ABSTRACT
Background: The morbidity associated with recovery from COVID-19 is huge with apparent persisting respiratory limitation. Aims and objectives: We investigate the persisting respiratory symptomatic and functional recovery of patients initially hospitalised with COVID-19 in a systematic review and meta-analysis using patient-reported outcome measures (PROMs). Method(s): Comprehensive database searches in accordance with the PRISMA statement were carried out up till 31/05/2021 where data exists for patients >8 weeks after hospital discharge, according to PROSPERO (1). Data were narratively synthesized, and meta-analyses were performed using the random-effects inverse variance method. Result(s): Of 49 studies, across 14 countries with 2-12 months follow up, fatigue was the most commonly reported persisting symptom at 2-4 months (36.6%, 95 % CI 27.6 to 46.6, n=14), and at >4 months (32.5%, 95% CI 22.6 to 44.2, n=15). Modified MRC dyspnoea score >=1 was reported in 48% (95% CI 30 to 37, n=5) at 2-4 months and 32% (95% CI 22 to 43, n=7) at >4 months. Persisting sick leave, change in their scope of work and increased healthcare usage was also reported. Conclusion(s): Persisting respiratory symptoms are experienced by survivors of COVID-19 hospital admission with associated impact on work and healthcare usage.
ABSTRACT
Introduction: Following hospitalisation with SARS-Cov2 infection a large proportion of individuals report fatigue as a persisting symptom. Here, we performed a detailed study of the muscle for insight into underlying mechanisms. Method(s): Adults were recruited at 5-7 months following hospital discharge for severe SARS-Cov2 infection (n=21), along with control volunteers (n=10) of a similar age, gender, ethnicity and body mass. Perceived fatigue was estimated using the fatigue severity scale. The short physical performance battery test determined habitual functionality, alongside isometric quadriceps strength normalised for appendicular mass and isokinetic force loss during 20 knee extensions (Cybex Norm dynamometer). Leg muscle volume, and phosphocreatine (PCr) resynthesis during recovery from ischemic plantar flexion exercise (an index of muscle metabolic resilience) were quantified using MRI and 31P MRS. Student t-test was used to detect differences between groups and all data are mean (SD). Result(s): Patients (P) reported greater perception of fatigue and demonstrated worse habitual functionality compared to controls (C). However, leg volume [P: 2,578 (303) cm3/m2 vs C: 2,384 (289) cm3/m2, p=0.1], strength [P: 21.8 (4.1) Nm/kg vs C: 21.1 (4.5) Nm/kg, p=0.7], force loss [P: 25% (6) vs C: 21% (10), p=0.1] and PCr recovery kinetics (Qmax) [P: 25.8 (11.3) vs C: 22.8 (8.7), p=0.5] were not different. Conclusion(s): Despite greater perception of fatigue and lower habitual functionality, patients recovering from severe COVID-19 infection did not have altered muscle volume, strength, fatiguability or metabolic resilience compared to controls.
ABSTRACT
P226 Figure 1ConclusionPatients recovering from severe Covid-19 have worse insulin sensitivity compared to controls, but similar metabolic flexibility. Physical inactivity and liver adiposity may play a role in these observations.FundingNIHR Nottingham BRC (NoRCoRP), PHOSP UKRI, Nottingham Hospitals Charity, University of Nottingham alumni donation.
ABSTRACT
OBJECTIVES: Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) was identified in late 2019, spreading to over 200 countries and resulting in almost two million deaths worldwide. The emergence of safe and effective vaccines provides a route out of the pandemic, with vaccination uptake of 75-90% needed to achieve population protection. Vaccine hesitancy is problematic for vaccine rollout; global reports suggest only 73% of the population may agree to being vaccinated. As a result, there is an urgent need to develop equitable and accessible interventions to address vaccine hesitancy at the population level. STUDY DESIGN: & Method: We report the development of a scalable digital intervention seeking to address COVID-19 vaccine hesitancy and enhance uptake of COVID-19 vaccines in the United Kingdom. Guided by motivational interviewing (MI) principles, the intervention includes a series of therapeutic dialogues addressing 10 key concerns of vaccine-hesitant individuals. Development of the intervention occurred linearly across four stages. During stage 1, we identified common reasons for COVID-19 vaccine hesitancy through analysis of existing survey data, a rapid systematic literature review, and public engagement workshops. Stage 2 comprised qualitative interviews with medical, immunological, and public health experts. Rapid content and thematic analysis of the data provided evidence-based responses to common vaccine concerns. Stage 3 involved the development of therapeutic dialogues through workshops with psychological and digital behaviour change experts. Dialogues were developed to address concerns using MI principles, including embracing resistance and supporting self-efficacy. Finally, stage 4 involved digitisation of the dialogues and pilot testing with members of the public. DISCUSSION: The digital intervention provides an evidence-based approach to addressing vaccine hesitancy through MI principles. The dialogues are user-selected, allowing exploration of relevant issues associated with hesitancy in a non-judgmental context. The text-based content and digital format allow for rapid modification to changing information and scalability for wider dissemination.