the natural history and evolution of novel pathogens and their clinical implications for patients.

COVID-19 Mortality Risk Factors

In addition to the study on persistent infections, other research has been conducted to evaluate the virus and host response factors associated with mortality risk among COVID-19 patients. Factors such as viral antigen, viral RNA, respiratory support, renal impairment, and interleukin-6 levels were found to be significantly associated with mortality risk. It is important to note that these baseline virus-specific clinical and biological variables were strongly linked to mortality risk, revealing potential pathogen and host response therapeutic targets for acute COVID-19 disease.

In conclusion, understanding the nature and implications of persistent COVID-19 infections is critical in the fight against the pandemic. These insights not only highlight the potential link to long COVID but also underscore the importance of genomic surveillance and further research to mitigate the impact of this global health crisis.

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Our birth month might be more than just a date on the calendar, it could also potentially dictate our susceptibility to flu. A US study published in the British Medical Journal (BMJ) has discovered an intriguing correlation between a child’s birth month and their likelihood of contracting the flu. The findings suggest that children born in October are the least likely to get the flu, while November-born individuals have a higher risk of getting the flu.

Unpacking the Study

The research analyzed data from over 35,000 individuals who had tested positive for the flu over a 10-year period. The aim was to identify whether the timing of birth could affect the body’s immune response to the flu virus. The results were fascinating: November-born individuals were found to have a weaker immune response. Conversely, those born in October seemed to have a stronger defense mechanism against the flu.

This ground-breaking research prompts further investigation into the underlying reasons for this pattern. Could it be linked to maternal vitamin D levels during pregnancy, exposure to germs in the first few months of life, or perhaps other environmental factors? The answer seems to be a complex interplay of various factors which still needs further exploration.

Implications for Flu Prevention Strategies

This study could have significant implications for flu prevention strategies and vaccination schedules for children. The findings not only highlight the importance of getting vaccinated against the flu but also offer insights into the optimal timing for vaccination, especially for those born in November.

Furthermore, understanding the link between birth month and flu susceptibility could provide healthcare providers with crucial information to personalize patient care. By foreseeing potential vulnerabilities, they could strategize the best preventive measures for each individual.

Understanding Respiratory Viruses and Prevention Measures

Respiratory viruses, including the flu, are a common cause of illness, particularly in communal environments like day care centers. A narrative review conducted to understand the most significant respiratory viruses in these settings found that five viruses – rhinovirus, influenza virus, respiratory syncytial virus, coronavirus, and adenovirus – were responsible for 95% of respiratory infections.

The review highlighted the impact of respiratory infections on absenteeism in day care centers, the elevated risk of contracting COVID-19 for childcare workers, and the potential economic and health benefits of reducing recurrent respiratory infections through better prevention measures. This underlines the crucial need for robust prevention strategies, including vaccination and good hygiene practices, to manage and minimize the impact of these infections.

Final Thoughts

While more research is needed to understand the exact reasons behind the link between birth month and flu susceptibility, the current findings certainly offer a fresh perspective. The potential to incorporate birth month into flu prevention strategies could revolutionize how we approach vaccination and disease prevention. Until then, regardless of when we are born, let’s continue to prioritize good hygiene practices and timely vaccinations to keep the flu at bay.

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Dr Rachel Clarke is a palliative care doctor and writer – the ITV drama ‘Breathtaking’ is based on her memoir.

The reaction to the first episode of the ITV drama Breathtaking, based on my memoir of the pandemic, has been phenomenal. There has been an outpouring of comments from NHS colleagues who feel as though the public is bearing witness to what they went through in hospitals.

Some of the comments are absolutely heart-breaking. Monday night’s episode focused on the lack of PPE [personal protective equipment] and the devastating effect it had on staff, and I’ve read so many comments from people saying “this happened to me on my ward”, “managers wouldn’t give us any PPE”, “we bought masks from B&Q and were told we had to take them off”.

It was just incredible to read those responses.

In a way, that was almost what motivated me more than anything: that simple desire to show the public what really happened in the early days of the pandemic and what NHS staff really endured.

One review described the episode as “a punch in the face”. We [Clarke co-wrote the three-part show with Line of Duty creator Jed Mercurio and actor Prasanna Puwanarajah – both former doctors] wanted that kind of reaction, but not in any sense gratuitously.

We were not setting out to shock the public unnecessarily, but there is no way to depict the pandemic inside a hospital that is both authentic and easy to watch. That wouldn’t do justice to the experience.

For the first episode in particular, we wanted to convey the bewilderment, fear, trauma, and uncertainty of staff as the early days of the pandemic unfolded. It was like a punch in the face for us.

Every day you came to work most of us knew, I certainly did, that you were not getting the right PPE. You knew there wasn’t enough to protect you. You knew you were surrounded by patients who were breathing out this virus that could infect you, kill you, that you could bring home to your families.

The hardest thing was the constantly changing guidance, which we knew full well was not even remotely based on the science. It was based on the size of the PPE stockpile, which was woefully inadequate.

Instead of NHS England being honest with us about that, they pretended they could justify not giving us the right PPE. And that was a grave misjudgement on their part as it meant staff felt they were being thrown to the wolves.

HTM TELEVISION FOR ITV/ITVX BREATHTAKING EARLY RELEASE IMAGES NO EMBARGO Pictured: JOANNE FROGGATT as Abbey. This image is under copyright and can only be reproduced for editorial purposes in your print or online publication. This image cannot be syndicated to any other third party. Copyright ITV For further information please contact: Patrick.smith@itv.com 07909906963
Joanne Froggatt as Dr Abbey Henderson in ‘Breathtaking’. Dr Clarke says ‘the majority of what you see on screen is what I personally experienced, witnessed and heard’ (Photographer: Nick Wall/ITV)

In Monday’s episode you saw an A&E consultant peeling off a sticker from a box of masks and discovering that NHS England has hastily covered up the expiry date on the box, which is 2016 – four years before the pandemic.

When we discovered this was going on it was terrifying, because you felt as if you were clearly expendable and no-one cared if you lived or died. There was a real sense of helplessness.

In Reading Hospital, close to where I worked in Oxford, a doctor sent emails begging his managers for even paper masks for his ward, because he knew his team was probably being exposed to Covid.

And he was told “no, you’re not getting any” and to stop emailing them – and he died from Covid he caught on his ward [The Royal Berkshire NHS Trust began a serious incident investigation after Dr Peter Tun, who specialised in helping patients with brain conditions recover, died on 13 April, 2020]. That kind of thing was happening everywhere.

When I went for a “fit test” for a proper FFP3 mask, there’s a big hood which you see on screen where Abbey is told “you’ve failed your test” but it’s because the PPE is designed for men, for male jaws, not female ones. I didn’t even get a proper fit test. There was no hood, nothing.

There was a person who handed me a mask saying “put this on, breathe out vigorously and tell me if you can feel any air on your cheeks”.

I said: “This isn’t a fit test. Where’s the hood? Where’s the proper equipment?” I was told you didn’t need any of that anymore and to not to worry about it. I knew that wasn’t true. It just made you feel you were being lied to. I had colleagues asking me to witness them signing their wills in case they died, because they were so frightened.

One of the most important failings on behalf of state and government dates to 2016 when we had Operation Cygnus – the influenza pandemic rehearsal plan which [then health secretary] Jeremy Hunt oversaw.

The recommendations of that were very clear: we needed a proper PPE stockpile, which didn’t exist. We didn’t have the right masks. We only had PPE relevant for a flu pandemic not a coronavirus pandemic. That meant come 2020 we essentially had nothing. That is a direct result of austerity.

It costs money to buy PPE and rather than act on the recommendations of that exercise the government clearly decided that NHS staff were not worth spending that money on. We were left unprotected. It directly led to my colleagues dying in 2020 because the government did not care enough about us. They had the temerity and hypocrisy to stand on the steps of No 10 clapping NHS staff and describing us as heroes.

The horror of the early weeks was that we could all see this coming. We were terrified at the lack of response from government. In January 2020 the editor of the Lancet, Richard Horton, posted in very clear terms about Covid-19, as it became known, describing how worried he was about the virus and I followed its progress from then on.

We all followed what was happening in China from January onwards. Then the next month, when we saw what was happening in Italy, that was the time when I started to feel sick and lie awake at night worrying about what was coming. It was clear that if this thing had already spread to Italy it was on our doorstep.

In mid-February, I had the worst infection I’ve ever had in my life. I was in bed for a week and couldn’t stop coughing. For about a month I couldn’t walk up a flight of stairs without clutching the banister.

I tried to get a Covid test from Public Health England, explaining that I worked in a hospice with palliative care patients, that if I have Covid I could infect them and kill them, but was told I didn’t fit the criteria. They didn’t want to waste a test on me.

Joanne Froggatt’s character [Dr Abbey Henderson] in Breathtaking goes through a large number of experiences I went through personally. They’re carefully anonymised and some of them are based on the collective first-hand experience of medical and nursing colleagues of mine. But the majority of what you see on screen is what I personally experienced, witnessed and heard. Some of the dialogue Jo speaks is verbatim what I was saying at the time.

I felt very strongly that we needed to get this show broadcast before the Covid inquiry has concluded its investigation. The urgency for me was also intimately related to the degree of historical revisionism that is already going on regarding the pandemic.

There are many people, including sitting MPs, who assert that lockdowns did more harm than good, that the NHS was never overwhelmed, Covid was a very mild virus, and we should never have responded in the way we did. I think that is a gross misrepresentation of what actually happened.

The NHS was overwhelmed. Care was rationed. People died because they couldn’t get a ventilator or an ambulance.

They died because we couldn’t diagnose their cancer because we were so overwhelmed coping with Covid. If we allow a revisionist version of those facts to take hold, we are encouraging governments in the future to make the same mistakes again and respond too sluggishly and without sufficient concern.

Part of getting this drama out was ensuring the public is not turning a blind eye to what happened. It is hard to look at, hard to confront, hard to watch. But we have to watch it if we want to minimise the number of people who die in the next pandemic.

Dr Clarke with her ‘Breathtaking’ co-writers Jed Mercurio, left, and actor Prasanna Puwanarajah, both former doctors

Crucially, for me, I’m very aware that many of the thousands and thousands of people who have been bereaved by Covid and all the thousands of NHS staff who remain deeply traumatised by what they went through, or who have severe long Covid to this day, feel very abandoned by society.

I think we have a duty to all those people to look head on at what they endured, to remember it and, almost as mark of respect, to acknowledge their stories. It’s incredibly painful to have gone through something so traumatic and feel society doesn’t want to know about it.

It is hard to move on from trauma and the country as a whole has been through such a traumatic experience. We have all lost something in the pandemic: our health, wellbeing, lives. And I think collectively we are witnessing a desire to pretend to ourselves we can just move on, but the truth is Covid has not gone away.

One hundred people are still dying from Covid every week – that is the main cause of death on their death certificate. People are severely disabled by long Covid and we don’t properly understand yet what the virus does to our brain, blood vessels, to every organ of our body. This is an ongoing problem.

The grief and post-traumatic stress symptoms that patients and NHS staff are enduring is still alive and a current issue.

I find it astonishing that the Government is on the one hand exercised about the fact that about two million people are registered as long-term unemployed and yet they are not investing resources into the psychological and physical support that so many people need post-Covid. It’s a remarkable disconnect.

In January 2021 I developed panic attacks for the first time in my life. I was literally trembling, couldn’t breathe and felt as if I was dying. I was driving to work the first time I had one.

Mentally I was moving towards the hospital and physically my body entered such a traumatised state that I had to pull over to the side of the road. I sought psychological support, which I was very lucky to get. There are many NHS staff who would dearly like that support now and they can’t get it, which is another travesty.

I needed those sessions to get over what I had experienced. I feel as though I’ve done that now, but like many colleagues if I talk about Covid I will start to cry. The tears are very close to the surface.

That’s the case for everyone who worked on a Covid ward or with Covid patients. It’s hard to explain really. We witnessed so much dying, over and over again, with all the haunting barriers of masks and PPE and the devastation of family members not being able to be there at the bedside. None of us ever expected to endure those conditions.

The worst period for me was the run-up to Christmas 2021 when the Omicron variant was ravaging the country. We went through this horrific period when Boris Johnson was telling the country we were “following the science” as hospitals filled up with Covid patients.

This wave was rising up like before, but it was so much worse than first time round as this time we knew exactly what needed to happen, but the same mistakes were being made in exactly the same way. And we were utterly powerless to stop it.

At times my distress was so extreme I remember saying to my husband that it felt like something cancerous inside me and I just couldn’t bear it. It hurt me, physically, to know this was coming.

And then the grief in January 2021 of once more going from dying patient to dying patient doing the best you could for them… which was not even remotely enough to save their lives.

And knowing they didn’t have to be there. This person who was suffocating in front of you today might not be suffocating if different political decisions had been made, if we had a prime minister who was responsible enough to make the hard decisions instead of the popular ones – that was so corrosive to me.

There were times when I thought I just couldn’t carry on because it was hurting too much. The only way I could do it was bully myself to carry on. Every day when I was driving to work I used to play a song, “Heart of Courage”, from the film Gladiator, this rallying music to help me go to work.

It sounds pathetic – it is pathetic – but I just had to tell myself “don’t you dare be self-pitying and think of yourself, you have a job to do and you are damn well going to do the best job you can for patients”.

At work, the only way I could get through the day was by only focusing on the patient in front of me: what do they need and how can I help them? Nothing else matters. But often at the end of every day, I’d have to pull over by the side of the road on my way home and cry.

We are not even slightly ready for the next pandemic and we’re still in the current one anyway. Contrary to what some people claim, the World Health Organisation has not declared the Covid pandemic over. We are still experiencing morbidity and mortality due to Covid.

Not only are we not ready for the next pandemic, but the Government and NHS England have not even learned from this one that we’re still occupying. We still do not have proper masks on hospital wards. We still have the pitifully inadequate paper masks, even though the evidence is insurmountable that we should get [most protective] FFP3 masks. We still can’t find them.

Staff and patients are still being put at risk every day because hospitals have not been fitted out with proper ventilation systems, because the Government has chosen not to spend the money on making hospitals safe. That, in the context of a Covid death toll of over 233,000 people, isn’t just unforgiveable, I think it’s grotesque.

Breathtaking airs on ITV1 between 19-21 February and is available on ITVX

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A man sweeping at the Chengdu Research Base of Giant Panda Breeding

Good afternoon. This is Jonathan Spira, director of research at the Center for Long Covid Research, reporting. Here now the news of the pandemic from across the globe on its 1,441st day.

THE LEDE

Getting Reinfected by SARS-CoV-2: It Takes a Village to Survive a Pandemic

There’s a lot scientists and physicians know about SARS-CoV-2, aka Covid-19, but there’s even more than they don’t know.

So far, the world has experienced over 703 million reported cases, just under seven million Covid-related deaths, and there are at the present time 22.2 million active reported Covid cases across the globe.

Covid, at least for the time being, is here to stay and we do know that contracting the virus doesn’t bestow permanent immunity. We also know that, when the virus enters the body, it affects multiple organ systems. For the tens of millions of people who suffer from Long Covid, a condition that in perhaps as much as 15% of those who have contracted Covid surfaces weeks or months after an individual has had an infection, suffer a variety of symptoms – some estimates indicate it could be as many as 200 – and chief among them are debilitating chronic pain, brain fog, shortness of breath, chest pain, and severe persistent chronic fatigue.

Most people have no idea how often they might be getting reinfected with Covid because many cases are asymptomatic and lingering protection from both past infections and vaccinations does typically reduce the severity.

Based on, however, evidence of the long-term impact of other viruses, it does not bode well for people to contract SARS-CoV-2 at regular intervals.

In Year 5 of the pandemic, we may be tired of hearing about it, tired of the idea of masks and vaccines, and tired being tired of it, but the fact that it continues to impact us all as a society – even if the most vulnerable among us, the aged and immunocompromised are bearing the brunt of the risk – we do need to think of health as the most important common good, one that we must guard and protect, regardless of economic and social forces.

We may think of ourselves as proud individuals but, just as, according to the proverb, it takes a village to raise a child, it also takes a village to survive the inevitable pandemic as well, provided that the villagers wash their hands, cover their coughs, and don face masks.

In other news we cover today, one state’s highest court rejected an appeal by a restaurant operator over its business interruption insurance policy rejection, hospitalizations in California are down, and experiments on mutant coronaviruses are not as uncommon as you might think.

UNITED STATES

Health officials in California reported that SARS-CoV-2 hospitalizations in the state are at their lowest point in two months. The news is particularly welcome after a particularly challenging winter marked by the tripledemic of influenza, Covid, and RSV, or respiratory syncytial virus.

In New York, the Court of Appeals – the state’s highest court – upheld lower court rulings that rejected a restaurant operator’s claims under its business interruption policy. The case was decided on February 15, 2024.

The Court of Appeals affirmed that there must be direct physical loss or damage, not just presence of a virus, to trigger coverage under a commercial property policy in order to claim business interruption losses.

The case involved Consolidated Restaurant Operations, a company that operates dozens of restaurants and which had an “all-risk” insurance policy, and Westport Insurance Corporation.

GLOBAL NEWS

While China’s experiments on mutant coronavirus strains made headlines across the globe in January when scientists in Beijing cloned and then mutated a Covid-like virus uncovered decades ago in a pangolin and used it to infect humanized mice, this type of work is not limited to the east. Such experiments are being conducted in the United Kingdom, led by leading virologists, as well as Germany, Switzerland, Japan, and the United States.

The researchers contend  that their work, which is conducted in safe, high-security laboratories, is essential in order to gain a better understanding of SARS-CoV-2 and the coronavirus family to which it belongs.

Oh, and about those humanized mice infected with the GX-P2V virus? They all died, in case you were fearful of encountering a humanized mouse on your evening stroll.

GLOBAL STATISTICS

Now here are the daily statistics for Tuesday, February 20.

As of Tuesday at press time, the world has recorded 703.52 million Covid-19 cases, an increase of 0.04 million in the last 72 hours, and 6.98 million deaths, according to Worldometer, a service that tracks such information. In addition, 674.3 million people worldwide have recovered from the virus, an increase of 0.05 million in the past 24 hours.

The reader should note that infrequent reporting from some sources may appear as spikes in new case figures or death tolls as well as the occasional downward or upward adjustment as corrections to case figures warrant.

Worldwide, the number of active coronavirus cases as of Tuesday at press time is 22,236,619, a decrease of 15,000 in the past 72 hours. Out of that figure, 99.8%, or 22,200,924, are considered mild, and 0.2%, or 35,695, are listed as critical. The percentage of cases considered critical has not changed over the past 18 months.

Since the start of the pandemic, the United States has, as of Tuesday, recorded 111.37 million cases, a higher figure than any other country, and a death toll of 1.2 million. India has the world’s second highest number of officially recorded cases, 45.03 million, and a reported death toll of 533,473.

The newest data from Russia’s Rosstat state statistics service showed that, at the end of July 2022, the number of Covid or Covid-related deaths since the start of the pandemic there in April 2020 is now 823,623, giving the country the world’s second highest pandemic-related death toll, behind the United States.  Rosstat last reported that 3,284 people died from the coronavirus or related causes in July 2022, down from 5,023 in June, 7,008 in May and 11,583 in April.

Meanwhile, France is the country with the third highest number of cases, with 40.14 million, and Germany is in the number four slot, with 38.82 million total cases.

Brazil, which has recorded the third highest number of deaths as a result of the virus, 709,765, has recorded 38.41 million cases, placing it in the number five slot.

The other five countries with total case figures over the 20 million mark are South Korea, with 34.57 million cases, as number six; Japan, with 33.8 million cases placing it in the number seven slot; and Italy, with 26.72 million, as number eight, as well as the United Kingdom, with 24.9 million, and Russia, with 23.96 million, as nine and ten respectively.

CURRENT U.S. COVID STATISTICS AT A GLANCE

In the United States, in the week ending February 10, 2024, the test positivity rate was, based on data released on February 16, 2024 from the Centers for Disease Control and Prevention was 9.1%, and the trend in test positivity is -0.6% in the most recent week. Meanwhile, the percentage of emergency department visits that were diagnosed as SARS-CoV-2 was 1.8%, and the trend in emergency department visits is -5.3%.

The number of people admitted to hospital in the United States due to SARS-CoV-2 in the same 7-day period was 21,373, a figure that is up 0.8% over the past 7-day period. Meanwhile, the percentage of deaths due to SARS-CoV-2 was 2.7%, a figure that is down 6.9% in the same period.

VACCINATION SPOTLIGHT

Some 70.6% of the world population has received at least one dose of coronavirus vaccine by Tuesday, according to Our World in Data, an online scientific publication that tracks such information.  So far, 13.57 billion doses of the vaccine have been administered on a global basis and 3,626 doses are now administered each day.

Meanwhile, only 32.7% of people in low-income countries have received one dose, while in countries such as Canada, China, Denmark, France, Italy, the United Kingdom, and the United States, at least 75% of the population has received at least one dose of vaccine.

Only a handful of the world’s poorest countries – Bangladesh, Bhutan, Cambodia and Nepal – have reached the 70% mark in vaccinations. Many countries, however, are under 20% and, in countries such as Haiti, Senegal, and Tanzania, for example, vaccination rates remain at or below 10%.

In addition, with the beginning of vaccinations in North Korea in late September, 2023, Eritrea remains the only country in the world that has not administered vaccines in any significant number.

Anna Breuer contributed reporting to this story.

The Coronavirus Daily News Brief is a publication of the Center for Long Covid Research. www.longcov.org

If you have Long Covid and need to talk to someone, call the Long Covid Patient Peer Counseling Phone Line, or HOPELINE.  The HOPELINE is our free, confidential support and information service.

☏ 844 LONGCOV (844 566-4268) 

(Photo: Accura Media Group)



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After the great critical acclaim for, and political impact of, Mr Bates vs The Post Office, lots of people wondered, half-jokingly, whether ITV could produce more dramatisations of public policy scandals that might lead to some sort of justice for other victims. Right on cue, ITV brings us the harrowing three-part drama Breathtaking, which painfully recalls the blunders, complacency and misfortunes inflicted on NHS staff in the earlier phases of the Covid pandemic.

In fact, the filming ended long before Mr Bates jolted the government into (possibly) giving the sub-postmasters their money and their lives back, so Breathtaking isn’t actually part of some rolling ITV mission to right societal wrongdoing. Yet, no doubt this new show will also prompt some further sharp arguments about what went wrong, as we approach the fourth anniversary of the lockdown. And so it should.

This is a deeply sad and often triggering drama, and also a highly authentic one, based on the moving Covid memoir by Dr Rachel Clarke, who worked on acute wards during the pandemic. Jed Mercurio (Line of Duty) and Prasanna Puwanaraja (The Crown) are on board as fellow executive producers. Joanne Froggatt (Downton Abbey) plays A&E consultant Abbey Henderson, who we see transform from cheerful leader of a hard-pressed but dedicated team into a woman barely able to comprehend what is happening around her, let alone prevent it.

Beginning a few weeks before the lockdowns of early 2020, the drama takes us with Abbey through the successive unpredictable, bewildering phases of the pandemic, the terrible sense of fear and then the reality of being completely overwhelmed by this mysterious new virus. We see Abbey losing patients and colleagues to the plague-like sickness (then poorly understood), spending whole weekends on shift and, among many other depredations, denied the PPE (personal protective equipment) that would have saved the lives of carers and staff alike.

Making a mark: protective masks and visors leave indentations on the skin of Joanne Froggatt as she portrays a consultant in ‘Breathtaking’

(ITV)

Most poignant is the plight of nurse assistant Divina Aquino (Georgia Goodman), seen at first tending as normal to patients who she assumed had a temperature and a nasty cough, and then being intubated and placed in an induced coma herself. The makers of Breathtaking capture superbly the sense of Abbey and her colleagues facing impending doom, as the “low oxygen” alert goes off on the ward, meaning that the hospital, as well as its patients, are running out of breath. No suitable masks, no aprons, no ventilators, no oxygen, and Abbey soon has to start making life or death decisions in the back of an ambulance.

Much of the action echoes the kind of hospital drama tropes we’re familiar with from the likes of Casualty – lots of professionals running around shouting, a cacophony of beeps and buzzers, semi-comprehensible medical jargon – but the director, Craig Viveiros, lifts it above the usual soapy style. With the camera moving with Abbey for long sequences, the effect is to immerse the viewers in the chaos and drench them in the nervous sweat of trepidation. It gives the story a dark and claustrophobic feel, and it is fairly debilitating for the audience too, but that’s inevitable. And in the series, a disproportionate number of victims, both staff and public, come from ethnic minorities, another well-caught reflection of reality.

Without lapsing into heavy-handed propagandising, the drama has the voice of Boris Johnson in “Mayor in Jaws” mode floating above the traumatic scenes, with the juxtaposition between lazy spin about “sending the coronavirus packing”, and the frantic reality of people basically drowning, adding to the tragedy.

The only error in the makers’ judgment is the way the hospital manager Mike (Mark Dexter) and NHS Trust boss Jo (Stephanie Street) are portrayed in a two-dimensional, unsympathetic and dismissive manner. It’s not easy to see how they were to blame, and there’s actually been no suggestion of managerial failings at that level in all the many Covid inquiries since.

And that, as it happens, is the crux of the difference in political status between Breathtaking and Mr Bates vs The Post Office, which is that, unlike the Post Office Horizon scandal, the shortage of PPE, the crisis in the hospitals, and the amateurishness of the official response to Covid was perfectly apparent to us all from the very beginning of the pandemic. That doesn’t, however, mean that we, like Dr Abbey, should be any less angry. The failures were, and still are, breathtaking.

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Introduction

Despite the respiratory nature of COVID-19, it affects other systems: cardiovascular, gastrointestinal, neurological, and musculoskeletal.1,2 Post-COVID-19, or “long COVID”, refers to the enduring symptoms of a COVID-19 infection, impacting various organs and bodily systems, including skeletal muscle.3 COVID-19 is a health problem that limits participation in physical activity because it creates many barriers to it, including physiological, psychological, behavioral, and reduced physical activity that adversely affect quality of life (QoL) and the musculoskeletal system. The practice of physical activity is essential for promoting overall wellness and maintaining a healthy lifestyle.4 COVID-19 survivors without preexisting musculoskeletal conditions experience skeletal muscle weakness, diminished performance, decreased physical fitness, respiratory impairment, psychiatric conditions such as post-traumatic stress disorder, reduced QoL, abnormal movement patterns, and musculoskeletal complications.2,3

Muscle atrophy after COVID-19 is one of the musculoskeletal system affections, and it was hypothesized that this atrophy might be attributed to inflammation, angiotensin converting enzyme 2, muscle catabolism, hypoxia, and medication received during COVID-19 treatment side effects.1 Studies have shown that individuals experience reduced muscle function even 12 months after discharge from the hospital due to prolonged COVID-19. The collective data suggests that prolonged COVID-19 adversely affects muscle mass, function, and QoL.5 Individuals with pulmonary disease and COVID-19 experience core muscle weakness and decreased static and dynamic balance, leading to fatigue and falls.6 Accordingly, it affects core stability.

Core stability (CS) is the lumbopelvic-hip complex’s core box and has the ability to maintain vertebral column balance and stability within normal motion, minimizing external displacement, and preserving core structural integrity.7 The core box is a three-dimensional structure with the transversus abdominis muscle in front, the paraspinal and gluteal muscles in back, the diaphragm in the top, and pelvic floor muscles in the bottom.8,9 A factor that complicates the contribution of these muscles to trunk control is their essential roles in respiration and continence. In chronic respiratory disease and during induced hypercapnia, postural activation of these muscles is impaired.10

A recent systematic review found that there is not much research on non-drug treatments for post-viral syndromes and COVID-19. The reviewers found randomized clinical trials that were done in 2021 that looked at music therapy, telerehabilitation, resistance therapy, and neuromodulation, but they did not look at all the symptoms experienced in these cases, focusing only on dyspnea, arthralgia, general pain, and quality of life.11 In this study, we addressed the effect of COVID-19 on core stability and introduced treatment exercises. Randomized control trials (RCTs) show Pilates offers significant benefits to enhance core muscle strength and alleviate discomfort compared to a lack of exercise.12 Pilates exercises have been shown to improve core muscle strength and have a positive effect on pain reduction. Moreover, it enhances the vital capacity and tidal volume of the lungs.13

Most physical therapy interventions during and after COVID-19 focused on respiratory and general fitness rehabilitation in severely infected elderly individuals rather than balance and endurance training, as reported in the following studies: Mayer et al demonstrated an 8-week program of aerobic exercise, strengthening exercises, diaphragmatic breathing techniques, and mindfulness training for the post-COVID-19 case and assessed the patient’s cognitive and emotional state.14 Cevei et al conducted robotic gait training, occupational therapy, and messages on six elderly individuals post-COVID-19, evaluating their activity and participation by the Barthel index and functional independence measure.15 Ponce-Campos et al looked at an indoor program of aerobic exercises for 4 weeks for people who had COVID.16 Mashhadi et al found that 8 weeks of respiratory exercises and core stabilization tele-exercise improved quality of life and functional capacity.17 A 10-week program using instrumental Pilates exercises with slow and controlled breathing exercises significantly improved heart rate variability (HRV) and respiratory parameters.13 So, the most important feature that distinguishes this study from other research is that it aimed to treat mild-to-moderately recovered infected cases in younger adults using Pilates exercises to improve core muscle endurance and balance.

Pilates is a comprehensive exercise technique that integrates mind and body, strengthens core muscles, and focuses on the posterior pelvic tilt, which is the conventional method of Pilates.18 It was developed by Joseph Pilates into contemporary Pilates and has evolved with modern scientific advancements to render it more suitable, effective, and secure for the involved individuals.19 There are six fundamental principles for Pilates training: centering, focus, control, precision, breath, and flow.20 They maintain neutral spinal alignment and engage deep abdominal and pelvic floor muscles through co-contraction.21 It was found that core muscle endurance, depression, and quality of life improved after pilates in online and face-to-face settings in healthy individuals during the COVID-19 pandemic.22

The scientific literature has focused primarily on severe COVID-19 cases, with limited understanding of patients with mild to moderate infections who have persistent musculoskeletal symptoms.23 Similarly, they have focused on physical therapy programs to improve quality of life, respiratory and pulmonary function, and functional capacity.24,25 There is no research and exercise program evaluating core stability and the effect of Pilates on core endurance and postural stability after COVID-19. Therefore, the purpose of this study was to evaluate the effect of Pilates exercises on core endurance and static balance of the trunk; accordingly, we hypothesized that there would be no effect of Pilates exercises on core endurance and static balance in participants recovering from COVID-19.

Materials and Methods

Study Design

This is a single randomized controlled trial conducted from December 26, 2021, to February 23, 2023, and it met the reporting requirements for randomized controlled trials.26 An independent assessor accompanied the randomization process. Computer-generated randomization was used to assign participants to two groups: the study group (Pilates) (41 females + 33 males) and the control group (43 females + 28 males). Allocation was performed using a sealed, opaque envelope.

Participants

A study was conducted on 145 COVID-19-infected students (both sexes) aged 19 to 26 from Jazan University. Participants were selected based on the following criteria: mild to moderate COVID-19 symptoms, a body mass index <25 kg/m2, and non-athletic. Participants were recruited through advertisements in social media groups and student bulletin boards, and we verified their medical status through the records of COVID-19 within the unified platform of the Ministry of Health (Sehhaty) in Saudi Arabia.

Any subject was excluded if they had severe COVID-19, chest pain or symptoms of heart failure, or cardiopulmonary, visual, vestibular, or central nervous system disorders;27 previous back or abdominal surgery; evidence of systemic or musculoskeletal disease within the previous six months;28 pregnancy and lower limb asymmetries; enrollment in another treatment program. Participants were informed of the potential risks and benefits of the study and signed a written informed consent form before the study began. The study was conducted according to the tenets of the Declaration of Helsinki, and the clinical trial registration number was NCT04871672. The ethical approval reference number (REC-43/03/036) was obtained from the Standing Committee for Scientific Research at Jazan University. The sample size was determined using G-Power software (Universities, Düsseldorf, Germany) with a power of 80%, a p-value of 0.05, and an effect size of 0.5. A sample size of 126 subjects was included in the study, and to compensate for the dropout rate, the sample was increased to 75 subjects in each group (Figure 1).

Figure 1 Consort flowchart.

Outcome Measures

Primary Outcome Measures

Core Endurance Test

Five core endurance tests were performed, in which the subject maintained a static position for as long as possible. The endurance tests are the abdominal fatigue test, the Sorensen back extension test, the prone plank test, and the right and left side plank tests.29 The investigator used a handheld digital stopwatch to time the trials in seconds, with the subjects receiving verbal instructions and visual examples.28 Participants were encouraged to give their best effort, and the order of the tests was randomized to eliminate order effects. In addition, an interval of approximately 10 seconds was maintained between consecutive tests to reduce the influence of fatigue on performance.30

Abdominal fatigue test (trunk flexor test): was performed with a 60° angle of flexion, a 90° knee and hip flexion, arms crossed over the chest, and the position was maintained as long as possible. The Sorensen test (trunk extensor test) was performed in a semi-prone position with the pelvis, hips, and knees fixed on a treatment table, the arms crossed over the chest, and a horizontal body position maintained for as long as possible. Side plank test: The participant assumed a sideways position on a mat, supporting the body weight with the lower elbows and feet while lifting the hips. The test was stopped when the side-lying position was lost or the hips returned to the mat.31 The Prone Plank Test: Participants assume a prone position on an elbow-supported mat, lifting their hips and torso on their forearms and toes while maintaining a straight position with their elbows under their shoulders.31

Secondary Outcome Measures

Static Balance Measurement

It is valid and accurate to use the Prokin System (Prokin-PK 212–252-TechnoBody-Italy) to check both static and dynamic balance by moving the force platform from the center of pressure (COP) movements to measure postural sway.32 A 5-minute warm-up of walking at a moderate speed (2.5–3 miles per hour) on the treadmill was performed prior to measurement. Participants using a Prokin device were instructed to look straight ahead at a screen with their arms at their sides and to focus on a stationary target. They performed two standing trials with eyes open and closed, each lasting 30 seconds. Four outcome variables were calculated in two conditions: perimeter (mm) and ellipse area (mm2) with eyes open (OE) and eyes closed (CE). The test was repeated twice, and the mean value was recorded.33

Perimeter (mm): measures chaotic lines during body sway, with good postural balance observed with shorter lines.34 Ellipse area (mm2): represents the area of body sway, elliptical in shape, covering at least 90% or 95% of the chaotic sway lines, with smaller areas resulting in better balance performance.35 Measurements were taken before and after three months of treatment.

Both outcomes were collected in the laboratories of the Physical Therapy Department, College of Applied Medical Sciences, Jizan University. An independent assessor collected data for the core endurance testing and static balance data. Both outcomes were measured in two separate, consecutive sessions to avoid participant fatigue.

Intervention

  1. The home exercise program included daily 15-minute breathing exercises, self-stretching activities targeting various muscles (pectoralis major, shoulder extensors, back muscles, hip flexors, hip adductors, and hamstring muscles), and 15 minutes of daily walking to improve overall physical health.
  2. Pilates exercise program: The Pilates exercise program lasted for three months and consisted of three weekly sessions. Each session lasted one hour. Each session began with 10 minutes of simple stretching movements to warm up, followed by 40 minutes of the main exercise routine, followed by 10 minutes of cool-down stretching. Participants were trained by a qualified practitioner, given step-by-step instructions, and taught the proper breathing techniques and spinal neutrality prior to the intervention. The program included five basic intermediate Pilates exercises: the mat hundred, roll-up, one-leg circle, rolling like a ball, and spine stretch. These exercises are suggested by Thompson et al and focus on voluntary activation of the deep abdominal muscles by pulling the navel toward the spine and combining the movement with breathing.36 CS was assessed by endurance testing after 12 sessions.37,38

The following are the descriptions of the Pilates exercises:

Mat-Hundred: The exercise involved lying on a mat with legs bent and feet flat on the floor. The participant inhales to engage the abdominal muscles, then lifts the head and shoulders off the mat with the eyes between the legs. Arms pump vigorously, lifting up and down no higher than the hips. The exercise was repeated 10 times with 5 inhales and 5 exhales for a total of 100.

Mat-Roll-Up: The participant positioned the legs parallel to the ground, flexed the legs, and extended the arms above the head. Focus on the gaze and position of the arms for a thorough examination. The action includes taking a deep breath, then rolling the body upward. Maintain the C-curve by exhaling forward and lifting the abdomen inward. Rolling shoulder blades down the back ensures the shoulders are relaxed and broad. Inhaling and maintaining the curvature of the spine by lowering the lower back towards the mat.

Mat-one-leg circle: The participant assumed supine, extended one leg vertically towards the ceiling, aligned both legs along the centerline, and secured arms, shoulder blades, pelvis, and head onto the mat. Create a circular shape with the toe, then cross a leg over the body and execute a circular motion below, around, and above. Roll down the shoulder blades while maintaining contact with the mat. Inhale during one cycle and exhale during the next.

Mat-Rolling Like a Ball: The participant demonstrated it by placing his hands crossed, keeping his heels firmly on the floor, and performing a forward curling motion. Then lifts his feet off the mat, keeping his heels close together and his toes slightly apart. Engaging the abdominal muscles, keep the chin lowered toward the chest, and inhale to initiate a backward rolling motion. Maintain a state of equilibrium while rolling up and looking down.

Mat-Spine Stretch: The student sat on his back, chin to chest, and extended his leg while imprinting his spine on the mat. He pressed his shoulder blade tips into the mat, drawing his belly in and up. He then lowered his leg to the ground, touching the calf three times. He inhaled to switch, and he exhaled to lower and touch.

Statistical Analysis

A histogram, drawing box plot, mean, standard deviation, and Shapiro–Wilk test were employed to examine the homogeneity of the observed results. The distribution of all assessed variables (core endurance tests, Prokin indices) showed a parametric distribution. In order to distinguish between and within the measured outcomes, a two-way mixed model MANOVA was employed. The demographic information of the individuals was compared using the unpaired t–test, and the nominal data were compared using the chi-square test. Mean and standard deviation were used to represent quantitative data, and numbers and percentages were used for nominal data. An alpha level of 0.05 or less was set as a significance level. SPSS version 20 was used for all statistical computations.

Results

This study included a total of 145 undergraduate students, consisting of 84 females and 61 males. Figure 1 presents the study flowchart. Table 1 displays the demographic characteristics of the participants. Findings revealed no statistically significant difference between the two groups regarding age, weight, height, BMI, or sex, and the baseline values of the measured outcomes (p ˃ 0.05), as displayed in Tables 1–3.

Table 1 Demographic and Clinical Characteristics of Both Groups

Table 2 Within and Between Groups, Comparisons of the Primary Outcome Measures (Core Endurance Tests)

Table 3 Within and Between Groups, Comparisons of the Secondary Outcome Measures (Prokin System Variables)

After 3 months of exercise, the within-group comparison revealed a significant difference in both the Pilates and control groups in all the tested outcomes (p<0.001). Comparison between groups exhibited an improvement that favored the Pilates group regarding the core endurance tests (p < 0.05), Prokin balance indices OE_Perimeter, OE_Perimeter, and OE_ Ellipse area (p < 0.001); however, there is no difference regarding CE_ Ellipse area (p = 0.062), as shown in Tables 2 and 3.

Discussion

To the best of our knowledge, this is the first study that has been conducted to investigate the effect of pilates exercise on core endurance and static balance after recovery from COVID-19. A 12-week Pilates exercise program showed positive results for core endurance and static balance; therefore, we rejected our null hypothesis regarding the effects of Pilates exercises on core endurance and static balance. For all participants, the baseline scores of the five core endurance tests performed were well below the normal average means, indicating the weakness of the core muscles of the participants included in the study. We used the normal average means from McGill et al for the trunk flexor, trunk extensor, and right and left side plank tests as guides in our study because the characteristics of their sample were similar to ours.29 For the prone plank test, we used the normal values from Strand et al.39 In the Pilates group, the post-scores on the core endurance tests increased by almost twice the pre-training score compared to the control group.

The core endurance improvement could be attributed to that Pilates exercises improve pulmonary function and capacity by engaging the respiratory muscles,40 increasing oxygen delivery to skeletal muscles. Moreover, enhancement of trunk proprioception and trunk control give another clarification of the effect of Pilates training on core endurance, particularly the effect on the local core muscles, which play an important role in improving movement quality, postural balance,41 and neuromuscular efficiency and consequently improve proximal stability.42

Pilates exercises increase the thickness of the transverse abdominis (TrA), internal and external oblique, pelvic floor, and multifidus muscles, as confirmed through ultrasound evaluation after the application of pilates exercises.43,44 These play a key role in trunk stability. In addition, Pilates exercises increase core muscle contraction and intra-abdominal pressure, stabilizing the lumbar spine and pelvis.45,46 This finding was confirmed recently by the Tsartsapakis et al.45 They found that Pilates exercises significantly improved overall TrA thickness and activation in 44 healthy young and middle-aged women, particularly in young women aged 25–35 years. Moreover, the current results are supported by previous studies examining the greatest effects of core stability exercises and Pilates on TrA activation.47–50

Pilates exercises also improve neutral spinal alignment, co-contraction of the pelvic floor and deep abdominal muscles,21 and awareness and coordination of the TrA,45 as supported by a systematic review and meta-analysis that concluded that Pilates exercises performed for 5 to 12 weeks in healthy individuals, showing improved activation of core muscle endurance in both sexes,51 despite being conducted on healthy individuals.

The improvement in core muscle endurance was verified by the Lee study, which analyzed 16 experienced Pilates practitioners and 16 non-experienced subjects using 3D motion analysis. He found that experienced subjects had stronger abdominal and lower back core muscles and better trunk and pelvic stability, with a moderate correlation between experience and core stability.42

The Pilates group showed better static core balance than the control group, as indicated by a significant decrease in perimeter with OE and CE and ellipse area with CE compared to the control group. The decrease in perimeter and ellipse area was higher in OE than CE due to visual information improving the brain’s motor program and replacing the loss of somatosensory function.52

The Prokin system is a valid instrument that was used for evaluation of balance after balance training in people with white matter lesions,33 and stroke patients.53 Their results showed decreased parameters in perimeter and ellipse areas after 2 to 3 weeks of training.

The present results come in agreement with a study that examined the effect of Pilates mat exercise for 12 weeks on static and dynamic balance posture in 20 Korean high school archers using the Humac Norm Balance System. Dividing participants into exercise and control groups showed that only the exercise group showed improvement in both balance postures.38

Previous studies investigated the effect of Pilates mat exercises on pulmonary function and quality of life in COVID-19 patients; recently, Bagherzadeh-Rahmani et al conducted a study on the impact of Pilates and aqua Pilates training on COVID-19 patients, revealing significant improvements in pulmonary function and quality of life, attributing this effect to Pilates’ impact on core muscle endurance and balance.54 Moreover, a recent systematic review conducted on multiple sclerosis patients reported that Pilates exercise improves core stabilization, balance, gait, muscle strength, and aerobic capacity.55

The results of this study provide evidence of decreased core stability as a result of COVID-19 and support what other studies have found about the effects of Pilates. Our study is valuable and has many strengths: the sample size was sufficient to represent the study population; we used an easily clinically applicable and reliable method to assess core endurance using the five core endurance tests; and we used an objective, reliable method for static balance testing. The treatment program of this study lasted for a 12-week period, demonstrating its importance and practical implications in the evaluation and treatment of core muscle endurance and static balance in cases of post-COVID-19 infection. However, there are certain limitations to this study: first, it was not possible to blind the participants; second, it focused on examining only two aspects of core stability (endurance and balance); and third, it did not examine long-term follow-up after Pilates training was discontinued.

Conclusion

The study confirmed the decreased core muscular endurance after recovery from COVID-19 and showed that adding Pilates training to home exercises significantly improved core stability, endurance, and static balance in post-COVID-19 cases.

Data Sharing Statement

The research study’s dataset is not publicly accessible, but can be obtained from the author upon formal request.

Acknowledgments

We are grateful to the students who have recovered from COVID-19 for their participation in this study.

Funding

The study received no specific financial support from public, commercial, or non-profit funding bodies.

Disclosure

The authors report no conflicts of interest in this work.

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