Procedural Motor Learning in Long COVID

Background: Early in the Covid pandemic, reports started to emerge of patients with lingering symptoms following recovery from acute infection, so called Long Covid (Miners, 2020;Nath, 2020;Troyer, 2020). Despite the high prevalence of neurological symptoms like brain fog and memory dysfunction (Davis, 2020), most research has relied on surveys or clinical tools typically used to assess declarative memory (Alemanno, 2021;Mendez 2021;Taquet, 2021). To our knowledge, no studies have examined Long Covid patients' ability to learn and consolidate a procedural motor skill. Method(s): We addressed this question in a group of 108 patients with Long Covid and 108 age-and sex-matched controls. Participants performed a well-characterized motor sequence typing task alternating 10-second practice with 10-second rest for 36 trials over 12 minutes (Bonstrup, 2020;Bonstrup, 2019;Buch, 2021). The following day, performance was tested to evaluate overnight consolidation. The behavioral endpoint measure was correct sequence typing speed (Buch, 2021) . Data were fitted to a 3-parameter model (initial performance, maximum performance, learning rate). Simple reaction times (RT) were measured twice: at the beginning and the end of the experimental session. Result(s): On average, patients had experienced 50 weeks of symptoms at time of testing. Long Covid patients' typing speed was slower than healthy controls at the beginning of the session (p=0.00075). While learning rates were comparable across groups (p=0.142), at the end of training Long Covid patients had not reached the same performance level as controls (p=0.046). Overnight consolidation was not statistically different between groups (p=0.58). Fourteen patients were hospitalized during their acute infection;they did not perform differently to patients who were not hospitalized. There were no sex differences when comparing healthy, long covid or combined groups. Pre-task RT was slower in Long Covid patients than in healthy controls (Covid 373+/-131ms, controls 317+/-43ms) but did not predict initial or final typing speed, nor learning rate in either group. Post-task RT was also faster in both groups, marginally more so in patients (Covid 353+/-117ms, controls 314+/-51ms). Conclusion(s): Long Covid patients exhibited slower starting performance. While they learned the skill at about the same pace, they failed to reach the same typing speed as healthy controls by the end of the task. Reaction times, here used as a measure of attention, did not exhibit a direct link with learning metrics.

Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme.

INTRODUCTION: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation. OBJECTIVES: The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program. METHODS: The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019). RESULTS: During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years. CONCLUSIONS: Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.

Impact of the COVID-19 pandemic in the cancer fast-track programme

Background: The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly in making timely cancer diagnosis. Our public health system has been concerned about potential delays leading to a higher proportion of patients with advanced stages. Our cancer diagnosis fast-track program (CFP) in the Clinic-Malvarrosa Health department in Valencia (Spain) is connecting primary care (PC) with different specialists to speed cancer diagnosis and treatment upon well founded suspicion. A 10-year evaluation of our CFP has recently been published. The aim of this analysis was to investigate the impact of the COVID-19 pandemic on the CFP. Methods: We analysed the programme flow during the state of emergency starting on March 16, 2020 for one year. Results: During that year, 975 suspected cancer cases were submitted to the CFP. The submissions only decreased during the times of highest COVID-19 incidence and stricter lockdown (March, April and October 2020). However, referrals were slightly higher than in the two previous years (average 877). Of those 975 patients, 817 were seen by the corresponding specialist. A cancer diagnosis was confirmed in 197 (24.1%) with 33% urological, 23% breast, 16% gastrointestinal and 9% lung cancer. Median time from referral to the specialist visit was 13 (interquartile range, 8 to 22 days) days and a diagnosis was reached in a median of 18 days (interquartile range, 10 to 30 days). In cancer patients, treatment was started in around 30 days (interquartile range, 13.5 to 51 days) from the time of diagnosis. Sixty-one percent of cancers were found in an early stage, 20% in a locally advanced stage, and 19% in an advanced stage. These intervals and proportions were similar to the previous years. Conclusions: Our programme has proven to be a reliable tool to help PC physicians referring patients with cancer suspicion cancer, maintaining its normal flow and efficacy despite the current pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.