BackgroundThe long term adverse effects of Severe Acute Respiratory Syndrome (SARS), a viral disease, are poorly understood.MethodsSleep physiology, somatic and mood symptoms of 22 Toronto subjects, 21 of whom were healthcare workers, (19 females, 3 males, mean age 46.29 yrs.+/- 11.02) who remained unable to return to their former occupation (mean 19.8 months, range: 13 to 36 months following SARS) were compared to 7 healthy female subjects. Because of their clinical similarities to patients with fibromyalgia syndrome (FMS) these post-SARS subjects were similarly compared to 21 drug free female patients, (mean age 42.4 +/- 11.8 yrs.) who fulfilled criteria for fibromyalgia.ResultsChronic post-SARS is characterized by persistent fatigue, diffuse myalgia, weakness, depression, and nonrestorative sleep with associated REM-related apneas/hypopneas, an elevated sleep EEG cyclical alternating pattern, and alpha EEG sleep anomaly. Post- SARS patients had symptoms of pre and post-sleep fatigue and post sleep sleepiness that were similar to the symptoms of patients with FMS, and similar to symptoms of patients with chronic fatigue syndrome. Both post-SARS and FMS groups had sleep instability as indicated by the high sleep EEG cyclical alternating pattern rate. The post-SARS group had a lower rating of the alpha EEG sleep anomaly as compared to the FMS patients. The post-SARS group also reported less pre-sleep and post-sleep musculoskeletal pain symptoms.ConclusionsThe clinical and sleep features of chronic post-SARS form a syndrome of chronic fatigue, pain, weakness, depression and sleep disturbance, which overlaps with the clinical and sleep features of FMS and chronic fatigue syndrome.

With improved survival rates in solid organ transplantation there has been an increased focus on long‐term outcomes following transplant, including physical function, health‐related quality‐of‐life and cardiovascular mortality. Exercise training has the potential to affect these outcomes, however, research on the optimal timing, type, dose of exercise, mode of delivery and relevant outcomes is limited. This article provides a summary of a 2‐day meeting held in April 2013 (Toronto, Canada) in which a multi‐disciplinary group of clinicians, researchers, administrators and patient representatives engaged in knowledge exchange and discussion of key issues in exercise in solid organ transplant (SOT). The outcomes from the meeting were the development of top research priorities and a research agenda for exercise in SOT, which included the need for larger scale, multi‐center intervention studies, development of standardized outcomes for physical function and surrogate measures for clinical trials, examining novel modes of exercise delivery and novel outcomes from exercise training studies such as immunity, infection, cognition and economic outcomes. The development and dissemination of “expert consensus guidelines,” synthesizing both the best available evidence and expert opinion was prioritized as a key step toward improving program delivery.

Objective: To determine the outcomes in solid organ transplant recipients following inpatient rehabilitation, as a result of a unique partnership between the rehabilitation hospital and the multiorgan transplant program in an acute hospital. Design: Retrospective observational study. Setting: Community rehabilitation hospital affiliated with a university. Participants: A cohort of 173 organ transplant patients admitted consecutively over a four-year period (2004-2008) was compared to a cohort of all rehabilitation patients (n = 9762) admitted to the same inpatient rehab facility during the same period. Interventions: Inpatient rehab program to all participants. Main Outcome Measures: Length of hospital stay, Functional Independence Measure (FIM ™) change (admission-discharge), and rate of discharges to home. Results: Outcomes were measured using components of the FIM ™ instrument, admission and discharge data. Chi-square and independent two-sample t-tests were used for statistical analysis. Compared to a general rehabilitation inpatient population, transplant rehabilitation inpatients had: more immediate (<3 days) transfers to an acute hospital (5.2% vs. 1.9%, p < 0.001); a higher rate of readmission to an acute hospital after the first 3 days (19.1% vs. 1.9%, p < 0.001); a longer mean length of stay (27 ± 19 vs. 20 ± 18 days, p < 0.001); a lower total FIM ™ change (8.9 vs. 20.9, p < 0.001); a lower FIM ™ efficiency (1.1 vs. 1.4, p < 0.001); and a higher rate of discharges to home in patients not readmitted to acute care (98.5% vs. 94.5% p < 0.001). Conclusion: Outcomes of rehabilitation in solid organ transplant patients are comparable but not identical to those in other patient groups. Inpatient rehabilitation for transplant patients is therefore fully justifiable and necessary. The ten times higher rate of transplant patient readmission to acute hospital must be communicated, facilitated, accepted and managed within a partnership strategy.

The Severe Acute Respiratory Syndrome (SARS) epidemic of 2003 was highly concentrated in health care settings and resulted in a high number of health care workers (HCWs) contracting the disease. The SARS epidemic has improved our understanding of how trauma impacts frontline HCWs who serve as first responders during an infectious disease outbreak. However, our insight into the trajectory of frontline HCWs' morbidity posttrauma continues to be limited, as the majority of the previous work has focused on the short-term or immediate impact of SARS on HCWs, with only a few studies dedicated to the evaluation of its long-term or sustained impact. Previous research into the long-term impact of SARS on HCWs spans 1-3 years postoutbreak. The present study extends previous research by examining HCWs up to 7 years postoutbreak. More specifically, frontline HCWs who contracted and survived SARS were evaluated at 1 year ( 2004), 4 years ( 2007), and 7 years (2010) postoutbreak by using a within-participants design. Across all three time points, frontline HCWs showed a lack of abatement in clinically significant levels of depression, anxiety, and posttraumatic stress disorder (PTSD) symptomatology. In addition, HCWs reported below average and persistent functional outcomes, such as problems with pain, reduced vitality, and reductions in physical, mental, and social functioning. Finally, we report on the particular psychiatric variables from 1 year postoutbreak that are significantly associated with functional debility at 4 and 7 years postoutbreak. Findings of this study underscore the importance of understanding the long-term sequelae of infectious disease outbreaks on frontline HCWs, in order to decrease the likelihood of chronic adverse outcomes in this population. This information is especially relevant now, given the current global outbreak of Coronavirus disease 2019 . Public Significance StatementThe present study is one of a few studies that has thus far examined the long-term impact of an infectious disease outbreak on frontline healthcare workers. A group of Canadian frontline healthcare workers who contracted and survived SARS were evaluated at 1 year (2004), 4 years (2007), and 7 years (2010) postoutbreak. Across all three time points, frontline healthcare workers reported clinically significant levels of anxiety, depression, and PTSD symptomatology, in addition to adverse functional outcomes.

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and Lay Abstract Is “Long Covid” similar to “Long SARS” (Severe Acute Respiratory Syndrome)? In 2019, a new pandemic started, and is still ongoing. The causative virus is the only known close relative of the SARS coronavirus (SARS-CoV-1), and is accordingly called SARS-CoV-2. Follow-up for between 2 and 10 years of 50 post SARS patients in a rehabilitation setting led to publications and clinical impressions that are summarized here regarding significant permanent disability for some of these patients. Similarities between permanent symptoms post SARS, and the reported so-far unresolving symptoms of Long Covid are remarkable. This makes it possible to predict that some Long Covid symptoms will be permanent.

Objective: Severe acute respiratory syndrome (SARS) is a highly contagious viral respiratory illness associated with hypoxia and dyspnea. Many of those who contracted and recovered from SARS during the 2002–2003 outbreak reported persistent physical, psychological, and cognitive difficulties. Here, we investigated the residual influences of SARS on cognition for a subset of healthcare professionals who recovered and were referred for neuropsychological evaluation through their workplace insurance. Method: Twenty-eight healthcare professionals were evaluated on neuropsychological and mood functioning approximately 1.5 years post-recovery from a severe respiratory illness. Test scores were compared with age-matched normative data, and correlations were examined between mood, self-report memory scales, subjective complaints (e.g., poor concentration, pain, fatigue), illness severity (i.e., length of hospitalization, oxygen use during hospital stay), and cognitive performance. Results: Participants performed within age expectations on the majority of cognitive measures including overall memory ability. Although processing speed was generally within normal limits, 43% showed significant speed–accuracy trade-offs favoring accuracy over maintaining speed. Deficits were observed on measures of complex attention, such as working memory and the ability to sustain attention under conditions of distraction. Participants endorsed poorer memory ability than same-age peers on a meta-memory measure and mild to moderate depression and anxiety symptoms. Objective test performance was largely uncorrelated with self-reports, mood, or illness severity, except for moderate correlations between complex attention and participants’ subjective ratings of Everyday Task-Oriented Memory. Conclusions: These findings demonstrate specific long-term cognitive deficits associated with SARS and provide further evidence of the cognitive effects of hypoxic illnesses.

Introduction: Outpatient exercise training has been shown to be beneficial for solid organ transplant recipients. Little is known about the effects of inpatient rehabilitation programs for recipients with a more complicated postoperative course. Research Question: This study was designed to (1) describe the changes in functional outcomes after an inpatient rehabilitation program, and (2) determine whether the changes in lower body strength and quadriceps strength are associated with changes in functional exercise capacity. Design: This was a single-arm prospective longitudinal study. The recipients participated in an inpatient rehabilitation program twice a day, 7 days a week for 3 to 4 weeks. Outcome Measures Included: 2-Minute Walking Test, Timed Up and Go, Berg Balance Scale, 30-Second Sit to Stand, biceps and quadriceps strength, Functional Independence Measure, SF-36, and Canadian Occupational Performance Measure. Results: Twenty-eight patients (54% female, mean age = 55 [11]) completed the study. Participants were mostly liver (42%) and lung recipients (35%). There were statistically significant improvements in all outcomes after the intervention. There was no relationship between changes in functional exercise capacity and quadriceps strength or lower body strength. Conclusion: An inpatient rehabilitation program may improve several functional outcomes and health-related quality of life in transplant recipients with a complicated postoperative course.