Mix-and-match approach to booster vaccination offers the best protection

 A new study on Chile’s national COVID-19 vaccination program, to be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022, Lisbon 23-26), and published in The Lancet Global Health, shows that giving a different type of vaccine (heterologous) for the third or ‘booster’ dose than was received for the first two doses, leads to better vaccine performance than using the same (homologous) inactivated SARS-CoV-2 vaccine for all three doses.

The study is by Dr Rafael Araos, Institute of Science and Innovation in Medicine, Clinica Alemana, Universidad del Desarrollo, Dr Alejandro Jara, and Dr Eduardo A Undurraga from Pontificia Universidad Católica de Chile, and colleagues including Dr  Johanna Acevedo  from the Chilean Ministry of Health.

The study assesses the effectiveness of CoronaVac (Sinovac Biotech), AZD1222 (Oxford-AstraZeneca), or BNT162b2 (Pfizer-BioNTech) vaccine boosters in individuals who had completed a primary two-dose immunisation schedule with CoronaVac, an inactivated SARS-CoV-2 vaccine which accounts for about half the COVID-19 vaccine doses delivered globally, compared with no vaccination. The study assessed the nationwide vaccination program in Chile, where the two-dose Coronavac schedule was by far the most commonly given. 

Individuals administered vaccines from Feb 2, 2021 to the prespecified trial end date of Nov 10, 2021 were evaluated; the team excluded individuals with a probable or confirmed SARS-CoV-2 infection (RT-PCR or antigen test) on or before Feb 2, 2021, and individuals who had received at least one dose of any COVID-19 vaccine before Feb 2, 2021. They estimated the vaccine effectiveness of booster doses against laboratory-confirmed symptomatic COVID-19 (symptomatic COVID-19) cases and COVID-19 outcomes (hospitalisation, admission to the intensive care unit [ICU], and death).

A total of 11 174 257 individuals were eligible for this study, among whom 4 127 546 completed a primary immunisation schedule (two doses) with CoronaVac and received a booster dose during the study period. 1 921 340 (46·5%) participants received a heterologous AZD1222 booster, 2 019 260 (48·9%) received a heterologous BNT162b2 booster, and 186 946 (4·5%) received a homologous booster with CoronaVac.

The authors calculated an adjusted vaccine effectiveness (using statistical modelling) in preventing symptomatic COVID-19 of 79% for a two-dose schedule plus CoronaVac booster, 97% for a BNT162b2 booster, and 93% for an AZD1222 booster. The adjusted vaccine effectiveness against COVID-19-related hospitalisation, ICU admission, and death was 86%, 92%, and 87% for a CoronaVac booster, 96%, 96%, and 97% for a Pfizer-BioNTech booster, and 98%, 99% and 98% for an Astra Zeneca booster.

The authors explain that booster programs were initiated in various countries due to emerging evidence of waning immunity from two dose schedules. Boosters are also important because evidence suggests that inactivated vaccines like Coronavac offer lower protection than the new mRNA technology vaccines from Pfizer -BioNTech and Moderna. Delta was the predominant circulating variant in Chile during the study period.

They conclude: “Our results suggest that a third dose of Coronavac or using a different booster vaccine such as Pfrizer-BioNTech or Astra Zeneca vaccines in those that had previously had two doses of Coronavac provides a high level of protection against COVID-19, including severe disease and death…However, receiving a different vaccine for the booster dose results in higher vaccine effectiveness than a third dose of Coronavac for all outcomes, providing additional support for a mix-and-match approach.”

The authors further explain that this is one of the first studies to examine the effectiveness of booster shots for inactivated SARS-CoV-2 vaccines. A recent study in Brazil1 showed that homologous and heterologous booster vaccines (BNT162b2 and AZD1222) following a CoronoVac primary vaccination schedule were safe and immunogenic. Similarly, a phase 1-2 study in the USA2 with mRNA-1273, Ad26.COV2.S, and BNT162b2 boosters found that heterologous boosters where on average more immunogenic than homologous boosters.

The UK’s Cov-Boost3 study (a phase 2 trial) showed that various vaccines are safe and immunogenic when given as boosters following a primary two-dose schedule of AZD1222 and BNT162b2, with the highest antibody levels achieved by mRNA boosters.

And prior studies4 have examined the immunogenicity of a heterologous two-dose regimen of ChAdOx1 followed by an mRNA vaccine, and found mix-and-match strategies were more immunogenic and offered more protection against COVID-19 than two-dose homologous strategies for that vaccine combination.

In Chile, the government has now advised that heterologous boosters should be use as the first option; however, people can and have received a homologous booster as an alternative.

JOURNAL

The Lancet Global Health

ARTICLE TITLE

Effectiveness of homologous and heterologous booster doses for an inactivated SARS-CoV-2 vaccine: a large-scale prospective cohort study

ARTICLE PUBLICATION DATE

23-Apr-2022

COI STATEMENT

Please see article for full disclosures

https://www.eurekalert.org/news-releases/950515

COVID-19 vaccine protection against hospitalization wanes

 A study released April 22 in The Lancet Respiratory Medicine shows that a booster dose of the Pfizer COVID-19 vaccine provides strong protection, roughly 80% to 90%, in the first few months against hospital admissions and emergency department visits caused by the delta and omicron variants. However, against omicron, this protection wanes over time — even after a third dose.

“Pfizer BioNTech COVID-19 booster doses significantly improve protection against omicron, although that protection seems to wane after 3 months against emergency room visits, and even for hospitalization,” said the study’s lead author, Sara Y. Tartof, PhD, an epidemiologist with the Kaiser Permanente Southern California Department of Research & Evaluation and a faculty member of the Kaiser Permanente Bernard J. Tyson School of Medicine, both in Pasadena. “Trends in waning against delta-related outcomes were generally similar to omicron, but with higher effectiveness at each time point than those seen for omicron.”

For this study, the researchers analyzed 11,123 hospital admissions and emergency department visits that did not result in hospital admission for acute respiratory infection. The study focused on Kaiser Permanente patient records in Southern California from December 1, 2021, through February 6, 2022, when both the delta and omicron variants were circulating.

• After 2 doses of the Pfizer COVID-19 vaccine effectiveness against omicron was 41% against hospital admission and 31% against emergency department visits at 9 months.
• After 3 doses, effectiveness against omicron-related hospitalization was 85% at less than 3 months but fell to 55% at 3 months or longer.
• Against emergency department visits that did not result in hospitalization, vaccine effectiveness of 3 doses against omicron was 77% at less than 3 months but fell to 53% at 3 months or longer.

“Although the Pfizer COVID-19 protection levels against omicron after 3 doses are substantially higher than those seen after 2 doses, they are less than those observed for delta or other COVID-19 strains,” Tartof said. “Additional doses of current, adapted, or novel COVID-19 vaccines may be needed to maintain high levels of protection against subsequent waves of COVID-19 caused by omicron or future variants with similar potential to escape protection.”

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JOURNAL

The Lancet Respiratory Medicine

ARTICLE TITLE

Durability of BNT162b2 vaccine against hospital and emergency department admissions due to the omicron and delta variants in a large health system in the USA: a test- negative case–control study

ARTICLE PUBLICATION DATE

22-Apr-2022

https://www.eurekalert.org/news-releases/950427

US study suggests COVID-19 pandemic may be accelerating antimicrobial resistance

 Among those hospitalised during the pandemic, both COVID-19 patients and those tested for SARS-COV-2 but negative, had higher rates of antibiotic-resistant bacterial infections compared to patients hospitalised before the pandemic, according to a study evaluating the pandemic’s impact on antimicrobial resistance (AMR) in 271 hospitals across the USA, to be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal (23-26 April).

 

The study, by Dr Karri Bauer of the pharmaceutical company MSD, a trade name of Merck & Co., Inc, Kenilworth, NJ, USA and Dr Vikas Gupta, of the medical technology company Becton Dickinson (BD) and colleagues, also found that drug resistant infections were significantly higher in hospital-onset cases during the pandemic.

 

An estimated 1.2 million people worldwide died in 2019 from antibiotic-resistant infections [1], and this number is predicted to increase ten-fold by 2050 [2]. The COVID-19 pandemic presents many challenges for appropriate antibiotic use and stewardship, and there have been studies reporting  that the pandemic was associated with AMR secondary infections, possibly due to the increase in the use of antibiotics to treat COVID-19 patients and disruptions to infection prevention and control practices in overwhelmed health systems. While conclusive evidence is lacking, these signals underscore the importance of continued monitoring of the impact of COVID-19 on AMR rates.

 

To provide more evidence, researchers conducted a multicenter, retrospective cohort analysis of all adults (aged 18 years or older) admitted to 271 hospitals across the USA before and during the COVID-19 pandemic, who had spent at least one day in hospital and had a record of discharge or death.

 

Patients were categorized according to when they were admitted: before the pandemic (from July 1, 2019 to February 29, 2020), or during the pandemic (from March 1, 2020 to October 30, 2021), and based on their COVID-19 status (with a positive SARS-CoV-2 result defined by positive PCR or antigen test within 7 days prior to admission or during hospitalisation). All admissions with at least one AMR infection (defined as a first positive culture for select gram-negative or gram-positive pathogens resistant to antibiotics) were recorded.

 

Researchers assessed AMR rates per 100 admissions before and during the COVID pandemic, and examined whether drug-resistant infections were acquired in the community-onset setting (defined as a culture collected less than 2 days after admission) or in the hospital-onset setting (more than 2 days after admission).

In total, 1,789,458 patients were admitted to the hospital in the pre-pandemic period and 3,729,208 during the pandemic. The number of patients admitted to the hospital with at least one AMR infection was 63,263 in the pre-pandemic period and 129, 410 during the pandemic.

 

The analyses found that the AMR rate was 3.54 per 100 admissions before the pandemic and 3.47 per 100 admissions during the pandemic. However, patients who tested positive or negative for COVID-19 had higher levels of AMR than patients before the pandemic—4.92 per 100 admissions and 4.11 per 100 admissions, respectively (see table in notes to editors).

 

For hospital-associated infections, the AMR rate was 0.77 per 100 admissions before the pandemic and 0.86 per 100 admissions during the pandemic, and highest at 2.19 per 100 admissions in patients with COVID-19. When looking at community-onset infections, the AMR rate was 2.76 per 100 admissions in the pre-pandemic period, and 2.61 per 100 admissions during the pandemic.

“These new data highlight the importance of closely monitoring the impact of COVID-19 on antimicrobial resistance  rates,” says Dr Bauer. “It is particularly worrying that antibiotic resistance has been rising during the pandemic in both SARS-CoV-2 positive and negative patients. Hospital-acquired infections are a major concern, with antimicrobial resistance rates significantly higher during the pandemic than before.”

 

Despite these important and timely findings, the authors note that additional evaluation of the pandemic’s impact on antimicrobial resistance is needed.​ “As healthcare capacity remains at the forefront of everyone’s mind, it will be critically important to keep a pulse on the growing impact of drug-resistant infections,” said Gupta. “This type of data and surveillance will help healthcare leaders identify needed resources to support antimicrobial stewardship programmes – and also support more detailed and sophisticated forecasting of future trends and outbreaks.”

 

This study is limited to US hospitals and evaluation of the impact of COVID-19 on AMR outside the US is warranted.

This press release is based on oral presentation 4960 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID). All accepted abstracts have been extensively peer reviewed by the congress selection committee. There is no full paper at this stage, but the authors are happy to answer your questions. The research has not yet been submitted to a medical journal for publication. 

COI STATEMENT

Conflict of interest statement: KAB, KPK, PAM, and LF are employees and shareholders of Merck & Co., Inc., Kenilworth, NJ, USA; LAP is an employee of Pfizer, Inc; and KCY, JW and VG are employees of, and also own stock in, Becton, Dickinson & Company.

https://www.eurekalert.org/news-releases/950576

Asthma drug can block crucial SARS-CoV-2 protein

 A drug used to treat asthma and allergies can bind to and block a crucial protein produced by the virus SARS-CoV-2, and reduce viral replication in human immune cells, according to a new study by researchers at the Indian Institute of Science (IISc).  

Approved by the US Food and Drug Administration (FDA), the drug, called montelukast, has been around for more than 20 years and is usually prescribed to reduce inflammation caused by conditions like asthma, hay fever and hives. 

In the study published in eLife, the researchers show that the drug binds strongly to one end (‘C-terminal’) of a SARS-CoV-2 protein called Nsp1, which is one of the first viral proteins unleashed inside the human cells. This protein can bind to ribosomes – the protein-making machinery – inside our immune cells and shut down the synthesis of vital proteins required by the immune system, thereby weakening it. Targeting Nsp1 could therefore reduce the damage inflicted by the virus. 

“The mutation rate in this protein, especially the C-terminal region, is very low compared to the rest of the viral proteins,” explains Tanweer Hussain, Assistant Professor in the Department of Molecular Reproduction, Development and Genetics (MRDG), IISc, and senior author of the study. Since Nsp1 is likely to remain largely unchanged in any variants of the virus that emerge, drugs targeting this region are expected to work against all such variants, he adds.   

Hussain and his team first used computational modelling to screen more than 1,600 FDA-approved drugs in order to find the ones that bound strongly to Nsp1. From these, they were able to shortlist a dozen drugs including montelukast and saquinavir, an anti-HIV drug. “The molecular dynamic simulations generate a lot of data, in the range of terabytes, and help to figure out the stability of the drug-bound protein molecule. To analyse these and identify which drugs may work inside the cell was a challenge,” says Mohammad Afsar, former Project Scientist at MRDG, currently a postdoc at the University of Texas at Austin, and first author of the study. 

Working with the group of Sandeep Eswarappa, Associate Professor in the Department of Biochemistry, Hussain’s team then cultured human cells in the lab that specifically produced Nsp1, treated them with montelukast and saquinavir separately, and found that only montelukast was able to rescue the inhibition of protein synthesis by Nsp1. 

“There are two aspects [to consider]: one is affinity and the other is stability,” explains Afsar. This means that the drug needs to not only bind to the viral protein strongly, but also stay bound for a sufficiently long time to prevent the protein from affecting the host cell, he adds. “The anti-HIV drug (saquinavir) showed good affinity, but not good stability.” Montelukast, on the other hand, was found to bind strongly and stably to Nsp1, allowing the host cells to resume normal protein synthesis. 

Hussain’s lab then tested the effect of the drug on live viruses, in the Bio-Safety Level 3 (BSL-3) facility at the Centre for Infectious Disease Research (CIDR), IISc, in collaboration with Shashank Tripathi, Assistant Professor at CIDR, and his team. They found that the drug was able to reduce viral numbers in infected cells in the culture.

“Clinicians have tried using the drug … and there are reports that said that montelukast reduced hospitalisation in COVID-19 patients,” says Hussain, adding that the exact mechanisms by which it works still need to be fully understood. His team plans to work with chemists to see if they can modify the structure of the drug to make it more potent against SARS-CoV-2. They also plan to continue hunting for similar drugs with strong antiviral activity.  

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JOURNAL

eLife

DOI

10.7554/eLife.74877.sa0 

ARTICLE TITLE

Drug targeting Nsp1-ribosomal complex shows antiviral activity against SARS-CoV-2

ARTICLE PUBLICATION DATE

24-Mar-2022

https://www.eurekalert.org/news-releases/950687

Long COVID has different clinical trajectories depending on severity of initial infection

 New research to be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal (23-26 April), suggests that the clinical trajectories and characteristics of long COVID may be different depending on the severity of the initial SARS-CoV-2 infection.

 

The large population-based study conducted during the first three waves of the pandemic, by Dr Pontus Hedberg from the Karolinska Institutet, Stockholm, Sweden and colleagues, also found a substantially higher rate of outpatient primary care use among individuals with long COVID-19, indicating persistence of the condition well beyond the initial infection.

 

The occurrence and risk factors of post COVID-19 condition, more commonly known as long COVID, and associated healthcare use before and after initial infection remain poorly understood.

 

To find out more, researchers conducted a retrospective population-based cohort study of 205,241 adult residents (aged 18 or older) of the Stockholm Region who had received a positive SARS-CoV-2 test between 1st March 2020 and 31st July 2021, and were alive 90 days after their test result, with and without a long COVID diagnosis. Individuals were determined to have long COVID if they received a diagnosis of post COVID-19 condition anytime between 90 and 360 days after their first positive test.

 

Modelling was used to analyse associations between age, sex, severity of infection, underlying medical conditions, previous healthcare usage, sociodemographic factors (eg, region of birth, education level and residential area type) and long COVID in non-hospitalised, hospitalised patients, and ICU-treated individuals.

 

In addition, individuals with long COVID-19 were propensity score matched to individuals without long COVID-19 by these factors as well as month of first positive test to assess healthcare use before and after the initial infection.

 

Among 205,241 adults with SARS-CoV-2 infection, almost a third (32%) of those treated for COVID-19 in ICU developed long COVID, as well as 6% of those hospitalised, and 1% of outpatients.

 

Fatigue was the most common registered symptom diagnosis among non-hospitalised patients (26%); while shortness of breath was the most frequently registered symptom diagnosis in both hospitalised patients (23%) and those treated in ICU (39%).

 

Analyses suggest that women were more than twice as likely to be diagnosed with long COVID compared to men among individuals with milder forms of initial infection, who did not require hospital care. A weaker association with female sex was also found among hospitalised but not ICU-treated individuals.

A history of mental illness or asthma was associated with twice the risk of being diagnosed with long COVID in people with initially mild COVID-19. This association was less pronounced among hospitalised individuals, and not seen among ICU-treated individuals.

The study also found a strong association between a history of outpatient primary care visits and long COVID-19 in those with initially mild COVID-19, but not in those who were treated in hospital or the ICU.

In addition, the researchers found the rate of outpatient care visits in people with long COVID-19 were substantially higher in the 10-12 months after the initial infection compared to before, indicating persistence well beyond the acute infection.

According to Dr Hedberg, “Many of the symptoms and risk factors reported in this study have been previously implicated in long COVID, but different study populations, assessment windows, and definitions of long COVID-19 prevents direct comparison between different studies. To the best of our knowledge, this is the first time the long COVID diagnosis issued by the WHO has been investigated across different severities of the initial SARS-CoV-2 infection.“

He continues, “Our findings reveal different associations between age, sex, comorbidities, symptoms, and healthcare use in people with more severe and milder forms of disease, which indicates different clinical trajectories and characteristics of long COVID. Future research should focus on better understanding the persistence of this debilitating condition across different groups of individuals.”

Despite the important findings, this is a retrospective observational study of a new diagnosis, and as such the observed associations do not necessarily indicate causation. In addition, the researchers acknowledge that they were unable to explore the impact of SARS-CoV-2 vaccination or the recent Omicron variant on long COVID, or to rule out the possibility that other unmeasured factors may have affected the results.

The study was funded by EuCARE, Region Stockholm, Swedish Research Council, Swedish Heart and Lung Foundation and Emil and Wera Cornell Foundation.

This press release is based on an oral presentation 3658 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID). All accepted abstracts have been extensively peer reviewed by the congress selection committee. There is no full paper at this stage, but the authors are happy to answer your questions. The research has not yet been submitted to a medical journal for publication. The abstract within have been update since submission to ECCMID, so the updated version is below. This is an oral presentation so no poster is available.

For full abstract click here

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COI STATEMENT

The authors declare no conflict of interest

https://www.eurekalert.org/news-releases/950651

Long Covid fatigue eased by four-week occupational therapy program

 Promising findings from a pilot long Covid rehabilitation programme in Ireland are being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal (23-26 April).

Post-COVID-19 syndrome, also known as long Covid, is estimated to affect at least 10% of people in Ireland who have had Covid. People from all ages and backgrounds are affected, with extreme fatigue one of the main symptoms.

This fatigue is beyond ordinary tiredness and affects day-to-day activities, including personal care, leisure activities and employment. Even basic tasks such as getting dressed and climbing the stairs can be exhausting.

“Long Covid is a new phenomenon and the exact long-term implications are unknown,” says Louise Norris, senior occupational therapist St James’s Hospital, Dublin, Ireland, who led the research.

“We became concerned after seeing increasing numbers of patients who were having difficulty carrying out everyday activities because of fatigue. Fatigue was also affecting their return to work.

“One of the key roles, and skills, of occupational therapy is to help people get back to their everyday activities.  We’ve previously helped those with other conditions, such as multiple sclerosis and rheumatoid arthritis, learn techniques to manage their fatigue and felt we could use that experience to address the needs of those with long-term fatigue post Covid.”

To find out more, Louise Norris and colleagues at St James’s Hospital and Trinity College Dublin developed a pilot occupational therapy Fatigue Management Education programme (FaME-PC).

The pilot programme in St James’s Hospital involved 53 patients (73% female), with a median age of 51, who had self-reported fatigue that was affecting their ability to take part in everyday activities.

Post-Covid symptom duration between 12 weeks and 12 months was reported by 36 (68%) participants. 13 (25%) reported post-Covid symptom duration >12 months.

At the start of the study, 52 participants (98%) reported moderate to severe fatigue. 38 participants (72%) reported moderate to severe breathing difficulties and half had difficulty with concentration and memory, known as brain fog

These symptoms caused moderate to severe disruption to return to work in 39 participants (74%), engagement in leisure activity in 34 participants (64%) and completion of everyday activities, such as preparing meals, driving or going for a walk, in 31 participants (58%).

The participants took part in three 1.5-hour-long group-based interventions delivered online by an occupational therapist over a four-week period.

These focused on self-management techniques to address everyday fatigue and brain-fog.  Topics covered included energy planning, dealing with stress and sleep hygiene.

Emphasis was placed on showing the participants how to identify their body and brain’s limit – allowing them to take a break before they reached the point of exhaustion.

The aim was to equip the participants with techniques they could practise in their day-to-day lives as much as possible.

Questionnaires about fatigue and energy levels, quality of life and concerns about wellbeing were filled in by the participants before the study and two weeks after the end of the four-week programme.

Preliminary analysis of the results showed significant improvements in all three areas: fatigue, quality of life and wellbeing concerns.

Louise Norris says: “There is an urgent need to find new and better ways of managing post-Covid fatigue and its wide-ranging, and in some cases, devastating, effects on people’s lives.

“Initial results from our pilot programme are highly promising. They show equipping patients with a range of practical techniques can result in meaningful improvements in fatigue and quality of life.  Patients also have fewer concerns about their wellbeing.”

The pilot has been extended and data collection is ongoing.

https://www.eurekalert.org/news-releases/950650

Ireland’s first exercised-based recovery program for COVID-19 patients

 Fatigue, breathlessness and other symptoms that persist after COVID-19 can be improved by a six-week virtual exercise programme, an Irish study being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal (23-26 April) suggests.

“Recovery from COVID-19 is complex, with many patients still experiencing persistent symptoms including breathlessness, debilitating fatigue, joint pains, chest pain and much more, weeks, months and, for some people, even years following acute infection,” says Kate O’Brien, of St James’s Hospital, Dublin, Ireland, a physiotherapist and the lead researcher.

“These symptoms can be present regardless of how severe their initial infection with SARS-CoV-2 may have been and affect their quality of life, ability to exercise, to work and to resume their normal societal roles.

“Many patients express a wish to get back into exercise but don’t know where to start and are too apprehensive or anxious to try on their own, fearing they may worsen their symptoms.

“Existing exercise classes for patients with other conditions do not cater for their needs and so we designed a specific recovery programme for COVID-19 patients.”

The programme, the first in Ireland, consists of two 50-minute virtual exercise classes a week, for a minimum of six weeks. Patients carry out circuits consisting of squats, lunges, stretches and other aerobic and strength-based exercises.

The intensity of the sessions increases gradually over time, as the patients build up their exercise tolerance.

Holding the classes virtually increases accessibility by allowing patients to log in from their office or home, as well as making it easier for patients who don’t live locally to participate.

Sixty patients (42% male, median age 45 years) who were experiencing persistent symptoms at least six weeks after being diagnosed with COVID-19 were referred to the recovery programme. Symptoms included including breathlessness on exertion, reduced exercise tolerance and muscle weakness.

Preliminary data on the first 40 to complete the programme is presented here.

Assessments were carried out the start and end of the programme to measure physical fitness and breathlessness (as assessed by the 6-Minute Walk Test), fatigue (Chalder Fatigue Score) and health-related quality of life (Short-Form-36 scores).

The programme led to a significant increase in the distance the participants could walk in six minutes. 

They were able to walk 34% further, on average, than at the start of the study (512.9m vs 382.4m). Improvements were seen in 93.5% of patients (defined as being able to walk at least 30m further), the rest experienced no change.

The patients also experienced a clinically significant improvement in breathlessness and improvements in quality of life. Improvements were seen in areas including ability to carry out everyday activities such as climbing the stairs and carry groceries, having more energy and feeling in better overall health.

Fatigue levels improved significantly in more than 70% of patients. 23% of patients experienced no change in their fatigue levels and none were more fatigued than before.  (One patient has, however, since left the class, due to worsening fatigue.)

Ms O’Brien, who devised the SJH Post-COVID-19 Virtual Recovery Programme, says: “These preliminary findings suggest a physiotherapist-delivered virtual post-COVID-19 recovery programme can improve exercise capacity, breathlessness and quality of life without exacerbating fatigue.”

Feedback has been collected from patients.  Examples include “Thank you for helping me to fall in love with exercise again” and “The classes gave me the confidence I really needed to get back to normality”.1

The authors declare no conflicts of interest.

This press release is based on oral presentation L0397 at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) Annual Meeting. The material has been peer reviewed by the congress selection committee. There is no full paper at this stage.

https://www.eurekalert.org/news-releases/950649