Recovery of Neurophysiological Measures in Post-COVID Fatigue - a 12-month Longitudinal Follow-up Study (preprint)

One of the major consequences of the COVID-19 pandemic has been the significant incidence of persistent fatigue following resolution of an acute infection (i.e. post-COVID fatigue). We have shown previously that, in comparison to healthy controls, those suffering from post-COVID fatigue exhibit changes in muscle physiology, cortical circuitry, and autonomic function. Whether these changes preceded infection, potentially predisposing people to developing post-COVID fatigue, or whether the changes were a consequence of infection was unclear. Here we present results of a 12-month longitudinal study of 18 participants from the same cohort of post-COVID fatigue sufferers to investigate these correlates of fatigue over time. We report improvements in self-perception of fatigue via questionnaires, as well as significant improvements in objective measures of peripheral muscle fatigue and autonomic function, bringing them closer to healthy controls. Additionally, we found reductions in muscle twitch tension rise times, becoming faster than controls, suggesting that the improvement in muscle fatigability might be due to a process of adaptation rather than simply a return to baseline function.

Neural Dysregulation in Post-Covid Fatigue (preprint)

Following infection from SARS-CoV-2, a substantial minority of people develop lingering after-effects known as "long COVID". Fatigue is a common complaint with substantial impact on daily life, but the neural mechanisms behind post-COVID fatigue remain unclear. We recruited volunteers with self-reported fatigue after a mild COVID infection and carried out a battery of behavioural and neurophysiological tests assessing the central, peripheral and autonomic nervous systems. In comparison to age and gender matched volunteers without fatigue, we show underactivity in specific cortical circuits, dysregulation of autonomic function, and myopathic change in skeletal muscles. Cluster analysis revealed no sub-groupings, suggesting post-COVID fatigue is a single entity with individual variation, rather than a small number of distinct syndromes. These abnormalities on objective tests may indicate novel avenues for principled therapeutic intervention, and could act as fast and reliable biomarkers for diagnosing and monitoring the progression of fatigue over time.

COVID 19: Open source model for rapid reduction of R to below 1 in high R0 scenarios (preprint)

We present an open source model that allows quantitative prediction of the effects of testing on the rate of spread of COVID-19 described by R, the reproduction number, and on the degree of quarantine, isolation and lockdown required to limit it. The paper uses the model to quantify the outcomes of different test types and regimes, and to identify strategies and tests that can reduce the rate of spread and R value by a factor of between 1.67 and 33.3, reducing it to between 60% and 3% of the initial value.