Long Covid: the pandemic’s testing aftermath

Jun 24, 2023

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By tracking Covid-19 patients, doctors in Europe are in search of treatments for a lingering sickness that is both debilitating and puzzling.

By ANTHONY KING

Evelina Tacconelli, an Italian infectious diseases specialist, is seeking cures for a coronavirus-induced illness that’s playing havoc with the lives of millions of people in Europe and elsewhere.

Though Covid-19 itself is no longer deemed a global emergency by the World Health Organization, many infections have been followed by a malady called “long Covid”. This disorder is taking a particularly hard toll on otherwise healthy women.

Unresolved symptoms

‘There is no proven treatment for long Covid,’ said Tacconelli, a professor of infectious diseases at the University of Verona in Italy.

One study estimated that almost half of all people who caught the coronavirus had unresolved symptoms after about four months, with one in 10 suffering from long Covid. That leaves at least 65 million people with what can be a life-changing illness.

Long Covid has a lengthy list of symptoms and scientists struggle to understand why some people suffer ill health well after they’ve overcome the coronavirus. Nonetheless, various elements are becoming clearer as doctors look at large groups of patients.

‘There is no one long Covid,’ said Tacconelli. ‘It includes several diseases.’

She coordinates a project that received EU funding to compile the medical information of tens of thousands of people from across Europe. These include participants both with and without Covid-19 to allow for comparisons.

The research initiative, called ORCHESTRA, is due to wrap up in November 2023 after three years. It has received almost €30 million in funding, most of which – nearly €28 million – has been from the EU.

Four strands

There are at least four types of long Covid, all with different symptoms, according to Tacconelli.

One is a respiratory form that can make it hard for people to exercise or run and sometimes even to walk or sleep properly.

A second form involves muscle pains that people didn’t have before Covid-19.

A third type resembles chronic fatigue characterised by severe tiredness and an inability to return to activities done before the infection.

The fourth version is predominantly neurological, with the major symptoms being headaches and forgetfulness.

Research surprise

The ORCHESTRA researchers have sought to answer two key questions: whether there were long-term health effects after the viral infection and what the results were of vaccination and early treatment over time.

A surprise in the project so far relates to women.

‘What was very much unexpected was that women with no other disease were at higher risk of post Covid-19 syndrome,’ said Tacconelli.

One reason this result was unforeseen is that elderly men were most at risk of dying from the infection itself.

Often the afflicted women are between 40 and 50 years old and have chronic fatigue symptoms followed by the neurological form of long Covid.

Women are long known to suffer more from autoimmune conditions – for reasons still debated by experts – and this could partly explain the prevalence of long Covid in female patients.

In any case, the initial coronavirus infection seemingly influences the form of long Covid. For example, people who complained mostly of headaches or stomach symptoms when ill with Covid-19 are at greater risk of the neurological form.

Revealing records

The ORCHESTRA team has tapped into the medical information of 70 000 healthcare workers who have had their condition checked every few months since 2020. Such workers were chosen because they were at high risk of Covid-19 transmission and are routinely screened for transmissible diseases.

The project scope also includes “patient cohorts” – groupings of individuals with common traits – in, for example, France and Germany.

And it includes thousands of vulnerable patients watched closely by hospital doctors.

‘All these medical records reveal that vaccinated people and vulnerable hospital patients who received antiviral drugs or antibody therapy soon after being infected have less risk of long Covid,’ said Tacconelli.

In March 2023, European Health Commissioner Stella Kyriakides said that 17 million people in the EU had been affected by long Covid and the number was rising. Kyriakides has promised more research into its causes, consequences and treatments.

Long Covid is a growing challenge for health systems in Europe and elsewhere. In December 2022, an online conference brought together 800 health experts and patient groups from the EU and US to tackle the matter, including through greater cooperation.

Quicker access

A European health-system weakness that the coronavirus pandemic exposed was difficulty in rapidly accessing real-world data needed to assess the effect on patients and to find effective treatments.

Had clinical information on patients in different hospitals been compared quickly, the ineffectiveness of an antibiotic called azithromycin and the very early effect of cortisone on survival would have been noticed, according to Tacconelli.

To address this, the ORCHESTRA researchers have established Europe-wide information on patient cohorts. This collection of data is based on existing and new large-scale cohorts in the EU and in non-European countries.

The project integrated epidemiological, clinical, microbiological and genotypic information on patient groups with common environmental and socioeconomic traits.

Major support for ORCHESTRA came from another EU-funded research project: unCoVer, which ended in May 2023 after two and a half years including a six-month extension.

This initiative sprang into action when Dr José Luis Peñalvo at the Institute of Tropical Medicine in the Belgian city of Antwerp foresaw the benefits of collating information on patients from different hospitals.

‘At the beginning of the pandemic, it was not clear what type of treatment should be used and it was not clear whether we should discontinue treatments for chronic patients once they got admitted to the hospital,’ said Peñalvo, an epidemiologist who worked in his native Spain and in the US before moving to Belgium in 2018.

Patient care

He sought to gather information quickly.

Peñalvo began by recruiting Antwerp University Hospital into the network before contacting former colleagues at medical centres in Madrid.

His interest is in patients with type 2 diabetes, high blood pressure and cardiovascular disease. Such people suffered more from Covid-19.

‘I had an interest in taking better care of these patients, but also in collecting data on patients and on how to analyse this data,’ said Peñalvo.

Dozens of hospitals – including in Croatia, Ireland, Italy, Norway and Portugal and as well as non-European countries such as Brazil and Colombia – joined the network.

The hope is that hospitals will be better prepared to handle a future pandemic or to answer medical questions using patient information from a number of health centres, all while preserving privacy by ensuring the anonymity of the people whose data gets used.

Meanwhile, Tacconelli of ORCHESTRA says possible cures for long Covid are being developed.

‘New treatments are in the pipeline,’ she said. ‘Maybe one year from now, if we are very lucky, we will have some answers from the studies now underway.’

Research in this article was funded by the EU. This article was originally published in Horizon, the EU Research and Innovation Magazine.

The Truth about Oil Diffusers: Do They Really Improve Air Quality?

The Truth about Oil Diffusers: Do They Really Improve Air Quality?

The Contribution of Knee Support to Overall Health

Autism cures may be closer as focus turns to early treatment

African governments are collaborating with innovators to strengthen local health supply chains

New clues to age-old illnesses emerge in the gut

Meet the 4 Major Medical Innovations that can Help to Aid Different Levels of Blindness

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Oil diffusers have increasingly become a staple in many homes due to the host of benefits they offer. These little devices utilize essential oils, releasing their properties into the air in a fine mist. They often serve as tools for relaxation, promoting an overall sense of tranquillity. But do they actually improve indoor air quality? This is a question that has stirred much debate. In this blog post, we’ll delve into the truth about air diffusers, unpacking the evidence, understanding the mechanisms at play, and ultimately revealing the role these devices can play in our quest for optimal indoor air quality.

At its core, an oil diffuser’s primary function is to disperse essential oils into the air, filling your indoor space with the soothing natural fragrances of your chosen oils. It uses a combination of heat, vibration, and airflow to break down the essential oil into tiny particles. These particles are then dispersed in a fine mist, ready to be absorbed into your body through the air you breathe. Some diffusers utilize water as a medium to carry oils into the air, while others use cold air or heat.

When it comes to the types available, the market offers an impressive array. For instance, ultrasonic diffusers use ultrasonic waves to break the oil into a fine mist, while nebulizing diffusers use the power of air and vacuum to maintain the oils’ utmost purity and strength.

Not only do these devices add a lovely aroma to your space, but essential oils also come with a myriad of potential health benefits. It can be selected based on your needs, mood, or even the time of day. Some oils are known to alleviate stress, promote sleep, enhance focus, or manage pain. When used carefully, this diffuser could serve as a holistic approach to maintaining your well-being.

Contrary to popular belief, air diffusers do more than infuse the air with a pleasant aroma. Take tea tree oil or eucalyptus oil, for example. These oils possess superb antimicrobial properties. When released into the air through a diffuser, these oils can actively combat airborne germs and significantly reduce indoor air pollutants. Lemon oil, renowned for its mood-enhancing and immune-boosting properties, is another heavyweight in the arena of air purification.

Beyond just health benefits, certain scents have profound impacts on our emotional well-being too. The soothing aroma of Lavender, for instance, is known to aid sleep and relaxation. Similarly, bright citrus or peppermint scents can be energizing and stimulating. Lastly, it’s worth mentioning the more subtle, therapeutic benefits of essential oils. Oils like Bergamot and Ylang Ylang are known to possess antidepressant and anxiolytic effects. When diffused, these oils can drastically ease feelings of stress and anxiety.

Additionally, the increased humidity from the device can be great for alleviating respiratory issues, especially during the dryer months or in air-conditioned rooms. However, the air diffuser needs to be sized correctly for the room it will be in, and proper ventilation is considered to avoid excessive humidity.

A study published in Atmospheric Environment examined “The effects of evaporating essential oils on indoor air quality“. This study was conducted in a controlled environment where oils were diffused in an office space. The varying compositions were taken into account as it found key compounds of oils like limonene, alpha-pinene, and eucalyptol substantially soared after the diffusion. Interestingly, it also revealed that diffusing certain oils could even affect the level of ozone in the room, varying with different environmental parameters.

While the study found positives in the use of diffusers, it discovered that increased concentrations of these chemical compounds could potentially react with indoor air pollutants such as nitrogen oxide leading to the formation of secondary pollutants. Notably, in the absence of proper ventilation, or when diffused for an extended period, secondary pollutants like formaldehyde could be produced. Therefore, the researchers suggested caution and moderation when using diffusers, especially in small, inadequately ventilated spaces.

The use of diffusers can, in some cases, provoke allergic reactions. These reactions can manifest as skin irritations, headaches, or even respiratory issues in some individuals. This could especially be noted when diffusers are used in excess or in a poorly ventilated space.

Proper dilution of oils is another essential requirement when using these devices. Essential oils in their pure form are incredibly potent, and using them undiluted could lead to various health concerns. For instance, if used excessively, lemon oil – treasured for its uplifting effects – can be irritating and lead to headaches or dizziness. Therefore, these oils should be diluted according to the manufacturer’s instructions before being added to the diffuser.

Lastly, consider your family – including children and pets. Some oils can be harmful to little ones, if not outright toxic. Certain oils like eucalyptus, peppermint, and some citrus-based oils can be harmful to children under a certain age. Additionally, household pets can be particularly sensitive to specific essential oils. It is important to research and ensure the safety of the selected one within your household.

Here, we will explore a few practical steps and guidelines to help you boost your air quality with an oil diffuser, without compromising the safety and well-being of your family.

While the debate rages on, it’s fair to conclude that diffusers can contribute positively to indoor air quality, especially when used thoughtfully with the right essential oils. They dispense a beautiful aroma, contribute to reducing stress, and can mildly improve air quality, making them an excellent addition to your home. However, for anyone dealing with severe allergies or respiratory issues, a dedicated air purifier may prove more effective in maintaining a healthier living environment.

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The human knee, a complex and unique structure, plays a significant role in our everyday physical activities. This joint carries the body weight while participating in common actions like walking, bending, and jumping. Yet, this joint is susceptible to injuries and diseases, often leading to pain and difficulty in mobility. This is where knee support comes into play, playing a crucial role in alleviating the pressure from the knee joint, providing much-needed relief, and enhancing overall health.

One of the key functions of a knee brace is the provision of stable and uniform pressure across the knee joint. Human knees are subject to various forces during daily activities, making them vulnerable to injuries and chronic pain conditions. By applying steady pressure, braces ensure the even distribution of these forces, therefore, reducing the likelihood of damage and strain. Such pressure also helps in managing swelling or inflammation from an injury or disease by compressing the area and reducing fluid buildup.

Moreover, the role of braces extends to optimal muscle support. When the knee is in motion, be it during a workout session or just a simple activity like walking or climbing stairs, the surrounding muscles are active and exerting force. In such scenarios, the protector acts as a facilitator, ensuring that these muscles function synchronously and optimally. It bridges the gap between the knee’s strength and any functional efforts, making movements smoother and pain-free.

During everyday activities, the knee is in continual use. Here again, the support helps reduce the load on the knee and the working muscles, decreasing the risk of overuse injuries and ensuring that the joint remains functional, flexible, and healthy, proving that the benefit of braces is not limited to those in recovery or those living with chronic knee conditions. Instead, it’s a supportive device with widespread application that can significantly contribute to maintaining and improving knee joint health. Thus, understanding and acknowledging its importance is the first step towards healthier knees and overall well-being.

Understanding how knee supports work and trying them at https://threo.nz/product/knee-support-for-running-walking-and-cycling-2/ can be of great value when implementing preventive measures for knee health.

Knee pain is a common ailment afflicting many individuals worldwide, drastically affecting their quality of life. Frequently, this pain results from various conditions such as arthritis, osteoporosis, tendonitis, and swelling due to injury or other underlying health issues. A knee brace can provide significant relief from discomfort as part of the treatment strategy for these conditions.

A scientific study conducted with patients suffering from knee pain showed a marked decrease in pain levels when wearing knee protectors regularly. The reduction was almost immediate, highlighting their crucial role in providing instant pain relief.

The warmth provided by knee braces enhances circulation within the joint. The resulting boost in blood flow aids in the delivery of essential nutrients to the joint, promoting faster muscle recovery after physical activities or injuries. This warming effect is yet another factor contributing to the pain-relieving function of knee support.

A knee brace is beneficial across a broad spectrum of activities that exert stress on the joints. Sports like baseball, basketball, soccer, and even activities like jogging, walking, cycling, or dancing can cause significant joint strain. It can mitigate this stress, preventing injuries and enabling individuals to perform to their fullest potential.

In conclusion, the knee brace isn’t just a medical accessory but a vital tool aiding in comprehensive health enhancement. It systematically performs multiple roles, from providing stable and constant pressure across your knee joints to offering optimal muscle support during workouts and everyday activities. With the incorporation of leading-edge techniques such as high-precision 3D knitted technology, modern protectors ensure a superior fit, thereby magnifying their benefits.

Given the amazing array of benefits, the use of knee support should not be limited only to those with existing knee conditions or athletes. Even individuals involved in regular physical activities can significantly benefit from these. So, if you are looking to boost your overall health, do consider incorporating it into your routine.

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Fresh insights into the genes that cause the neurological disorder could open new routes for the prevention and perhaps even reversal of symptoms.

By VITTORIA D’ALESSIO

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that has been intensely investigated since the mid-20th century. It’s estimated that ASD affects around 1 in 100 children and mainly boys.

Studies suggest that ASD is closely linked to genetics. The basic challenge is untangling the relationships between the many genes involved and the symptoms.

Genes and symptoms

A focus on these links has the potential to enhance understanding of the condition and treatments for it.

For instance, children born with a rare genetic mutation – on a gene called BCKDK – are more likely to develop impairments that, left untreated, would likely result in lifelong autism. Symptoms can include intellectual disability, epilepsy and a condition – microcephaly – where a baby’s head is smaller than expected.

The faulty gene in question disrupts the way the brain can process essential nutrients known as “branched-chain amino acids” and creates the conditions for delayed neurological development.

‘This got us thinking: now we know what causes this neurodevelopmental disorder, can we reverse it once the brain has developed?’ said Gaia Novarino, a neuroscience professor whose team discovered the BCKDK mutation and its link to autism in 2012. ‘Can we go back in time?’

Award winner

Novarino is a high-profile neuroscientist from Italy who has received numerous awards for her work in the field of autism research, including the Order of Merit of the Italian Republic.

‘I have always been interested in genetic disorders and was struck by the general lack of understanding of paediatric, neurodevelopmental disorders,’ she said. ‘We know too little about these diseases.’

Because autism shapes the developing brain long before birth, many assume it’s irreversible – a lifelong condition that, at best, can be managed with psychological support paired with speech and physical therapy.

Some people prefer to forgo treatment because they don’t believe autism needs to be cured, regarding it as an integral part of personality.

‘Not everyone wants their ASD, or their child’s ASD, to be treated,’ said Novarino. ‘If symptoms aren’t profound, a person can live with the condition with minimal support and they may come to see their autism as an essential part of who they are.’

In any case, more recent research has led scientists to assess whether some forms of ASD may be treatable – either fully or in part.

Mice tests

Novarino’s team, based at the Institute of Science and Technology in Austria near Vienna, turned to mice for answers under a five-year European research project called REVERSEAUTISM that ended in September 2022.

Backed by EU funding, the researchers genetically engineered mice to be unable to process essential amino acids correctly, similarly to children with the BCKDK genetic mutation.

Amino acids are protein building blocks needed for vital reactions within and between nerve cells. The body can’t make amino acids itself and instead must find them from foods such as meat, fish, grains and nuts.

The team found that rodents with the mutation developed both motor and social difficulties after birth.

‘These mice have behavioural issues,’ said Novarino. ‘They also move in a strange way, with coordination problems.’

REVERSEAUTISM then took this research one step further to see whether, by injecting the missing amino acids directly into the brains of affected mice, their autism-like symptoms could be reversed.

‘The answer was yes,’ said Novarino. ‘Not all symptoms disappeared, but there was considerable improvement in both social behaviour and coordination in mice that received injections. In other words, some signs of the disorder were reversed.’

Study of 21 infants

REVERSEAUTISM’s findings so intrigued Dr Angeles García-Cazorla of Spain that she decided to study whether children with a BCKDK deficiency showed symptom improvements after taking the missing amino acids as a food supplement in conjunction with a high-protein diet.

García-Cazorla is head of Metabolic Diseases Unit at the Hospital Sant Joan de Déu in Barcelona. The missing amino acids are leucine, valine and isoleucine.

The study was based on 21 patients, aged between eight months and 16 months, recruited from centres around the world. The results were very promising.

‘In general, all patients improved, in particular regarding the growth of their head, which means there was a proliferation of neurons,’ said García-Cazorla. ‘They also showed improved motor function. Infants who weren’t able to walk could now walk and infants who couldn’t speak developed some basic language.’

Sooner the better

The earlier treatment was begun, the better the outcomes were.

‘In the three children who started supplementation before the age of two, the evolution was much better and the child who started at eight months did best – she had normal brain development, with no signs of autism, by the age of three,’ said García-Cazorla.

The study was carried out under an EU-initiated health alliance called the European Reference Network for Rare Hereditary Metabolic Disorders (MetabERN), which is led by patients and experts.

If future studies involving a larger cohort of BCKDK-deficient infants validate the results of the MetabERN investigation, García-Cazorla and Novarino hope national health policies will be changed to require all babies to be tested for BCKDK deficiency at birth.

This would form part of the newborn “heel prick” test, which checks up to 25 rare but serious health conditions.

‘One of the challenges in the field of autism is that diagnosis is usually done quite late – rarely before the age of three or four – and at that point it becomes hard to treat,’ said Novarino. ‘Our work shows that starting supplementation early can make a real difference to people’s lives.’

She and her team are pursuing this line of research in a European project called SecretAutism that began in December 2022 and will run through November 2027. They received EU funding to grow brain tissue in the laboratory using human stem cells.

By studying these “organoids”, the researchers hope to gain further insights into what exactly the many different genes associated with autism are doing in the body, the stages at which problems develop and how to interrupt the process.

‘We’re approaching this from many angles, trying to understand how else we can treat patients with ASD,’ said Novarino. ‘It’s very complex research, but that won’t put us off.’

Research in this article was funded by the EU via the European Research Council (ERC). This article was originally published in Horizon, the EU Research and Innovation Magazine.

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