Long COVID: mechanisms, risk factors and recovery

Astin, Rónan; Banerjee, Amitava; Baker, Mark R.; Dani, Melanie; Ford, Elizabeth; Hull, James H.; Lim, Phang Boon; McNarry, Melitta A.; Morten, Karl; O’Sullivan, Oliver; Pretorius, Etheresia; Raman, Betty; Soteropoulos, Demetris S.; Taquet, Maxime; Hall, Catherine N.

doi:10.1113/ep090802

Cited by 121 publications

(114 citation statements)

References 148 publications

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“…Duly supporting all aspects of a healthy lifestyle, regardless of whether their clients have had COVID disease or not, making sure they have exposure to fresh air and some form of vitamin D, plus anti inflammatory and muscle, possible respiratory muscle training, along with bone building foods, social support, and counseling are likely to prove especially helpful and should be further investigated. 50 Researchers too can greatly help by conducting more well delineated case control and prospective studies, as well as expanding their assessment procedures in efforts to accurately identify future health care needs using sound research design approaches, careful sub group analyses, and high technology for diagnosing or uncovering any preventable health determinants or correlates. Efforts too to develop more standardized assessment and evaluation procedures are strongly indicated.…”

Section: Discussionmentioning

confidence: 99%

Aging and long COVID-19 syndrome: what’s new in 2023?

Marks¹

2023

MOJGG

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Since 2019 that saw the onset of the COVID-19 pandemic, its ongoing impact on many older adults remains a persistent public health concern, especially among those who report suffering from long or post-acute COVID-19 disease health challenges. This report presents data published largely since January 1 2023 on this topic and concerning: Long COVID or COVID-19, Older Adults, Post-Acute COVID-19 Outcomes, and Prevention. Data show that even though long COVID-19 was discussed in 2021 at some length, it still remains a relatively unchartered poorly understood topic in which a sizeable percentage of older adult COVID-19 survivors may experience delayed features of breathing, movement, cognitive and mental health challenges. What causes the observed and perceived problems, what may help to identify who is at risk, and what will reduce these remains unknown, but may benefit from insightful research and extended observations and possible.

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Section: Discussionmentioning

confidence: 99%

Aging and long COVID-19 syndrome: what’s new in 2023?

Marks¹

2023

MOJGG

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“…Alterations in cellular energy metabolism from aberrant mitochondrial function may result in insufficient ATP generation (248,249). Proinflammatory cytokines and OS potentiate the mitochondrial dysfunction in ME/CFS, resulting in glucose hypometabolism and decreased ATP (125).…”

Section: Bioenergetic Abnormalitiesmentioning

confidence: 99%

A review of cytokine-based pathophysiology of Long COVID symptoms

Low¹,

Low

Akrami

2023

Front. Med.

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The Long COVID/Post Acute Sequelae of COVID-19 (PASC) group includes patients with initial mild-to-moderate symptoms during the acute phase of the illness, in whom recovery is prolonged, or new symptoms are developed over months. Here, we propose a description of the pathophysiology of the Long COVID presentation based on inflammatory cytokine cascades and the p38 MAP kinase signaling pathways that regulate cytokine production. In this model, the SARS-CoV-2 viral infection is hypothesized to trigger a dysregulated peripheral immune system activation with subsequent cytokine release. Chronic low-grade inflammation leads to dysregulated brain microglia with an exaggerated release of central cytokines, producing neuroinflammation. Immunothrombosis linked to chronic inflammation with microclot formation leads to decreased tissue perfusion and ischemia. Intermittent fatigue, Post Exertional Malaise (PEM), CNS symptoms with “brain fog,” arthralgias, paresthesias, dysautonomia, and GI and ophthalmic problems can consequently arise as result of the elevated peripheral and central cytokines. There are abundant similarities between symptoms in Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). DNA polymorphisms and viral-induced epigenetic changes to cytokine gene expression may lead to chronic inflammation in Long COVID patients, predisposing some to develop autoimmunity, which may be the gateway to ME/CFS.

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“…Recently, a virtual meeting of the Physiological Society (U.K.), held in February 2022 and published in January 2023, brought together clinicians and researchers to take stock of risk factors, therapies, and recovery deadlines for long COVID-19 sufferers, highlighting some important aspects of this pathology. A first consideration that can be made is that long COVID-19 research has been most effective in those populations that routinely monitor their physical performance, namely, military and elite athletes [ 12 ]. The results obtained on these subjects significantly highlight the success of the anti-long COVID-19 strategies implemented.…”

Section: Introductionmentioning

confidence: 99%

“…Since the most prominent symptom of ME/CFS is significant difficulty in performing even very mildly loaded exercise, the use of exercise therapy has been attempted in recent decades to try to alleviate this problem [ 17 ]. The only effective strategy related to physical activity in ME/CFS patients is so-called pacing, a limitation of both physical and metabolic activities [ 12 , 13 ]. At some extent, long COVID-19 and ME/CFS show an overlap of symptoms [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Physical Activity Effects on Muscle Fatigue in Sport in Active Adults with Long COVID-19: An Observational Study

et al. 2023

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Long COVID-19-related changes in physiology includes alterations in performing muscle work as fatigue. Data available do not allow us to define the usefulness of physical activity to attenuate long COVID-19 functional modifications. The present observational study investigates the effects of physical activity on the perception of fatigue, maximum power output, sleep, and cognitive modifications in subjects affected by long COVID-19, distinguishing between active and sedentary subjects. The data demonstrated the following: the perception of fatigue 1 year after the end of virus positivity was significantly reduced with respect to that observed after 6 months by more than 50% more in active subjects compared to sedentary ones; 6 months after the end of virus positivity, the force developed by active subjects was reduced (RM factor: p < 0.001, η2p = 0.527, post hoc: p < 0.001), but the reduction was more pronounced in sedentary ones (mean difference = 38.499 W); poor sleep quality and mild cognitive impairment were assessed in both active and sedentary subjects. In conclusion, the study suggests that the long COVID-19 fatigue was lower in active subjects respect to sedentary ones. A comparative analysis performed due to the overlap of functional alterations between long COVID-19 and ME/CFS showed that in a small percentage of the enrolled subjects (8%), the symptomatology reflected that of ME/CFS and was independent of the individual physical capacities.

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Long COVID: mechanisms, risk factors and recovery

Cited by 121 publications

References 148 publications

Aging and long COVID-19 syndrome: what’s new in 2023?

Aging and long COVID-19 syndrome: what’s new in 2023?

A review of cytokine-based pathophysiology of Long COVID symptoms

Physical Activity Effects on Muscle Fatigue in Sport in Active Adults with Long COVID-19: An Observational Study

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