preVIEW: COVID-19

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Overview

MeSH Disease

Cognition Disorders (60)

COVID-19 (58)

Fatigue (9)

Depressive Disorder (9)

Anxiety Disorders (7)


HGNC Genes

dedicator of cytokinesis 3 (2)

C-reactive protein (2)

membrane associated ring-CH-type finger 1 (1)

furin (1)

lymphocyte antigen 6 family member E (1)


SARS-CoV-2 proteins

There are no SARS-CoV-2 protein terms in the subcorpus


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    Characteristics of Long Covid: findings from a social media surve

    Authors: Nida Ziauddeen; Deepti Gurdasani; Margaret E O'Hara; Claire Hastie; Paul Roderick; Guiqing Yao; Nisreen A Alwan

    doi:10.1101/2021.03.21.21253968 Date: 2021-03-26 Source: medRxiv

    Many people are not recovering for months after being infected with SARS-CoV-2. Long Covid has emerged as a major public health concern that needs defining, quantifying, and describing. We aimed to explore the initial and ongoing symptoms of Long Covid following SARS-CoV-2 infection MESHD and describe its impact on daily life in people who were not admitted to hospital during the first two weeks of the illness. We co-produced a survey with people living with Long Covid. We collected the data through an online survey using convenience non-probability sampling, with the survey posted both specifically on Long Covid support groups and generally on social media. The criteria for inclusion were adults with lab-confirmed (PCR or antibody) or suspected COVID-19 MESHD managed in the community (non-hospitalised) in the first two weeks of illness. We used agglomerative hierarchical clustering to identify specific symptom clusters, and their demographic and functional correlates. We analysed data from 2550 participants with a median duration of illness of 7.7 months (interquartile range (IQR) 7.4-8.0). The mean age was 46.5 years (standard deviation 11 years) with 82.8% females and 79.9% of participants based in the UK. 89.5% described their health as good, very good or excellent before COVID-19 MESHD. The most common initial symptoms that persisted were exhaustion, chest pressure/tightness, shortness of breath MESHD and headache MESHD. Cough, fever MESHD, and chills were common initial symptoms that became less prevalent later in the illness, whereas cognitive dysfunction MESHD and palpitations became more prevalent later in the illness. 26.5% reported lab-confirmation of infection. The biggest difference in ongoing symptoms between those who reported testing positive and those who did not was loss of smell/taste. Ongoing symptoms affected at least 3 organ systems in 83.5% of participants. Most participants described fluctuating (57.7%) or relapsing symptoms (17.6%). Physical activity, stress and sleep disturbance commonly triggered symptoms. A third (32%) reported they were unable to live alone without any assistance at six weeks from start of illness. 16.9% reported being unable to work solely due to COVID-19 MESHD illness. 66.4% reported taking time off sick (median of 60 days, IQR 20, 129). 37.0% reported loss of income due to illness, and 64.4% said they were unable to perform usual activities/duties. Acute systems clustered broadly into two groups: a majority cluster (n=2235, 88%) with cardiopulmonary predominant symptoms, and a minority cluster (n=305, 12%) with multisystem symptoms. Similarly, ongoing symptoms broadly clustered in two groups; a majority cluster (n=2243, 88.8%) exhibiting mainly cardiopulmonary, cognitive symptoms MESHD and exhaustion, and a minority cluster (n=283, 11.2%) exhibited more multisystem symptoms. Belonging to the more severe multisystem cluster MESHD was associated with more severe functional impact, lower income, younger age, being female, worse baseline health, and inadequate rest in the first two weeks of the illness, with no major differences in the cluster patterns when restricting analysis to the lab-confirmed subgroup. This is an exploratory survey of Long Covid characteristics. Whilst it is important to acknowledge that it is a non-representative population sample, it highlights the heterogeneity of persistent symptoms, and the significant functional impact of prolonged illness MESHD following confirmed or suspected SARS-CoV-2 infection MESHD. To study prevalence, predictors and prognosis, research is needed in a representative population sample using standardised case definitions (to include those not lab-confirmed in the first pandemic wave).

    Understanding and Addressing Vaccine Hesitancy in the Context of COVID-19 MESHD: Development of a Digital intervention

    Authors: Holly Knight; Ru Jia; Kieran Ayling; Katherine Bradbury; Katherine Baker; Trudie Chalder; Joanne R Morling; Lindy Durrant; Tony Avery; Jonathan Ball; Caroline Barker; Robert Bennett; Tricia McKeever; kavita vedhara

    doi:10.1101/2021.03.24.21254124 Date: 2021-03-26 Source: medRxiv

    Background Severe Acute Respiratory Coronavirus MESHD 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. Method We report the development of a scalable digital intervention seeking to address COVID-19 MESHD vaccine hesitancy and enhance uptake of COVID-19 MESHD vaccines. Guided by motivational interviewing ( MI MESHD) 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 MESHD 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 MESHD 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.

    Functional and microstructural brain abnormalities MESHD, fatigue MESHD, and cognitive dysfunction MESHD after mild COVID-19 MESHD

    Authors: Lucas Scardua Silva; Rafael Batista Joao; Mateus Henrique Nogueira; Italo Karmann Aventurato; Brunno Machado de Campos; Mariana Rabelo de Brito; Marina Koutsodontis Machado Alvim; Guilherme Vieira Nunes Ludwig; Cristiane Rocha; Thierry Kaue Alves Silva Souza; Beatriz Amorim da Costa; Maria Julia Mendes; Takeshi Waku; Vinicius de Oliveira Boldrini; Natalia Silva Brunetti; Sophia Nora Baptista; Gabriel da Silva Schmitt; Jhulia Gabriela Duarte de Sousa; Tania Aparecida Marchiori de Oliveira Cardoso; Andre Schwambach Vieira; Leonilda Maria Barbosa Santos; Alessandro Farias; Fernando Cendes; Clarissa Lin Yasuda

    doi:10.1101/2021.03.20.21253414 Date: 2021-03-24 Source: medRxiv

    Although post-acute cognitive dysfunction MESHD and neuroimaging abnormalities have been reported after hospital discharge in patients recovered from COVID-19 MESHD, little is known about persistent, long-term alterations in people without hospitalization. We conducted a cross-sectional study of 87 non-hospitalized recovered individuals 54 days after the laboratory confirmation of COVID-19 MESHD. We performed structured interviews, neurological examination, 3T-MRI scans with diffusion tensor images (DTI) and functional resting-state images (fMRI). Also, we investigated fatigue MESHD, anxiety MESHD, depression MESHD, somnolence MESHD, language, memory, and cognitive flexibility, using validated instruments. Individuals self-reported a high frequency of headache MESHD (40%) and memory difficulties MESHD (33%). The quantitative analyses confirmed symptoms of fatigue MESHD (68%), excessive somnolence MESHD (35%), anxiety MESHD (29%), impaired cognitive flexibility MESHD (40%) and language impairment MESHD (33%). There were widespread cerebral white matter alterations (mainly characterized by increased fractional anisotropy), which correlated with abnormal attention and cognitive flexibility. The resting-state fMRI networks analysis showed severely disrupted brain hyperconnectivity and loss of resting-state networks specificity.

    Physical, cognitive and mental health impacts of COVID-19 MESHD following hospitalisation: a multi-centre prospective cohort study

    Authors: Rachael Andrea Evans; Hamish McAuley; Ewen M Harrison; Aarti Shikotra; Amisha Singapuri; Marco Sereno; Omer Elneima; Annemarie B Docherty; Nazir I Lone; Olivia C Leavy; Luke Daines; J Kenneth Baillie; Jeremy S Brown; Trudie Chalder; Anthony De Soyza; Nawar Diar Bakerly; Nicholas Easom; John R Geddes; Neil J Greening; Nick Hart; Liam G Heaney; Simon Heller; Luke Howard; Joseph Jacob; R Gisli Jenkins; Caroline Jolley; Steven Kerr; Onn M Kon; Keir Lewis; Janet M Lord; Gerry P McCann; Stefan Neubauer; Peter JM Openshaw; Paul Pfeffer; Matthew Rowland; Malcolm G Semple; Sally J Singh; Aziz Sheikh; David Thomas; Mark Toshner; James D Chalmers; Ling-Pei Ho; Alex Horsley; Michael Marks; Krisnah Poinasamy; Louise V Wain; Christopher E Brightling

    doi:10.1101/2021.03.22.21254057 Date: 2021-03-24 Source: medRxiv

    Background The impact of COVID-19 MESHD on physical and mental health, and employment following hospitalisation is poorly understood. Methods PHOSP-COVID is a multi-centre, UK, observational study of adults discharged from hospital with a clinical diagnosis of COVID-19 MESHD involving an assessment between two- and seven-months later including detailed symptom, physiological and biochemical testing. Multivariable logistic regression was performed for patient-perceived recovery with age, sex, ethnicity, body mass index (BMI), co-morbidities, and severity of acute illness MESHD as co-variates. Cluster analysis was performed using outcomes for breathlessness, fatigue MESHD, mental health, cognition and physical function. Findings We report findings of 1077 patients discharged in 2020, from the assessment undertaken a median 5 [IQR4 to 6] months later: 36% female, mean age 58 [SD 13] years, 69% white ethnicity, 27% mechanical ventilation, and 50% had at least two co-morbidities. At follow-up only 29% felt fully recovered, 20% had a new disability, and 19% experienced a health-related change in occupation. Factors associated with failure to recover were female, middle-age, white ethnicity, two or more co-morbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial and weakly related to acute severity. Four clusters were identified with different severities of mental and physical health impairment: 1) Very severe (17%), 2) Severe (21%), 3) Moderate with cognitive impairment MESHD (17%), 4) Mild (46%), with 3%, 7%, 36% and 43% feeling fully recovered, respectively. Persistent systemic inflammation MESHD determined by C-reactive protein HGNC was related to cluster severity, but not acute illness severity. Interpretation We identified factors related to recovery from a hospital admission with COVID-19 MESHD and four different phenotypes relating to the severity of physical, mental, and cognitive health five months later. The implications for clinical care include the potential to stratify care and the need for a pro-active approach with wide-access to COVID-19 MESHD holistic clinical services. Funding: UKRI and NIHR

    Authors: Yadi Zhou; Jielin Xu; Yuan Hou; James B. Leverenz; Asha Kallianpur; Reena Mehra; Yunlong Liu; Haiyuan Yu; Andrew A. Pieper; Lara Jehi; Feixiong Cheng

    doi:10.1101/2021.03.15.435423 Date: 2021-03-22 Source: bioRxiv

    Background: Dementia-like cognitive impairment MESHD is an increasingly reported complication of SARS-CoV-2 infection MESHD. However, the underlying mechanisms responsible for this complication remain unclear. A better understanding of causative processes by which COVID-19 MESHD may lead to cognitive impairment MESHD is essential for developing preventive interventions. Methods: In this study, we conducted a network-based, multimodal genomics comparison of COVID-19 MESHD and neurologic complications. We constructed the SARS-CoV-2 virus-host interactome from protein-protein interaction assay and CRISPR-Cas9 based genetic assay results, and compared network-based relationships therein with those of known neurological manifestations using network proximity measures. We also investigated the transcriptomic profiles (including single-cell/nuclei RNA-sequencing) of Alzheimer disease MESHD ( AD MESHD) marker genes from patients infected with COVID-19 MESHD, as well as the prevalence of SARS-CoV-2 entry factors in the brains of AD MESHD patients not infected with SARS-CoV-2. Results: We found significant network-based relationships between COVID-19 MESHD and neuroinflammation and brain microvascular injury MESHD pathways and processes which are implicated in AD MESHD. We also detected aberrant expression of AD MESHD biomarkers in the cerebrospinal fluid and blood of patients with COVID-19 MESHD. While transcriptomic analyses showed relatively low expression of SARS-CoV-2 entry factors in human brain, neuroinflammatory changes were pronounced. In addition, single-nucleus transcriptomic analyses showed that expression of SARS-CoV-2 host factors (BSG and FURIN HGNC) and antiviral defense genes ( LY6E HGNC, IFITM2 HGNC, IFITM3 HGNC, and IFNAR1 HGNC) was significantly elevated in brain endothelial cells of AD MESHD patients and healthy controls relative to neurons and other cell types, suggesting a possible role for brain microvascular injury MESHD in COVID-19 MESHD-mediated cognitive impairment MESHD. Notably, individuals with the AD MESHD risk allele APOE HGNC E4/E4 displayed reduced levels of antiviral defense genes compared to APOE E3/E3 individuals. Conclusion: Our results suggest significant mechanistic overlap between AD MESHD and COVID-19 MESHD, strongly centered on neuroinflammation and microvascular injury MESHD. These results help improve our understanding of COVID-19 MESHD-associated neurological manifestations and provide guidance for future development of preventive or treatment interventions.

    A Prospective Study of Long-Term Outcomes Among Hospitalized COVID-19 MESHD Patients with and without Neurological Complications MESHD

    Authors: Jennifer A. Frontera; Dixon Yang; Ariane Lewis; Palak Patel; Chaitanya Medicherla; Vito Arena; Taolin Fang; Andres Andino; Thomas Snyder; Maya Madhavan; Daniel Gratch; Benjamin Fuchs; Alexa Dessy; Melanie Canizares; Ruben Jauregui; Betsy Thomas; Kristie Bauman; Anlys Olivera; Dhristie Bhagat; Michael Sonson; George Park; Rebecca Stainman; Brian Sunwoo; Daniel Talmasov; Michael Tamimi; Yingrong Zhu; Jonathan Rosenthal; Levi Dygert; Milan Rustic; Haruki Ishii; Eduard Valdes; Mirza Omari; Lindsey Gurin; Joshua Huang; Barry M Czseiler; D. Ethan Kahn; Ting Zhou; Jessica Lin; Aaron Lord; Kara Melmed; Sharon Meropol; Andrea Troxel; Eva Petkova; Thomas Wisniewski; Laura Balcer; Chris Morrison; Shadi Yaghi; Steven Galetta

    doi:10.1101/2021.03.18.21253881 Date: 2021-03-20 Source: medRxiv

    Background: Little is known regarding long-term outcomes of patients hospitalized with COVID-19 MESHD. Methods: We conducted a prospective study of 6-month outcomes of hospitalized COVID-19 MESHD patients. Patients with new neurological complications during hospitalization who survived were propensity score-matched to COVID-19 MESHD survivors without neurological complications hospitalized during the same period. The primary 6-month outcome was multivariable ordinal analysis of the modified Rankin Scale(mRS) comparing patients with or without neurological complications MESHD. Secondary outcomes included: activities of daily living (ADLs;Barthel Index), telephone Montreal Cognitive Assessment and Neuro-QoL batteries for anxiety MESHD, depression MESHD, fatigue MESHD and sleep. Results: Of 606 COVID-19 MESHD patients with neurological complications MESHD, 395 survived hospitalization and were matched to 395 controls; N=196 neurological patients and N=186 controls completed follow-up. Overall, 346/382 (91%) patients had at least one abnormal outcome: 56% had limited ADLs, 50% impaired cognition MESHD, 47% could not return to work and 62% scored worse than average on [≥]1 Neuro-QoL scale (worse anxiety MESHD 46%, sleep 38%, fatigue MESHD 36%, and depression MESHD 25%). In multivariable analysis, patients with neurological complications MESHD had worse 6-month mRS (median 4 vs. 3 among controls, adjusted OR 2.03, 95%CI 1.22-3.40, P=0.01), worse ADLs (aOR 0.38, 95%CI 0.29-0.74, P=0.01) and were less likely to return to work than controls (41% versus 64%, P=0.04). Cognitive and Neuro-QOL metrics were similar between groups. Conclusions: Abnormalities in functional outcomes, ADLs, anxiety MESHD, depression MESHD and sleep occurred in over 90% of patients 6-months after hospitalization for COVID-19 MESHD. In multivariable analysis, patients with neurological complications MESHD during index hospitalization had significantly worse 6-month functional outcomes than those without.

    The effect of Covid-19 MESHD isolation measures on the cognition and mental health of people living with dementia MESHD: a rapid systematic review of one year of evidence.

    Authors: Aida Suarez-Gonzalez; Jayeeta Rajagopalan; Gill Livingston; Suvarna Alladi

    doi:10.1101/2021.03.17.21253805 Date: 2021-03-20 Source: medRxiv

    Background: Covid-19 MESHD control policies have entailed lockdowns and confinement. Although these isolation measures are thought to be particularly hard and possibly harmful to people with dementia MESHD, their specific impact during the pandemic has not yet been synthesised. We aimed to examine and summarise the global research evidence describing the effect of Covid-19 MESHD isolation measures on the health of people living with dementia MESHD. Method: We searched Pubmed, PsycINFO and CINAHL up to February 2021 for peer-reviewed quantitative studies of the effects of isolation measures during Covid-19 MESHD on cognitive, psychological MESHD and functional symptoms of people with any kind of dementia MESHD or mild cognitive impairment MESHD. We summarised the findings of included papers following current guidelines for rapid reviews. Results: We identified 15 eligible papers, examining a total of 6,442 people with dementia MESHD. 13/15 were conducted in people living in the community and 2 in care homes. 60% (9/15) studies reported changes in cognition with 77% (7/9) of them describing declined cognition by >50% of respondents. 93% (14/15) of studies reported worsening or new onset of behavioural and psychological symptoms MESHD. 46% (7/15) studies reported changes in daily function, 6 of them reporting a functional decline in a variable proportion of the population studied. Conclusion: Lockdowns and confinement measures brought about by the pandemic have damaged the cognitive and psychological health and functional abilities of people with dementia MESHD across the world. It is urgent that infection control measures applied to people with dementia MESHD are balanced against the principles of non-maleficence. This systematic review makes 4 specific calls for action.

    COVID-19 MESHD and Cognitive Impairment: Severity, Evolution, and Functional Impact during Inpatient Rehabilitation

    Authors: Ruchi Patel; Irene Savrides; Christine Cahalan; Gargi Doulatani; Michael W. O'Dell; Joan Toglia; Abhishek Jaywant

    doi:10.1101/2021.03.15.21253637 Date: 2021-03-17 Source: medRxiv

    ObjectiveTo determine the frequency, magnitude, and change in cognitive impairment MESHD in patients with COVID-19 MESHD undergoing acute inpatient rehabilitation. We secondarily evaluated correlates of cognitive impairment MESHD and the relationship between cognition and functional gain. DesignCross-sectional observational study with assessments at admission and discharge SettingAcute inpatient rehabilitation unit within a large, urban academic medical center Participants77 patients hospitalized for COVID-19 MESHD and subsequently admitted to an inpatient rehabilitation unit between March-August 2020, 45 of whom were re-assessed at discharge. InterventionsN/A Main Outcome MeasuresMontreal Cognitive Assessment ( MoCA HGNC) scores on admission and discharge (when available) and Quality Indicator for Self-Care (QI-SC) scores on admission and discharge. Results62/77 (80.5%) of patients demonstrated cognitive deficits MESHD on the MoCA HGNC at admission: 39/77 (50.6%) were mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. Cognitive impairment MESHD was associated with a prior history of delirium MESHD, but not age or length of acute care hospitalization. 32/45 (71.1%) patients with discharge scores improved and met the MoCA HGNC minimally clinically important difference (MCID); however, 35/45 (77.8%) continued to score in the impaired range. Patients who met the MoCA HGNC MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID (p=.02). ConclusionCognitive impairment MESHD is common among hospitalized COVID-19 MESHD patients requiring acute inpatient rehabilitation. Cognitive impairment MESHD improves over the course of inpatient rehabilitation, and is associated with functional gain. Nonetheless, cognitive deficits MESHD frequently remain present at discharge, indicating the need for systematic assessment and follow-up, especially given the association with functional outcome.

    COVID-19 MESHD vaccine distrust in Colombian university students: Frequency and associated variables

    Authors: Adalberto Campo-Arias; John C Pedrozo-Pupo

    doi:10.1101/2021.03.07.21253080 Date: 2021-03-09 Source: medRxiv

    The study aimed to know the frequency and variables associated with COVID-19 MESHD vaccine distrust in students of a Colombian university. A cross-sectional study was carried out which participated emerging adult students of a Colombian university. A total of 1,136 students between 18 and 29 years (M= 22.0, SD = 3.0); most of them were female (66.0%), non-health students (82.8%), low-income (79.0%), and residents of urban areas (84.9%). It was frequent low institutional trust (74.8%), low cognitive MESHD, social capital (27.9%), low fear of COVID-19 MESHD (49.5%), low perceived stress related to COVID-19 MESHD (83.5%), and high COVID-19 MESHD vaccine distrust (78.9%). Non-health carrier (Adjusted OR = 3.63, 95%CI 2.58-5.10), rural residence (AOR = 1.85, 95%CI 1.13-3.04), low income (AOR = 1.84, 95%CI 1.31-2.57), and perceived stress related to COVID-19 MESHD (AOR = 1.74, 95%CI 1.20-2.54) were related to high COVID-19 MESHD vaccine distrust. In conclusion, COVID-19 MESHD vaccine distrust is high among emerging adult Colombian university students. The COVID-19 MESHD vaccine distrust is related to non-health science carriers, rural residents, low-income, and low-perceived stress related to COVID-19 MESHD. The COVID-19 MESHD related health literacy should be improved in students of this university considering socio-cultural background.

    Effectiveness of a telerehabilitation program for COVID-19 MESHD survivors (TERECO) on exercise capacity, pulmonary function, lower limb muscle strength, and quality of life: a randomised controlled trial

    Authors: Jian'an Li; Wenguang Xia; Chao Zhan; Shouguo Liu; Zhifei Yin; Jiayue Wang; Yufei Chong; Chanjuan Zheng; Xiaoming Fang; Wei Cheng; Jan D. Reinhardt

    doi:10.1101/2021.03.08.21253007 Date: 2021-03-09 Source: medRxiv

    ObjectivesTo investigate superiority of a telerehabilitation program for Covid-19 MESHD (TERECO) over no rehabilitation with regard to functional exercise capacity, lower-limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL), and perceived dyspnoea MESHD. DesignParallel-group randomised controlled-trial with 1:1 block-randomisation. SettingThree major hospitals from Jiangsu and Hubei provinces, China. Participants120 Covid-19 MESHD survivors with modified Medical Research Council (mMRC) dyspnoea MESHD score of 2-3 who had been discharged from hospital were randomised. 61 were allocated to the control group and 59 to the TERECO group. InterventionThe control group received educational instructions. The TERECO group participated in a 6-week home-based, pulmonary rehabilitation program delivered via smartphone and monitored with chest-worn heart rate telemetry. Exercise types comprised breathing control and thoracic expansion, aerobic exercise, and LMS exercise. OutcomesPrimary outcome was 6-minute walking distance (6MWD) in metres. Secondary outcomes were LMS measured as squat time in seconds; pulmonary function assessed by spirometry with parameters being forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, maximum voluntary ventilation (MVV), and peak expiratory flow; HRQOL measured with SF-12 physical component score (PCS) and mental component score (MCS); and mMRC dyspnoea MESHD, favourable outcome (no dyspnoea MESHD). Outcomes were assessed at 6 weeks (post-treatment) and 28 weeks (follow-up). Results120 patients were randomised, 15 (12.5%) were lost to follow-up at study endpoint. No serious adverse events occurred. 38 participants in the TERECO group complied with the exercise protocol (64.41% of randomized). The adjusted between-group difference in change in 6MWD from baseline was 65.45 metres (95% CI 43.8-87.1, p<0.001) at post-treatment and 68.62 metres (95% CI 46.39-90.85, p<0.001) at follow-up. Treatment effects for LMS were 20.12 seconds (95% CI 12.34-27.9, p<0.001) post-treatment and 22.23 seconds (95% CI 14.24-30.21, p<0.001) at follow-up. No group differences were found for lung function apart from post-treatment MVV (10.57 litres/minute, 95% CI 0.26-17.88, p=0.005). Increase in SF-12 PCS was greater in the TERECO group with treatment effects estimated as 3.79 (95% CI 1.24-6.35, p=0.004) at post-treatment and 2.69 (95% CI 0.06-5.32, p=0.045) at follow-up. No significant between-group differences were found for improvements in SF-12 MCS. At post-treatment 90.4% endorsed a favourable outcome for mMRC dyspnoea MESHD in the TERECO group vs. 61.7% in control (adjusted RR 1.46, 1.17-1.82, p=0.001). ConclusionsThis trial demonstrated superiority of TERECO over no rehabilitation for 6MWD, LMS, and SF-12 PCS. We found no persistent effects on pulmonary function, SF-12 MCS, and perceived dyspnoea MESHD. Trial registrationChinese Clinical Trial Registry: ChiCTR2000031834, 11 Apr 2020, URL: http://www.chictr.org.cn/showproj.aspx?proj=52216 KEY POINTSO_ST_ABSWhat is already knownC_ST_ABSMany Covid-19 MESHD survivors discharged from hospital have reduced exercise capacity, impaired pulmonary function MESHD, muscle weakness MESHD, and reduced quality of life, all of which might be addressed with pulmonary rehabilitation. However, evidence on effective pulmonary rehabilitation measures for this population is currently lacking. As delivery of conventional rehabilitation services is furthermore limited due to pandemic control measures, telerehabilitation programs represent a possible alternative. What the study addsWe developed a telerehabilitation program for Covid-19 MESHD survivors (TERECO program) that is delivered via smartphone and can be carried out at home. Our study suggests that TERECO was safe and participants of the TERECO program had improved exercise capacity, lower-limb muscle strength, and physical quality of life. No relevant group differences were found for lung function, self-reported breathlessness, and mental quality of life. The TERECO program is inexpensive and could be implemented on a large scale to improve physical health of Covid-19 MESHD survivors after discharge from hospital.

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SARS-CoV-2 Proteins

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