Characterising patterns of COVID-19 and long COVID symptoms: Evidence from nine UK longitudinal studies (preprint)

Multiple studies across global populations have established the primary symptoms characterising COVID-19 (Coronavirus Disease 2019) and long COVID. However, as symptoms may also occur in the absence of COVID-19, a lack of appropriate controls has often meant that specificity of symptoms to acute COVID-19 or long COVID, and the extent and length of time for which they are elevated after COVID-19, could not be examined. We analysed individual symptom prevalences and characterised patterns of COVID-19 and long COVID symptoms across nine UK longitudinal studies, totalling over 42,000 participants. Conducting latent class analyses separately in three groups ('no COVID-19', 'COVID-19 in last 12 weeks', 'COVID-19 > 12 weeks ago'), the data did not support the presence of more than two distinct symptom patterns, representing high and low symptom burden, in each group. Comparing the high symptom burden classes between the 'COVID-19 in last 12 week,' and 'no COVID-19' groups we identified symptoms characteristic of acute COVID-19, including loss of taste and smell, fatigue, cough, shortness of breath and muscle pains or aches. Comparing the high symptom burden classes between the 'COVID-19 > 12 weeks ago' and 'no COVID-19' groups we identified symptoms characteristic of long COVID, including fatigue, shortness of breath, muscle pain or aches, difficulty concentrating and chest tightness. The identified symptom patterns among individuals with COVID-19 > 12 weeks ago were strongly associated with self-reported length of time unable to function as normal due to COVID-19 symptoms, suggesting that the symptom pattern identified corresponds to long COVID. Building the evidence base regarding typical long COVID symptoms will improve diagnosis of this condition and the ability to elicit underlying biological mechanisms, leading to better patient access to treatment and services.

Atmospheric CO2 concentration and its influence factors during 2020 COVID-19 pandemic in Nanchang: Journal of Nanjing University of Information Science & Technology

The atmospheric CO2 concentrations are mainly influenced by regional sinks/sources and atmospheric transport processes, thus observations in urban area contain essential information of anthropogenic CO2 emissions. To investigate the effect of COVID-19 on atmospheric CO2 concentration and its anthropogenic emissions, this study chose Nanchang city as the study area and used a priori emission inventory with WRF-STILT (Stochastic Time-Inverted Lagrangian Transport) atmospheric transport model to simulate hourly CO2 concentrations from January 24th to April 30th, 2020. In accordance with the government measures to control COVID-19 epidemic, the whole study period was divided into two periods of Level 1 period (from January 24th to March 11th) and Level 2 period (from March 12th to April 30th). Results indicate the model can well capture hourly variations of CO2 concentration, but it overestimated nighttime concentrations due to the negligence of emission source height. During Level 1 period, the observed and simulated afternoon (12:00-18:00) CO2 mole fractions were 433. 63×10-6 and 438. 22×10-6, respectively,in which the anthropogenic emissions were 21.9% overestimated by simulation compared with observations. While during Level 2 period, the observation and simulation were very close as 432. 06×10-6 and 432. 24 × 10-6. The above comparisons indicate that the CO2 emissions can be represented by a priori CO2 emission inventory in Level 2 period, but was overestimated by 21.9% in Level 1 period, and the discrepancy was mainly due to government measures to control COVID-19 pandemic during this period. Besides, the average biological NEE enhancements were generally lower than 2×10-6, indicating a small contribution compared with anthropogenic emissions. The higher PBLH (Planetary Boundary Layer Height) in Level 2 period also offset the enhancement in CO2 emissions, which was also the main reason for the close observations during two periods. Our findings can provide scientific method supports for greenhouse gas emission inversions at urban scale.

Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK (preprint)

The impact of long COVID is increasingly recognised, but risk factors are poorly characterised. We analysed questionnaire data on symptom duration from 10 longitudinal study (LS) samples and electronic healthcare records (EHR) to investigate sociodemographic and health risk factors associated with long COVID, as part of the UK National Core Study for Longitudinal Health and Wellbeing. Methods Analysis was conducted on 6,899 adults self-reporting COVID-19 from 45,096 participants of the UK LS, and on 3,327 cases assigned a long COVID code in primary care EHR out of 1,199,812 adults diagnosed with acute COVID-19. In LS, we derived two outcomes: symptoms lasting 4+ weeks and symptoms lasting 12+ weeks. Associations of potential risk factors (age, sex, ethnicity, socioeconomic factors, smoking, general and mental health, overweight/obesity, diabetes, hypertension, hypercholesterolaemia, and asthma) with these two outcomes were assessed, using logistic regression, with meta-analyses of findings presented alongside equivalent results from EHR analyses. Results Functionally limiting long COVID for 12+ weeks affected between 1.2% (age 20), and 4.8% (age 63) of people reporting COVID-19 in LS. The proportion reporting symptoms overall for 12+ weeks ranged from 7.8 (mean age 28) to 17% (mean age 58) and for 4+ weeks 4.2% (age 20) to 33.1% (age 56). Age was associated with a linear increase in long COVID between age 20-70. Being female (LS: OR=1.49; 95%CI:1.24-1.79; EHR: OR=1.51 [1.41-1.61]), poor pre-pandemic mental health (LS: OR=1.46 [1.17-1.83]; EHR: OR=1.57 [1.47-1.68]) and poor general health (LS: OR=1.62 [1.25-2.09]; EHR: OR=1.26; [1.18-1.35]) were associated with higher risk of long COVID. Individuals with asthma also had higher risk (LS: OR=1.32 [1.07-1.62]; EHR: OR=1.56 [1.46-1.67]), as did those categorised as overweight or obese (LS: OR=1.25 [1.01-1.55]; EHR: OR=1.31 [1.21-1.42]) though associations for symptoms lasting 12+ weeks were less pronounced. Non-white ethnic minority groups had lower 4+ week symptom risk (LS: OR=0.32 [0.22-0.47]), a finding consistent in EHR. Associations were not observed for other risk factors. Few participants in the studies had been admitted to hospital (0.8-5.2%). Conclusions Long COVID is clearly distributed differentially according to several sociodemographic and pre-existing health factors. Establishing which of these risk factors are causal and predisposing is necessary to further inform strategies for preventing and treating long COVID.

Covid-19 lockdown: Ethnic differences in childrens self-reported physical activity and the importance of leaving the home environment. A longitudinal and cross-sectional (preprint)

BackgroundIn England, the onset of COVID-19 and a rapidly increasing infection rate resulted in a lockdown (March-June 2020) which placed strict restrictions on movement of the public, including children. Using data collected from children living in a multi-ethnic city with high levels of deprivation, this study aimed to: (1) report childrens self-reported physical activity (PA) during the first COVID-19 UK lockdown and identify associated factors; (2) examine changes of childrens self-reported PA prior to and during the first UK lockdown. MethodsThis study is part of the Born in Bradford (BiB) COVID-19 Research Study. PA (amended Youth Activity Profile), sleep, sedentary behaviours, daily frequency/time/destination/activity when leaving the home, were self-reported by 949 children (9-13 years). A sub-sample (n=634) also self-reported PA (Physical Activity Questionnaire for Children) pre-pandemic (2017-February 2020). Univariate analysis assessed differences in PA between sex and ethnicity groups; multivariable logistic regression identified factors associated with childrens PA. Differences in childrens levels of being sufficiently active were examined using the McNemar test examined change in PA prior to and during the lockdown, and multivariable logistic regression to identify factors explaining change. ResultsDuring the pandemic, White British (WB) children were more sufficiently active (34.1%) compared to Pakistani Heritage children (PH) (22.8%) or Other ethnicity children (O) (22.8%). WB children reported leaving the home more frequently and for longer periods than PH and O children. Modifiable variables related to being sufficiently active were frequency, duration, type of activity, and destination away from the home environment. There was a large reduction in children being sufficiently active during the first COVID-19 lockdown (28.9%) compared to pre-pandemic (69.4%). ConclusionsPromoting safe extended periods of PA everyday outdoors is important for all children, in particular for children from ethnic minority groups. Childrens PA during the first COVID-19 UK lockdown has drastically reduced from before. Policy and decision makers, and practitioners should consider the findings in order to begin to understand the impact and consequences that COVID-19 has had upon childrens PA which is a key and vital behaviour for health and development.

Vulnerabilities in child wellbeing among primary school children: a cross-sectional study in Bradford, UK (preprint)

ABSTRACT Objective To describe the prevalence of factors related to wellbeing among primary school children in a deprived multi-ethnic community. Design and participants Cross-sectional survey of 15,641 children aged 7-10 years in Born in Bradford’s Primary School Years study: whole-classroom samples in 89 Bradford primary schools between 2016 and 2019. Main outcome measures Prevalence estimates by ethnicity (%, 95% CI) of single and multiple vulnerabilities in child wellbeing within and across four domains (home, family, relationships; material resources; friends and school; subjective wellbeing). Results Only 10% of children have no vulnerabilities in any domain of wellbeing; 10% have one or more vulnerabilities in all four domains. The highest prevalence estimates were for being bullied some or all of the time (52.7%, 51.9 to 53.4%), keeping worries to oneself (31.2%, 30.5 to 31.9%), having no park near home (30.8%, 30.1 to 31.5%) and worrying all the time about how much money their family has (26.3%, 25.6 to 27%). Boys were consistently significantly more likely than girls to report all of the vulnerabilities in the Home, Family and Family Relationships domain, and the majority of indicators in the other domains, and in all domains except Friends and School, boys were significantly more likely to have at least one vulnerability. Girls were significantly more likely to report not having many friends (16.7%, 95% CI: 15.9 to 17.6% vs. 12.5%, 95% CI: 11.8 to 13.2%), being bullied some or all of the time (55.8%, 95% CI: 54.7 to 56.9% vs. 49.7%, 95% CI: 48.6 to 50.8%) and feeling left out all the time (12.1%, 95% CI: 11.4 to 12.8%) vs. 10.3%, 95% CI: 9.7 to 11.0%). Variations in vulnerabilities by ethnicity were complex, with children in Black, Asian and Minority Ethnic groups sometimes reporting more vulnerabilities and sometimes fewer than White British children. For example, compared to children of Pakistani heritage, White British children were more likely to say that their family never gets along well (6.3%,5.6 to 7.1% vs. 4.1%,3.6 to 4.6%) and to have no access to the internet at home (22.3%,21 to 23.6% vs. 18%,17 to 18.9%). Children with Pakistani heritage were more likely than White British children to say they had no park near their home where they can play with friends (32.7%,31.6 to 33.9% vs. 29.9%,28.6 to 31.3%), to report not having three meals a day (17.9%,16.9 to 18.8% vs. 11.9%,10.9 to 12.9%) and to worry all the time about how much money their families have (29.3%,28.2 to 30.3%) vs. 21.6%,20.4 to 22.9%). Gypsy/Irish Traveller children were less likely than White British children to say they were bullied some or all of the time (42.2%,35.4 to 49.4% vs. 53.8%,52.3 to 55.3%), but more likely to say they were mean to others all the time (9.9%,6.3 to 15.2% vs. 4%,3.5 to 4.7%) and can never work out what to do when things are hard (15.2%,10.6 to 21.2% vs. 9%, 8.2 to 9.9%). We considered six vulnerabilities to be of particular concern during the current Covid-19 pandemic and associated national and local lockdowns: family never gets along well together; no garden where child can play; no nearby park where they can play; not having 3 meals a day; no internet at home; worried about money all the time. Pre-pandemic, 37.4% (36.6 to 38.3%) of Bradford children had one of these vulnerabilities and a further 29.6% (28.9 to 30.4%) had more than one. Conclusions Although most primary school children aged 7-10 in our study have good levels of wellbeing on most indicators across multiple domains, fewer than 10% have no vulnerabilities at all, a worrying 10% have at least one vulnerability in all the four domains we studied and two thirds have vulnerabilities of concern during the Covid-19 lockdowns.