Reviewing fair subject selection considerations for the unique case of post sequelae COVID-19 translational studies.

Fair inclusion of research subjects is necessary to ensure that post-acute sequelae COVID-19 (PASC) research results benefit all members of society. Scientists should conduct research on a broad sample of individuals who represent clinically relevant factors influencing a disease. Without demographic diversity and sociological and environmental variability, research outputs are less likely to apply to different populations and would thus increase health disparities. The goal of this narrative literature review and ethical analysis is to apply fair selection criteria to PASC research studies. We briefly highlight the importance of fair subject selection in translational research and then identify features of PASC, as well as PASC research, that hinder fair inclusion of research participants. We will demonstrate that determining an adequate and representative sample is not simply a matter of ensuring greater diversity; rather, fairness requires a broader evaluation of risks, burdens, and benefits specific to underrepresented populations. We provide recommendations to ensure fair subject selection in PASC research and promote translation toward positive health outcomes for all individuals, including the most vulnerable.

Pulmonary Rehabilitation and Its Role in Long-Term COVID-19 Recovery

Coronavirus - 2019 (COVID-19)-a respiratory syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2)-is responsible for the world's latest pandemic unlike any seen since the 1980s HIV/AIDs pandemic. While significant effort has been made towards acute management, long-term management has received less attention. To address this, our study identified patients diagnosed with COVID-19 and recorded the time to enrollment into a formal pulmonary rehabilitation program at an academic center;the differences in time allowed us to assess whether earlier enrollment led to differences in physiologic and psychologic outcomes. First, we hypothesize that enrollment into a pulmonary rehabilitation program is essential to a patient's long term treatment and management of post-infectious, chronic COVID-19 symptoms. Second, we aim to demonstrate that early participation leads to improvements in dyspnea, anxiety and depression as supported by the UCSD SOBQ, GAD-7 and PHQ-9 scores respectively. Through chart review, we collected data from 24 patients enrolled in a post-COVID recovery program centered around pulmonary rehabilitation at an academic medical center in Texas. We administered: (1) pulmonary function test (PFT);(2) University of California - San Diego (UCSD) Dyspnea Questionnaire;and (3) six-minute walk (6MW) tests when a patient entered and completed the program. We used this data to assess for subjective and objective changes in respiratory function postrehabilitation. To analyze the indirect benefits of pulmonary rehabilitation on mental health effects of COVID-19, we used the Generalized Anxiety Disorder 7 (GAD7) and Patient Health Questionnaire (PHQ9) questionnaires to evaluate a patients' anxiety and depression respectively at the same time points. Our results showed that it took patients an average 67.8 days to initiate rehabilitation after initial diagnosis. 13 of 24 patients began rehab earlier than the average and had an average decrease in UCSD SOBQ score of 35.6 and 6MW increase of 64.5 m compared to the group averages of 17.8 and 74.7 m respectively. The average initial GAD7 and PHQ9 scores were 6.7 and 8.7, with an average decrease of 1.5 and 2.2 respectively. Through our study, we highlight the benefit of early initiation of pulmonary rehabilitation in the post-COVID 19 recovery period. Through both subjective and objective measurements of patient respiratory function and mental health, our study supports inclusion and standardization of early pulmonary rehabilitation as a component of COVID-19 recovery.