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; Morten, Karl; O'Sullivan, Oliver; Pretorius, Etheresia; Raman, Betty; Soteropoulos, Demetris S.; Taquet, Maxime; Hall, Catherine N.

doi:10.1113/ep090802

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Long COVID: mechanisms, risk factors and recovery

Rónan Astin, Amitava Banerjee, Mark R. Baker, Melanie Dani, Elizabeth Ford, James H. Hull, Phang Boon Lim, Melitta McNarry

, Karl Morten, Oliver O'Sullivan

, Etheresia Pretorius, Betty Raman, Demetris S. Soteropoulos, Maxime Taquet, Catherine N. Hall

Experimental Physiology, Volume: 108, Issue: 1, Pages: 12 - 27

Swansea University Author: Melitta McNarry

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DOI (Published version): 10.1113/ep090802

Abstract

Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss current understa...

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Published in:	Experimental Physiology
ISSN:	0958-0670 1469-445X
Published:	Wiley 2023
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URI:	https://cronfa.swan.ac.uk/Record/cronfa62011
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The nature and impact of dysautonomia are further discussed in relation to Postural Orthostatic Tachycardia Syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagal nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. 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spelling	2023-01-25T13:46:13.5570081 v2 62011 2022-11-23 Long COVID: mechanisms, risk factors and recovery 062f5697ff59f004bc8c713955988398 0000-0003-0813-7477 Melitta McNarry Melitta McNarry true false 2022-11-23 STSC Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss current understanding of long COVID mechanisms, risk factors and recovery. This review highlights the themes arising from that meeting. It considers the nature of long COVID, exploring its links with other post-viral illness such as myalgic encephalolmyelitis/ chronic fatigue syndrome, and highlighting how long COVID research can help us better support those suffering from all post-viral syndromes. Long COVID research started particularly swiftly in populations routinely monitoring their physical performance - namely the military and elite athletes. The review highlights how the high degree of diagnosis, intervention and monitoring of success in these active populations can suggest management strategies for the wider population. We then consider how a key component of performance monitoring in active populations, cardiopulmonary exercise training, has revealed long COVID-related changes in physiology – including alterations in peripheral muscle function, ventilatory inefficiency, and autonomic dysfunction. The nature and impact of dysautonomia are further discussed in relation to Postural Orthostatic Tachycardia Syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagal nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. Overall, this review showcases how physiology research reveals the changes that occur in long COVID and how different therapeutic strategies are being developed and tested to combat this condition. Journal Article Experimental Physiology 108 1 12 27 Wiley 0958-0670 1469-445X cardiovascular, coagulation, dysautonomia, fatigue, long COVID, ME/CFS, respiratory, SARS-CoV-2 1 1 2023 2023-01-01 10.1113/ep090802 COLLEGE NANME Sport and Exercise Sciences COLLEGE CODE STSC Swansea University National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre National Institute for Health Research. Grant Numbers: NIHR200937, COV-LT2-0043 UK Research and Innovation. Grant Number: KTP 11678 NIHR Applied Research Collaboration Kent, Surrey and Sussex Welsh Government Sêr Cymru III. Grant Number: MA/KW/1457/20 The Higher Education Funding Council for Wales Research Wales Innovation Fund. Grant Numbers: FF4, ID 101390, ID 20045, ID 125132 NRF of South Africa. Grant Number: 142142 SA MRC BHF Oxford Centre of Research Excellence. Grant Number: RE/18/3/34214 NIHR Oxford BRC British Medical Association AstraZeneca European Union (Innovative Medicines Initiative). Grant Number: 116074 ME Association MRC. Grant Numbers: MR/S026495/1, MR/V036750/1 2023-01-25T13:46:13.5570081 2022-11-23T13:42:12.7151415 Faculty of Science and Engineering School of Engineering and Applied Sciences - Sport and Exercise Sciences Rónan Astin 1 Amitava Banerjee 2 Mark R. Baker 3 Melanie Dani 4 Elizabeth Ford 5 James H. Hull 6 Phang Boon Lim 7 Melitta McNarry 0000-0003-0813-7477 8 Karl Morten 9 Oliver O'Sullivan 0000-0002-9184-4713 10 Etheresia Pretorius 11 Betty Raman 12 Demetris S. Soteropoulos 13 Maxime Taquet 14 Catherine N. Hall 0000-0002-2316-7714 15 62011__26086__a322d10f19f74d6abec639386c233dc3.pdf 62011.pdf 2022-12-15T12:53:05.6204241 Output 689410 application/pdf Version of Record true © 2022 The Authors. This is an open access article under the terms of the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title	Long COVID: mechanisms, risk factors and recovery
spellingShingle	Long COVID: mechanisms, risk factors and recovery Melitta McNarry
title_short	Long COVID: mechanisms, risk factors and recovery
title_full	Long COVID: mechanisms, risk factors and recovery
title_fullStr	Long COVID: mechanisms, risk factors and recovery
title_full_unstemmed	Long COVID: mechanisms, risk factors and recovery
title_sort	Long COVID: mechanisms, risk factors and recovery
author_id_str_mv	062f5697ff59f004bc8c713955988398
author_id_fullname_str_mv	062f5697ff59f004bc8c713955988398_***_Melitta McNarry
author	Melitta McNarry
author2	Rónan Astin Amitava Banerjee Mark R. Baker Melanie Dani Elizabeth Ford James H. Hull Phang Boon Lim Melitta McNarry Karl Morten Oliver O'Sullivan Etheresia Pretorius Betty Raman Demetris S. Soteropoulos Maxime Taquet Catherine N. Hall
format	Journal article
container_title	Experimental Physiology
container_volume	108
container_issue	1
container_start_page	12
publishDate	2023
institution	Swansea University
issn	0958-0670 1469-445X
doi_str_mv	10.1113/ep090802
publisher	Wiley
college_str	Faculty of Science and Engineering
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hierarchy_parent_id	facultyofscienceandengineering
hierarchy_parent_title	Faculty of Science and Engineering
department_str	School of Engineering and Applied Sciences - Sport and Exercise Sciences{{{_:::_}}}Faculty of Science and Engineering{{{_:::_}}}School of Engineering and Applied Sciences - Sport and Exercise Sciences
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description	Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss current understanding of long COVID mechanisms, risk factors and recovery. This review highlights the themes arising from that meeting. It considers the nature of long COVID, exploring its links with other post-viral illness such as myalgic encephalolmyelitis/ chronic fatigue syndrome, and highlighting how long COVID research can help us better support those suffering from all post-viral syndromes. Long COVID research started particularly swiftly in populations routinely monitoring their physical performance - namely the military and elite athletes. The review highlights how the high degree of diagnosis, intervention and monitoring of success in these active populations can suggest management strategies for the wider population. We then consider how a key component of performance monitoring in active populations, cardiopulmonary exercise training, has revealed long COVID-related changes in physiology – including alterations in peripheral muscle function, ventilatory inefficiency, and autonomic dysfunction. The nature and impact of dysautonomia are further discussed in relation to Postural Orthostatic Tachycardia Syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagal nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. Overall, this review showcases how physiology research reveals the changes that occur in long COVID and how different therapeutic strategies are being developed and tested to combat this condition.
published_date	2023-01-01T04:21:17Z
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Long COVID: mechanisms, risk factors and recovery

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