@article {pmid42646003,
year = {2026},
author = {Siedlecki, KL and Kobrinsky, V},
title = {The Impact of Long COVID on Cognitive Functioning.},
journal = {Journal of Intelligence},
volume = {14},
number = {8},
pages = {},
pmid = {42646003},
issn = {2079-3200},
abstract = {This study systematically examined whether long COVID negatively impacts subjective and objective measures of cognition in a community-based sample of 251 participants. Participants completed a battery of neurocognitive tasks (including assessments of short-term memory, working memory, episodic memory, processing speed, executive functioning, and reasoning) and provided self-ratings of their cognition (mental fatigue and subjective cognitive difficulties), depressive symptoms, the impact of symptoms on their life, and completed surveys assessing other psychosocial outcomes. Subgroups included individuals with no known lifetime history of COVID-19 illness (n = 66), those who had recovered from a short-term COVID infection (n = 119), and those who had been diagnosed with long COVID (n = 62). Analyses indicated that long COVID was associated with worse performance on measures of processing speed and executive functioning. In addition, those with a history of long COVID reported higher levels of mental fatigue and subjective cognitive difficulties compared to the other subgroups. Analyses within the long COVID subsample indicated that after controlling for covariates, depressive symptoms were significantly associated with mental fatigue and self-reported cognitive difficulties, and ratings of symptom impact also significantly predicted mental fatigue. These findings reinforce the value of incorporating both subjective and objective assessments when evaluating cognitive outcomes in long COVID, as each captures distinct aspects of functioning. Furthermore, these findings underscore the importance of assessing subjective cognitive concerns and functional symptom burden in clinical encounters, even when objective performance is generally unimpaired.},
}

@article {pmid42647302,
year = {2026},
author = {Theologou, M and Kyriakongonas, P and Syrmos, N and Theologou, T},
title = {Treatment and Diagnostic Challenges in a Patient with Atypical SARS-CoV-2-Associated Encephalitis Mimicking a Neoplasm: A Case Report.},
journal = {Reports (MDPI)},
volume = {9},
number = {3},
pages = {},
pmid = {42647302},
issn = {2571-841X},
abstract = {Background and Clinical Significance: Encephalitis is a rare neurological complication associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. In rare cases, focal neuroinflammation can manifest as a mass-like parenchymal lesion, creating profound diagnostic and treatment dilemmas by mimicking primary central nervous system neoplasms. Case Presentation: A 34-year-old female presented with cephalalgia, nausea, confusion, facial palsy, and a new onset of focal impaired awareness seizures (FIAS). Brain magnetic resonance imaging (MRI) revealed a prominent hyperintense lesion within the left temporal lobe with associated vasogenic edema and focal leptomeningeal enhancement highly suspicious of a low-grade glial neoplasm. Although nasopharyngeal RT-PCT was negative, the presence of serum anti-SARS-CoV-2 IgM and IgG suggested recent subclinical SARS-CoV-2 infection. To resolve diagnostic ambiguity and avoid empiric oncological overtreatment, a stereotactic brain biopsy was performed. Histopathology revealed acute neuroinflammation characterized by reactive gliosis, microglial hyperplasia, and perivascular lymphatic cuffing, with no evidence of neoplastic presence. Quantitative tissue RT-PCR confirmed the presence of SARS-CoV-2 (Ct33). Follow-up imaging demonstrated complete resolution of the abnormalities following conservative treatment with corticosteroids and antiepileptics, though mild clinical symptoms persisted for 12 months thereafter. Conclusions: Encephalitis presents a rare yet critical manifestation of SARS-CoV-2. Establishing definitive etiology remains challenging. Stereotactic biopsy is a valuable tool to guide appropriate treatment in cases of ambiguous imaging and clinical findings. Radiographic resolution may precede complete clinical recovery.},
}

@article {pmid42648354,
year = {2026},
author = {Zahiriharsini, A and Ho, C and Manhas, KP},
title = {Response to the Letter to the Editor: Comment on Effectiveness and Economic Impact of Medical and Rehabilitation Interventions in Long COVID Care.},
journal = {The American journal of the medical sciences},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.amjms.2026.08.014},
pmid = {42648354},
issn = {1538-2990},
}

@article {pmid42649155,
year = {2026},
author = {Charlton, BT and Slaghekke, A and Appelman, B and Eggelbusch, M and Huijts, JY and Noort, W and Hendrickse, PW and Bloemers, FW and Posthuma, JJ and van Amstel, P and Goulding, RP and Degens, H and Jaspers, RT and van Vugt, M and Wüst, RCI},
title = {Skeletal muscle properties in long COVID and ME/CFS differ from those induced by bed rest.},
journal = {Nature communications},
volume = {17},
number = {1},
pages = {},
pmid = {42649155},
issn = {2041-1723},
mesh = {Humans ; *Bed Rest/adverse effects ; *COVID-19/physiopathology/pathology/complications ; Female ; *Fatigue Syndrome, Chronic/physiopathology/pathology/metabolism ; *Muscle, Skeletal/physiopathology/pathology/metabolism ; Male ; Post-Acute COVID-19 Syndrome ; Adult ; Middle Aged ; Exercise/physiology ; Muscular Atrophy/physiopathology/pathology/etiology ; Oxygen Consumption ; SARS-CoV-2 ; Adaptation, Physiological ; Oxidative Phosphorylation ; },
abstract = {Patients with long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) suffer from post-exertional malaise. The accompanying physical inactivity may contribute to a lower aerobic capacity and may explain skeletal muscle adaptations in these patients. Here, we compare whole-body exercise responses and skeletal muscle adaptations after strict 60-day bed rest in healthy people with those in long COVID and ME/CFS patients, and healthy age- and sex-matched controls. Bed rest alters respiratory and cardiovascular responses to maximal exercise, which are dissimilar in patients. Bed rest causes muscle atrophy without altering fiber type. Both patient groups have more glycolytic fibers, and ME/CFS patients display type I-specific atrophy. Only after bed rest is oxidative phosphorylation capacity associated with maximal oxygen uptake. As skeletal muscle characteristics differ between patients and healthy individuals after bed rest, physical inactivity cannot solely explain the lower exercise capacity and skeletal muscle adaptations in long COVID and ME/CFS patients.},
}

Humans
*Bed Rest/adverse effects
*COVID-19/physiopathology/pathology/complications
Female
*Fatigue Syndrome, Chronic/physiopathology/pathology/metabolism
*Muscle, Skeletal/physiopathology/pathology/metabolism
Male
Post-Acute COVID-19 Syndrome
Adult
Middle Aged
Exercise/physiology
Muscular Atrophy/physiopathology/pathology/etiology
Oxygen Consumption
SARS-CoV-2
Adaptation, Physiological
Oxidative Phosphorylation

@article {pmid42650277,
year = {2026},
author = {Silva, RC and Quaresma, JAS and Mineshita, BKH and Costa, MEA and Reis, VMC and Silva, CIMD and Pinheiro, RF and Barbosa, LGV and Miranda, KJS and Chaves, ECR and Menezes, DC and Freitas, JJDS and Domingues, RJS and Vasconcelos, PFDC and Falcão, LFM},
title = {Persistent Redox Imbalance in Post-COVID-19 Syndrome: Lipid Peroxidation, Antioxidant Enzyme Depletion, and Reduced Nitric Oxide Availability in an Amazonian Population.},
journal = {Antioxidants (Basel, Switzerland)},
volume = {15},
number = {8},
pages = {},
doi = {10.3390/antiox15081013},
pmid = {42650277},
issn = {2076-3921},
support = {09/2021//Pará Secretariat for Science, Technology and Higher, Professional and Technological Education (SECTET)/ ; code 001, grant number 13/2020//Coordenação de Aperfeicoamento de Pessoal de Nível Superior/ ; INCT:406360/2022//National Council for Scientific and Technological Development/ ; },
abstract = {Post-COVID-19 syndrome (PCS) can persist even after mild acute illness, and oxidative stress has been proposed as a central mechanism for this persistence, although it remains poorly studied in the Amazon. This study characterized redox imbalance in patients with PCS through a combined analysis of lipid peroxidation, antioxidant defenses, and nitric oxide bioavailability. In a cross-sectional observational design, 85 patients with PCS and 53 healthy controls were evaluated, with determination of TBARS, total antioxidant capacity (ABTS), erythrocyte SOD, CAT, and GPx activity, plasma nitric oxide levels, and subgroup analysis according to disease duration (≤6, 6-12, and >12 months). Patients with PCS showed significantly higher TBARS concentrations and lower nitric oxide, ABTS, SOD, CAT, and GPx levels than controls, with predominantly large effect sizes. Lipid peroxidation correlated positively with HDL-c levels, and none of the markers differed significantly among the symptom duration subgroups. The findings indicate that PCS is associated with a persistent redox imbalance, marked by continuous lipid oxidative damage and sustained depletion of enzymatic and non-enzymatic antioxidant defenses, with a vascular component suggested by reduced nitric oxide levels, regardless of the time elapsed since symptom onset.},
}

@article {pmid42651302,
year = {2026},
author = {Meseguer-Fernández, MR and Badanta, B},
title = {Long COVID-19 in Spain: A Phenomenological Exploration of Health, Support, and Systemic Challenges.},
journal = {Healthcare (Basel, Switzerland)},
volume = {14},
number = {16},
pages = {},
doi = {10.3390/healthcare14162533},
pmid = {42651302},
issn = {2227-9032},
abstract = {INTRODUCTION: Long COVID-19 is a complex and multifaceted condition characterized by persistent and fluctuating symptoms extending beyond the acute phase of infection.

AIM: To explore the health and support experiences of the Spanish population living with long COVID-19.

METHODOLOGY: A qualitative study with an interpretative phenomenological approach was used. Semi-structured interviews were conducted over 10 months (2023-2024) across 17 Spanish provinces. The sample included 36 participants.

RESULTS: Participants reported persistent and fluctuating symptoms that severely limited daily functioning and generated anxiety, depression, and post-traumatic distress. Chronic fatigue and cognitive impairment affected social participation and work performance, frequently leading to absenteeism and job loss. Delayed diagnosis limited professional knowledge, and perceived lack of credibility contributed to dissatisfaction with healthcare services. Family members and patient associations were key sources of emotional and practical support.

CONCLUSIONS: Long COVID-19 has a multidimensional impact that requires a comprehensive and multidisciplinary approach. Participants' narratives reveal how underestimation of symptoms, delayed diagnosis, social stigma, limited healthcare and social support, additional family burdens, and disrupted work and social routines create complexity in care and challenge existing health and economic systems.},
}

@article {pmid42651327,
year = {2026},
author = {Skrypnyk, R and Skrypnyk, M and Skikevych, M and Skrypnyk, I and Yatsenko, T and Petrushanko, T and Spahr, A and Xu, C and Takahashi, S and Osada, T and Berkovsky, S and Hattori, K and Heissig, B},
title = {Salivary Gland Manifestations of Long COVID: A Case Report and Literature Review.},
journal = {Healthcare (Basel, Switzerland)},
volume = {14},
number = {16},
pages = {},
doi = {10.3390/healthcare14162558},
pmid = {42651327},
issn = {2227-9032},
support = {JP24K10435 , JP24K11549 , JP25K11620, JP25K11940//Japan Society for the Promotion of Science/ ; //The Japanese Society of Hematology/ ; //Salt Science Research Foundation/ ; //Taiju Life Social Welfare Foundation/ ; //Okinaka Memorial Institute for Medical Research/ ; K.H//Nakatani Foundation/ ; //Society of Iodine Science/ ; foundation grant//Heiwa (Japan)/ ; //Radiation Effects Association/ ; //International Joint Usage Research Center/ ; //Juntendo University/ ; //Macquarie University/ ; },
abstract = {Background: While acute coronavirus disease 2019 (COVID-19) infections of the oral cavity, with clinical signs such as taste loss, dry mouth, and mucosal lesions, are well-established health problems, involvement of the oral cavity as a sign of long COVID is poorly understood. One of the organs in the oral cavity that is prone to the virus is the salivary gland. Case presentation: We describe the case of an elderly patient with severe generalized xerostomia and left-sided facial swelling involving the submandibular gland, an uncommon presentation, as the parotid gland is typically involved COVID-19 infections. Ultrasound demonstrated marked ductal dilation without glandular tissue changes. The absence of other causes of sialodochitis, together with a history of repeated COVID-19 infections, led to the diagnosis of post-COVID sialodochitis. Management options were limited by the patient's frailty and polypharmacy. Nevertheless, conservative symptomatic treatment led to clinical recovery, with no evidence of progression to bacterial or necrotizing sialadenitis. Conclusions: This case demonstrates that COVID-19 infection and its history should be included in the differential diagnosis of sialadenitis. Along with the clinical case presentation, a narrative review of similar studies on COVID-19-associated salivary gland disease was conducted, spanning molecular and post-mortem evidence, acute clinical cases, and post-COVID sequelae.},
}

@article {pmid42652045,
year = {2026},
author = {Daodu, LP and Raste, Y and Allgrove, JE and Arrigoni, FIF and Kayyali, R},
title = {Phenotypic Evolution, Clinical Subtypes, and Independent Predictors of Long COVID: A Retrospective Cohort Study.},
journal = {Biomedicines},
volume = {14},
number = {8},
pages = {},
doi = {10.3390/biomedicines14081662},
pmid = {42652045},
issn = {2227-9059},
support = {N/A//Croydon Health Services NHS Trust/ ; },
abstract = {Background: Post-acute sequelae of COVID-19 (PASC), commonly known as long COVID, affects an estimated 10-30% of SARS-CoV-2 non-hospitalised and 50-70% of hospitalised survivors. This condition remains clinically heterogeneous, and the specific mechanisms driving the transition from acute infection to chronic sequelae remain poorly understood. We assessed independent risk factors, tracked the evolution of clinical features, defined distinct symptom-based phenotypes, and assessed the impact of different pandemic waves on the likelihood of developing long COVID in hospitalised survivors. Methods: We conducted a single-centre, retrospective cohort study at a university hospital in London. The population comprised 627 adults hospitalised with acute COVID-19 between February 2020 and December 2022. Baseline characteristics and outcomes were compared between long COVID and resolved cases using appropriate statistical tests for continuous and categorical variables. Multivariable logistic regression identified risk factors. McNemar's test quantified the phenotypic shift from admission to follow-up. Latent Class Analysis (LCA) identified clinical subtypes based on symptom clusters. Results: Of 627 patients, 252 (40.2%) met long COVID criteria. Comorbidity burden was the strongest predictor; patients with a single condition had a 4-fold increase in odds (aOR 4.62, 95% CI 2.36-9.04). The ORs were also significantly elevated among patients with 2 (aOR 3.26), 3 (aOR 2.68), or 4 or more (aOR 3.24) comorbidities. Older age (aOR 1.04), acute disease severity (measured by length of hospital stay) (aOR 1.27 per log-day) and elevated admission fibrinogen (aOR 1.21 per g/L) were significant predictors. Temporal analysis revealed a precipitous decline in risk from Wild-type/Alpha (>50%) to Delta/Omicron (<21%). We observed a distinct phenotypic shift: while acute respiratory inflammation resolved, systemic fatigue increased fourfold (7.0% to 32.4%), and memory difficulties emerged in the post-acute phase. LCA identified two phenotypes: fatigue-dominant and multisystem phenotypes. Conclusions: Long COVID is a multifactorial syndrome driven by host susceptibility, acute severity, and persistent coagulopathy. Clinical management should move beyond a monolithic approach and favour phenotype-specific strategies.},
}

@article {pmid42652076,
year = {2026},
author = {Khodanovich, M and Svetlik, M and Kamaeva, D and Usova, A and Anan'ina, T and Wasserlauf, I and Shadrina, M and Pashkevich, V and Moshkina, M and Obukhovskaya, V and Kataeva, N and Levina, A and Alifirova, V and Titova, M and Zhukova, I and Vasilieva, S and Schastnyy, E and Tumentceva, YA and Yarnykh, V},
title = {MRI-Based Quantitative Assessment of Normal-Appearing White and Gray Matter Demyelination in Multiple Sclerosis, Parkinson's Disease, Long COVID, and Normal Aging.},
journal = {Biomedicines},
volume = {14},
number = {8},
pages = {},
doi = {10.3390/biomedicines14081691},
pmid = {42652076},
issn = {2227-9059},
support = {22-15-00481-П//Russian Science Foundation/ ; },
abstract = {Background/Objectives: Normal-appearing white (WM) and gray (GM) matter outside focal demyelinating lesions (WMH) has been found impaired in many diseases and normal aging. The present study aimed to compare global GM and WM alterations in patients with multiple sclerosis (MS), Parkinson's disease, long COVID (LC) and normal aging. Methods: The study population comprised 196 participants including patients with MS (n = 42), PD (n = 16), LC (n = 75), and healthy volunteers (n = 63). All participants underwent MR scanning using the fast macromolecular fraction (MPF) mapping protocol and routine clinical sequences. MPF in global normal-appearing WM, GM, and mixed WM-GM was measured after exclusion of segmented focal lesions. To eliminate the influence of gender, age, and brain atrophy on the results, the corresponding covariates were included in the analysis. Results: Significant WMH volume increase and MPF decrease in global WM, WM-GM, and GM were found both in normal aging (75-85 years) and MS, PD, and LC patients (except for WM and WMH volume in LC patients). The greatest MPF decrease was observed in MS patients. The youngest (18-24 years) controls had a significant MPF decrease in global WM, WM-GM, and GM compared to middle-aged (35-44 years) participants. Among LC patients, the greatest global MPF reduction was found in patients with depression and insomnia as COVID-19 complications. In healthy controls, the peak age of myelination was estimated as 42.2 years for WM, 46.5 years for WM-GM, and 45.4 years for GM. Significant correlations were found between MPF and EDSS in MS patients (r = -0.71 in GM, r = -0.58 in WM-GM, r = -0.44 in WM) and stage of PD in PD patients (r = -0.58 in GM, r = -0.55 in WM-GM, r = -0.52 in WM). Conclusions: MPF mapping showed high sensitivity to age-related and disease-related differences in brain myelination, particularly in GM. Our results confirm the feasibility of using MPF mapping in large-scale clinical studies.},
}

@article {pmid42652253,
year = {2026},
author = {Noda, Y and Osawa, R and Takeda, Y and Kitahata, R},
title = {Comparative Treatment Response to Intermittent Theta Burst Stimulation in Long COVID-Associated Depression Versus Major Depressive Disorder: A Propensity Score-Matched Retrospective Cohort Study.},
journal = {Biomedicines},
volume = {14},
number = {8},
pages = {},
doi = {10.3390/biomedicines14081872},
pmid = {42652253},
issn = {2227-9059},
abstract = {Background: Long COVID has emerged as a global health challenge characterized by persistent neuropsychiatric symptoms, including depression, fatigue, and cognitive impairment. Growing evidence indicates that sustained neuroinflammation, endothelial dysfunction, and fronto-limbic network disruption may underlie these symptoms, representing pathophysiological features distinct from major depressive disorder (MDD). Although repetitive transcranial magnetic stimulation (rTMS) is an established treatment for MDD, its therapeutic efficacy in Long COVID-associated depression remains uncertain. Methods: Long COVID was defined as laboratory-confirmed SARS-CoV-2 infection followed by persistent neuropsychiatric symptoms lasting ≥3 months, including cognitive impairment ("brain fog"), fatigue, and new-onset depressive symptoms. We conducted a retrospective registry-based cohort study using real-world clinical data from two TMS clinics in Tokyo (May 2022-April 2026). Forty-four medication-free patients with Long COVID-associated MDD were compared with eighty-eight propensity score-matched patients with primary MDD (1:2 nearest-neighbor matching based on age, sex, and baseline Montgomery-Åsberg Depression Rating Scale (MADRS)). All participants received left dorsolateral prefrontal cortex intermittent theta burst stimulation (iTBS). Treatment outcomes were evaluated using MADRS and 17-item Hamilton Depression Rating Scale (HAM-D17) improvement rates, HAM-D17 response, and remission. Statistically adjusted analyses (inverse probability of treatment weighting (IPTW) and doubly robust estimation) were used to reduce measured confounding; however, residual unmeasured confounding cannot be excluded due to the retrospective observational design. Results: Long COVID patients showed significantly attenuated antidepressant response. Improvement rates were markedly lower for MADRS (38.4% vs. 61.5%) and HAM-D17 (36.7% vs. 58.4%). IPTW and doubly robust models demonstrated large adjusted percentage-point differences (MADRS: -23.0 percentage points; HAM-D17: -21.8 percentage points; both p < 0.001). While HAM-D17 response did not differ significantly, remission rates were substantially reduced (27.3% vs. 61.4%). Conclusions: These findings indicate an adjusted association suggesting reduced rTMS responsiveness in Long COVID-associated depression. Given the retrospective observational design and the possibility of residual unmeasured confounding, the results should be interpreted as associations rather than evidence of a causal effect.},
}

@article {pmid42652915,
year = {2026},
author = {Chagas-Sena, M and Lau, WL and Lane, TE and Resende, PC and Nunes, ACF},
title = {Blood-Brain Barrier Changes and Related Microvascular Outcomes in Long-COVID: A Comprehensive Review.},
journal = {Life (Basel, Switzerland)},
volume = {16},
number = {8},
pages = {},
doi = {10.3390/life16081227},
pmid = {42652915},
issn = {2075-1729},
abstract = {UNLABELLED: Caused by the SARS-CoV-2 virus, the COVID-19 pandemic is still considered a complex challenge, with manifestations not only of respiratory issues, but also conditions related to chronic cerebrovascular damage. Endothelial biomarkers, neuropathological and neuroimaging findings indicate endothelial dysfunction, microthrombosis, and disruption of the blood-brain barrier (BBB) are central mechanisms for acute and chronic ischemic and hemorrhagic cerebral events. Understanding these mechanisms is vital to reducing their impact on population health, whether through treatment or prevention of adverse outcomes. The objective of this study is to perform a review of the scientific literature on the post-infection effects of SARS-CoV-2 affecting the cerebral endothelium and the BBB, correlating them with potential clinical outcomes.

MATERIAL AND METHODS: Analysis of studies extracted from the PubMed database using the following terms: Long-COVID "AND" SARS-CoV-2 "AND" blood-brain barrier.

INCLUSION CRITERIA: keywords, publications related to the topic, and primary studies published after peer review.

EXCLUSION CRITERIA: preprint studies, publication outside of the timeframe 2020-2025, study design not compatible with this research, and full text not available.

RESULTS: An initial 121 studies were identified, of which 105 were excluded due to not meeting all inclusion criteria and 6 studies were inaccessible due to not being in the English language and full-text access limitations. Fifteen articles were included in the analysis, for topics as expression of viral receptors in the endothelium, markers of their activation, cerebral microvascular injury and coagulopathies. To clarify the pathogenic cascade, the evidence was stratified by biological model where in vitro evidence demonstrates that the Spike protein induces direct endothelial toxicity and platelet aggregation, establishing the primary molecular insult. Animal models confirm the translation of this insult into structural degradation of the BBB and pericyte loss. Clinically, infection-phase findings, characterized by multifocal microthrombosis and permeability spikes, act as the determining event that predisposes to the persistent neuroinflammatory environment. Biomarkers of BBB disruption and neuronal damage were consistently reported, with persistence of BBB dysfunction modifying risk stratification and rehabilitation efforts. Reported cases of Long-COVID demonstrated normalization of BBB markers without correlation with long-term symptoms, suggesting that other mechanisms are involved in Long-COVID.

CONCLUSION: Cerebral endotheliopathies and BBB dysfunction in patients with COVID-19 continue to impact the health of the population. The scientific literature indicates that SARS-CoV-2 induces cerebral endothelial injury, BBB disruption, and an increased risk of vascular events related to endotheliopathy, inflammation, and hypercoagulability. Understanding the impact of COVID-19 pathology on the population and developing prospective studies is essential to quantify the prevalence and mechanisms of brain injury. The identification of molecular targets and infection pathways are promising toward defining both preventive and therapeutic strategies to improve outcomes in the Long-COVID population.},
}

@article {pmid42653474,
year = {2026},
author = {Hanson, BA and Cogswell, AC and Lopez, M and Miller, J and Knutson, KL and Carnethon, MR and Koralnik, IJ},
title = {Cognition-Linked Monocyte State Reveals Altered Myeloid-Lymphoid Coordination in Neuro-PASC.},
journal = {International journal of molecular sciences},
volume = {27},
number = {16},
pages = {},
doi = {10.3390/ijms27167474},
pmid = {42653474},
issn = {1422-0067},
support = {3R01AG059291-04S1/AG/NIA NIH HHS/United States ; },
mesh = {Humans ; *Monocytes/metabolism/immunology ; *COVID-19/complications/immunology ; Female ; Post-Acute COVID-19 Syndrome ; Mitochondria/metabolism ; Male ; Aged ; Middle Aged ; *Cognition/physiology ; Oxidative Phosphorylation ; SARS-CoV-2 ; },
abstract = {Neurologic manifestations of long COVID, also called neurologic post-acute sequelae of SARS-CoV-2 infection (Neuro-PASC: NP) include persistent alteration of cognitive functions. We investigated whether these could be driven by immune perturbations. We combined flow cytometry (FC), sleep profiling, and single-cell RNA sequencing of peripheral blood immune cells from older adult (>55 years) individuals with and without NP to evaluate relationships with objective cognitive performance. NP participants showed reduced numbers of blood monocytes with increased mitochondrial superoxide, indicating an altered monocyte mitochondrial redox state. Higher peripheral capillary oxygen saturation (SpO2) was associated with better processing speed in NP participants. Monocyte transcriptional analyses identified mitochondrial adenosine triphosphate (ATP) synthase/Complex V (Complex V) pathway associated with cognitive performance in people without NP; this coupling was abrogated in NP patients, in whom cognitive performance instead showed an opposite relationship with Complex V. Shared leading-edge genes defined a 13-gene monocyte anchor representing this cognition-associated NP phenotype. Higher anchor scores were associated with coordinated oxidative phosphorylation and cytotoxic programs across CD3[+] T-cell subsets in individuals without NP, but not in NP participants. T-cell receptor stratified analyses showed that this altered relationship occurred in both expanded and unexpanded T-cell populations. FC correlations also supported reduced monocyte-to-lymphocyte mitochondrial coordination in NP. These exploratory findings identify a sleep and cognition-linked monocyte mitochondrial phenotype characterized by altered myeloid-lymphoid immune coordination in NP.},
}

Humans
*Monocytes/metabolism/immunology
*COVID-19/complications/immunology
Female
Post-Acute COVID-19 Syndrome
Mitochondria/metabolism
Male
Aged
Middle Aged
*Cognition/physiology
Oxidative Phosphorylation
SARS-CoV-2

@article {pmid42653699,
year = {2026},
author = {Khan, A and Rabbani, F and Mumtaz, SU and Javed, R and Ujjan, I and Kanwal, A and Conti, G},
title = {Potential Adjunctive Effects of Quercetin-Curcumin Co-Supplementation in Adults with Mild-to-Moderate Long COVID: Results from a Pragmatic Exploratory Real-World Clinical Study.},
journal = {Pharmaceuticals (Basel, Switzerland)},
volume = {19},
number = {8},
pages = {},
doi = {10.3390/ph19081202},
pmid = {42653699},
issn = {1424-8247},
abstract = {Background/Objectives: Long COVID is characterised by persistent symptoms such as fatigue, pain, cognitive impairment, sleep disturbances, and reduced quality of life (QoL) following SARS-CoV-2 infection. Proposed mechanisms include persistent immune activation, chronic inflammation, oxidative stress, endothelial dysfunction, mitochondrial disturbances, and virus-induced cellular senescence. Current management is largely supportive, highlighting the need for complementary strategies targeting these pathways. Natural polyphenols such as quercetin and curcumin possess anti-inflammatory, antioxidant, immunomodulatory, and potential senolytic properties that may modulate multiple pathways implicated in Long COVID. This study aimed to explore the potential complementary effects of oral quercetin-curcumin co-supplementation, administered alongside usual symptomatic management, in adults with persistent Long COVID symptoms. Methods: This single-centre, open-label, single-arm, pragmatic exploratory study enrolled 15 adults with Long COVID in an outpatient real-life clinical practice setting. Participants received a nutraceutical formulation containing quercetin (65 mg) and Curcuma longa extract standardised to provide 42 mg curcumin (Nasafytol[®]), administered as two capsules twice daily for 8 weeks in addition to standard care. The primary endpoint was change in overall symptom burden assessed using the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS). Secondary outcomes included fatigue (Fatigue Severity Scale, FSS), pain (Brief Pain Inventory-Short Form, BPI-SF), cognitive function (Patient-Reported Outcomes Measurement Information System Cognitive Function Short Form 8a, PROMIS-CF-8a), mood (Hospital Anxiety and Depression Scale, HADS), sleep quality (Pittsburgh Sleep Quality Index, PSQI), autonomic symptoms (Composite Autonomic Symptom Score-31, COMPASS-31), and health-related QoL (Medical Outcomes Study 36-Item Short-Form Health Survey, SF-36). Results: After 8 weeks, overall symptom burden significantly decreased (C19-YRS median 50 to 32; q = 0.018). Significant reductions were observed in patient-reported fatigue (q = 0.006), pain severity and interference (q = 0.006), and improved physical health-related QoL (SF-36 PCS; q = 0.025). Numerically favourable changes were also observed in cognitive function, anxiety, sleep quality, and autonomic symptoms, although these did not reach statistical significance. The supplementation was generally well tolerated with no serious adverse events. Conclusions: Quercetin-curcumin co-supplementation was associated with lower patient-reported symptom burden, fatigue, and pain and better physical health-related QoL after 8 weeks of supplementation in adults with Long COVID. These observed findings represent treatment-associated changes within this uncontrolled exploratory study and should be interpreted cautiously. Further evaluation in adequately powered randomised placebo-controlled trials is warranted. Trial registration: ClinicalTrials.gov (ID NCT06974058).},
}

@article {pmid42653958,
year = {2026},
author = {Nodola, P and Molefe, PSS and Tseki, PF and Gumede, NJ},
title = {Recent Advances in the Design of Inhibitors Targeting the Viral Entry and Replication of the SARS-CoV-2 Virus, Driven by In Silico Approaches.},
journal = {Molecules (Basel, Switzerland)},
volume = {31},
number = {16},
pages = {},
doi = {10.3390/molecules31162877},
pmid = {42653958},
issn = {1420-3049},
support = {CPRR23031081848//National Research Foundation/ ; },
mesh = {*Virus Internalization/drug effects ; *Antiviral Agents/pharmacology/chemistry/therapeutic use ; Humans ; *SARS-CoV-2/drug effects/physiology ; *Virus Replication/drug effects ; Molecular Dynamics Simulation ; Quantitative Structure-Activity Relationship ; *Drug Design ; Molecular Docking Simulation ; Computer Simulation ; COVID-19/virology ; Pandemics ; *Betacoronavirus/drug effects/physiology ; },
abstract = {The SARS-CoV-2 pandemic has significantly impacted global health, politics, medicine, finance, and society. Since 2020, various mutations have been reported, leading to drug resistance in current treatments against different SARS-CoV-2 strains and a drastic increase in cases of long-COVID. This situation underscores the urgent need to develop targeted and effective drugs to combat the spread of SARS-CoV-2 strains and their mutants, manage long-COVID symptoms and prepare for future pandemics. Currently, the treatment of SARS-CoV-2 focuses on targeting the virus's entry and replication mechanisms to disrupt its life cycle. This review examines approved drugs, clinical candidates, and inhibitors under development, along with their bioassay data, while highlighting associated challenges. It illustrates how inhibitors bind to active sites, providing insights and emphasizing the importance of in silico studies, such as molecular docking, molecular dynamics simulation, FEP+, WaterMap, and quantitative structure-activity relationship (QSAR) analyses, and their correlation with experimental studies in expediting the drug discovery process. The review aims to provide researchers with insights into the gaps that need to be addressed concerning mutations affecting viral entry and to prepare for future pandemics.},
}

*Virus Internalization/drug effects
*Antiviral Agents/pharmacology/chemistry/therapeutic use
Humans
*SARS-CoV-2/drug effects/physiology
*Virus Replication/drug effects
Molecular Dynamics Simulation
Quantitative Structure-Activity Relationship
*Drug Design
Molecular Docking Simulation
Computer Simulation
COVID-19/virology
Pandemics
*Betacoronavirus/drug effects/physiology

@article {pmid42654231,
year = {2026},
author = {Praet, SFE},
title = {Targeting Bioenergetic, Redox and Prostaglandin Pathways in Long COVID-Associated Post-Exertional Malaise and Brain Fog: A Nutraceutical Translational Hypothesis.},
journal = {Nutrients},
volume = {18},
number = {16},
pages = {},
doi = {10.3390/nu18162650},
pmid = {42654231},
issn = {2072-6643},
mesh = {Humans ; *Dietary Supplements ; *COVID-19/complications ; Post-Acute COVID-19 Syndrome ; *Energy Metabolism/drug effects ; Oxidation-Reduction/drug effects ; SARS-CoV-2 ; *Prostaglandins/metabolism ; Ubiquinone/analogs & derivatives ; Mitochondria/metabolism ; Brain/metabolism ; },
abstract = {Post-exertional malaise (PEM) and cognitive dysfunction (hereafter "cognitive dysfunction", including the patient-reported syndrome often described as "brain fog") are among the most disabling features of Long COVID; yet, approved disease-modifying treatments remain lacking. Emerging evidence implicates interacting disturbances in mitochondrial bioenergetics, redox regulation and neurovascular inflammation, although much of the supporting evidence remains indirect and derives from acute COVID-19, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), primary mitochondrial disease, inflammatory biology and mechanistic pharmacology rather than from direct Long COVID intervention trials. This hypothesis-generating narrative review develops a mechanism-based translational framework: that a pathway-targeted nutraceutical programme may modulate selected elements of these three axes, subject to prior demonstration of formulation quality, pharmacokinetic feasibility, target engagement and safety. Candidate modules comprise coenzyme Q10 and alpha-lipoic acid for bioenergetic/redox support; selenium, sulforaphane and resveratrol for Nrf2-thioredoxin-related redox regulation; and Boswellia serrata, luteolin and eicosapentaenoic acid for putative prostaglandin/resolution-pathway modulation. Sonlicromanol provides a conceptual mechanistic precedent for combined redox and prostaglandin-directed pharmacology, but it is not considered pharmacologically equivalent to an eight-agent nutraceutical combination. We summarise the mechanistic rationale, distinguish direct from indirect evidence, define qualitative evidence-grading criteria, outline safety and interaction considerations, and propose a staged translational research programme. This framework is intended to generate falsifiable hypotheses for future Long COVID studies, not to imply established clinical efficacy.},
}

Humans
*Dietary Supplements
*COVID-19/complications
Post-Acute COVID-19 Syndrome
*Energy Metabolism/drug effects
Oxidation-Reduction/drug effects
SARS-CoV-2
*Prostaglandins/metabolism
Ubiquinone/analogs & derivatives
Mitochondria/metabolism
Brain/metabolism

@article {pmid42654971,
year = {2026},
author = {Suba, MI and Rosca, O and Hogea, B and Pescaru, CC and Lucaciu, FC and Abu-Awwad, A and Ilie, AC and Pop, D and Abu-Awwad, SA},
title = {Association of Prior SARS-CoV-2 Infection with Immune Activation in Virally Suppressed People Living with HIV.},
journal = {Microorganisms},
volume = {14},
number = {8},
pages = {},
doi = {10.3390/microorganisms14081624},
pmid = {42654971},
issn = {2076-2607},
support = {//Victor Babeș University of Medicine and Pharmacy Timișoara/ ; },
abstract = {Residual inflammation remains a hallmark of treated HIV infection despite durable viral suppression. Whether previous SARS-CoV-2 infection is associated with residual inflammation in people living with HIV (PLWH) remains incompletely understood. This study evaluated the association between previous COVID-19 and persistent inflammation in virally suppressed PLWH. In this retrospective observational single-center study, 286 adults receiving antiretroviral therapy between January 2023 and December 2025 were included. Patients were stratified according to documented SARS-CoV-2 infection history. A secondary analysis included 231 individuals with sustained viral suppression (HIV-RNA < 50 copies/mL). Inflammatory biomarkers, immune recovery parameters, metabolic characteristics, and independent predictors of elevated inflammatory biomarker levels were evaluated. Previous SARS-CoV-2 infection was associated with significantly higher concentrations of C-reactive protein, interleukin-6, tumor necrosis factor-α, erythrocyte sedimentation rate, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (all p < 0.01). Among virally suppressed patients, elevated inflammatory biomarker levels were associated with lower CD4+ T-cell counts, lower CD4/CD8 ratios, obesity, metabolic syndrome, dyslipidemia, and hepatic steatosis. Previous SARS-CoV-2 infection, obesity, metabolic syndrome, and CD4+ T-cell counts < 500 cells/mm[3] were independently associated with elevated inflammatory biomarker levels. Previous SARS-CoV-2 infection was independently associated with an unfavorable inflammatory profile in virally suppressed people living with HIV. Given the retrospective observational design, these findings should be interpreted as associations rather than evidence of causality. These findings suggest that long-term host-related and metabolic factors may contribute to residual inflammation beyond viral control and highlight the need for prospective studies investigating strategies to reduce residual immune activation in treated HIV infection.},
}

@article {pmid42656694,
year = {2026},
author = {Groysman, R},
title = {Fragile mitophagy in long COVID: a proposed recovery-failure endotype for post-exertional malaise.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1905758},
pmid = {42656694},
issn = {2296-858X},
abstract = {Long COVID is frequently characterized by exertion intolerance, delayed symptom exacerbation, treatment sensitivity, and prolonged recovery. Post-exertional malaise (PEM) is often interpreted as a manifestation of low energy availability, autonomic dysfunction, immune activation, endothelial disturbance, or deconditioning. This paper proposes an additional recovery-failure mechanism for a PEM-dominant subgroup: fragile mitophagy, defined as a mismatch in which mitochondrial injury and mitophagy engagement occur but lysosomal completion of mitochondrial degradation is inadequate. Incomplete clearance could permit mitochondrial debris and danger signaling to persist and amplify oxidative, innate immune, endothelial, and neuroimmune responses after physiologic stress. The model predicts delayed crashes, progressive lowering of baseline with repeated exertion, and poor tolerance of interventions that increase mitochondrial turnover when lysosomal capacity is insufficient. Patient-derived Long COVID studies demonstrate mitochondrial, metabolic, and structural abnormalities but do not yet establish defective dynamic mitophagy flux or lysosomal completion. Hydroxychloroquine and chloroquine are used only as pharmacologic analogies showing that late autophagic flux can be impaired by disrupted lysosomal handling. Trehalose, genistein, curcumin, and the curcumin analog C1 are presented as experimental mechanistic probes because of reported effects on TFEB or autophagy-lysosome biology, not as established Long COVID treatments. The central prediction is that PEM severity will correlate more closely with impaired lysosomal completion, abnormal mitophagy flux, mitochondrial debris, and danger signaling than with baseline adenosine triphosphate (ATP) deficiency alone.},
}

@article {pmid42656817,
year = {2026},
author = {Yang, J and Li, J and Li, Y and Yuan, L and Lu, Y and Xue, Y and Wang, T and Xu, X and Zhu, Y and Zhang, Z and Qin, Z and Zhuang, G and He, X},
title = {Risk factors of long COVID among discharged patients with omicron infection in Changzhi, China: a retrospective cohort study.},
journal = {Frontiers in public health},
volume = {14},
number = {},
pages = {1774108},
pmid = {42656817},
issn = {2296-2565},
mesh = {Humans ; Retrospective Studies ; China/epidemiology ; *COVID-19/epidemiology ; Risk Factors ; Male ; Middle Aged ; Post-Acute COVID-19 Syndrome ; Female ; Aged ; *Patient Discharge/statistics & numerical data ; SARS-CoV-2 ; Prevalence ; },
abstract = {BACKGROUND: Relatively little is known about long COVID (LC) in China, particularly regarding the effects of recent Omicron sub-lineages. Therefore, we systematically assessed the prevalence and risk factors for developing LC.

METHODS: This retrospective cohort study included COVID-19 patients who had been hospitalized at two hospitals in Changzhi, China, between December 15, 2022 and April 30, 2024. All patients were interviewed via telephone ≥ 3 months after discharge. The follow-up study was conducted between July 18 and August 20, 2024. Logistic regression models were used to analyze risk factors for developing long COVID.

RESULTS: A total of 2,765 patients (1,407 male [50.9%]; median [IQR] age 70.0 [59.0-78.0] years) were successfully evaluated by telephone; 458 (16.6%) self-reported long COVID symptoms. The most common symptom was fatigue (4.9%), followed by muscle weakness (3.9%), sleep difficulties (3.0%), brain fog (2.8%) and cough (2.5%). Severe COVID-19 patients had a higher risk of LC than non-severe patients (OR = 1.275, 95% CI: 1.036-1.570). In subgroup analyses stratified by follow-up time, overweight patients (OR = 1.564; 95% CI: 1.052-2.326), patients with ≥ 7 acute-phase symptoms (OR = 1.275; 95% CI: 1.064-1.528), and farmer (OR = 1.439, 95% CI: 1.047, 1.976) had a higher risk of LC, whereas individuals who received immunosuppressant therapy had a lower risk (OR = 0.691, 95% CI: 0.504, 0.948). In addition, aged ≥ 50 years (OR = 2.441, 95% CI: 1.175-5.072) and underweight status (OR = 2.183; 95% CI: 1.115-4.273) were associated with a higher risk of muscle weakness.

CONCLUSION: This study provides valuable insights into LC after discharge, with 16.6% of discharged patients reporting symptoms. It is essential to monitor at-risk individuals according to identified risk factors for public health efforts.},
}

Humans
Retrospective Studies
China/epidemiology
*COVID-19/epidemiology
Risk Factors
Male
Middle Aged
Post-Acute COVID-19 Syndrome
Female
Aged
*Patient Discharge/statistics & numerical data
SARS-CoV-2
Prevalence

@article {pmid42656834,
year = {2026},
author = {Emery, IF and Sahagun, SJ and Zunica, ERM and Axelrod, C and Beyl, RA and Cho, E and Spielmann, G and Costa, S and DeKay, JT and Chlebek, C and Amano, S and Stevens, K and Scherer, PE and Bu, D and Javidan, A and Finlin, BS and Zhang, XD and Nikolajczyk, B and Blish C, C and Bramante, C and McLaughlin, T and DeLine-Caballero, S and Ratnasiri, K and Mangalanathan, U and Li, JZ and Leeman, BM and Edelstein, G and Karlson, EW and Kirwan, JP and Kern, PA and Ryzhov, S and Rosen, CJ},
title = {Metabolic, viral, and immune phenotypes in long COVID.},
journal = {Frontiers in endocrinology},
volume = {17},
number = {},
pages = {1899115},
pmid = {42656834},
issn = {1664-2392},
mesh = {Humans ; Female ; *COVID-19/immunology/metabolism/virology ; Middle Aged ; Male ; Case-Control Studies ; Post-Acute COVID-19 Syndrome ; *SARS-CoV-2 ; Cross-Sectional Studies ; T-Lymphocytes/metabolism/immunology ; Symptom Burden ; Phenotype ; Body Composition ; Adult ; Adipose Tissue/metabolism/virology ; Mitochondria/metabolism ; },
abstract = {CONTEXT: Long COVID is characterized by persistent symptoms ≥ 3 months after acute SARS-CoV-2 infection. To date, the underlying pathophysiology is unclear.

OBJECTIVE: To characterize the immune and metabolic features of Long COVID and the potential role of viral persistence in adipose tissue.

DESIGN: Case-control, cross-sectional study under the RECOVER initiative.

SETTING: Maine, Louisiana, and Kentucky.

PARTICIPANTS: Adults from the RECOVER study with high or low symptom burden assessed by the PROMIS scoring system or the Long COVID RECOVER Index (LCRI), matched by age, sex, BMI comparing post infected individuals with Long COVID vs those without sequelae.

MAIN OUTCOME MEASURES: The primary outcome was a difference in T cell mitochondrial respiration by symptom severity. Secondary outcomes included glucose tolerance, body composition, T cell surface markers, subcutaneous adipose biopsy.

RESULTS: There were 54 participants, 80% female, mean age was 51.7 years, mean BMI 31. Time from initial infection was 894 days. The participant cohort by symptom burden was elucidated using a PROMIS symptom score subdivided by the following: High Symptom Burden (HSB) >15:n=25, Intermediate Symptom Burden (ISB) 10-15: n=14 and Low Symptom Burden (LSB) <10;n=15. Using the LCRI, n=15 were Long COVID+ (LC+) and n=39 were Indeterminate. The primary outcome, T-cell oxidative phosphorylation, did not differ between LC+ and Indeterminate nor by PROMIS scores. BMI and fat mass did not differ but T cell glycolytic activity was greater in those with LC+ vs Indeterminate. Lean mass and femoral BMD trended lower in the HSB vs LSB by both classifications. Prevalence of Type 2 diabetes did not differ by symptom scores, but HOMA-IR was higher and HOMA-B was lower in LC+ vs Indeterminate. SARS-CoV-2 viral RNA was not detectable in subcutaneous adipose tissue biopsies. CD26+ T cell number, and DPP-4 (CD26) activity were higher in the HSB and correlated significantly with symptom scores (r=0.52, p<0.01); plasma cytokines and stimulated T-cell cytokines did not differ by symptom group in either classification.

CONCLUSIONS: Individuals with Long COVID symptoms show subtle impairments in glucose tolerance, serum leptin, lean mass and enhanced T-cell DPP-4 activity. Participants with Long COVID have subtle changes in glucose metabolism that are not driven by SARS-CoV-2 virus in subcutaneous adipose tissue.},
}

Humans
Female
*COVID-19/immunology/metabolism/virology
Middle Aged
Male
Case-Control Studies
Post-Acute COVID-19 Syndrome
*SARS-CoV-2
Cross-Sectional Studies
T-Lymphocytes/metabolism/immunology
Symptom Burden
Phenotype
Body Composition
Adult
Adipose Tissue/metabolism/virology
Mitochondria/metabolism

@article {pmid42641158,
year = {2026},
author = {Karipidis, YK and Karipidis, KY},
title = {eNOS Uncoupling, Shear-Stress Tolerance, and the Two-Threshold Model of Post-Exertional Malaise in Long COVID: A Mechanistic Hypothesis With Implications for Physiotherapy and Recovery Protocols.},
journal = {Microcirculation (New York, N.Y. : 1994)},
volume = {33},
number = {6},
pages = {e70082},
doi = {10.1111/micc.70082},
pmid = {42641158},
issn = {1549-8719},
mesh = {Humans ; *Nitric Oxide Synthase Type III/metabolism ; Post-Acute COVID-19 Syndrome ; *COVID-19/physiopathology/complications/therapy ; Biopterins/analogs & derivatives/metabolism ; SARS-CoV-2 ; *Physical Therapy Modalities ; Nitric Oxide/metabolism ; Stress, Mechanical ; Endothelium, Vascular/physiopathology ; },
abstract = {OBJECTIVE: To propose and make testable a mechanistic hypothesis for post-exertional malaise (PEM) in a clinically distinct subset of Long COVID patients, in whom delayed exertional symptoms coexist with consistently normal macrovascular investigations.

METHODS: Established vascular-biology literature is synthesized into an integrated, falsifiable model centered on endothelial nitric oxide synthase (eNOS) uncoupling, from which mechanism-specific predictions and a dynamic pre-/post-exertion biomarker validation framework are derived.

RESULTS: We propose that SARS-CoV-2-induced endotheliitis activates inducible nitric oxide synthase and silently depletes the tetrahydrobiopterin (BH4) pool on return to activity, shear-stress activation of structurally intact eNOS against a depleted BH4 background yields superoxide rather than nitric oxide, generating peroxynitrite that sustains a self-amplifying nitro-oxidative cycle. The Two-Threshold Model distinguishes a PEM threshold from a shear-stress-tolerance threshold and predicts that prolonged immobility may paradoxically erode endothelial function. eNOS uncoupling is positioned as one node among alternative microvascular pathways, and autonomic findings are proposed to be secondary within this phenotype.

CONCLUSIONS: This phenotype-specific, falsifiable hypothesis yields mechanism-derived predictions and rehabilitation implications consistent with symptom-contingent pacing guidance; it does not claim to explain all Long COVID presentations.},
}

Humans
*Nitric Oxide Synthase Type III/metabolism
Post-Acute COVID-19 Syndrome
*COVID-19/physiopathology/complications/therapy
Biopterins/analogs & derivatives/metabolism
SARS-CoV-2
*Physical Therapy Modalities
Nitric Oxide/metabolism
Stress, Mechanical
Endothelium, Vascular/physiopathology

@article {pmid42641338,
year = {2026},
author = {Fanelli, M and Petrone, V and Chirico, R and Matteucci, C and Minutolo, A},
title = {Extracellular vesicles in COVID-19 and long COVID: Structural mediators of viral persistence and immune dysfunction.},
journal = {Current opinion in structural biology},
volume = {101},
number = {},
pages = {103375},
doi = {10.1016/j.sbi.2026.103375},
pmid = {42641338},
issn = {1879-033X},
abstract = {Extracellular vesicles (EVs) have emerged as pivotal structural mediators of immune dysregulation and viral antigen persistence in long COVID. Rather than passive biological carriers, EVs released during SARS-CoV-2 infection function as highly organized lipid nanostructures that preserve the native conformational integrity of viral proteins, including the spike glycoprotein, thereby facilitating chronic signaling and systemic inflammation. Recent advancements in single-particle analytical techniques, such as cryo-electron tomography and atomic force microscopy, are now overcoming the limitations of bulk analysis, enabling the visualization of EV heterogeneity and the quantitative profiling of their nanomechanical properties. This review synthesizes current insights into how EV-associated viral remnants and host-derived inflammatory cargo propagate neuro-immune crosstalk and vascular injury. We conclude by evaluating the potential of EVs as precision biomarkers and bioengineered therapeutic platforms, emphasizing the need for standardized structural characterization to transition these nanovesicles from physiological mediators to clinical diagnostic and regenerative tools.},
}

@article {pmid42642266,
year = {2026},
author = {Floridia, M and Parati, G and Soranna, D and Weimer, LE and Onder, G and , },
title = {New Cardiovascular Diagnoses, Symptoms and Functional Status Following SARS-CoV-2 Infection in a National Cohort of 1,734 Patients in Italy.},
journal = {Heart, lung & circulation},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.hlc.2026.02.024},
pmid = {42642266},
issn = {1444-2892},
abstract = {BACKGROUND: Few clinical studies have assessed cardiovascular events and associated symptoms following coronavirus disease 2019 (COVID-19).

METHOD: This was a multicentre study of patients with previous severe acute respiratory syndrome coronavirus 2 infection followed at university and hospital clinics, with collection of both retrospective and prospective data. Demographics, comorbidities, severity and timing of acute COVID-19, subjective functional status, and presence of 30 symptoms were collected. New diagnoses following COVID-19 were classified as cardiovascular or non-cardiovascular. The associations between clinical and demographic covariates and occurrence of new diagnoses were assessed in multivariable logistic regression models.

RESULTS: New diagnoses were made in 40.5% of 1,734 adult patients (non-cardiovascular, 35.1%; cardiovascular, 10.9%; both types, 5.4%). The most common new cardiovascular diagnoses were arrhythmias (3.0%), pulmonary embolism (2.6%), hypertension (2.4%), and pericarditis (2.0%), followed by heart failure and venous thrombosis (both at 1.3%), myocarditis (0.6%), and ischaemic heart disease (0.3%). In the multivariable analyses, new cardiovascular diagnoses were associated with age >65 years (adjusted odds ratio 1.64; 95% confidence interval 1.15-2.33), admission to the intensive care unit during acute infection (1.85; 1.08-3.17), and chronic pulmonary disease (1.76; 1.02-3.06). After a mean follow-up of 7 months, patients with new cardiovascular diagnoses had a significantly higher mean number of symptoms, significantly higher prevalence of several individual symptoms, and worse functional status compared with pre-infection.

CONCLUSIONS: The findings suggest that new cardiovascular diagnoses following COVID-19 significantly affect subsequent wellbeing. Preventing their occurrence may reduce not only acute and post-acute cardiovascular morbidity, but also the persistence, breadth, and burden of post-COVID-19 symptoms, and may avert a significant decline in functional status.},
}

@article {pmid42642464,
year = {2026},
author = {Saad, J and Hensen, J and Bergelt, C and Lerch, SP},
title = {Medical invalidation is associated with structural barriers in postacute immune mediated syndromes based on patient perspectives in Germany.},
journal = {Scientific reports},
volume = {16},
number = {1},
pages = {},
pmid = {42642464},
issn = {2045-2322},
mesh = {Humans ; Germany/epidemiology ; Female ; Post-Acute COVID-19 Syndrome ; Cross-Sectional Studies ; Male ; *COVID-19/epidemiology/complications/immunology ; Middle Aged ; Adult ; Fatigue Syndrome, Chronic/epidemiology ; *Health Services Accessibility ; SARS-CoV-2 ; Aged ; },
abstract = {Post-acute immune-mediated syndromes (PAIMS), including Long COVID/Post-COVID (LC/PC), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and post-acute COVID-19 vaccination syndrome (PACVS), are characterized by persistent, multisystemic symptoms and significant healthcare challenges. A key issue is medical invalidation, defined as the dismissal or delegitimization of patients' reports of symptoms. This cross-sectional online study, conducted in Germany between October and December 2025 (N = 577), examined healthcare experiences, access barriers, and perceived invalidation. Although healthcare utilization was high, 87% of participants reported difficulties accessing appropriate treatment. Major barriers included lack of available therapies (60%) or not being taken seriously (26%). Perceived invalidation by medical personnel was moderate across all groups (LC: M = 2.80; ME/CFS: M = 2.99; PACVS: M = 3.03) and did not differ significantly (Welch-F(2, 190.50) = 2.87, p = 0.059) between groups. Invalidation occurred not only within healthcare settings but was particularly pronounced in interactions with authorities and workplaces. Social media and online communities served as important sources of information and support, especially among individuals with ME/CFS. Overall, the findings reveal substantial structural barriers in the care of PAIMS and highlight the need for improved clinical education, better care coordination, and stronger institutional recognition of these conditions.},
}

Humans
Germany/epidemiology
Female
Post-Acute COVID-19 Syndrome
Cross-Sectional Studies
Male
*COVID-19/epidemiology/complications/immunology
Middle Aged
Adult
Fatigue Syndrome, Chronic/epidemiology
*Health Services Accessibility
SARS-CoV-2
Aged

@article {pmid42645657,
year = {2026},
author = {Jmii, H and Haverty, R and Rochfort, KD and Fletcher, NF},
title = {SARS-CoV-2 disrupts the integrity of a human blood-brain barrier model in the absence of infection.},
journal = {Journal of neurovirology},
volume = {32},
number = {5},
pages = {},
pmid = {42645657},
issn = {1538-2443},
support = {20/COV/8492//Research Ireland/ ; },
mesh = {Humans ; *Blood-Brain Barrier/virology/pathology/immunology/metabolism ; *SARS-CoV-2/pathogenicity/immunology ; Endothelial Cells/virology/pathology/immunology/metabolism/drug effects ; *COVID-19/virology/pathology/immunology ; Astrocytes/virology/pathology/immunology/metabolism/drug effects ; *Spike Glycoprotein, Coronavirus/immunology/metabolism/genetics ; Microglia/virology/pathology/immunology/drug effects/metabolism ; Pericytes/virology/pathology/immunology/drug effects/metabolism ; Cytokines/genetics ; },
abstract = {Neurological symptoms are recognized in patients with COVID-19, and include anosmia, ageusia, cognitive impairments as well as more severe complications including encephalitis and ischemic strokes. Furthermore, persistent cognitive impairment including 'brain fog' is recognised as part of the long COVID syndrome. While SARS-CoV-2 has been shown to infect cells of the central nervous system (CNS) in vitro and in vivo, it is unclear whether direct infection of the CNS or indirect mechanisms including activation of the coagulation cascade or immune activation are the key drivers of COVID-19 neuropathology. We investigated whether inactivated SARS-CoV-2, or spike protein, can disrupt the integrity of the blood-brain barrier (BBB) and characterised neuroinflammation in the absence of infection. Using an in vitro model of the BBB composed of primary human microvascular endothelial cells, astrocytes, pericytes and microglia, we observed BBB disruption following exposure of the model to SARS-CoV-2 or spike protein. Importantly, loss of BBB integrity was observed in response to luminal (mimicking 'blood side') or abluminal ('brain side') exposure to inactivated virus or spike protein. Transcriptional upregulation of a range of chemokines, inflammatory cytokines and adhesion factors, and release of inflammatory cytokines from BBB models was also observed in response to luminal or abluminal SARS-CoV-2 or spike protein exposure. These data indicate that BBB disruption and immune activation in vitro occurs in response to SARS-CoV-2 in the absence of infection, highlighting the importance of the host immune system in BBB disruption during SARS-CoV-2 infection.},
}

Humans
*Blood-Brain Barrier/virology/pathology/immunology/metabolism
*SARS-CoV-2/pathogenicity/immunology
Endothelial Cells/virology/pathology/immunology/metabolism/drug effects
*COVID-19/virology/pathology/immunology
Astrocytes/virology/pathology/immunology/metabolism/drug effects
*Spike Glycoprotein, Coronavirus/immunology/metabolism/genetics
Microglia/virology/pathology/immunology/drug effects/metabolism
Pericytes/virology/pathology/immunology/drug effects/metabolism
Cytokines/genetics

@article {pmid42479649,
year = {2026},
author = {Zhang, Z and Hoang, MT and Wastesson, JW and Johnell, K},
title = {Post-COVID-19 Condition Diagnosis among Older People: Findings from Swedish National Register Data.},
journal = {Gerontology},
volume = {},
number = {},
pages = {1-16},
doi = {10.1159/000553601},
pmid = {42479649},
issn = {1423-0003},
abstract = {INTRODUCTION: Post-COVID-19 condition (PCC) denotes the persistence of symptoms following Severe Acute Respiratory Syndrome Coronavirus 2 infection. PCC poses a large disease burden worldwide. We aimed to explore the epidemiological characteristics of clinically diagnosed PCC among older people aged ≥65 years in Sweden and to establish a machine learning tool to predict PCC risk.

METHODS: This nationwide register-based study employed a cross-sectional design. Prevalence of PCC diagnosis recorded in hospital and specialized outpatient care settings among older people aged ≥65 years in Sweden was calculated. Logistic regression models were employed to assess the associations between various factors and PCC diagnosed in hospital and specialized outpatient care. A prediction model based on extreme gradient boosting was constructed based on selected features.

RESULTS: Of 236,943 older people aged ≥65 years who were diagnosed with COVID-19, 2.5% of them were diagnosed with PCC in hospital or specialized outpatient care. The odds of PCC diagnosed in hospital and specialized outpatient care in women were lower (odds ratio [OR] = 0.78, 95% confidence interval [CI]: 0.73-0.82). The odds decreased for each additional year of age (OR = 0.98, 95% CI: 0.98-0.98). Higher odds of PCC were found in people with higher Charlson Comorbidity Index and who used more types of medication. The odds of PCC were the lowest for infections during Omicron-predominant period (OR = 0.09, 95% CI: 0.08-0.10). The predicted PCC risk was generally higher among individuals aged 65-74 years with higher comorbidity burden, with more types of medication use, and during early variant-dominant periods.

CONCLUSION: In summary, the prevalence of PCC diagnosis among older people in Sweden was relatively low when restricted to hospital and specialized outpatient care. A higher burden of comorbidities and more types of medication use were associated with increased odds of PCC diagnosed in hospital and specialized outpatient care. Register-based predictive models may help identify older people at higher risk of PCC.},
}

@article {pmid42627164,
year = {2026},
author = {Kiyohara, CL and Kim, S and Thomas, WE},
title = {Antibody-mediated SARS-CoV-2 entry and conformational regulation.},
journal = {Microbiology spectrum},
volume = {},
number = {},
pages = {e0012026},
doi = {10.1128/spectrum.00120-26},
pmid = {42627164},
issn = {2165-0497},
abstract = {Antibody-mediated entry (AME) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into monocytes and macrophages has been linked to activation of inflammatory phenotypes that are associated with severe coronavirus disease 2019 (COVID-19), but why only some antibodies mediate this entry while others do not is unknown. However, it has been demonstrated that conformational dynamics of the SARS-CoV-2 receptor-binding domain (RBD) are critical to viral entry, and that antibodies targeting the RBD can conformationally regulate these dynamics. Here, we identified four groups of RBD-specific monoclonal antibodies (mAbs) that target unique epitopes on the SARS-CoV-2 RBD and are also associated with different RBD conformational regulation and AME abilities. Steric clash quantification elucidated a structural basis for differences in conformational regulation by these antibody groups. We found that some, but not all, antibody groups were able to mediate entry into THP1-derived macrophages, and also found that this entry was inhibitable by antibodies in other groups. Collectively, these results suggest that there is a connection between RBD conformational regulation, epitope, and AME for antibodies targeting SARS-CoV-2. This connection improves understanding of the AME mechanism and how to inhibit AME for SARS-CoV-2, which has potential applications in the continued development of safe and effective vaccines and therapeutics for COVID-19 and related diseases.IMPORTANCEAntibody-mediated entry (AME) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) into immune cells and resulting activation of inflammatory pathways is increasingly being associated with coronavirus disease 2019 (COVID-19) disease severity. Vaccination against COVID-19 remains one of our strongest tools to prevent these effects; vaccines continue to protect patients from both severe and long COVID-19 symptoms, and serum from vaccinated individuals was shown not to cause AME in immune cells in vitro. However, a lack of understanding about why some, but not all, antibodies cause AME limits our ability to actively prevent AME in antigen design. In this work, we identify characteristics that differentiate individual AME and non-AME antibodies. We also report that AME can be inhibited by other antibodies. Understanding these characteristics and differences between antibodies could allow us to add functionality to already effective vaccines by designing them to actively avoid eliciting AME antibodies and promote antibodies that inhibit AME and its downstream systemic effects.},
}

@article {pmid42630997,
year = {2026},
author = {Tamariz, L and Rodriguez, D and Bast, E and Klimas, N and Pyne, M and Cruz-Jimenez, M and Gomez-Manjarrez, D and Palacio, A},
title = {Systematic Review of Randomized Clinical Trials for the Treatment of Long COVID Syndrome.},
journal = {Journal of community hospital internal medicine perspectives},
volume = {16},
number = {4},
pages = {1-12},
pmid = {42630997},
issn = {2000-9666},
abstract = {BACKGROUND: There is a critical need for interventions for long COVID. Our aim was to conduct a systematic review on the efficacy and safety of different interventions in patients with long COVID.

METHODS: We searched the MEDLINE 1965 until August 2024. We included randomized clinical trials that reported a primary outcome. We evaluated the GRADE certainty of the effect measures.

RESULTS: Our initial search yielded 2606 potentially relevant studies. We include 43 randomized clinical trials that ultimately included 2878 participants with long COVID. The GRADE criteria found all but one study had low certainty. Eight studies reported on the use of nutraceuticals, 6 tested respiratory muscle training, 7 studies evaluated supervised exercise, 7 studies tested brain stimulation, and 5 studies used FDA regulated medications. The majority of the studies improved the primary outcome and included symptoms, quality of life, and exercise capacity.

CONCLUSION: In randomized clinical trials medications, respiratory cognitive and physical therapy interventions improved outcomes in long COVID patients. However, the studies had low GRADE certainty of the effect measures. Larger and higher quality studies are needed.},
}

@article {pmid42632541,
year = {2026},
author = {Jabbar, D and Maqsood, S and Kumar, R and Kumar, A and Ghansham, F},
title = {Effectiveness and Economic Impact of Medical and Rehabilitation Interventions in Long COVID Care.},
journal = {The American journal of the medical sciences},
volume = {},
number = {},
pages = {},
doi = {10.1016/j.amjms.2026.08.015},
pmid = {42632541},
issn = {1538-2990},
}

@article {pmid42638142,
year = {2026},
author = {Holmes-McCoid, HJ and Lecky, FE},
title = {Exploring the influence of long COVID upon self-identity: a systematic literature review.},
journal = {Archives of public health = Archives belges de sante publique},
volume = {84},
number = {1},
pages = {},
pmid = {42638142},
issn = {0778-7367},
abstract = {BACKGROUND: Long COVID (LC) is understood to be a multisystemic illness involving symptoms of an enduring nature. As underlying pathophysiological mechanisms of LC become better understood, attention has turned towards the psychological aspects of LC lived experience. Comparable conditions, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), are known to significantly impact self-identity. However, no prior review has explored this topic in the LC population. This review sought to offer an original and exploratory narrative of LC patients' experiences connected to self-identity.

METHODS: A systematic literature review using a Narrative Synthesis approach. Twenty-one qualitative studies (including 613 participants), published between January 2021-March 2025, exploring the influence of LC upon perceptions of self-identity were reviewed. Narrative Synthesis (NS) and PRISMA guidelines were followed.

RESULTS: Four main themes emerged: "Grief and Loss of the Familiar Self", "Reflections of Self, Mirrored by Others", "Threats to Identity", and "Repairing Fractured Identity".

CONCLUSIONS: For many, LC ruptures self-narratives that contribute to a stable and continuous sense of self across time. This can bring forth a strong grieving response to perceived losses and the unfamiliarity of self. Despite this, narratives of post-traumatic growth (PTG) were realised. Current guidance lacks direction for psychological interventions targeting LC-related distress. Acknowledgement of identity-based challenges must also be reflected in future guidance, with clear recommendations for clinical practice. Qualitative longitudinal exploration of LC's influence upon self-identity should be prioritised. Similarly, the acceptability and feasibility of interventions targeting identity-transformation work require further investigation.

TRIAL REGISTRATION: PROSPERO ID: CRD420251008410.},
}

@article {pmid42638691,
year = {2026},
author = {Dietzel, J and Bauer, T and Tissen-Diabaté, T and Ortiz, M and Siewert, J and Bellmann-Strobl, J and Engelhardt, U and Roll, S and Grabowska, W and Scheibenbogen, C and Willich, SN and Paul, F and Brinkhaus, B},
title = {Acupressure and Qigong in post-infectious fatigue with impaired physical function: a randomized clinical trial.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1872035},
pmid = {42638691},
issn = {2296-858X},
}

@article {pmid42626062,
year = {2026},
author = {Müller, L and Di Benedetto, S and Müller, V},
title = {Host-virus resilience networks and viral inflammaging circuits in aging and long COVID: a CMV-centered perspective.},
journal = {Frontiers in cellular and infection microbiology},
volume = {16},
number = {},
pages = {1896480},
pmid = {42626062},
issn = {2235-2988},
mesh = {Humans ; *Aging/immunology ; Virus Latency/immunology ; *Cytomegalovirus/physiology/immunology ; *COVID-19/immunology/virology ; *Cytomegalovirus Infections/immunology/virology ; Virus Activation/immunology ; Inflammation/immunology/virology ; SARS-CoV-2/immunology ; *Host-Pathogen Interactions/immunology ; Post-Acute COVID-19 Syndrome ; },
abstract = {Aging and long COVID are increasingly recognized as states of disrupted host homeostasis characterized by chronic inflammation, immune remodeling, metabolic dysfunction, and impaired stress adaptation. These alterations may compromise the mechanisms that normally maintain viral latency, thereby increasing susceptibility to reactivation of persistent viruses such as Cytomegalovirus (CMV). In this mini-review, we propose a systems-level framework in which latent viral reactivation emerges as a manifestation of declining organismal resilience rather than an isolated virological event. We introduce the concept of host-virus resilience networks, encompassing interconnected immune, metabolic, epigenetic, and cellular stress-response pathways that collectively preserve CMV latency across the lifespan. Age-associated immunosenescence, inflammaging, mitochondrial dysfunction, and epigenetic drift may progressively destabilize these networks, weakening antiviral surveillance and facilitating viral reactivation. We further propose the concept of viral inflammaging circuits, defined as self-reinforcing feedback loops in which chronic inflammation promotes viral reactivation, while viral activity further amplifies immune dysregulation, tissue stress, and inflammatory signaling. Within this framework, CMV is considered both a marker and a potential driver of immune aging through persistent antigenic stimulation, T-cell remodeling, and chronic inflammatory activation. Long COVID may represent a convergent resilience failure state in which persistent immune perturbation and metabolic stress intersect with latent herpesvirus biology. By integrating concepts from geroscience, immunology, and systems virology, this review aims to provide a conceptual model linking CMV persistence to network-level dysregulation in ageing and post-viral syndromes and highlights the importance of resilience-based approaches for understanding chronic inflammatory disease progression across the lifespan.},
}

Humans
*Aging/immunology
Virus Latency/immunology
*Cytomegalovirus/physiology/immunology
*COVID-19/immunology/virology
*Cytomegalovirus Infections/immunology/virology
Virus Activation/immunology
Inflammation/immunology/virology
SARS-CoV-2/immunology
*Host-Pathogen Interactions/immunology
Post-Acute COVID-19 Syndrome

@article {pmid42626188,
year = {2026},
author = {Jain, P and Wu, HHL and Ali, W and Mamidi, V and Chinnadurai, R},
title = {Shadows of infection: Post-coronavirus disease condition and outcome patterns in patients receiving dialysis and kidney transplant recipients.},
journal = {World journal of nephrology},
volume = {15},
number = {3},
pages = {118018},
pmid = {42626188},
issn = {2220-6124},
abstract = {Post-coronavirus disease 2019 (COVID-19) condition describes a constellation of persistent or fluctuating symptoms and organ dysfunction following severe acute respiratory syndrome coronavirus 2 infection. Patients with end-stage kidney disease (ESKD) on dialysis and kidney transplant recipients (KTR) inhabit a landscape of immune dysfunction, multimorbidity, and high healthcare interaction, which may amplify both the risk and consequences of post-COVID condition (PCC). In this article, we aimed to review current evidence on PCC and related post-acute sequelae in dialysis patients and KTR-focusing on symptom burden, risk factors, functional outcomes, health-related quality of life (HRQoL), kidney and graft outcomes, and recovery trajectories. It was found that dialysis patients and KTR experience a substantial burden of PCC superimposed on already complex symptoms and risk profiles. Long COVID in these groups encompasses not only fatigue, dyspnea and a "brain fog" phenomenon but also impaired HRQoL, reduced functional recovery, and potential acceleration of kidney and graft decline. Harmonized PCC definitions, kidney-specific outcome measures, and prospective multicentre studies in ESKD and kidney transplant populations are urgently required to inform prevention and management strategies embedded within the dialysis and kidney transplantation pathways.},
}

@article {pmid42622238,
year = {2026},
author = {Pradeep, A and Ramalho, I and Carvour, ML and Sivamurugan, SM and Singh, U and Comellas, AP and Dayal, S},
title = {Cardiovascular, Renal, and Pulmonary Risks of Long COVID: A Retrospective Cohort Study Stratified by Age and Sex.},
journal = {Journal of the American Heart Association},
volume = {},
number = {},
pages = {e049226},
doi = {10.1161/JAHA.126.049226},
pmid = {42622238},
issn = {2047-9980},
abstract = {BACKGROUND: A substantial proportion of patients with acute COVID-19 develop postacute sequelae of SARS-CoV-2 infection (Long COVID). The risk of adverse cardiovascular and related outcomes in Long COVID remains elusive. We hypothesized that individuals with Long COVID are at elevated risk for adverse cardiovascular, renal, and pulmonary (CRP) outcomes compared with those who recovered from COVID-19 without developing Long COVID.

METHODS: We performed a retrospective cohort study using the global TriNetX network (>150 million patients). Adults with documented COVID-19 were classified by the presence/absence of clinically recognized Long COVID. We analyzed absolute risks and relative risks for 15 CRP outcomes, stratified by age (18-50, 51-64, ≥65 years). After excluding patients with preexisting outcomes of interest, propensity score matching was applied for age, sex, and common confounders.

RESULTS: Among 2 613 432 adults identified with COVID-19 within TriNetX network, 315 612 matched individuals were included in the study. Long COVID was associated with higher risk of most CRP outcomes across all ages regardless of sex. Relative risks were disproportionately higher in younger adults, especially in young women for cardiovascular and renal outcomes and in young men for pulmonary outcomes. Findings remained directionally consistent across sensitivity analyses. Prior SARS-CoV-2 vaccination was not consistently associated with reduced CRP risk.

CONCLUSIONS: Clinically recognized Long COVID was associated with increased risk of CRP outcomes, with relatively higher relative risks observed in younger adults. These findings support the need for continuing surveillance and risk-reduction strategies for cardiovascular and related disorders in Long COVID.},
}

@article {pmid42624459,
year = {2026},
author = {Wang, X and Huang, J and Lu, M and Wang, X},
title = {Beyond R0: How Vaccination and Post-Infection Mortality Drive Epidemic Persistence and Oscillations.},
journal = {Mathematical biosciences},
volume = {},
number = {},
pages = {109797},
doi = {10.1016/j.mbs.2026.109797},
pmid = {42624459},
issn = {1879-3134},
abstract = {The long-term consequences of infectious diseases, particularly post-infection mortality (PIM), represent a significant yet understudied aspect of epidemiology. Furthermore, the interaction between PIM and vaccination, a key public health intervention, remains poorly understood from a dynamical systems perspective. In this paper, we develop a six-dimensional compartmental model that incorporates both PIM and vaccination. Analytical results show that the model admits a rich bifurcation structure, including a backward bifurcation where a stable endemic equilibrium coexists with a stable disease-free state even when the basic reproduction number R0<1. We further prove the existence of Hopf bifurcations, demonstrating the potential for sustained epidemic oscillations driven by PIM. Numerical continuation in the two-dimensional parameter space of vaccination and PIM rates reveals organizing centers, specifically Bogdanov-Takens and cusp points, that govern transitions among these dynamical regimes. Our central finding is that the interplay between vaccination and PIM can undermine control strategies based solely on reducing R0 below unity. This highlights the importance of incorporating post-infection health outcomes and their interaction with vaccination into epidemiological models to design robust and effective disease-control policies.},
}

@article {pmid42624521,
year = {2026},
author = {O'Dowd, A},
title = {Covid-19: 40% of affected healthcare workers had long covid, and a quarter still had symptoms after a year.},
journal = {BMJ (Clinical research ed.)},
volume = {394},
number = {},
pages = {e100628},
doi = {10.1136/bmj-2026-100628},
pmid = {42624521},
issn = {1756-1833},
}

@article {pmid42625219,
year = {2026},
author = {Westermeier, F and Pretorius, E and Untersmayr, E and Bertinat, R and Sepúlveda, N and Fisman, E},
title = {A cardiometabolic perspective on post-exertional malaise in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Long COVID.},
journal = {Cardiovascular diabetology},
volume = {25},
number = {1},
pages = {},
doi = {10.1186/s12933-026-03316-8},
pmid = {42625219},
issn = {1475-2840},
mesh = {Humans ; *Fatigue Syndrome, Chronic/epidemiology/physiopathology/diagnosis ; *COVID-19/diagnosis/epidemiology ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; Diabetes Mellitus, Type 2/epidemiology/physiopathology/diagnosis ; *Coronavirus Infections/epidemiology/diagnosis/physiopathology ; *Pneumonia, Viral/diagnosis/epidemiology/physiopathology ; Obesity/epidemiology/physiopathology ; Pandemics ; },
abstract = {Post-exertional malaise (PEM), the defining feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is increasingly recognized in individuals with Long COVID. Although traditionally viewed as symptom exacerbation and/or emergence of new symptoms following exertion, PEM may reflect disrupted coordination across interconnected physiological systems operating over distinct post-exertional timescales. Such disruption may result in altered post-exertional physiological trajectories that contribute to multisystem manifestations and potential cardiometabolic consequences. This perspective outlines a conceptual approach for investigating PEM through longitudinal assessment of post-exertional physiological trajectories while considering disease severity and underlying cardiometabolic health, including obesity and type 2 diabetes. Integrating these dimensions may help contextualize post-exertional responses, inform future longitudinal cardiometabolic profiling, facilitate patient stratification, and provide a framework for future mechanistic and interventional studies in ME/CFS and Long COVID.},
}

Humans
*Fatigue Syndrome, Chronic/epidemiology/physiopathology/diagnosis
*COVID-19/diagnosis/epidemiology
Post-Acute COVID-19 Syndrome
SARS-CoV-2
Diabetes Mellitus, Type 2/epidemiology/physiopathology/diagnosis
*Coronavirus Infections/epidemiology/diagnosis/physiopathology
*Pneumonia, Viral/diagnosis/epidemiology/physiopathology
Obesity/epidemiology/physiopathology
Pandemics

@article {pmid42625590,
year = {2026},
author = {Schick, V and Morawa, E and Herold, R and Koller, K and Erim, Y},
title = {Hope of success and fear of failure in post-COVID patients.},
journal = {Health psychology report},
volume = {14},
number = {3},
pages = {271-279},
pmid = {42625590},
issn = {2353-5571},
abstract = {BACKGROUND: Post-COVID syndrome (PCS) affects mental health, but knowledge of PCS remains limited. Investigating key motives, such as personal achievement, might help in understanding the behavior of patients with PCS. This study examined the associations between hope of success (HS) and fear of failure (FF) and health indicators in a PCS sample.

PARTICIPANTS AND PROCEDURE: In total, 332 patients completed questionnaires of PCS symptom severity (PCS-S), post-exertional malaise (PEM), fatigue (Fatigue Severity Scale, FSS), depression (Patient Health Questionnaire, PHQ-9), and anxiety (Generalized Anxiety Disorder Scale, GAD-7), as well as HS and FF. Correlations among these constructs and multiple linear regression analysis with PCS-S as a dependent variable were examined. A two-step cluster analysis identified clusters based on HS and FF scores, which were compared with each other.

RESULTS: The strength of the correlations between increased HS and elevated levels of depression and anxiety was moderate, while the correlations of strength with higher fatigue and PEM were weak. In the linear regression model, high HS was associated with lower PCS-S levels. Clusters with high HS tended to show more symptoms of depression and anxiety. The cluster with both high HS and FF exhibited the highest levels of these symptoms.

CONCLUSIONS: HS appeared to be a relevant achievement motive for mental health impairment of PCS patients. Clusters demonstrated differing effects of combinations of HS and FF on health. To understand the underlying mechanisms, further research is necessary.},
}

@article {pmid42615783,
year = {2026},
author = {Freitas, FC and Sousa, VC and Melo, D and Ramos, DAM and Ochiai, GS and Kolisch, D and Guimarães, JC and Silva, LGD and Silva, ECGE and Pompeu, JE and Schmitt, ACB},
title = {Functional impact of long Covid on work performance and return to work: a cross-sectional study.},
journal = {Revista de saude publica},
volume = {60},
number = {},
pages = {e35},
doi = {10.11606/s1518-8787.2026060007097},
pmid = {42615783},
issn = {1518-8787},
mesh = {Humans ; Cross-Sectional Studies ; *COVID-19/epidemiology/physiopathology ; *Return to Work/statistics & numerical data ; Post-Acute COVID-19 Syndrome ; Female ; Brazil/epidemiology ; Male ; Adult ; Socioeconomic Factors ; Middle Aged ; *Work Performance/statistics & numerical data ; Severity of Illness Index ; },
abstract = {OBJECTIVE: To evaluate the association between long Covid and socioeconomic, clinical, healthcare, and functional factors with reduced work performance and difficulty returning to work.

METHODS: A cross-sectional study of individuals in São Paulo aged ≥ 18 years with long Covid (77.8%), with data collected between April 2023 and June 2024. A systematic random sample of severe and mild Covid-19 cases from March 2020 to January 2022. The severity of Covid-19 was classified according to the U.S. Centers for Disease Control and Prevention (CDC) guidelines. Prevalences were assessed, and a Poisson test was performed to examine the association between reduced work performance and difficulty returning to work and sociodemographic, clinical, healthcare-related, and functional factors considered significant (p ≤ 0.05). Among the participants, 43.9% experienced reduced work performance, and 22.2% had difficulty returning to work. Long Covid is defined as having two or more symptoms that develop and persist for more than four weeks after Covid-19, cannot be explained by an alternative diagnosis, and are assessed using a Likert scale for the intensity of self-reported symptoms (0-10). Participants' functional status was assessed using scales for basic activities (Katz), instrumental activities (Lawton), functional limitations (WHO-DAS), and sarcopenia (SARC-F).

RESULTS: Poorer work performance was associated with advanced age (PR = 2.20; 95%CI 1.27-3.80), as well as being the primary provider (PR = 1.55; 95%CI 1.05-2.29), and having moderate (OR = 2.99; 95%CI 1.60-5.58) or severe (OR = 4.88; 95%CI 2.59-9.19) functional impairment. For difficulty returning to work, the main association observed was severe functional impairment (OR = 4.33; 95%CI 1.58-11.80).

CONCLUSION: It is noteworthy that advanced age and, particularly, severe functional impairment were significantly associated with poorer performance and difficulty returning to work in the studied population with long Covid.},
}

Humans
Cross-Sectional Studies
*COVID-19/epidemiology/physiopathology
*Return to Work/statistics & numerical data
Post-Acute COVID-19 Syndrome
Female
Brazil/epidemiology
Male
Adult
Socioeconomic Factors
Middle Aged
*Work Performance/statistics & numerical data
Severity of Illness Index

@article {pmid42615987,
year = {2026},
author = {Comba, IY and Mars, RAT and Yang, L and Dumais, M and Chen, J and Van Gorp, TM and Harrington, JJ and Sinnwell, JP and Johnson, S and Holland, LA and Khan, AK and Lim, ES and Aakre, C and Athreya, AP and Gerber, GK and O'Horo, JC and Lazaridis, KN and Kashyap, PC},
title = {Gut microbiome signatures during acute infection are associated with long COVID.},
journal = {Gut microbes},
volume = {18},
number = {1},
pages = {2718581},
doi = {10.1080/19490976.2026.2718581},
pmid = {42615987},
issn = {1949-0984},
mesh = {Humans ; *COVID-19/microbiology ; Female ; Longitudinal Studies ; Feces/microbiology ; *Gastrointestinal Microbiome ; Post-Acute COVID-19 Syndrome ; Male ; SARS-CoV-2 ; Middle Aged ; Adult ; Machine Learning ; Metagenomics ; Acute Disease ; },
abstract = {BACKGROUND: Long COVID (LC) manifests in 10%-30% of non-hospitalized individuals post-SARS-CoV-2 infection, leading to significant morbidity. The predictive role of gut microbiome composition during acute infection in the development of LC is not well understood, partly because of the heterogeneous nature of the disease.

OBJECTIVES: To determine whether the gut microbiome composition in the acute phase of SARS-CoV-2 infection predicts subsequent LC and to investigate the role of microbiome signatures in disease subphenotypes.

DESIGN: We conducted a longitudinal cohort study involving 799 outpatient participants tested for SARS-CoV-2 due to similar symptom presentation, including 380 SARS-CoV-2 positive and 419 negative individuals. Stool samples were collected at two time points for metagenomic sequencing. Logistic regression with L1 regularization was employed to predict LC based on the microbiome and clinical metadata.

RESULTS: The individuals who developed LC harbored a distinct gut microbiome during acute infection compared to those who recovered fully and uninfected controls with similar symptomatology. However, the temporal changes in the gut microbiome between the acute (0-1 month) and post-acute (1-2 months) phases were similar across the three cohorts. Using machine learning, we showed that the gut microbiome carried a modest signal for subsequent LC, but model performance was insufficient for clinical prediction, likely reflecting the heterogeneous nature of LC. Finally, we identified four LC symptom clusters, with gastrointestinal and fatigue-only groups strongly linked to gut microbiome alterations.

CONCLUSION: The gut microbiome can potentially offer solutions for understanding the heterogeneous nature of LC. Larger cohorts and phenotype-aware computational algorithms may help overcome current model performance limitations and support the development of targeted diagnostic and therapeutic strategies.},
}

Humans
*COVID-19/microbiology
Female
Longitudinal Studies
Feces/microbiology
*Gastrointestinal Microbiome
Post-Acute COVID-19 Syndrome
Male
SARS-CoV-2
Middle Aged
Adult
Machine Learning
Metagenomics
Acute Disease

@article {pmid42618450,
year = {2026},
author = {Geng, J and Zhu, Y and Chen, S and Song, X and Huang, Q and Ma, H and Liu, H and Yang, X and Zhang, X and Zhang, J and Luo, L and Wu, Y and Dai, S and Cheng, J and Zhang, C and Chen, L},
title = {Intestinal flagellin drives multisystem inflammation through TLR5-IL-15-ARA axis.},
journal = {Gut},
volume = {},
number = {},
pages = {},
doi = {10.1136/gutjnl-2026-339112},
pmid = {42618450},
issn = {1468-3288},
abstract = {BACKGROUND: Systemic inflammatory diseases including rheumatoid arthritis (RA), ankylosing spondylitis (AS), IBD and long covid share convergent multi-organ phenotypes. Long covid provides a tractable model for dissecting gut-driven mechanisms of systemic inflammation, given its defined temporal onset and treatment-naïve postinfectious context.

OBJECTIVE: To characterise a gut-driven mechanism of systemic inflammation in long covid and assess its cross-disease correlates in RA, AS and IBD.

DESIGN: Comparative metagenomic analyses across RA, AS, IBD and long covid cohorts. Long covid was established as a paradigm for postdysbiotic inflammatory diseases, single-cell RNA sequencing and functional studies in longitudinal human cohorts and co-infection mouse models (SARS-CoV-2 and Pseudomonas aeruginosa) were employed to dissect cellular and molecular mechanisms. Genetic and pharmacological interventions targeting the interleukin (IL)-15-arachidonic acid (ARA) axis were validated for therapeutic efficacy.

RESULTS: Flagellated bacterial expansion defined a shared intestinal signature across all four diseases. Mechanistic studies in long covid demonstrated that flagellated bacteria activated toll-like receptor 5 (TLR5) on neutrophils, triggering the formation of neutrophil extracellular trap (NET) and IL-15 release. IL-15 subsequently stimulated macrophage ARA production. The co-infection murine model recapitulated multi-organ pathophysiology of long Covid, including pulmonary fibrosis and intestinal lymphoid aggregates. Genetic ablation of macrophage ARA synthesis or neutrophil IL-15 attenuated lung pathology, whereas gut microbiome clearance with gentamicin uniquely suppressed systemic inflammation.

CONCLUSIONS: We delineate a flagellin-TLR5-IL-15-ARA axis as a candidate mechanism driving systemic inflammation in long covid. These findings position intestinal flagellin as a candidate therapeutic target and ARA as a potential biomarker for long covid, warranting prospective validation across inflammatory disease boundaries.},
}

@article {pmid42618913,
year = {2026},
author = {Mikuteit, M and Schröder, D and Niewolik, J and Klawonn, F and Degen, C and Müller, F and Behrens, GMN and Dopfer-Jablonka, A and Steffens, S},
title = {Longitudinal observation of persistent Long COVID symptoms and health-related quality of life in an adult German cohort.},
journal = {BMC infectious diseases},
volume = {26},
number = {1},
pages = {},
pmid = {42618913},
issn = {1471-2334},
mesh = {Humans ; Female ; Male ; *Quality of Life ; Germany/epidemiology ; Adult ; *COVID-19/epidemiology/complications ; Longitudinal Studies ; Middle Aged ; Post-Acute COVID-19 Syndrome ; Surveys and Questionnaires ; Symptom Burden ; Severity of Illness Index ; SARS-CoV-2 ; Prevalence ; Fatigue ; Cohort Studies ; },
abstract = {BACKGROUND: Many individuals experience persistent symptoms following an acute COVID-19 infection, a condition known as Long COVID. The aim of this study was to analyse the prevalence, intensity and longitudinal trajectories of different Long COVID symptoms at baseline and at follow-ups up to 60 weeks later in a German cohort.

METHODS: This longitudinal observational study is part of the DEFEAT Corona project, wherein Long COVID subjects completed online questionnaires on symptom severity (0-10 points) and health-related quality of life (hrQoL), measured with EQ5D-VAS, at three time points. At baseline, sociodemographic information, COVID-19 infection characteristics, and COVID-19 vaccination status were also recorded. Symptom occurrence and intensity was compared between baseline and two follow-up surveys 54 to 60 weeks later.

RESULTS: Among n = 262 adult participants (84.4% female, 14.8% male and 0.8% diverse, mean age 44.85 ± 11.48 years), the most frequent symptoms at baseline were fatigue (67.2%, mean severity 9.02 ± 0.89), palpitations (61.1%, mean severity 6.58 ± 1.95), and concentration impairment (61.0%, mean severity 8.55 ± 1.12). The prevalence decreased in 3/27 Long COVID symptoms and symptom intensity decreased in 15/27 symptoms with small changes in severity (between 0.6 and 2 points of max. 10 points). HrQoL decreased significantly over time (p = 0.006). However, the mean change of - 4.31 ± 21.2 points remained below the established MCID of 7.5 points, indicating no clinically meaningful deterioration.

CONCLUSION: More than a year after the acute infection, Long COVID patients of the DEFEAT Corona cohort describe symptoms as persistent and intense. With the corresponding impairment in hrQoL, this underlines the urgent need for comprehensive therapies for Long COVID.

TRIAL REGISTRATION: The study was in the German Clinical Trial Registry (DRKS00026007) on 9th Sep 2021.},
}

Humans
Female
Male
*Quality of Life
Germany/epidemiology
Adult
*COVID-19/epidemiology/complications
Longitudinal Studies
Middle Aged
Post-Acute COVID-19 Syndrome
Surveys and Questionnaires
Symptom Burden
Severity of Illness Index
SARS-CoV-2
Prevalence
Fatigue
Cohort Studies

@article {pmid42619307,
year = {2026},
author = {Abdul Razak, HR and Strain, WD and Rogers, P and Faghy, MA and Skipper, L and Kranen, SH and Mokbel, K and Bewick, T and Ashton, R and Sands, KA and Neilens, H and Lord, A and Hambly, H and Chynoweth, J and Allgar, V and Scott-Cleasby, M and Hoare, J and Knapp, KM},
title = {Whole body fluorine-18 fluorodeoxyglucose parametric PET/computed tomography in people with long coronavirus disease: the ERASE-LC trial protocol.},
journal = {Nuclear medicine communications},
volume = {},
number = {},
pages = {},
doi = {10.1097/MNM.0000000000002229},
pmid = {42619307},
issn = {1473-5628},
abstract = {The ERASE-LC feasibility trial will evaluate the feasibility of using remdesivir for the treatment of long coronavirus disease (COVID) with a wide range of outcome measures. This paper focuses on the nested parametric PET/computed tomography study and outlines the novel protocol utilized. The PET/computed tomography scans will be performed at one of the sites in 20 participants with an overall recruitment target of 72 participants across both centers. The PET/computed tomography scans will be performed at day 11 for the baseline scan and day 55 for the follow-up scan, with an estimated effective radiation dose of approximately 22 mSv under typical study conditions and a maximum anticipated exposure of 31.2 mSv. Dynamic scans will be acquired using the FlowMotion acquisition on a Siemens Biograph Vision 600 scanner with an acquisition time of 75-90 min depending on the height of the participant. Patient and public involvement and engagement was undertaken throughout the study design. The early experiences of performing this protocol demonstrated that participants were able to tolerate the scan duration and positioning. In conclusion, this protocol demonstrates a novel use of parametric PET/computed tomography fluorine-18 fluorodeoxyglucose whole body scans for the assessment of long COVID and response to remdesivir.},
}

@article {pmid42620510,
year = {2026},
author = {Lee, EA and Maziero, MP and Merrill, LC and Colpo, GD and Couture, L and Baskin, L and Cahuiche, AE and Petway, A and Fan, H and Reese, E and Anderson, KM and McCullough, LD and Schulz, PE and Ortiz, GJ},
title = {Longitudinal trajectories of neurologic symptoms and cognitive associations at 36-months post-hospitalization for COVID-19.},
journal = {Frontiers in neurology},
volume = {17},
number = {},
pages = {1882710},
pmid = {42620510},
issn = {1664-2295},
mesh = {Humans ; *COVID-19/complications/psychology ; Female ; Middle Aged ; Adult ; Male ; Longitudinal Studies ; Aged ; Hospitalization ; Post-Acute COVID-19 Syndrome ; *Nervous System Diseases/etiology/epidemiology ; Neuropsychological Tests ; Young Adult ; *Cognitive Dysfunction/etiology ; Cognition ; },
abstract = {BACKGROUND: A substantial proportion of individuals hospitalized for COVID 19 experience persistent neurological and psychiatric symptoms. The long-term trajectories of these symptoms, collectively referred to as neuropsychiatric manifestation of Post-Acute Sequelae of COVID-19 (Neuro-PASC), and their association with cognitive outcomes remains poorly understood. We conducted a 36-month longitudinal cohort study to characterize Neuro-PASC symptom trajectories, examine their associations with domain specific cognitive performance, and identify baseline biological predictors of long-term neurological outcomes.

METHODS: We performed a longitudinal observational study of 227 adults ages 19-79 (mean = 47.6), previously hospitalized for COVID-19 symptoms. Participants completed follow-up assessments at 3/6-, 12-, 24-, and 36-months post-hospitalization. At each visit, structured, self-reported neurological symptom surveys, digital cognitive testing (BrainCheck), and updated medical history were collected. Generalized estimating equation models assessed longitudinal associations between cognitive subdomains and individual symptoms. K-means clustering identified distinct symptom trajectory groups. Baseline demographic and clinical factors were examined and compared across symptom trajectory groups.

RESULTS: Several neurological symptoms increased in prevalence over 36 months following hospitalization in some individuals. Fatigue remained most common (53-65%), followed by memory/concentration difficulties (47-61%) and sleep disturbances (40-48%). Dizziness had a modest increase (30-49%), while coordination impairment more than doubled (18-41%). Headaches remained prevalent and relatively stable (21-35%). Symptom co-occurrence strengthened over time, with fatigue frequently clustering with other symptoms (up to 45% at 36 months). Overall BrainCheck composite scores were not independently associated with neurological symptoms, but significant associations emerged for executive function, memory, and attention, including time-dependent effects. Trajectory analyses identified distinct longitudinal patterns (1. stable trajectory, 2. worsening trajectory, and 3. improving trajectory), associated with baseline demographics, comorbidities, and acute disease severity.

CONCLUSION: Neurological symptoms can persist or worsen up to 36 months post- COVID-19 hospitalization, even as some cognitive functions show partial recover. Distinct symptom trajectories and evolving associations with specific cognitive domains and biological outcomes underscore the heterogeneous and dynamic nature of Neuro-PASC, supporting the need for long-term neuropsychological monitoring and informing targeted interventions and mechanistic studies.},
}

Humans
*COVID-19/complications/psychology
Female
Middle Aged
Adult
Male
Longitudinal Studies
Aged
Hospitalization
Post-Acute COVID-19 Syndrome
*Nervous System Diseases/etiology/epidemiology
Neuropsychological Tests
Young Adult
*Cognitive Dysfunction/etiology
Cognition

@article {pmid42621909,
year = {2026},
author = {Li, X and Cheng, S and Wang, S and Gao, K and Bai, Y and Li, S and Gao, M and Guo, Y},
title = {Post-COVID varicella-zoster virus reactivation: lowering the immunological threshold for latency breakdown.},
journal = {Frontiers in cellular and infection microbiology},
volume = {16},
number = {},
pages = {1904565},
pmid = {42621909},
issn = {2235-2988},
mesh = {Humans ; *Virus Activation/immunology ; *Virus Latency/immunology ; *Herpesvirus 3, Human/physiology/immunology ; *COVID-19/immunology/complications/virology ; *Herpes Zoster/immunology/virology ; SARS-CoV-2/immunology ; Post-Acute COVID-19 Syndrome ; Immunity, Cellular ; },
abstract = {Herpes zoster (HZ) is the clinically apparent manifestation of latent varicella-zoster virus (VZV) reactivation. Aging and immunosuppression are established risk contexts. SARS-CoV-2 infection has prompted renewed attention to whether acute or post-acute immune changes can reduce the reserve needed to maintain VZV latency. Large observational studies report a modest increase in HZ after COVID-19, most consistently after severe disease or hospitalization and within early post-infection windows. These associations do not establish direct causation or a population-wide shift of HZ toward younger adults. A threshold-lowering interpretation is more consistent with the available evidence: SARS-CoV-2 infection may narrow latency-control reserve through cellular immune disruption, interferon dysregulation, and inflammation, particularly in hosts already affected by comorbidity or treatment-related immunosuppression. Long COVID provides a setting in which persistent immune dysregulation can be studied, but it is not yet a proven causal framework for VZV disease. Post-COVID HZ may therefore represent a clinically visible manifestation of disrupted host-virus homeostasis in susceptible individuals. Prospective studies that combine clinical phenotyping with VZV-specific cellular immune measurements are needed to test this model.},
}

Humans
*Virus Activation/immunology
*Virus Latency/immunology
*Herpesvirus 3, Human/physiology/immunology
*COVID-19/immunology/complications/virology
*Herpes Zoster/immunology/virology
SARS-CoV-2/immunology
Post-Acute COVID-19 Syndrome
Immunity, Cellular

@article {pmid42610174,
year = {2026},
author = {Babashahi, M and Yazdannik, A and Ghafari, S and Sami, R},
title = {Transitional Care in Long Covid Patients, The Missing Link in the Healthcare Systems in Iran: A Qualitative Study.},
journal = {Iranian journal of nursing and midwifery research},
volume = {31},
number = {4},
pages = {645-651},
pmid = {42610174},
issn = {1735-9066},
abstract = {BACKGROUND: Long COVID, a chronic and multisystemic consequence of coronavirus infection, significantly reduces patients' quality of life due to persistent symptoms. Transitional care (TC) is essential to ensure continuity and coordination of care and to reduce the risk of hospital readmissions. This study aims to identify the barriers to providing effective TC for long COVID patients within the Iranian healthcare system.

MATERIALS AND METHODS: This qualitative descriptive study used thematic analysis. Participants-10 long COVID patients, 5 family caregivers, and 16 healthcare providers-were selected via purposeful sampling from outpatient clinics and rehabilitation centers affiliated with Isfahan University of Medical Sciences, Iran. Between November 2022 and May 2023, 33 semistructured, in-depth interviews (30-40 min each) were conducted, audio-recorded, transcribed verbatim, and analyzed using MAXQDA (v. 20) until data saturation. Trustworthiness was ensured using Guba and Lincoln's criteria.

RESULTS: Barriers to effective TC for long COVID patients were systematically classified into three main themes with 10 subthemes. The main theme included inefficient healthcare infrastructure, nonintegrated management, and lack of comprehensive continuous care.

CONCLUSIONS: The findings revealed that the Iranian healthcare system lacks integrated TC for long COVID patients. Addressing these barriers requires policy-level reforms, standardized care pathways, and investment in community-based and rehabilitation services. Strengthening TC could bridge the current gaps and significantly improve outcomes for long COVID patients in Iran. The findings provide insights into structural and operational challenges in TC delivery and highlight the need for policy reforms to improve outcomes for long COVID patients.},
}

@article {pmid42610257,
year = {2026},
author = {Gao, Y and Wu, N and Shen, S and Zheng, X and Chen, Y and Shi, C},
title = {Association between psychological wellbeing and the COVID-19-related outcomes in Europeans aged ≥ 50 years old: The SHARE study.},
journal = {Human vaccines & immunotherapeutics},
volume = {22},
number = {1},
pages = {2714597},
pmid = {42610257},
issn = {2164-554X},
mesh = {Humans ; *COVID-19/psychology/epidemiology/prevention & control ; Psychological Well-Being ; Female ; Male ; Europe/epidemiology ; Cross-Sectional Studies ; Middle Aged ; Aged ; *Vaccination/statistics & numerical data/psychology ; European People ; SARS-CoV-2 ; Prospective Studies ; COVID-19 Vaccines/administration & dosage ; Post-Acute COVID-19 Syndrome ; Aged, 80 and over ; },
abstract = {The aim of the present study was to prospectively investigate the associations between psychological wellbeing and COVID-19 outcomes (vaccination, infection, long COVID) based on the Survey of Health, Aging, and Retirement in Europe (SHARE), using the data from Wave 8 and two supplementary COVID-19 surveys (Corona Survey 1 and 2) covering 27 European countries and Israel. Furthermore, we also conducted a cross-sectional study to evaluated the joint effects of wellbeing and vaccination status on the risks of SARS-CoV-2 infection and long COVID. A total of 29,597 participants were included in this study. Psychological wellbeing was measured using the Control, Autonomy, Self-realization, and Pleasure (CASP)-12 scale. Multivariable logistic regression models were performed to explore these associations, and odds ratios (ORs) with 95% confidence intervals (CIs) were estimated. Compared with participants in the lowest CASP-12 score group, those in the highest group had significantly higher odds of COVID-19 vaccination (OR 2.68, 95% CI: 2.44-2.96) and a significant 23% reduction in the likelihood of long COVID (OR 0.77, 95% CI: 0.64-0.93). However, we failed to observe a significant association on infection risk (OR 0.87, 95% CI: 0.74-1.02). Protective effects were more pronounced with higher CASP-12 scores. Higher psychological wellbeing was associated with increased COVID-19 vaccination and reduced risks of infection and long COVID among European adults aged 50 y and older. Further high-quality studies were warranted to confirm these findings.},
}

Humans
*COVID-19/psychology/epidemiology/prevention & control
Psychological Well-Being
Female
Male
Europe/epidemiology
Cross-Sectional Studies
Middle Aged
Aged
*Vaccination/statistics & numerical data/psychology
European People
SARS-CoV-2
Prospective Studies
COVID-19 Vaccines/administration & dosage
Post-Acute COVID-19 Syndrome
Aged, 80 and over

@article {pmid42611889,
year = {2026},
author = {Khatkar, P and Batrakova, EV and Branscome, H and Kashanchi, F},
title = {Brain Organoids as Emerging Platforms for Modeling CNS Infections: Neuropathogenesis, Therapeutic Discovery, and Drug Delivery.},
journal = {Journal of visualized experiments : JoVE},
volume = {},
number = {234},
pages = {},
doi = {10.3791/70757},
pmid = {42611889},
issn = {1940-087X},
mesh = {Humans ; *Organoids/virology/pathology ; *Brain/virology/pathology/cytology ; Drug Delivery Systems/methods ; Antiviral Agents/administration & dosage/pharmacology ; *Central Nervous System Infections/drug therapy/pathology/virology ; Animals ; *Models, Biological ; COVID-19/pathology/virology ; Zika Virus Infection/pathology/drug therapy ; },
abstract = {Neurotropic viruses remain a persistent global health challenge, and the mechanisms by which they damage the human brain are not yet fully understood. Animal models are often limited by human-specific aspects of CNS biology, whereas two-dimensional (2D) cell cultures cannot recapitulate the complex three-dimensional (3D) cellular interactions that occur during viral infection of the brain. Over the past decade, brain organoids derived from human stem cells have emerged as physiologically relevant models that address these limitations. These 3D cultures self-assemble into structures containing neurons, astrocytes, and progenitor cells arranged in patterns that resemble early brain development. This review examines the application of brain organoids to the study of infections caused by Zika virus (ZIKV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), herpes simplex virus (HSV), and human immunodeficiency virus type 1 (HIV-1). Studies were screened from PubMed and shortlisted based on their relevance to organoid-based CNS infection modeling, antiviral drug screening, CNS-targeted drug delivery, and neuroinflammation. Organoid-based antiviral screening has identified promising compounds from libraries containing more than 1,000 candidates. Drug delivery strategies are also discussed, with particular emphasis on nanoparticles, polymer-based carriers, and extracellular vesicles (EVs) evaluated in organoid and spheroid models for their ability to cross the blood-brain barrier (BBB) and deliver therapeutic cargo to neural cells. The roles of damage-associated and pathogen-associated molecular patterns (DAMPs and PAMPs) in neuroinflammation, complement evasion, and chronic post-infection damage, including long COVID, are also examined. Current limitations, including the lack of functional vasculature, incomplete BBB components, and reproducibility challenges, are discussed. Despite these limitations, CNS organoids bridge the gap between basic research and clinical application, advancing the development of effective therapies for viral infections of the brain.},
}

Humans
*Organoids/virology/pathology
*Brain/virology/pathology/cytology
Drug Delivery Systems/methods
Antiviral Agents/administration & dosage/pharmacology
*Central Nervous System Infections/drug therapy/pathology/virology
Animals
*Models, Biological
COVID-19/pathology/virology
Zika Virus Infection/pathology/drug therapy

@article {pmid42614493,
year = {2026},
author = {Guo, S and Li, M and Liu, Y and Zhang, Y and Pan, Y and Wang, X and Li, H and Zhai, X and Hong, X and Wang, B},
title = {Analysis of epidemiological characteristics and influencing factors of Long COVID syndrome among university students in the post-pandemic era.},
journal = {Frontiers in public health},
volume = {14},
number = {},
pages = {1771458},
pmid = {42614493},
issn = {2296-2565},
mesh = {Humans ; Female ; *Students/statistics & numerical data ; *COVID-19/epidemiology/complications ; Universities ; Male ; Young Adult ; Post-Acute COVID-19 Syndrome ; China/epidemiology ; SARS-CoV-2 ; Cohort Studies ; Adult ; Risk Factors ; Immunoglobulin M/blood ; Pandemics ; },
abstract = {OBJECTIVE: To analyze the epidemiological characteristics of Long COVID syndrome in university students during the post-pandemic era, providing evidence for developing prevention strategies and rehabilitation plans for COVID-19 patients.

METHODS: A cohort study was conducted in November 2023, recruiting students from a university in Nanjing for baseline investigations. Demographic characteristics, vaccination history, infection history, and venous blood samples were collected to detect SARS-CoV-2 IgG and IgM antibody levels. For individuals with prior COVID-19 infections, Long COVID syndrome status was assessed 1 year post-infection. Multivariate logistic regression analysis was employed to identify influencing factors.

RESULTS: The study included 246 participants (mean age: 21.88 ± 2.06 years; 65.04% female). Median SARS-CoV-2 IgG and IgM levels were 16.500 (105.000, 239.000) AU/ml and 0.095 (0.053, 0.183) AU/ml, respectively. Among 246 participants with prior COVID-19 infection, 82 (33.33%) developed Long COVID syndrome, with alopecia (36.59%), memory decline (28.05%), and sleep disturbances (28.05%) being the most prevalent symptoms. Multivariate analysis revealed that, compared to the non-Long COVID group, depressive symptoms may be positively associated with Long COVID syndrome (adjusted OR = 8.235, 95%CI: 3.478-19.500).

CONCLUSION: The incidence of Long COVID syndrome among university students is comparable to that of the general population. A bidirectional relationship may exist between depressive symptoms and Long COVID syndrome, warranting increased clinical and public health attention.},
}

Humans
Female
*Students/statistics & numerical data
*COVID-19/epidemiology/complications
Universities
Male
Young Adult
Post-Acute COVID-19 Syndrome
China/epidemiology
SARS-CoV-2
Cohort Studies
Adult
Risk Factors
Immunoglobulin M/blood
Pandemics

@article {pmid42614792,
year = {2026},
author = {Tusconi, M and Fornaro, M and Atzeni, M and Cantone, E and Pintus, E and Primavera, D and Nardi, AE and Carta, MG},
title = {Altered core depressive symptom balance in post-COVID fatigue: reduced depressed mood in an exploratory matched historical-control study.},
journal = {Frontiers in psychiatry},
volume = {17},
number = {},
pages = {1877162},
pmid = {42614792},
issn = {1664-0640},
abstract = {BACKGROUND: Post-COVID chronic fatigue syndromes are frequently associated with depressive episodes and alterations in reward processing. Anhedonia, a core depressive symptom linked to reward-system dysfunction, may be particularly relevant in this context.

OBJECTIVE: To investigate whether depressive symptoms in individuals with post-COVID-like chronic fatigue syndrome display a distinctive configuration of core depressive features, particularly in the balance between depressed mood and anhedonia.

METHODS: In an exploratory cross-sectional comparative study with a matched historical control group, patients with post-COVID-like chronic fatigue syndrome were compared with matched controls from a pre-COVID community sample. Groups were matched for age, sex, and overall depression severity. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and item-level scores were analyzed.

RESULTS: The post-COVID fatigue group and matched historical controls showed comparable overall depressive symptom severity and similar rates of mild and moderate depressive symptoms. However, depressed mood was significantly less pronounced in the post-COVID fatigue group, while anhedonia did not differ significantly between groups. Consequently, the depressed mood/anhedonia ratio was markedly reduced in the post-COVID fatigue group.

CONCLUSIONS: Depressive symptoms in post-COVID-like chronic fatigue syndrome may show an altered balance between the two core depressive features assessed by the PHQ-9. In this exploratory comparison, the most robust finding was reduced depressed mood in the post-COVID fatigue group, whereas anhedonia was not significantly increased. These findings should therefore be interpreted as preliminary evidence of a different depressive symptom configuration, rather than as demonstration of an anhedonia-dominant phenotype.},
}

@article {pmid42604064,
year = {2026},
author = {Spensieri, I and Mathews, M and Hedden, L and Lukewich, J and Meredith, L and Ryan, D and Spencer, S and Cusack, C and Vaughan, C},
title = {The Experiences of Canadian Primary Care Nurses Caring for COVID-Positive Patients: A Qualitative Study.},
journal = {Global qualitative nursing research},
volume = {13},
number = {},
pages = {23333936261479459},
pmid = {42604064},
issn = {2333-3936},
abstract = {Primary care nurses (PCNs) in Canada were instrumental in caring for COVID-positive patients during the pandemic, yet their contributions received little attention in the pandemic preparedness plans published before the pandemic. Therefore, the purpose of this study was to explore PCNs' experiences caring for COVID-positive patients and the roles they fulfilled in supporting this patient population. Using a pragmatic, qualitative descriptive design, we conducted semi-structured interviews with 76 PCNs from four Canadian provinces (British Columbia, Ontario, Nova Scotia, Newfoundland and Labrador). Participants were asked to describe their actual and potential roles during different stages of the COVID-19 pandemic, as well as facilitators and challenges they encountered. We applied a thematic analysis approach to the data and analyzed codes related to treating and managing COVID-positive patients. We identified four roles performed by PCNs caring for COVID-positive patients: (1) conducting patient outreach and monitoring initiatives; (2) adapting infection prevention and control protocols; (3) administering medications to treat COVID-19; and (4) supporting patients with post-COVID-19 condition/long COVID. Roles and specific activities varied by nurse designation, consistent with their scope of practice. These findings can be used to inform the development of future pandemic preparedness plans for primary care providers.},
}

@article {pmid42604070,
year = {2026},
author = {Brunet, JL and van Ockenburg, SL and Leyli-Abadi, M and Lunter, G and Rosmalen, JGM},
title = {Recovery trajectories and predictors of symptom resolution in post-COVID-19 condition: a population-based cohort study.},
journal = {The Lancet regional health. Europe},
volume = {69},
number = {},
pages = {101802},
pmid = {42604070},
issn = {2666-7762},
abstract = {BACKGROUND: SARS-CoV-2 infection can lead to persistent symptoms, known as Post-COVID-19 Condition (PCC). Previous studies on PCC prognosis mainly looked at severe cases in rehabilitation settings and without knowledge about pre-infection symptom levels. Uncertainty remains about recovery trajectory in the general population, its predictors, and whether recovery differs by symptom.

METHODS: We analysed data from Lifelines, a prospective population-based observational cohort. Adults completed 31 COVID-19 questionnaires between March 2020 and October 2022 providing longitudinal symptom data to assess PCC status, and recovery. PCC was defined as at least one moderately severe symptom, among 12 identified as PCC-specific, that worsened 90-150 days after infection. Cox-proportional hazard models estimated recovery, defined as symptom decline to an individual's pre-infection baseline, adjusted for symptoms present at PCC diagnosis, age, sex, BMI, smoking, hospitalization, vaccination, and comorbidities.

FINDINGS: We analysed time series of 809 cases (mean age 55.0; [SD 11.0]; 590 [73%] female; mean follow up 368 days; [SD 200]). Symptom decline to pre-infection baseline or below was observed in 558 participants; the Kaplan-Meier 24-month symptom decline estimate was 92%. Greater symptom burden was associated with a lower likelihood of recovery (HR per additional symptom 0.69, 95% CI 0.63-0.76), whereas younger age had a higher likelihood of recovery compared with middle adulthood (HR 1.52, 95% CI 1.06-2.18). Median time to symptom decline was 226 days (IQR 182-372), with most improvement within the first 235 days before slowing and plateauing.

INTERPRETATION: Most individuals with PCC recover, but older adults and those with multiple symptoms are at higher risk of prolonged illness, underscoring the need for ongoing support.

FUNDING: This work was supported by The Netherlands Organisation for Health Research and Development (ZonMw) COVID-19 Program. The data collection in this project is co-financed by EU Horizon Europe Program grant Long Covid.},
}

@article {pmid42604647,
year = {2026},
author = {Peng, B and Allen-Benson, D and Talebi, Y and Ghosh, S and Yaseen, A and Valerio-Shewmaker, M and Boerwinkle, E and DeSantis, SM and Swartz, M and Cazaban, CG and Bi, K},
title = {Temporal, Demographic, and Geographic Patterns of Long COVID Incidence in Relation to SARS-CoV-2 Variant Emergence: Insights from the Texas All-Payer Claims Database (TX-APCD).},
journal = {International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases},
volume = {},
number = {},
pages = {109051},
doi = {10.1016/j.ijid.2026.109051},
pmid = {42604647},
issn = {1878-3511},
abstract = {OBJECTIVES: Long COVID, defined by symptoms persisting or emerging after the acute SARS-CoV-2 phase, poses a growing public health challenge.

METHODS: Using the Texas All-Payer Claims Database (TX-APCD), covering approximately 60% of insured Texans from October 2021 to October 2023, we examined associations between COVID-19 emergency department (ED) visits and Long COVID claims across variant periods. Individual-level time to first Long COVID diagnosis was modeled comparing ED and non-ED cohorts, adjusting for age, sex, payer, and HHS region.

RESULTS: Weekly COVID-19 ED visits preceded Long COVID claims, with the strongest association at a two-week lag during the Omicron BA.1 period, lengthening to three weeks during the BA.4/BA.5, XBB, and EG.5 periods. The median interval from a COVID-related ED encounter to the first Long COVID diagnosis was 22 days, compared with 26 days following non-ED encounters. Crude incidence was highest among Medicare Fee-for-Service beneficiaries (155 per 10,000), individuals over 70 (156 per 10,000), with higher rates in females than males (81 vs. 59 per 10,000). Claims clustered in High Plains and Northwest Texas.

CONCLUSION: Administrative claims data can characterize the documented burden of Long COVID and identify high-incidence regions and Medicare-heavy populations that may require expanded post-acute care capacity.},
}

@article {pmid42597999,
year = {2026},
author = {Natarajan, C and Harshini, G and Priyadharsini, GT and Maheswaran, T and Naveenraj, NS and Venkat, M},
title = {Scope, Prospects, and Limitations of Living Systematic Reviews in Medical Literature: A Narrative Overview.},
journal = {Cureus},
volume = {18},
number = {7},
pages = {e112631},
pmid = {42597999},
issn = {2168-8184},
abstract = {Living systematic reviews (LSRs) have emerged as a response to the persistent lag between the publication of primary research and its incorporation into systematic reviews, a delay that has historically spanned several years and can render a meaningful proportion of reviews outdated within two years of publication. Since their formal introduction in 2014, LSRs have evolved from a single conceptual proposal into a maturing methodological field, supported by a dedicated PRISMA reporting extension, decision frameworks for determining when a living approach is warranted, and demonstrated applications in COVID-19 therapeutics, vaccine effectiveness, long COVID, and the development of formal clinical guidelines. Uptake accelerated markedly during the COVID-19 pandemic, and automation, ranging from human-machine collaborative workflows to large language models, has become central to sustaining the frequency of updates required by the living model, with reported gains in screening and extraction efficiency. However, methodological guidance for reporting and appraising LSRs remains underdeveloped relative to the pace of adoption, statistical methods for repeated meta-analytic updating are heterogeneous and imperfectly matched to network meta-analyses, and operational surveys consistently document inconsistent update schedules, limited communication of living status, and resource constraints that threaten their long-term sustainability. Realizing the full clinical and policy value of LSRs will require coordinated progress across methodological guidance, automation, and institutional support. Hence, this narrative review aims to examine the above concerns related to LSR.},
}

@article {pmid42598831,
year = {2026},
author = {Piao, Y and Welithotage, T and Haq, M and Lamptey, DL and Ezeugwu, VE and Maina, G and Flowers, K and Nowrouzi-Kia, B},
title = {Navigating long COVID: integrated self-management, structural barriers, and patient-identified recommendations among marginalized populations and individuals with preexisting mental health conditions.},
journal = {Disability and rehabilitation},
volume = {},
number = {},
pages = {1-17},
doi = {10.1080/09638288.2026.2715082},
pmid = {42598831},
issn = {1464-5165},
abstract = {PURPOSE: This qualitative study explored how adults living with long COVID, including persons from marginalized and visible minority groups, or individuals with preexisting mental health conditions, manage symptoms, navigate healthcare systems, and identify priorities for improving long COVID care and support.

METHODS: We conducted semi-structured virtual interviews with 34 adults living in Canada with long COVID, drawn from marginalized/visible minority groups or with preexisting mental health conditions. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. The results were reported per the COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

RESULTS: Four overarching themes were identified. (1) Personal Strategies for Well-Being and Daily Living (coordinated self-management, pacing, adapted routines); (2) Advocacy and Access Barriers (fragmented services, delayed care, persistent self-advocacy); (3) Clinical Awareness and Information Sharing (diagnostic uncertainty, symptom-based diagnosis, centralized information); (4) Social Support and Equitable Care Experiences (identity-based bias, reliance on social networks).

CONCLUSION: Participants managed integrated self-management systems while navigating structural gaps, credibility challenges, and inequities in care. Recommendations emphasized symptom-based diagnosis, coordinated pathways, pacing-centred rehabilitation, navigation support, and culturally informed services.},
}

@article {pmid42599642,
year = {2026},
author = {Prinz, JM and Prinz, C},
title = {Diagnostic reification and the conservativity test: a pragmatic criterion for ontological commitments in medicine.},
journal = {Medicine, health care, and philosophy},
volume = {},
number = {},
pages = {},
pmid = {42599642},
issn = {1572-8633},
abstract = {Diagnosis is indispensable to medicine, yet diagnostic labels often acquire more authority than their evidence can bear. They come to function as if they named natural entities that explain, authorize, and stabilize clinical action. This article proposes a pragmatic criterion for evaluating that ontological surplus: the Conservativity Test. The test asks which clinical, institutional, explanatory, and self-interpretive consequences follow from treating a diagnostic label as a disease entity, but would not already follow from a label-free base description of symptoms, signs, impairments, risks, mechanisms, values, and lived experience. It does not presuppose that diagnoses are either natural kinds or mere social constructions. Rather, it distinguishes conservative shorthand, justified non-conservativity, and reifying non-conservativity. To avoid circularity, the article develops a minimal-ontological account of base description and connects it with pluralist realism and causal-cluster accounts of kinds. Situating the test within the epistemology of diagnosis, it treats diagnostic labels as revisable causal-explanatory hypotheses and spells out why unjustified ontological surplus carries epistemic, clinical, ethical, and institutional costs. It then identifies four modes of diagnostic reification: explanatory, threshold, nominal-institutional, and looping. Prediabetes, ADHD, and long COVID serve as stress tests for the framework. Phenomenologically, the test protects the lived complexity of illness against both objectifying reduction and epistemic dismissal. Ethically, it offers a participatory audit for clinicians, guideline panels, researchers, and patient communities deciding when diagnostic names should coordinate care, justify intervention, or carry stronger ontological commitments.},
}

@article {pmid42593604,
year = {2026},
author = {Goulart, CDL and Franzoni, LT and Ferrari, F and Cardoso, AS and Bittencourt, N and Stein, R},
title = {Exercise and Cardiovascular Risk Modulation in Post-COVID Syndrome.},
journal = {Current atherosclerosis reports},
volume = {28},
number = {1},
pages = {},
pmid = {42593604},
issn = {1534-6242},
mesh = {Humans ; *COVID-19/complications/physiopathology ; Post-Acute COVID-19 Syndrome ; *Cardiovascular Diseases/physiopathology/prevention & control/etiology ; *Exercise/physiology ; Endothelium, Vascular/physiopathology ; *Exercise Therapy/methods ; SARS-CoV-2 ; Vascular Stiffness ; Heart Disease Risk Factors ; },
abstract = {PURPOSE OF REVIEW: Post-COVID syndrome (PASC) has emerged as a multisystem condition associated with persistent cardiovascular abnormalities, including endothelial dysfunction, arterial stiffness, chronic inflammation, metabolic disturbances, autonomic imbalance, and increased atherosclerotic risk. This review summarizes the current evidence regarding the pathophysiological mechanisms linking PASC to cardiovascular disease and discusses the potential role of exercise training as a strategy to mitigate vascular dysfunction and cardiovascular risk.

RECENT FINDINGS: Recent studies demonstrate that individuals with PASC exhibit persistent low-grade inflammation, impaired endothelial function, accelerated vascular aging, platelet hyperreactivity, insulin resistance, sarcopenia, and autonomic dysfunction. These alterations contribute to a pro-atherogenic phenotype that may persist months to years after SARS-CoV-2 infection. Emerging evidence indicates that exercise training improves inflammatory status, endothelial function, arterial stiffness, metabolic health, autonomic regulation, and functional capacity in post-COVID patients, potentially attenuating mechanisms involved in atherosclerotic progression. Post-COVID syndrome is associated with multiple interconnected biological pathways that increase long-term cardiovascular risk. Exercise training appears to be a promising non-pharmacological intervention capable of targeting several of these mechanisms simultaneously. Although further randomized controlled trials are needed, current evidence supports the integration of individualized exercise-based rehabilitation into the management of patients with PASC to promote vascular recovery and reduce cardiovascular risk.},
}

Humans
*COVID-19/complications/physiopathology
Post-Acute COVID-19 Syndrome
*Cardiovascular Diseases/physiopathology/prevention & control/etiology
*Exercise/physiology
Endothelium, Vascular/physiopathology
*Exercise Therapy/methods
SARS-CoV-2
Vascular Stiffness
Heart Disease Risk Factors

@article {pmid42594160,
year = {2026},
author = {Alshahrani, A and Reddy, RS and Gular, K and Kakaraparthi, VN and Gautam, AP},
title = {Postural control and trunk mobility impairments in adults with long COVID: A cross-sectional study using computerized posturography and clinical biomechanical tools.},
journal = {PloS one},
volume = {21},
number = {8},
pages = {e0354593},
pmid = {42594160},
issn = {1932-6203},
mesh = {Humans ; Cross-Sectional Studies ; *Postural Balance/physiology ; Post-Acute COVID-19 Syndrome ; Female ; Biomechanical Phenomena ; Male ; Middle Aged ; *Torso/physiopathology ; *COVID-19/physiopathology/complications ; Muscle Strength/physiology ; Adult ; SARS-CoV-2 ; Range of Motion, Articular ; Aged ; },
abstract = {Long COVID is increasingly associated with persistent neuromuscular and functional impairments, including deficits in balance and trunk control. This cross-sectional study examined postural stability and trunk biomechanics in adults with Long COVID, comparing them to matched healthy controls. A total of 128 participants (64 per group) underwent computerized posturography to assess sway area, sway velocity, and stability index under varying sensory conditions. Trunk range of motion and isometric muscle strength were measured, along with fatigue, pain sensitivity, and physical function, using validated patient-reported outcomes. Compared to controls, individuals with Long COVID demonstrated significantly larger sway area (eyes closed on foam: 8.12 ± 1.87 cm2 vs. 6.01 ± 1.65 cm2, p < 0.001), higher sway velocity (1.23 ± 0.34 cm/s vs. 0.98 ± 0.29 cm/s, p < 0.001), and lower stability index (78.45 ± 5.67 vs. 83.21 ± 6.12, p < 0.001). Trunk flexion and extension were reduced (p < 0.001), as were flexor and extensor strength (p < 0.001). Fatigue was markedly elevated (FSS: 5.72 ± 1.03 vs. 2.34 ± 0.98, p < 0.001). Multivariate analysis identified trunk extensor strength (β = 0.34, p = 0.001), fatigue severity (β = -0.38, p = 0.002), and physical function (β = 0.28, p = 0.015) as independent predictors of postural instability. These findings underscore the need for integrated rehabilitation that addresses both trunk biomechanics and symptom burden in Long COVID.},
}

Humans
Cross-Sectional Studies
*Postural Balance/physiology
Post-Acute COVID-19 Syndrome
Female
Biomechanical Phenomena
Male
Middle Aged
*Torso/physiopathology
*COVID-19/physiopathology/complications
Muscle Strength/physiology
Adult
SARS-CoV-2
Range of Motion, Articular
Aged

@article {pmid42594489,
year = {2026},
author = {Vink, M and Vink-Niese, F},
title = {Non-controlled study incorrectly labels concentrated micro-choice based treatment effective for long COVID. Response to Frisk et al.},
journal = {Journal of psychosomatic research},
volume = {211},
number = {},
pages = {112957},
doi = {10.1016/j.jpsychores.2026.112957},
pmid = {42594489},
issn = {1879-1360},
}

@article {pmid42597450,
year = {2026},
author = {Goldman, DL and Fong-Silva, V and Demirhan, S and Alrikaby, J and Lee, KE and Sancimino, C and Molholm, S and Cabana, MD and Herold, BC},
title = {Persistent physical and mental health effects of COVID-19 hospitalization.},
journal = {Frontiers in pediatrics},
volume = {14},
number = {},
pages = {1710900},
pmid = {42597450},
issn = {2296-2360},
abstract = {INTRODUCTION: The long-term health effects of the COVID pandemic on children remain an area of active investigation. Viral infection, immune responses, and societal disruption have been implicated as contributing factors.

METHODS: We conducted a retrospective survey-based study of children infected with SARS-CoV-2 and uninfected controls admitted to a single urban children's hospital in the Bronx, NY, USA, during the Original/Alpha variant wave (1 March 2020 to 1 March 2021) or Omicron wave (2 December 2021 to 21 December 2022). Persistent symptoms, time to recovery, family stress, and psychiatric outcomes were assessed. A psychometric assessment using Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) (n = 48) and Pediatric Symptom Checklist (PSC-17) (n = 64) was completed.

RESULTS: A total of 176 children and families completed surveys. Approximately 31.9% of children admitted during the Original/Alpha wave and 8.8% during the Omicron wave reported that their illness took several months or more to resolve. The most common symptoms after hospitalization were fatigue, shortness of breath, and difficulty sleeping, and these were similar to those experienced by uninfected controls. PHQ-9 and GAD-7 scores did not differ by infection status. However, PHQ-9 scores were significantly higher during the Original/Alpha wave than during the Omicron wave (median 5 vs. 1; p = 0.04; r = 0.62), with GAD-7 trending similarly (p = 0.05). Overall, 43.8% of children screened positive for depressive symptoms on PHQ-9, including 20.9% in the moderate-to-severe range. PSC-17 scores did not differ significantly by wave or infection status. High levels of pandemic-related stress, including job loss, childcare disruption, and food insecurity, were reported across both COVID-positive and uninfected families.

CONCLUSION: Children hospitalized during the Original/Alpha wave experienced a significantly greater burden of prolonged recovery than those during the Omicron wave, implicating virologic and immunologic factors in postacute physical outcomes. Notably, posthospitalization symptoms were similar between COVID-positive children and uninfected controls, underscoring the importance of contemporaneous control groups in studies of postacute sequelae. Mental health outcomes were more strongly associated with the pandemic phase than infection status, suggesting societal disruption rather than direct viral effects as a key contributor. These findings highlight the need for routine mental health screening in hospitalized children during public health emergencies.},
}

@article {pmid42581368,
year = {2026},
author = {Zhang, Z and Gao, L and Guan, L and Qian, Z and Li, J and Tong, Z},
title = {Longitudinal profiling of upper respiratory tract microbiota and metabolome in hospitalized COVID-19 convalescents: a 3-year prospective cohort study.},
journal = {Journal of translational medicine},
volume = {24},
number = {1},
pages = {},
pmid = {42581368},
issn = {1479-5876},
support = {2023YFC0872500//the Ministry of Science and Technology of the People's Republic of China/ ; BJRID2024-008//Beijing Research Center for Respiratory Infectious Diseases Project/ ; 062//Beijing Scholars Program/ ; Laboratory for Clinical Medicine, Capital Medical University//Laboratory for Clinical Medicine, Capital Medical University/ ; },
mesh = {Humans ; *COVID-19/microbiology/metabolism ; Prospective Studies ; *Microbiota ; *Metabolome ; Saliva/microbiology ; SARS-CoV-2 ; Female ; Longitudinal Studies ; Male ; Multiomics ; Post-Acute COVID-19 Syndrome ; RNA, Ribosomal, 16S/genetics ; Hospitalization ; *Convalescence ; },
abstract = {BACKGROUND: Long COVID is characterized by persistent, far-reaching effects in convalescent individuals, with pulmonary diffusion impairment emerging as a clinically impactful sequela affecting more than one-third of this population. The salivary microbiome and metabolome, reflecting the oral-lung axis, offer a window into the mechanisms underlying this condition. However, systematic longitudinal evidence on their long-term dynamics after infection and their predictive value for persistent pulmonary diffusion impairment remains scarce.

METHODS: In this prospective cohort, we profiled the salivary bacterial microbiome (16S rRNA sequencing) and metabolome (untargeted LC-MS/MS) in 424 COVID-19 convalescents at 2 (T1) and 3 (T2) years post-discharge, alongside 106 demographically matched healthy controls. To explore whether 2-year salivary multiomics signatures were associated with 3-year pulmonary diffusion status, microbial and metabolic features were ranked using random forest mean decrease in accuracy and used to train 10 machine-learning classifiers after stratified training/internal validation splitting. Because this modeling strategy was exploratory, we further performed a repeated stability-selection analysis across 100 stratified resampling iterations to identify reproducibly selected salivary multiomics features.

RESULTS: COVID-19 convalescents exhibited sustained, interrelated salivary microbiome dysbiosis and metabolic reprogramming at 3 years post-infection. The microbial perturbations were characterized by reduced alpha diversity, a shift in phylogenetic dominance from Bacteroidota to Actinobacteriota, and a marked expansion of Proteobacteria at the 2-year follow-up. The microbial co-occurrence networks also became sparser, suggesting diminished stability. Metabolomic profiling revealed upregulation of the TCA cycle, purine/pyrimidine metabolism, arginine biosynthesis, and other pathways at the 2-year follow-up, with a discernible trend toward recovery by year 3. Notably, 36.6% of patients presented with persistent pulmonary diffusion dysfunction at the 3-year follow-up. Leveraging 2-year salivary multiomics signatures, we developed an exploratory proof-of-concept model for predicting 3-year pulmonary diffusion dysfunction. The CatBoost classifier achieved the best overall performance, achieving an area under the curve of 0.808 in the internal validation set; key predictive features included genera Catonella and Actinomyces, and metabolites adenosine 3',5'-diphosphate, triiodothyronine sulfate and betaine. In an exploratory stability-selected analysis, a conservatively tuned CatBoost model based on repeatedly selected features achieved an internal validation AUC of 0.798.

CONCLUSIONS: This research provides the first longitudinal characterization of the salivary bacterial microbiome and metabolome in COVID-19 convalescents up to 3 years post infection. Furthermore, we developed a novel predictive model for post-SARS-CoV-2 pulmonary diffusion impairment based on salivary multiomics features, which may represent a promising screening tool for identifying high-risk individuals.},
}

Humans
*COVID-19/microbiology/metabolism
Prospective Studies
*Microbiota
*Metabolome
Saliva/microbiology
SARS-CoV-2
Female
Longitudinal Studies
Male
Multiomics
Post-Acute COVID-19 Syndrome
RNA, Ribosomal, 16S/genetics
Hospitalization
*Convalescence

@article {pmid42582779,
year = {2026},
author = {Yang, J and Li, J and Li, Y and Yuan, L and Xue, Y and Wang, T and Xu, X and Zhu, Y and Zhang, Z and Qin, Z and Zhuang, G and He, X},
title = {Longitudinal trajectories of long COVID among hospitalized patients with omicron infection in Changzhi, China.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1867430},
pmid = {42582779},
issn = {2296-858X},
abstract = {BACKGROUND: Understanding the persistence of long COVID (LC) among discharged patients with Omicron infection remains limited.

METHODS: The study used a retrospective longitudinal cohort to evaluate the dynamic trajectory of LC after hospital discharge and to identify factors associated with new-onset and persistent LC following Omicron infection. Patients admitted to Heping Hospital Affiliated to Changzhi Medical College and Changzhi People's Hospital for coronavirus disease 2019 between 15 December 2022 and 30 April 2024 were included. The first follow-up was conducted from 18 July to 20 August 2024, and the second from 9 May 2025 to 13 June 2025.

RESULTS: Of the 3,777 discharged patients, 1,922 [median (IQR) age, 70.0 (59.0-78.0) years; 968 male individuals (50.4%)] who completed both follow-up visits were included in the final analysis. The median (IQR) time from discharge to the second follow-up was 727 (688-854) days. At the second follow-up, 292 patients (15.2%) were diagnosed with LC, including 121 (6.3%) with persistent LC and 171 (8.9%) with new-onset LC. The most common symptoms were muscle weakness, sleep difficulties, fatigue, cough, and dyspnea at rest. Notably, the proportions of muscle weakness, sleep difficulties, cough, arthralgia, and palpitations increased significantly, whereas brain fog decreased significantly from 2.8% at the first follow-up to 0.4% at the second follow-up. Overall, antiviral treatment (OR = 1.503; 95% CI: 1.063-2.126), female sex (OR = 3.729; 95% CI: 1.145-12.147), being a farmer as an occupation (OR = 4.695; 95% CI: 2.188-10.101), and BMI < 18.5 kg/m[2] (OR = 5.291; 95% CI: 1.115-25.000) were associated with increased new-onset LC susceptibility, whereas having one or more complications was associated with decreased new-onset LC susceptibility (OR = 0.329; 95% CI: 0.125-0.865).

CONCLUSION: Omicron-infected patients report a persistent burden of symptoms consistent with the WHO definition of LC after discharge. These findings provide valuable information on the dynamic trajectory of long-term health outcomes in patients infected with Omicron. However, the non-specific nature of the symptoms should be considered when interpreting these findings.},
}

@article {pmid42584205,
year = {2026},
author = {Dashtban, A and Mizani, M and Mu, Y and Mamas, M and Kontopantelis, E and Denaxas, S and Huang, Q and Khunti, K and Heightman, M and Priedon, R and Gomes, M and Banerjee, A},
title = {Healthcare utilisation and cost among individuals with Long COVID in England and Wales: potential value of specialised post-COVID services.},
journal = {Journal of the Royal Society of Medicine},
volume = {},
number = {},
pages = {1410768261476537},
doi = {10.1177/01410768261476537},
pmid = {42584205},
issn = {1758-1095},
abstract = {OBJECTIVE: To compare healthcare utilisation and costs for Long COVID (LC) in England and Wales.

DESIGN: Case-control cohort analysis with multiple age-, sex-, ethnicity-, deprivation-, region- and comorbidity-matched control groups: (1) COVID-only, no LC; (2) pre-pandemic; (3) contemporary non-COVID and (4) pre-LC (self-controlled, pre-COVID pandemic).

SETTING: National, population-based, linked UK electronic health records (British Heart Foundation/NHS England Secure Data Environment).

PARTICIPANTS: Adults aged ⩾18 years with LC between January 2020 and December 2023.

MAIN OUTCOME MEASURES: Healthcare utilisation (number of consultations/visits per person): primary care (general practitioner (GP)), secondary care (outpatient, inpatient and emergency department, investigations and procedures) and inflation-adjusted cost (£) for LC and control populations.

RESULTS: In England (n = 295,180) and Wales (n = 7925), LC was associated with higher utilisation and costs across primary and secondary care. Mean annual total cost for LC versus contemporary controls was £6681.6 versus £2039.9 in Wales (3.27-fold) and £3378.3 versus £1355.8 in England (2.49-fold). GP consultations averaged 26.76 (SD 22.07) per person-year in the Welsh LC cohort versus 14.63 (SD 14.34) in England (absolute difference 12.13 visits/year). Cross-national multiplicative difference-in-differences estimates indicated a 25% greater relative LC-related cost increase in Wales compared with England (ratio 1.25, 95% CI 1.09-1.42), corresponding to an absolute excess of £2501 per person-year (95% CI £1707-£3270).

CONCLUSIONS: LC is associated with sustained increases in healthcare utilisation and costs in England and Wales. Our findings suggest that system-level service design may influence healthcare use and costs following COVID-19, warranting further evaluation of post-viral care models.},
}

@article {pmid42588397,
year = {2026},
author = {Axon, DR and Szott, RF},
title = {Characteristics Associated with Mental and Physical Health Among US Adults with Long COVID.},
journal = {Healthcare (Basel, Switzerland)},
volume = {14},
number = {15},
pages = {},
doi = {10.3390/healthcare14152430},
pmid = {42588397},
issn = {2227-9032},
abstract = {Background/Objectives: Long COVID (LC) has affected 7.2% of the population of the United States (US). Mental and physical health have been increasing in prevalence over the last few years. This study aimed to investigate the association between various characteristics and mental and physical health status among US adults with LC. Methods: The study was cross-sectional in design and used data from the 2023 Medical Expenditure Panel Survey (MEPS). We assessed predisposing, enabling, and need variables in US adults with MEPS-defined LC using multivariable logistic regression analysis. The data was weighted to produce nationally representative estimates. Results: It was determined that individuals with a low income level, a high degree of pain, and poor physical health were each associated with higher odds of poor mental health in US adults with LC. An age of 50-70+ was associated with lower odds of poor physical health in US adults with LC. Educational achievement up to and including high school, having a functional limitation, exercise participation, any pain, multiple comorbid conditions, and poor mental health were each associated with higher odds of poor physical health in US adults with LC. Conclusions: Several variables were associated with poor mental and physical health status among US adults with LC. Further research should be conducted to explore these variables in more detail and investigate possible interventions for healthcare providers.},
}

@article {pmid42589551,
year = {2026},
author = {Marek-Józefowicz, L and Borkowska, A and Nedoszytko, B and Cubała, WJ and Purzycka-Bohdan, D and Bohdan, M},
title = {Neurodegenerative and Cognitive Consequences of Long COVID.},
journal = {International journal of molecular sciences},
volume = {27},
number = {15},
pages = {},
doi = {10.3390/ijms27156897},
pmid = {42589551},
issn = {1422-0067},
mesh = {Humans ; *COVID-19/complications/pathology/virology ; *Neurodegenerative Diseases/etiology/virology ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2/isolation & purification ; *Cognitive Dysfunction/etiology/virology ; Blood-Brain Barrier ; },
abstract = {The SARS-CoV-2 virus has infected approximately 778 million people worldwide since the pandemic. Patients who have survived coronavirus disease (COVID-19) may experience long-term symptoms related to cognitive deficits, mood changes, and depressive disorders. The mechanisms underlying the long-term effects of COVID-19 on the brain are being actively investigated. SARS-CoV-2 infection triggers various mechanisms, such as hyperstimulation of the immune response, which may lead to changes in the central nervous system. In this article, we review the evidence linking COVID-19 to neurodegenerative disorders and cognitive impairment. Current research indicates that patients with pre-existing cognitive and neuropsychiatric deficits have a poorer prognosis after SARS-CoV-2 infection, and patients who have survived COVID-19 may be at increased risk of developing dementia and mood disorders. We analyse the available evidence regarding SARS-CoV-2 brain infection, induction of inflammation, coagulopathy, and blood-brain barrier (BBB) dysfunction as possible mechanisms underlying the disorders in the acute phase of COVID-19 disease and contributing to the development of neurodegenerative disorders in long COVID. Viral infection can trigger inflammation of the central nervous system (CNS), leading to damage and contributing to the development of cognitive dysfunction.},
}

Humans
*COVID-19/complications/pathology/virology
*Neurodegenerative Diseases/etiology/virology
Post-Acute COVID-19 Syndrome
SARS-CoV-2/isolation & purification
*Cognitive Dysfunction/etiology/virology
Blood-Brain Barrier

@article {pmid42589614,
year = {2026},
author = {Dutta, D and Liu, J and Xiong, H},
title = {Involvement of NLRP3 Inflammasome in Methamphetamine Augmentation of SARS-CoV-2 N-Protein-Induced Neuroinflammation in Rat Microglial Cells.},
journal = {International journal of molecular sciences},
volume = {27},
number = {15},
pages = {},
doi = {10.3390/ijms27156960},
pmid = {42589614},
issn = {1422-0067},
support = {R01DA050540/DA/NIDA NIH HHS/United States ; },
mesh = {Animals ; *Microglia/metabolism/drug effects/pathology ; *NLR Family, Pyrin Domain-Containing 3 Protein/metabolism ; *Methamphetamine/pharmacology ; *Inflammasomes/metabolism ; Rats ; *Coronavirus Nucleocapsid Proteins/metabolism ; *SARS-CoV-2/metabolism ; *COVID-19/metabolism/complications/virology ; Cells, Cultured ; Rats, Sprague-Dawley ; Nitric Oxide Synthase Type II/metabolism ; *Neuroinflammatory Diseases/metabolism/pathology ; Nitric Oxide/metabolism ; Calcium-Binding Proteins ; Microfilament Proteins ; },
abstract = {Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes an immune-mediated neurological syndrome, which persists long after infection. Mechanisms for SARS-CoV-2-associated neurological complications are multifactorial, with an increased risk of drug abuse such as methamphetamine (meth). SARS-CoV-2 infection and its viral proteins play pivotal roles in coronavirus disease 2019 (COVID-19)-associated neuroinflammation, which can lead to long COVID. We hypothesize that meth augments activation of the microglial NOD-, leucine-rich repeat, and pyrin domain-containing protein 3 (NLRP3) inflammasome by the SARS-CoV-2 nucleocapsid (N) protein, resulting in neuroinflammation. To test this hypothesis, we investigated the effect of N-protein and meth on NLRP3 inflammasome activation in primary rat microglial cultures using enzyme-linked immunosorbent assay (ELISA), Reverse Transcription quantitative Polymerase Chain reaction (RT-qPCR), western blot (WB), and immunofluorescence assay (IFA). Our results showed that meth augmented N-protein-induced microglial activation, as evidenced by increased ionized calcium-binding adapter 1 (Iba-1) expression. The addition of meth to the microglial cultures treated with N-protein increased proinflammatory cytokine production. Meth augmentation of N-protein-induced neuroinflammation was further supported by increased inducible nitric oxide synthase (iNOS)-mediated nitric oxide (NO) production. The effects of meth on N-protein-associated inflammatory responses were significantly attenuated by MCC950, a specific NLRP3 inhibitor. Moreover, meth-associated NLRP3 activation was either blocked by the opioid sigma1-receptor (σ1-R) inhibitor BD1047 or by σ1R siRNA knockdown. Taken together, these results demonstrated that meth augmented SARS-CoV-2 N-protein-induced neuroinflammation via microglial σ1-R and the NLRP3 inflammasome, which may underlie the pathogenesis of neurological manifestations in COVID-19, such as long COVID with meth abuse. These results may also underscore the impact of drug abuse on long COVID and provide targets for the development of therapeutic strategies to control the neurological outcomes of long COVID.},
}

Animals
*Microglia/metabolism/drug effects/pathology
*NLR Family, Pyrin Domain-Containing 3 Protein/metabolism
*Methamphetamine/pharmacology
*Inflammasomes/metabolism
Rats
*Coronavirus Nucleocapsid Proteins/metabolism
*SARS-CoV-2/metabolism
*COVID-19/metabolism/complications/virology
Cells, Cultured
Rats, Sprague-Dawley
Nitric Oxide Synthase Type II/metabolism
*Neuroinflammatory Diseases/metabolism/pathology
Nitric Oxide/metabolism
Calcium-Binding Proteins
Microfilament Proteins

@article {pmid42589652,
year = {2026},
author = {Moezzi, A and Elremaly, W and Leveau, C and Franco, A and Nepotchatykh, O and Armstrong, CW and Moreau, A},
title = {Haptoglobin Phenotypes Stratify Post-Exertional Cognitive Dysfunction Associated with Altered Cerebral Oxygenation and Metabolic Signatures in Long COVID.},
journal = {International journal of molecular sciences},
volume = {27},
number = {15},
pages = {},
doi = {10.3390/ijms27157000},
pmid = {42589652},
issn = {1422-0067},
support = {//Montreal TransMedTech Institute/ ; //Open Medicine Foundation Canada/ ; //Patient-Led Research Collaborative/ ; },
mesh = {Humans ; *Haptoglobins/metabolism/genetics ; *COVID-19/complications/metabolism ; Post-Acute COVID-19 Syndrome ; Female ; Phenotype ; Male ; *Cognitive Dysfunction/metabolism/etiology ; Middle Aged ; Longitudinal Studies ; *Oxygen/metabolism ; Adult ; *Brain/metabolism ; SARS-CoV-2/isolation & purification ; },
abstract = {Long COVID (LC) is a heterogeneous post-infectious syndrome characterized by persistent symptoms, yet the biological basis underlying its interindividual variability remains poorly understood. Given the clinical overlap between LC and myalgic encephalomyelitis (ME), and prior demonstration that haptoglobin (Hp) phenotypes modulate symptom severity in ME, we investigated whether Hp phenotypes similarly stratify post-exertional cognitive dysfunction in LC. In this longitudinal observational study, 44 individuals with LC and 20 short-course COVID controls, who recovered rapidly from SARS-CoV-2 infection without persistent symptoms or sequelae, underwent Hp phenotyping alongside metabolomic and physiological profiling before and after a standardized 90 min passive post-exertional challenge. Hp phenotypes identified clinically distinct LC subgroups. Compared with Hp1-1 individuals, Hp2 allele carriers exhibited greater fatigue, poorer physical function, and more severe post-exertional symptoms. Immediately following the challenge, Hp2-2 participants with LC showed significant cognitive decline, whereas Hp1-1 individuals demonstrated cognitive resilience and more favorable longitudinal cognitive trajectories. This differential susceptibility was accompanied by higher post-exertional cerebral fractional tissue oxygen extraction in the right hemisphere in Hp1-1 individuals and by distinct metabolic signatures, with Hp2 allele carriers exhibiting lower post-exertional plasma concentrations of citric acid, isethionate, and glucosamine. Lower metabolite levels were associated with poorer cognitive performance. These findings support Hp phenotypes as promising candidate biomarkers for biological stratification in Long COVID, pending validation in larger independent cohorts.},
}

Humans
*Haptoglobins/metabolism/genetics
*COVID-19/complications/metabolism
Post-Acute COVID-19 Syndrome
Female
Phenotype
Male
*Cognitive Dysfunction/metabolism/etiology
Middle Aged
Longitudinal Studies
*Oxygen/metabolism
Adult
*Brain/metabolism
SARS-CoV-2/isolation & purification

@article {pmid42589982,
year = {2026},
author = {Del Duca, G and Franco, M and Talamanca, L and Antinori, A and Camici, M},
title = {Beyond Fatigue: The Fatigue Assessment Scale as a Potential Indicator of Long COVID Severity.},
journal = {Journal of clinical medicine},
volume = {15},
number = {15},
pages = {},
doi = {10.3390/jcm15155878},
pmid = {42589982},
issn = {2077-0383},
support = {Linea 1//Ministry of Health/ ; },
abstract = {Patient-reported outcomes (PROs) are often regarded in clinical practice as less reliable than biomarkers because they are patient-dependent and not objectively measurable in the same way as circulating molecules or imaging findings. This view may be reductive. Biomarkers are frequently considered reliable because they are easily quantifiable, yet biological meaning does not depend solely on measurement. In precision and personalized medicine, the absolute level of a circulating hormone, cytokine, or metabolite is often insufficient unless interpreted in relation to how a given patient, at a given time, responds to that molecular signal. If biomarkers are considered less absolute and more context-dependent, the relevance of PROs becomes clearer. Standardized PROs capture the subjective impact of disease on the patient system in a reproducible and clinically interpretable manner. This is particularly relevant in Long COVID, where no validated diagnostic biomarker is currently available, and severity stratification cannot rely exclusively on objective biological measures. Among available tools, the Fatigue Assessment Scale (FAS) may be particularly useful for quantifying the fatigue burden in Long COVID, including both physical and mental components. Moreover, FAS scores have been shown to correlate with the number of symptoms reported by patients, suggesting that this scale may help stratify patients not only according to fatigue severity but also according to overall symptom burden. Greater standardization of clinical characterization through instruments such as the FAS may improve comparability across cohorts and facilitate interpretation of data from different clinical trials.},
}

@article {pmid42590004,
year = {2026},
author = {Alshomrani, A and Hussaini, AS and Miskeen, E},
title = {Determinants and Consequences of Long Impact of COVID-19: A National Cross-Sectional Study in Saudi Arabia.},
journal = {Journal of clinical medicine},
volume = {15},
number = {15},
pages = {},
doi = {10.3390/jcm15155902},
pmid = {42590004},
issn = {2077-0383},
support = {Ub-11-1442//Deputyship for Research & Innovation, Ministry of Education in Saudi Arabia/ ; },
abstract = {Background: The post-acute consequences of prolonged Coronavirus Disease 2019 (COVID-19) infection are a major public health problem characterized by long-lasting, multisystem manifestations. There is limited evidence from Saudi Arabia, particularly from nationally representative studies using standard case definitions. Objective: This study aimed to estimate the prevalence of Long COVID, characterize its symptoms, identify risk factors, and assess disease burden and healthcare utilization among Saudi adults. Methods: Between June 2023 and December 2024, we conducted a national cross-sectional mixed-methods study among 1790 adults with PCR-confirmed COVID-19 infection in all 13 regions of Saudi Arabia. Long COVID was defined using the WHO consensus case definition (symptoms persisting ≥ 3 months post-infection not attributable to alternative diagnoses). Results: The prevalence of Long COVID was 32.0% (95% CI 29.8-34.3). The most common symptoms were fatigue (68%), dyspnea (45%), and cognitive impairment (39%). Independent predictors included female sex (adjusted odds ratio [aOR] 1.8, 95% CI 1.4-2.3), moderate-to-severe acute infection (aOR 2.5, 95% CI 2.0-3.1), incomplete vaccination (aOR 1.6, 95% CI 1.2-2.1), metabolic disorders (aOR 1.6, 95% CI 1.2-2.1), and obesity (aOR 1.5, 95% CI 1.2-1.9). Among Long COVID patients, 41% required specialty care and 12% reported work disability. Conclusions: Long COVID affects approximately one-third of COVID-19 survivors in Saudi Arabia, imposing a significant healthcare and socioeconomic burden. These findings highlight the need for swift action and policy implementation within the health care system to mitigate long-term consequences.},
}

@article {pmid42590129,
year = {2026},
author = {Cianciulli, A and Santoro, E and Manente, R and Figura, M and Pacifico, A and Boccia, G},
title = {NeuroCOVID Burden and Functional Impairment in Adults with Long COVID: A Secondary Analysis of an Italian Cohort.},
journal = {Journal of clinical medicine},
volume = {15},
number = {15},
pages = {},
doi = {10.3390/jcm15156027},
pmid = {42590129},
issn = {2077-0383},
abstract = {Background/Objectives: Long COVID is frequently characterized by neurological, cognitive, neuropsychiatric, and autonomic symptoms (NeuroCOVID). However, their impact on daily functioning remains insufficiently investigated. This study evaluated the association between NeuroCOVID burden and functional impairment among Italian Long COVID survivors. Methods: A secondary cross-sectional analysis was conducted on 250 adults using a validated Italian Long COVID questionnaire. A NeuroCOVID Burden Score (10 symptom domains) and a Functional Impairment Score (daily activities) were constructed and analyzed using correlation and multivariable linear regression. Results: The sample (mean age 33.2 years; 63.6% female) demonstrated high internal consistency for both scores. A strong positive correlation was found between NeuroCOVID burden and functional impairment (r = 0.703; p < 0.001). Conclusions: Persistent NeuroCOVID burden was strongly associated with greater limitations in daily activities. In multivariable regression, NeuroCOVID Burden Score remained independently associated with functional impairment (B = 0.671; 95% CI 0.566-0.776; p < 0.001), together with acute COVID-19 severity (B = 0.156; 95% CI 0.055-0.257; p = 0.003). The final model explained 52.5% of the variance in functional impairment (R[2] = 0.525).},
}

@article {pmid42591237,
year = {2026},
author = {Sams, CH and Davis, J and Ramdas, A and Delgoda, R and Vidot, D and Reid, M and De La Haye, W},
title = {Psilocybin-containing mushroom-assisted psychotherapy is associated with sustained psychological and somatic improvements: two case studies from Jamaica.},
journal = {Frontiers in psychiatry},
volume = {17},
number = {},
pages = {1876189},
pmid = {42591237},
issn = {1664-0640},
abstract = {We report two case studies that examine the therapeutic potential of structured psilocybin-containing mushroom biomass regimens administered within a clinical framework, evaluating their impact on mental health outcomes as well as associated somatic symptoms. Two patients underwent the De La Haye Psilocybin Treatment Protocol (DPTP), which integrates micro- and high-doses (combined psilocybin and psilocin content of 1-2 mg versus 40-60 mg) with psychohistoriographic psychotherapy. Follow-up included an integration session and subsequent office visits, including the completion of the Revised Mystical Experience Questionnaire (MEQ-30) two months post-treatment. Case 1 described a 29-year-old female with social anxiety, self-criticism, chronic musculoskeletal pain, and a recent diagnosis of diabetes. Post-treatment, she reported reduced shame, increased self-confidence, and substantial reductions in pain severity. Case 2 involved a 44-year-old female presenting with depression, hopelessness, and long-COVID-related anosmia and ageusia. She reported enhanced psychological resilience, improved mood, and resolution of diffuse body aches. Following the therapeutic dose, she also reported a 80-90% recovery of smell and taste after three years of dysfunction, post COVID-19 infection. The MEQ-30 scores were both high, indicating profound mystical-type experiences. These cases demonstrate improvements in psychological and somatic symptoms following participation in the DPTP. While the pain reduction and observed recovery of olfactory and gustatory function is noteworthy, spontaneous improvements cannot be excluded and further controlled investigation is warranted.},
}

@article {pmid42591479,
year = {2026},
author = {Silva-Passadouro, B and Khoja, O and Casson, AJ and Delis, I and Brown, C and Sivan, M},
title = {Peak alpha frequency is associated with pain severity in Long COVID patients with new-onset chronic pain.},
journal = {Frontiers in pain research (Lausanne, Switzerland)},
volume = {7},
number = {},
pages = {1893610},
pmid = {42591479},
issn = {2673-561X},
abstract = {BACKGROUND: New-onset chronic pain is a common and debilitating symptom of Long COVID (LC) that remains not fully understood in terms of pathophysiology and therapeutic targets. A growing body of evidence in chronic pain syndromes similar to LC demonstrates an association between EEG alpha oscillatory activity and the experience of pain, with clinical studies showing maladaptive changes, particularly a slowing of alpha activity.

AIMS: This study aims to investigate the association between EEG alpha oscillatory activity and pain perception in new-onset LC-chronic pain.

METHODS: We recruited 31 individuals (20 females) with a clinical diagnosis of LC reporting new-onset chronic pain and 31 healthy pain-free age- and sex-matched controls. Participants completed questionnaires regarding symptoms and psychological functioning prior to recording eyes-open resting-state EEG. Peak alpha frequency (PAF) and alpha band (8-13 Hz) spectral power were extracted from EEG signals.

RESULTS: Lower PAF over the posterior scalp region was significantly associated with higher LC-chronic pain severity when controlling for age, depression and the use of centrally acting medication. This finding was consistent across PAF estimation methods. No differences in PAF were observed between the LC patient group and the healthy pain-free control group. Alpha power did not differ between groups and was not associated with pain severity.

DISCUSSION: Together, these findings suggest that PAF may index individual differences in pain severity within LC-associated chronic pain, although the absence of overall patient-control differences indicates that PAF should not be interpreted as a disease-specific biomarker and warrants further longitudinal research.},
}

@article {pmid42591780,
year = {2026},
author = {Daher, J and Koberssy, Z and Diaz, M and Zisis, SN and Rosen, CJ and McComsey, GA},
title = {Glucose metabolism across COVID-19 and long COVID: a longitudinal study.},
journal = {Journal of the Endocrine Society},
volume = {10},
number = {9},
pages = {bvag173},
pmid = {42591780},
issn = {2472-1972},
abstract = {BACKGROUND: COVID-19 has been associated with new-onset diabetes. Prior studies are limited by lack of pre-infection data and preexisting cardiometabolic factors. Clarifying how COVID-19 and long COVID (LC) affect glucose metabolism is essential to guide prevention. We evaluated longitudinal changes in glycemic and cardiometabolic markers after SARS-CoV-2 infection in a prospective cohort with pre-infection baseline measurements.

METHODS: We included 821 uninfected adult participants from the RECOVER cohort who subsequently developed COVID-19, characterizing participants in their pre-COVID state. Data from up to 12 months post-infection were compared to pre-infection baseline. Participants with preexisting diabetes or pregnancy were excluded. The primary endpoint was change in HbA1c up to 12 months after infection. Analysis was stratified by LC status using the 2024 RECOVER Adult Long COVID Research Index (LCRI).

RESULTS: HbA1c remained stable from pre-infection to 12 months post-infection (5.39% vs 5.40%; P = .435). Non-HDL cholesterol and blood pressure decreased modestly, while cystatin C increased slightly; absolute changes were small. High-sensitivity C-reactive protein (hs-CRP), troponin, pro-brain natriuretic peptide (pro-BNP), body mass index, and waist circumference remained stable. The 10-year atherosclerotic cardiovascular disease (ASCVD) risk increased slightly (6.7% to 7.3%; P < .001). Trends were similar across LC groups. New-onset metabolic syndrome incidence was comparable across LC categories (18%-20%), although persistent metabolic syndrome was more frequent in participants with more severe LC.

CONCLUSION: In this cohort with pre-infection baseline data, we found no significant changes in HbA1c or cardiometabolic biomarkers through 12 months after infection, although 10-year ASCVD risk slightly increased. These findings emphasize the importance of longitudinal assessment in differentiating transient physiological changes from persistent cardiometabolic disease after COVID-19.},
}

@article {pmid42592003,
year = {2026},
author = {Almulla, AF and Natelson, BH and Calabrese, LH and Jahanbani, F},
title = {Editorial: Unraveling the biological mechanisms of chronic fatigue: a multifaceted approach.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1936679},
pmid = {42592003},
issn = {2296-858X},
}

@article {pmid42592765,
year = {2026},
author = {Hansen, JS and Rohde, M and Fjældstad, AW},
title = {Patient burden of chemosensory dysfunction and long COVID.},
journal = {Danish medical journal},
volume = {73},
number = {7},
pages = {},
doi = {10.61409/A01260014},
pmid = {42592765},
issn = {2245-1919},
mesh = {Humans ; Female ; *COVID-19/complications ; Middle Aged ; *Quality of Life ; Male ; Prospective Studies ; *Taste Disorders/virology/etiology/epidemiology ; *Olfaction Disorders/virology/epidemiology/etiology ; Post-Acute COVID-19 Syndrome ; Adult ; SARS-CoV-2 ; Surveys and Questionnaires ; Pandemics ; Fatigue ; Aged ; Symptom Burden ; },
abstract = {INTRODUCTION: Chemosensory dysfunction (CD), particularly olfactory and gustatory dysfunction, is a common symptom of SARS-CoV-2 infection. While often transient, some patients develop persistent dysfunction. The long-term relationship between persistent CD, long COVID (LC) and quality of life (QoL) remains unclear. This study aimed to evaluate CD recovery four years after infection and its association with LC symptoms and QoL.

METHODS: In this prospective cohort study, 356 individuals with sudden CD during the COVID-19 pandemic completed a questionnaire four years after symptom onset. The survey assessed CD recovery, LC symptoms and QoL using validated self-report items. Outcomes were compared between participants with recovered versus persistent CD. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

RESULTS: Only 43% reported full recovery of CD after four years. Persistent dysfunction was most common among participants aged 45-59 years (68%). Participants with persistent CD were significantly more likely to report LC symptoms, particularly fatigue (OR = 4.33), memory difficulties (OR = 3.30) and insomnia (OR = 3.39), each affecting more than 30% of this group. QoL scores indicated a greater impact on physical than emotional well-being.

CONCLUSIONS: A substantial proportion of respondents continued to experience CD and other LC symptoms four years after infection. These findings highlight the need for long-term clinical awareness and further research on post-viral CD.

FUNDING: None.

TRIAL REGISTRATION: Not relevant.},
}

Humans
Female
*COVID-19/complications
Middle Aged
*Quality of Life
Male
Prospective Studies
*Taste Disorders/virology/etiology/epidemiology
*Olfaction Disorders/virology/epidemiology/etiology
Post-Acute COVID-19 Syndrome
Adult
SARS-CoV-2
Surveys and Questionnaires
Pandemics
Fatigue
Aged
Symptom Burden

@article {pmid42577970,
year = {2026},
author = {Farooqui, I and Kumar, M},
title = {Post-COVID-19 Manifestation Persistence and Its Resolution: A Prospective Comparative Study From Hazaribagh, Jharkhand, India.},
journal = {Cureus},
volume = {18},
number = {7},
pages = {e112451},
pmid = {42577970},
issn = {2168-8184},
abstract = {Background COVID-19 survivors from both the first wave (ancestral SARS-CoV-2 strain) and the second wave (Delta variant, B.1.617.2) face a shared risk of persistent post-COVID symptoms - collectively termed Post-Acute Sequelae of SARS-CoV-2 (PASC) or Long COVID. Community-based data comparing post-COVID symptom trajectories between wave cohorts across multiple structured follow-up timepoints remain limited in India, particularly in tier-two city settings. This prospective comparative observational study examined and compared post-COVID symptom prevalence between first- and second-wave survivors from urban Hazaribagh, Jharkhand, across six structured contacts spanning 30 months. The primary objective was to compare symptom prevalence between the two wave cohorts at each contact and the secondary objective was to characterise the trajectory of symptom resolution within each cohort across the follow-up period. Methods A total of 601 adults with COVID-19 from urban Hazaribagh were enrolled - 155 from Wave 1 and 446 from Wave 2 - through systematic random sampling from the Integrated Disease Surveillance Programme (IDSP) registers. The sampling intervals (every seventh Wave-1 and every 17th Wave-2 case) were set in proportion to the differing sizes of the two source registers (1,065 and 7,686 confirmed cases, respectively), so as to draw similarly powered, logistically feasible samples from each wave. Seventeen post-COVID symptoms were assessed using a validated semi-structured questionnaire at six structured contacts: Contact 1 (enrolment, Month 0) and five further contacts at six-monthly intervals through Month 30. A symptom present beyond 30 days was recorded as a post-COVID manifestation; Chi-squared tests (Yates'-corrected) and Fisher's exact test were used for inter-wave comparisons; p<0.05 was considered statistically significant. Results Post-COVID symptom burden declined markedly in both cohorts from Contact 1 onwards and remained consistently low through Contact 6. The only statistically significant inter-wave difference at any contact was fatigue at Contact 1 (Wave 1: 12/155 (7.7%) vs. Wave 2: 17/446 (3.8%); p=0.049). No other symptom at any of the six contacts reached statistical significance between wave cohorts (all p>0.05). Fatigue, difficulty in breathing, and rhinorrhoea were the most consistently reported symptoms across contacts, each persisting in fewer than 3% of participants per wave from Contact 3 onwards. Stratified analyses found no sex-based difference in any symptom at any contact; hospitalisation during acute illness and incomplete vaccination status, but not sex, were each associated with higher rates of a small number of symptoms (chiefly difficulty in breathing, chest heaviness, fatigue and rhinorrhoea) at specific contacts. Conclusion Post-COVID symptom persistence is low and broadly comparable between first- and second-wave COVID-19 survivors beyond six months, with fatigue being the only symptom distinguishing the waves, and only at the earliest contact. The convergence of post-COVID trajectories from Contact 2 onwards is consistent with a single, uniform post-COVID follow-up protocol for survivors of both waves, though this comparative design - lacking a SARS-CoV-2-negative reference arm - cannot establish what symptom burden would have occurred in the absence of infection. Fatigue warrants prioritised clinical attention as the most persistent post-COVID symptom in this community setting.},
}

@article {pmid42578732,
year = {2026},
author = {Serrano-Salcedo, JA and Puente, AE and Guzmán-Echevarría, Y and Vega-Carrero, M},
title = {Subjective cognitive complaints and emotional symptoms after COVID-19: preliminary data in a sample of Puerto Rican adults.},
journal = {Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists},
volume = {41},
number = {6},
pages = {},
doi = {10.1093/arclin/acag060},
pmid = {42578732},
issn = {1873-5843},
mesh = {Adult ; Female ; Humans ; Male ; Middle Aged ; *Affective Symptoms/etiology/epidemiology ; *Cognitive Dysfunction/etiology ; *COVID-19/complications/psychology ; Neuropsychological Tests ; Post-Acute COVID-19 Syndrome ; Puerto Rico/epidemiology ; Self Report ; Severity of Illness Index ; Symptom Burden ; },
abstract = {OBJECTIVE: This exploratory study examined relationships between predisposing factors (age, pre-morbid medical conditions, educational attainment), COVID-19 disease severity indicators (hospitalization status, symptom burden, symptom duration), and self-reported cognitive complaints and emotional symptoms in Puerto Rican adults with prior COVID-19.

METHOD: Fifty-nine Puerto Rican adults (71.2% female; M age = 39.27 years, SD = 12.21) with a confirmed history of COVID-19 completed an investigator-developed sociodemographic questionnaire, the Neurobehavioral Symptom Inventory (NSI), and the Neuro-QoL v2.0 Cognitive Function-Short Form Spanish via an online platform. Non-parametric analyses included Spearman correlations, Mann-Whitney U tests, and Kruskal-Wallis tests with effect sizes. A sensitivity power analysis estimated the smallest detectable effects.

RESULTS: Symptom burden was the strongest correlate of self-reported cognitive and emotional symptoms, correlating positively with NSI Total (rho = 0.651, p < .001) and NSI Affective (rho = 0.637, p < .001) scores, and negatively with Neuro-QoL (rho = -0.329, p = .011). Pre-morbid conditions were associated with worse NSI Total (rho = 0.298, p = .022) and NSI Cognitive (rho = 0.344, p = .008). Age and education showed no significant associations. Cognitive complaints were strongly associated with emotional symptoms, holding across instruments and after adjusting for symptom burden. Hospitalization comparisons showed small-to-medium but nonsignificant effects, inconclusive given the small hospitalized subgroup.

CONCLUSIONS: In this Puerto Rican sample, COVID-19 symptom burden and pre-morbid health status were the primary correlates of cognitive difficulties, which were closely intertwined with emotional symptoms. These exploratory findings offer preliminary empirical evidence to inform future research in Puerto Rico.},
}

Adult
Female
Humans
Male
Middle Aged
*Affective Symptoms/etiology/epidemiology
*Cognitive Dysfunction/etiology
*COVID-19/complications/psychology
Neuropsychological Tests
Post-Acute COVID-19 Syndrome
Puerto Rico/epidemiology
Self Report
Severity of Illness Index
Symptom Burden

@article {pmid42579936,
year = {2026},
author = {Casado Sánchez, M and Morales Fajardo, K and Long, S and Janaudis-Ferreira, T and Duclos, C and Boudrias, MH},
title = {Identifying EEG biomarkers of fatigue and brain fog in long COVID: insights from rest and movement-related brain activity.},
journal = {Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia},
volume = {153},
number = {},
pages = {112230},
doi = {10.1016/j.jocn.2026.112230},
pmid = {42579936},
issn = {1532-2653},
abstract = {BACKGROUND: Fatigue and brain fog are among the most reported symptoms in Long COVID (LC), yet their underlying neural mechanisms remain unclear. In this context, we aimed to identify neural correlates associated with LC symptoms.

METHODS: Electroencephalography (EEG) was used to quantify brain oscillatory activity during sustained handgrips and rest in the left central region overlying the primary hand motor (C3) and somatosensory areas (C5). A sample of twenty LC participants reporting fatigue, brain fog, and post-exertional malaise (PEM) was analyzed, along with 20 age- and sex-matched controls. All participants were right-handed, and EEG activity was recorded on the dominant left hemisphere over motor and somatosensory areas. The main LC symptoms were assessed using the Fatigue Severity Scale (FSS), the Cognitive Failures Questionnaire (CFQ), and the DePaul Symptom Questionnaire for PEM (DSQ-PEM).

RESULTS: LC participants showed a smaller post-movement beta rebound (PMBR) during handgrips in the left central region (electrode C3, p = 0.02) compared to controls, which negatively correlated with cognitive symptoms (r = -0.35, p = 0.02). They also showed a slower alpha central frequency (CF) at rest (electrode C5, p = 0.003), which correlated with fatigue (r = -0.264, p = 0.019).

CONCLUSIONS: Both the lower PMBR and slower alpha CF suggest impaired inhibitory control and reduced excitability in the sensorimotor cortex of LC individuals. Together, these features, which were associated with fatigue and brain fog, highlight altered dynamics in the sensorimotor cortex of LC individuals. These findings offer preliminary mechanistic insight into LC symptoms and suggest that PMBR and alpha CF warrant further investigation as candidate EEG markers of this condition.},
}

@article {pmid42571046,
year = {2026},
author = {Gravenstein, S and Cooke, CE and Verdi, D and Fedele, MJ and Ganguli, S and Martin, S and Draica, F},
title = {Current Impact of COVID-19 in Long-Term Care Facilities in the United States: A Systematic Literature Review.},
journal = {The Senior care pharmacist},
volume = {41},
number = {5},
pages = {167-186},
doi = {10.4140/TCP.n.2026.167},
pmid = {42571046},
issn = {2639-9636},
mesh = {Humans ; *COVID-19/epidemiology/mortality ; United States/epidemiology ; *Long-Term Care/statistics & numerical data ; *Nursing Homes/statistics & numerical data ; Nursing Home Residents ; SARS-CoV-2 ; Aged ; Hospitalization/statistics & numerical data ; },
abstract = {Background: COVID-19 disproportionately affects older adults, placing residents of closed-community settings, such as long-term care facilities (LTCFs), at increased risk for severe illness and death. Objective: To describe the epidemiology and healthcare resource utilization associated with acute COVID-19 in LTCFs in the United States during Omicron variant predominance. Data Sources: MEDLINE and Embase databases were searched on January 15, 2025 for full-text citations published on or after January 1, 2022. Conference abstracts from long-term care conferences in 2023 and 2024 were hand-searched. Records were included if they described acute COVID-19 in LTCFs (nursing homes, assisted living facilities, or Veterans Affairs Community Living Centers). Records were excluded if they were conducted outside the United States, published in languages other than English, focused on long COVID, did not include data from the Omicron predominance period (beginning November 1, 2021), or were clinical trials, case reports/case series, narrative reviews, editorials, or commentaries. Data Synthesis: Forty-three articles met the inclusion criteria, most of which reported COVID-19 cases (20 studies), mortality (18 studies), and/or healthcare resource utilization (11 studies). Although all studies included COVID-19 data during the Omicron period, most also included earlier periods during which other COVID-19 variants were predominant. In the United States, weekly incidence rates for COVID-19 infections and hospitalizations among nursing home residents ranged from 614 to 1338 and from 38 to 71 per 1,000 residents, respectively. Approximately 1 in 6 COVID-19 hospitalizations occurred among LTCF residents. Compared with community-dwelling individuals, mortality was 4.6-fold higher among LTCF residents. Conclusion: COVID-19 in LTCFs was associated with high rates of hospitalization and mortality among residents, including vaccinated individuals, during the study period.},
}

Humans
*COVID-19/epidemiology/mortality
United States/epidemiology
*Long-Term Care/statistics & numerical data
*Nursing Homes/statistics & numerical data
Nursing Home Residents
SARS-CoV-2
Aged
Hospitalization/statistics & numerical data

@article {pmid42571155,
year = {2026},
author = {Riley, M and Treneman-Evans, G and Taylor, O and Pike, K and Troop, N},
title = {An interpretative phenomenological analysis study of perceptions around factors relating to coping amongst young people with Long Covid and mental health difficulties in the UK.},
journal = {Health psychology open},
volume = {13},
number = {},
pages = {20551029261440419},
pmid = {42571155},
issn = {2055-1029},
abstract = {The nature and causes of neuropsychiatric symptoms in children and young people (CYP) with Long Covid are debated in current research. This study explored CYP perceptions of their mental health difficulties in association with Long Covid diagnoses. Nine CYP were interviewed, asking about their experiences of Long Covid and mental health. Data was analysed using Interpretive Phenomenological Analysis. There were two principal findings in this research. (1) Participants related their mental health difficulties to difficulties associated with having Long Covid and wider system pressures. (2) Participants spoke about the impact of stigma in healthcare services delaying access to specialist medical professionals. Findings suggest that healthcare services need to be better informed, and to reduce barriers to access healthcare services. These measures would reduce the pressure on families to fight for services.},
}

@article {pmid42571535,
year = {2026},
author = {Khawaja, I and Khan, N and Kannangara, L and Panangala Liyanage, SN and Gomez Canales, E and Sahedra, SS},
title = {The Association Between COVID-19 and Herpes Zoster in Adult Populations: A Systematic Review.},
journal = {Cureus},
volume = {18},
number = {7},
pages = {e112344},
pmid = {42571535},
issn = {2168-8184},
abstract = {Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2), has been associated with a wide range of dermatological manifestations. Herpes zoster (HZ), also known as shingles, has been increasingly reported in adults with COVID‑19 infection. Several reports suggest that SARS‑CoV‑2-associated immune dysregulation, particularly lymphopenia and impaired T-cell-mediated immunity, may contribute to varicella-zoster virus (VZV) reactivation. This systematic review aimed to evaluate the temporal relationship between COVID‑19 infection and shingles rash, including the onset, clinical outcomes, prognostic implications, recovery, and relationship with lymphopenia. This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature review was conducted using PubMed, MEDLINE and Cochrane databases for studies published within the last five years. Search terms included "COVID‑19", "SARS-CoV-2", "herpes zoster" and "shingles rash". Inclusion criteria consisted of case reports, case series, cohort studies, systematic reviews, and research studies. Studies included were in the English language. Studies not relevant to the research question, paediatric cohorts, or commenting on vaccination were excluded. Fifty-seven studies (N=57) were initially identified through database search, with 35 studies (N=35) deemed relevant to the research question following screening. Twenty-five studies (N=25) were excluded due to data not being relevant to the research question, paediatric cohort data, or vaccination-related data. After exclusion, 10 studies (N=10) were included in the review for qualitative analysis. Most studies demonstrated a temporal association between COVID‑19 infection and HZ occurrence. HZ rash developed from two days before COVID‑19 symptoms and up to 70 days after infection, with an average onset approximately 17 days after COVID‑19 diagnosis. Several studies reported that HZ preceded or coincided with COVID‑19 symptoms, suggesting that shingles may serve as an early indicator of SARS‑CoV‑2 infection. Associated lymphopenia was noted, suggesting that COVID-19-induced immune dysregulation contributes to VZV reactivation. Most patients recovered from HZ rash following antiviral therapy, although severe complications and prolonged hospitalisation were observed in cases involving co-infection and systemic disease. Overlooking this possible association may result in an undiagnosed COVID-19 infection in those presenting with shingles rash and a higher risk of developing long COVID. The reviewed studies indicate that COVID-19 may be associated with HZ reactivation in the general adult population, although causality remains unproven. This detailed data analysis and systematic review demonstrate that evidence is scarce in this domain, which warrants larger epidemiological and immunological studies as well as further meta-analyses to determine the prognostic significance of shingles rash in COVID‑19 infection, in particular long COVID.},
}

@article {pmid42577247,
year = {2026},
author = {Takemura, M and Arahata, M and Kuriyama, M},
title = {Mortality and Causes of Death among Older Inpatients with Non-Severe Coronavirus Disease 2019 during the Omicron Era: A Retrospective Cohort Study in a Community Hospital.},
journal = {JMA journal},
volume = {9},
number = {4},
pages = {887-899},
pmid = {42577247},
issn = {2433-3298},
abstract = {INTRODUCTION: Quantifying the impact of coronavirus disease (COVID) 2019 (COVID-19) on mortality has become increasingly challenging in the Omicron-variant era. This difficulty arises from reduced excess mortality, the presence of long COVID, and the lack of a strict definition of COVID-19-related death, which has led to inconsistencies in reported mortality rates. Accurate cause-of-death statistics are essential for health care policymaking.

METHODS: We conducted a retrospective cohort study in patients aged ≥65 years who were admitted to the COVID-19 isolation ward of our hospital between July 1, 2021 and September 30, 2023. The primary outcome was survival to hospital discharge. Causes of death were classified according to the World Health Organization definition into four categories: COVID-19, COVID-19-associated complications, pre-COVID-19 medical conditions, and post-COVID-19 complications. The latter two categories were considered deaths unrelated to COVID-19.

RESULTS: A total of 182 patients with mild or moderate COVID-19 were included for analysis. Among these, 23 (13%) died during hospitalization. Those who died were more likely to have moderate COVID-19, impaired physical or eating functions, and multiple comorbidities than were survivors. Of the 23 deaths, only 8 (35%) were attributed to COVID-19 or COVID-19-associated complications, whereas 15 (65%) were due to pre-COVID-19 medical conditions or post-COVID-19 complications. Concordance between Japanese public criteria for COVID-19-related death and our classification method was low (Cohen's κ = 0.223).

CONCLUSIONS: In this cohort of older patients with mild or moderate COVID-19, in-hospital mortality was relatively high. However, most deaths were not directly attributable to COVID-19. Larger studies are needed to further clarify mortality outcomes in this population.},
}

@article {pmid42577968,
year = {2026},
author = {Amoroso, C and Marinoni, B and Maragno, P and Rimondi, A and Bottaro, F and Ciafardini, C and Muià, M and Honcharyuk, I and Noviello, D and Caridi, B and Sommella, EM and Bandera, A and Gori, A and Mantero, M and Blasi, F and Ferrucci, R and Priori, A and Strati, F and Vecchi, M and Facciotti, F and Caprioli, F},
title = {VSL#3[®] supplementation improves fatigue in long COVID: results from the DELong#3 randomized placebo-controlled trial.},
journal = {British journal of biomedical science},
volume = {83},
number = {},
pages = {16993},
pmid = {42577968},
issn = {2474-0896},
mesh = {Humans ; Female ; *Fatigue/therapy/etiology/virology/drug therapy ; Male ; *COVID-19/complications ; Double-Blind Method ; Middle Aged ; Post-Acute COVID-19 Syndrome ; Quality of Life ; Gastrointestinal Microbiome/drug effects ; SARS-CoV-2 ; *Probiotics/therapeutic use/administration & dosage ; Adult ; Treatment Outcome ; Dietary Supplements ; Aged ; Dysbiosis ; },
abstract = {BACKGROUND: Long COVID is frequently characterized by persistent fatigue and impaired quality of life. Increasing evidence suggests that gut microbiota dysbiosis and immune dysregulation may contribute to symptom persistence. We evaluated the effects of the probiotic formulation VSL#3® in patients with long COVID.

METHODS: In this randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov identifier: NCT05874089), patients with long COVID and clinically relevant fatigue received VSL#3® or placebo for 4 weeks. The primary endpoint was fatigue improvement assessed by the Chalder Fatigue Scale (CFS). Secondary and exploratory analyses included patient-reported outcomes, gut microbiota profiling, immune phenotyping, cytokine analyses, and targeted metabolomics.

RESULTS: Forty-eight patients completed the study (placebo n = 25; VSL#3® n = 23). VSL#3® supplementation significantly improved fatigue compared with placebo, with a greater reduction in CFS score (24.24% vs. 6.06%; p = 0.037) and a higher proportion of responders (68% vs. 35.7%; p = 0.019). Clinical benefit persisted after treatment discontinuation and was accompanied by improvements in selected quality-of-life and gastrointestinal symptom domains. VSL#3® supplementation was associated with selective enrichment of health-associated bacterial taxa, including Bifidobacterium, Lactobacillus, Ruminococcus, and Coprococcus, together with modulation of inflammatory and immune-related pathways. Exploratory multi-omic analyses identified coordinated associations among microbiota-derived metabolites, immune markers, and clinical outcomes.

CONCLUSION: VSL#3® supplementation improved fatigue and selected clinical outcomes in patients with long COVID and was associated with coordinated microbiota and immune changes. These findings support further investigation of microbiota-targeted interventions in long COVID.},
}

Humans
Female
*Fatigue/therapy/etiology/virology/drug therapy
Male
*COVID-19/complications
Double-Blind Method
Middle Aged
Post-Acute COVID-19 Syndrome
Quality of Life
Gastrointestinal Microbiome/drug effects
SARS-CoV-2
*Probiotics/therapeutic use/administration & dosage
Adult
Treatment Outcome
Dietary Supplements
Aged
Dysbiosis

@article {pmid42568470,
year = {2026},
author = {Roncati, L and Weissert, R},
title = {Editorial: Long- and post-COVID syndromes: immune mechanisms and therapeutic strategies.},
journal = {Frontiers in immunology},
volume = {17},
number = {},
pages = {1935027},
pmid = {42568470},
issn = {1664-3224},
}

@article {pmid42569310,
year = {2026},
author = {Zetum, ASS and da Silva, DRC and Ventorim, VDP and Mion, FA and Passarela, FDS and Rosa, HP and Campos, TL and Acioli-Santos, B and Oliveira, FRDS and Barbosa, KRM and Morais, LC and Dos Reis Trabach, RS and Altoé, LSC and Moreto Guaitolini, Y and Brasil, P and Casotti, MC and Louro, ID and Meira, DD},
title = {An exploratory exome-wide machine learning analysis identifies candidate host gene signatures associated with Long COVID in a large admixed Brazilian cohort.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1837186},
pmid = {42569310},
issn = {2296-858X},
abstract = {INTRODUCTION: Genetic factors have been suggested as modifiers of vulnerability to postCOVID-19 sequelae, referred to as Long COVID (LC). We hypothesize that LC may involve central nervous system (CNS)-related mechanisms, influenced by neuroinflammatory, autoimmune, viral mechanisms, and genetic factors. In this work, we used whole-exome sequencing in conjunction with a machine learning-based prioritization framework to investigate the connection between LC and host genomic variation.

METHODS: Our patient group included 312 individuals previously infected with SARS-CoV-2 enrolled in two public hospitals of Vitoria city, Brazil, between November 2020 and July 2023. After rigorous quality control in accordance with reference guidelines, the exome data revealed 651,652 variants in our cohort. To rank candidate variants, a supervised machine learning framework combining Recursive Feature Elimination (RFE) and XGBoost was implemented. Five variants were found to be statistically significant after Benjamini-Hochberg false discovery rate (FDR) correction in subsequent logistic regression analyses that were adjusted for age, sex, and principal components of ancestry under an additive genetic model.

RESULTS: The variant at LERFS - rs200443822 was associated with increased odds of LC (OR = 6.21, 95% CI 2.98-12.91, FDR-adjusted p < 0.01). Similarly, the variant at PNKD - rs1870125 (OR = 2.33, 95% CI 1.52-3.57, FDR-adjusted p < 0.01) and LIPA - rs1051338 (OR = 2.87, 95% CI 1.77-4.65, FDR-adjusted p < 0.01) showed increased odds. In contrast, variants at chromosome 10 (rs7912524 - HK1 and LAMB4 - rs1735499) were associated with reduced odds of LC, with ORs ranging from 0.38 to 0.50 (all FDR-adjusted p < 0.01).

DISCUSSION: Our findings do not support single-gene causal effects; rather, they are consistent with the notion that common variants may collaboratively influence inter-individual variations in LC manifestations within a more extensive polygenic framework. Clinical features such as fatigue, pain, anosmia, dysautonomia, and cognitive impairment may reflect interactions between host genomic background and clinical or demographic factors. Overall, this study provides a hypothesis-generating integrative framework for investigating host genetic contributions to LC in an underrepresented admixed population. Targeted functional studies are important to ascertain the biological significance and translational applicability of these findings.},
}

@article {pmid42569680,
year = {2026},
author = {Tillery, A and O'Leary, R and Pisanic, N and Youpee, B and Aherrera, A and Krucynski, K and Farlee, J and Wilks, M and Hovhannisyan Romero, ES and Cajero, M and Duran, J and Heaney, C and Rule, AM and Erdei, E},
title = {Indoor Air Nicotine, Nitrogen Dioxide Exposure, and COVID-19 Outcomes in a Great Plains Tribal Community.},
journal = {Indoor air},
volume = {2026},
number = {},
pages = {},
pmid = {42569680},
issn = {1600-0668},
abstract = {INTRODUCTION: Indigenous communities in the United States have disproportionately high tobacco use and reliance on propane for heating and cooking fuel compared to other demographic groups. Of concern is exposure to air nicotine (AN) and NO2 in indoor environments and their potential impact on respiratory infections.

OBJECTIVE: The objective of this study is to assess indoor air pollution and COVID-19 infection outcomes in multigenerational households within the Cheyenne River Sioux Tribe (CRST).

METHODS: The COVID-19 Wayakta He? ("Are you on guard against COVID-19?") Study recruited 290 multigenerational households with two adults at least 9 years apart. All participants responded to a questionnaire on COVID-19 outcomes, housing conditions, and environmental health factors. Households deployed passive AN and NO2 air monitors in their homes for 1 week. Each participant provided saliva samples for COVID-19 serological testing.

RESULTS: The geometric mean AN concentration was 0.052 μg/m[3] (range: 0.017-5.35); 40.1% of households had AN detected. The geometric mean NO2 concentration was 10.5 ppb (range: 0.65-138). The odds of previous COVID-19 infection were 1.21 (95% CI: 1.01, 1.51) times higher for those exposed to AN; the odds of self-reported long COVID-19 disease were 3.69 (95% CI: 1.11, 16.6) times higher for those exposed to NO2.

CONCLUSION: Indoor air exposures to AN and NO2 increased the odds of having COVID-19 infection and long COVID-19 outcomes. The combination of toxic chemical exposures, increased prevalence of existing chronic diseases, and structural social problems placed Indigenous communities at increased risk of having COVID-19 infections. High exposures to household AN and NO2 and the occurrence of COVID-19 disease highlight the importance of consistently including exposure assessments to design targeted interventions in Tribal communities.},
}

@article {pmid42559367,
year = {2026},
author = {Asghar, AUR and Yuen, HK and Aksoy, M and Salawu, A and Baseler, HA},
title = {Long COVID affects working memory: assessment using a single rapid online test.},
journal = {Frontiers in human neuroscience},
volume = {20},
number = {},
pages = {1881458},
pmid = {42559367},
issn = {1662-5161},
abstract = {OBJECTIVE: Long COVID, or post-COVID-19 syndrome, is characterized by persistent symptoms following SARS-CoV-2 infection, including cognitive impairments such as "brain fog" that adversely affect quality of life. The aim of this study was to evaluate the impact of long COVID on working memory using a single, rapid, anonymous online survey and visual working memory quiz.

METHODS: We analyzed working memory scores in relation to reported long COVID status (clinically diagnosed, self-reported, and non-long COVID), age, number of COVID-19 infections, long COVID duration, and subjective ratings of brain fog severity and the overall life impact of symptoms. The study utilized the Rapid Objective Working Memory Assessment (ROWMA), a brief, gamified visual recognition task designed to maximize compliance and minimize fatigue.

RESULTS: A total of 1,064 participants aged 16 to over 85 years were recruited, with 39% reporting long COVID. Categorical regression revealed that long COVID status was the strongest predictor of working memory performance, followed by age and number of infections. Participants with long COVID performed significantly worse on the working memory quiz than non-long COVID controls, with the lowest scores observed in the clinically diagnosed group. Furthermore, working memory scores declined with age, particularly among those aged 35 and older, and decreased with multiple COVID-19 infections within the diagnosed group. Individuals in the diagnosed group reported the most severe brain fog and the greatest life impact, both of which strongly correlated with lower memory scores. Although longer long COVID duration was associated with lower memory performance, an exploratory analysis indicated this trend may have been influenced by the SARS-CoV-2 variant.

CONCLUSION: Our results support the hypothesis that long COVID is associated with objective working memory impairment, particularly among individuals with a clinical diagnosis. These findings add to the growing body of evidence linking long COVID to objective cognitive difficulties. Moreover, the study advocates the use of rapid, single-task online cognitive assessments as a practical, scalable, and low-burden approach for evaluating working memory function in this population.},
}

@article {pmid42564177,
year = {2026},
author = {Zhou, T and Zhang, B and Lu, Y and Chen, J and Zang, C and Li, H and Elia, J and Prasad, R and Arnold, J and Avedissian, SN and Bailey, LC and Becich, MJ and Bensken, WP and Bisyuk, Y and Bunnell, HT and Castro, L and Chrischilles, EA and Christakis, DA and Cowell, LG and Cummins, MR and Fernandez, S and Fort, D and Gonzalez, S and Herring, SJ and Hornig, M and Hwang, W and Jain, N and Jones, WS and Kaelber, DC and Kelleher, K and Kenney, R and Leikauf, JE and Letts, R and Liu, M and Martinez, AT and May, HT and Mosa, ASM and Pajor, NM and Rao, S and Salisbury, AL and Suresh, S and Swaminathan, AC and Taylor, BW and Thomas, NA and Williams, DA and Witvliet, MG and Kaushal, R and Wang, F and Forrest, CB and Chen, Y},
title = {SSRI/SNRI and long COVID in children and adolescents with neuropsychiatric conditions: a cohort study from the RECOVER Initiative.},
journal = {Nature. Mental health},
volume = {4},
number = {8},
pages = {1275-1284},
pmid = {42564177},
issn = {2731-6076},
abstract = {Long COVID has been an important health concern in children and adolescents, yet factors associated with its development remain incompletely understood. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for pediatric neuropsychiatric conditions and may influence immune and autonomic pathways involved in postinfectious symptoms. Here we show associations between SSRI/SNRI use and long coronavirus disease (COVID)-related outcomes in a retrospective cohort of 110,955 children and adolescents with pre-existing neuropsychiatric conditions across 37 US health systems participating in the National Institutes of Health Researching COVID to Enhance Recovery consortium. SSRI/SNRI use was not associated with clinician-recorded long COVID diagnosis but showed heterogeneous associations with individual symptoms. Lower risks were observed for some symptoms, including fever, chills and hair loss, whereas higher risks were observed for neurological and systemic outcomes, including postural orthostatic tachycardia syndrome, cognitive dysfunction and fatigue. These findings suggest that antidepressant exposure may be associated with differing post-COVID symptom patterns in youth and warrant further investigation.},
}

@article {pmid42568003,
year = {2026},
author = {Mora Zetina, AA and Ortega Sanchez, EF and Zuñiga Ascencio, BS and Castorena Maldonado, AR and Ahumada Topete, VH and Torres Espíndola, LM and Aquino Gálvez, A and Fernández Plata, R and Higuera Iglesias, AL and Martínez Briseño, D and Bernal Silva, A and García Martín, MO and Márquez García, JE and Moncada Morales, A and Chávez Alderete, J and Hernandez Zenteno, R and Becerril Vargas, E and Cataneo Piña, DJ and Aguilar Faisal, JL and García Machorro, J and López Sánchez, P and Hernandez Campos, ME and Castillejos López, M},
title = {Long-term angiogenic and thromboinflammatory signatures in post-COVID-19 syndrome.},
journal = {Angiogenesis},
volume = {29},
number = {4},
pages = {},
pmid = {42568003},
issn = {1573-7209},
mesh = {Humans ; *COVID-19/blood/complications ; Female ; Biomarkers/blood ; Male ; Middle Aged ; *Angiogenesis ; *Thromboinflammation/blood/etiology ; *SARS-CoV-2 ; Post-Acute COVID-19 Syndrome ; Adult ; Angiopoietin-1/blood ; alpha-Macroglobulins/metabolism ; Mexico ; },
abstract = {BACKGROUND: Post-COVID-19 syndrome is a major long-term sequela of severe SARS-CoV-2 infection, potentially involving persistent angiogenic and thromboinflammatory dysfunction, though long-term biomarker behavior remains unclear.

OBJECTIVE: To evaluate the evolution of angiogenic and thromboinflammatory biomarkers in post-COVID-19 syndrome patients.

METHODS: This ambispective cohort study was conducted at the National Institute of Respiratory Diseases in Mexico City. Thirty-two adults hospitalized for severe or critical COVID-19 in 2020 were followed for three and a half years. Paired plasma samples were collected during hospitalization and at long-term follow-up. Endothelial dysfunction markers included soluble P-selectin, vascular endothelial growth factor receptor 2, vascular endothelial growth factor D, and angiopoietin-1. Hemostasis was assessed by prothrombin time. Acute-phase proteins alpha-2-macroglobulin and haptoglobin were measured via immunoassay. Persistent symptoms were documented at follow-up.

RESULTS: At three and a half years, persistent symptoms were common: fatigue in sixty-five point 6%, dyspnea in sixty-two point 5%, and concentration difficulties in sixty-five point 6%. Vascular endothelial growth factor D and angiopoietin-1 remained elevated. Alpha-2-macroglobulin stayed high, and prothrombin time was prolonged in a subset of patients.

CONCLUSIONS: Severe COVID-19 survivors show sustained angiogenic dysregulation and thromboinflammatory imbalance. Elevated vascular endothelial growth factor D and angiopoietin-1 indicate ongoing angiogenic perturbations, while increased alpha-2-macroglobulin and prolonged prothrombin time reflect persistent coagulation disturbances. These biomarkers may help identify long-term vascular alterations in post-COVID-19 syndrome.},
}

Humans
*COVID-19/blood/complications
Female
Biomarkers/blood
Male
Middle Aged
*Angiogenesis
*Thromboinflammation/blood/etiology
*SARS-CoV-2
Post-Acute COVID-19 Syndrome
Adult
Angiopoietin-1/blood
alpha-Macroglobulins/metabolism
Mexico

@article {pmid42557952,
year = {2026},
author = {Acharya, A and Thurman, M and Sutar, D and Olasunkanmi, OI and Malik, JR and Dyavar, SR and Végvári, Á and Byrareddy, SN},
title = {In-Vitro Evaluation of HIV/SARS-CoV-2 Co-Infection Mediated Proteomic Changes in Astrocytes and Pericytes Reveals Altered Signaling Pathways Associated With Neurodegenerative Disorders.},
journal = {Journal of medical virology},
volume = {98},
number = {8},
pages = {e71086},
pmid = {42557952},
issn = {1096-9071},
support = {R01DA05284/NH/NIH HHS/United States ; R01DA061678/NH/NIH HHS/United States ; },
mesh = {*Pericytes/virology/metabolism ; *Astrocytes/virology/metabolism ; Humans ; *Signal Transduction ; *HIV Infections/metabolism/complications/virology ; *SARS-CoV-2/physiology ; *Coinfection/virology/metabolism ; *Neurodegenerative Diseases/metabolism/virology ; *COVID-19/metabolism/complications/virology ; Proteomics ; Microglia/virology/metabolism ; Post-Acute COVID-19 Syndrome ; Virus Replication ; Proteome ; },
abstract = {Coronavirus disease 2019 (COVID-19) survivors frequently experience a wide range of symptoms known as post-acute sequelae of SARS-CoV-2 (PASC) or long COVID. Importantly, complications arising from microvascular dysfunction, blood-brain barrier (BBB) disruption, and chronic neuroinflammation have been implicated in driving PASC within the central nervous system (CNS), known as neuro-PASC. Notably, people with HIV (PWH), who suffer from chronic neuroinflammation, BBB impairment, and glial cell dysfunction, collectively known as neuro-HIV, are generally at higher risk of neuro-PASC. The overlap between neuro-PASC and neuro-HIV raises concerns that HIV and SARS-CoV-2 co-infection may exacerbate neurological dysfunctions among PWH. In this study, using an in-vitro cell culture model, we examine the effects of HIV and SARS-CoV-2 mono- and co-infection in microglia, astrocytes, and pericytes. Our results demonstrated that majority of brain cell types support SARS-CoV-2 replication, in the presence and absence of HIV infection. Furthermore, in both mono- and co-infected cells, there were varying degree of up- and downregulation of SARS-CoV-2 host cell entry factors, such as ACE2, TMPRSS2, NRP1, and TRIM28, and inflammatory cytokines including IL-6, TNF-α, and IL-1β. Moreover, conditioned media collected from HIV, SARS-CoV-2, and HIV/SARS-CoV-2 co-infected astrocytes and pericytes were shown to be neurotoxic. Additionally, proteomic analysis has revealed a unique set of proteins significantly up/down regulated in HIV/SARS-CoV-2 co-infected astrocytes and pericytes. The gene set enrichment analysis of these proteins indicates dysregulation of lipid, energy, and immune metabolism pathways linked to neurodegenerative disorders like Alzheimer's, Parkinson's, Huntington's disease, and amyotrophic lateral sclerosis. These in-vitro findings indicate that astrocytes and pericytes from HIV/SARS-CoV-2 co-infection exhibit altered protein expression profiles, implicating dysregulated signaling pathways associated with neurodegenerative dysfunction.},
}

*Pericytes/virology/metabolism
*Astrocytes/virology/metabolism
Humans
*Signal Transduction
*HIV Infections/metabolism/complications/virology
*SARS-CoV-2/physiology
*Coinfection/virology/metabolism
*Neurodegenerative Diseases/metabolism/virology
*COVID-19/metabolism/complications/virology
Proteomics
Microglia/virology/metabolism
Post-Acute COVID-19 Syndrome
Virus Replication
Proteome

@article {pmid42558771,
year = {2026},
author = {Abio, A and Sourander, A and Dadras, O and Hinkka-Yli-Salomäki, S and Gilbert, S and Ruuskanen, O},
title = {Is fatigue associated with adolescents' mental health? A pre- vs. post-COVID-19 cross-sectional survey comparison.},
journal = {Frontiers in child and adolescent psychiatry},
volume = {5},
number = {},
pages = {1745757},
pmid = {42558771},
issn = {2813-4540},
abstract = {AIM: Fatigue is a common complaint reported by adolescents and adults; and one of the persistent symptoms of long COVID-19. The aim of this study was to assess the prevalence of self-reported fatigue and associated factors among adolescents in Finland at two distinct time points, pre- (2018) and post-COVID (2023).

METHODS: A cross-sectional survey was conducted among adolescents in two cities, Rovaniemi and Salo, Finland, in 2018 and 2023. All schools with students in the 7-9th grades in Rovaniemi (10) and Salo (4) cities were invited to participate in the survey, except special needs schools and classes. The Checklist Individual Strength (CIS) questionnaire was used to determine the severity of fatigue among adolescents. A total of 5,583 adolescents aged 13-17 years (n = 2,774, in 2018) and (n = 2,809, in 2023) were included in the analyses. Linear regression analysis was used to determine the association between fatigue, survey year and explanatory variables.

RESULTS: The prevalence of fatigue increased among females from 16.2% in 2018 to 24.3% in 2023 (p < 0.001), but not among males at 6.7% vs. 5.6% (p = 0.239) respectively. The mean fatigue score change among females was 29.1 vs. 32.2 (p < 0.001), and males 24.6 vs. 25.2 (p = 0.081) in 2018 vs. 2023 respectively. The fatigue score was higher among females by 0.7 points in 2023 (β = 0.68; 95% CI: 0.07, 1.28), but not among males (β = 0.03; 95% CI: -0.56, 0.62). Internalizing problems were associated with fatigue among females (β = 5.00; 95% CI: 4.68, 5.32); and males (β = 3.74; 95% CI: 3.37, 4.11). Externalizing problems were associated with fatigue (β = 2.87; 95% CI: 2.53, 3.20) among females and (β = 2.19; 95% CI: 1.85, 2.53) males. Other factors associated with fatigue included living with one biological parent and being overweight among across both sexes.

CONCLUSION: The notable increase in fatigue, among girls, post-COVID highlights the need for sustained attention to adolescent mental health and physical health, especially in relation to internalizing and externalizing problems.},
}

@article {pmid42553540,
year = {2026},
author = {Goulding, T},
title = {Case Report: Mitochondrial insufficiency underlies cholinergic failure in post-vaccination long COVID: a candidate treatment protocol.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1813032},
pmid = {42553540},
issn = {2296-858X},
abstract = {An 80-year-old male with severe long COVID developed acute deterioration following COVID-19 vaccination despite ongoing cholinergic therapy (Mestinon 90 mg daily). A comprehensive mitochondrial support protocol targeting NAD+ repletion, electron transport chain function, and oxidative stress was initiated, with all components delivered in fresh-squeezed orange juice. Clinical response was dramatic within 48 h, with sustained functional recovery over 6 weeks. Challenge-rechallenge testing demonstrated rapid symptom recurrence and resolution with three key observations: missed doses, wrong component sequence, and substitution of water for orange juice. This final observation suggests citric acid may function as a rate-limiting Krebs cycle substrate, consistent with impaired endogenous citrate synthesis in severe long COVID. This case suggests that cholinergic support may require concurrent metabolic foundation including direct substrate supplementation, and some long COVID manifestations may be metabolically reversible with multi-pathway intervention. As a single self-case report, these findings generate hypotheses for systematic investigation rather than establishing treatment guidelines.},
}

@article {pmid42553659,
year = {2026},
author = {Du, J and Wang, Y and Wang, H and Zou, H and Hua, C and Xie, W and Chen, J and Yu, Z and Shen, X and Wu, K and Zhang, C and Wang, W and Wu, B and Zhang, Z},
title = {A pilot study of nebulized 3D-cultured mesenchymal stem cell-derived extracellular vesicles for the treatment of post-COVID-19 chronic cough.},
journal = {Frontiers in medicine},
volume = {13},
number = {},
pages = {1809451},
pmid = {42553659},
issn = {2296-858X},
abstract = {INTRODUCTION: Chronic cough, particularly prevalent in post-COVID condition (PCC, also known as long COVID), remains a significant medical challenge. Recently, extracellular vesicles (EVs) have gained significant attention for their therapeutic potential.

METHODS: In this study, we explore the therapeutic effects of EVs derived from mesenchymal stem cells (MSCs) cultured in a 3D system (3D-EVs) in treating chronic cough, with a focus on post-COVID-19 patients.

RESULTS: Our in vitro experiments demonstrated that 3D-EVs promote angiogenesis and cell migration, crucial processes in tissue repair and regeneration. Notably, 3D-EVs exhibited a robust suppressive effect on lymphocyte proliferation in human PBMCs, indicating their potential immunomodulatory role. At day 6, nebulized 3D-EVs treatment group showed significantly higher rates of significant improvement (22.5% vs. 5.0%, P = 0.023) and total effectiveness (67.5% vs. 47.5%, P = 0.035), as well as a shorter mean time to cough resolution (13.83 vs. 19.90 days, P = 0.037). By day 14, total effective rates were comparable (85% vs. 80%, P > 0.05). No safety concerns were observed. RNA sequencing revealed altered B cell receptor signaling and downregulation of the mitotic cell cycle pathway, while exploratory immunophenotyping identified a significant reduction in plasma cells (P < 0.05) and directional trends in other immune subsets, providing preliminary evidence that 3D-EVs may modulate B cell differentiation and immune responses.

CONCLUSION: These findings demonstrate the feasibility and preliminary efficacy of 3D-EVs for rapid relief of post-COVID-19 chronic cough, supporting larger controlled trials to validate their role in this and related respiratory diseases.},
}

@article {pmid42555615,
year = {2026},
author = {Gouraud, C and Guemouni, S and Thoreux, P and Ouazana-Vedrines, C and Pitron, V and Verot, C and Xiang, K and Baudry, F and Ranque, B and Lemogne, C and , },
title = {Health-related quality of life among patients with long COVID according to the presence of a diagnosis of functional somatic disorder: A cross-sectional study.},
journal = {PloS one},
volume = {21},
number = {8},
pages = {e0354238},
pmid = {42555615},
issn = {1932-6203},
mesh = {Humans ; *Quality of Life ; Female ; *COVID-19/complications/psychology ; Middle Aged ; Male ; Cross-Sectional Studies ; Adult ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; *Somatoform Disorders/diagnosis/psychology/epidemiology/complications ; Pandemics ; Depression ; Anxiety ; },
abstract = {BACKGROUND: Long COVID is associated with poor health-related quality of life (QoL), with substantial interindividual variations. This study aimed to investigate the association between QoL and a diagnosis of functional somatic disorder (FSD) among patients seeking care for long COVID.

METHODS: Data were drawn from the CASPer-COVID program, a multidisciplinary tertiary care program for patients with persistent symptoms following COVID-19. QoL was evaluated with the 36-Item Short-Form health survey (SF-36), yielding a Physical Component Summary (PCS) and a Mental Component Summary (MCS). Multivariable linear regression analyses were performed to investigate the associations between PCS or MCS scores and a diagnosis of FSD, adjusting for age, gender, body mass index, comorbidities, hospitalization for acute COVID-19, core persistent symptoms, symptom duration, depressive and anxiety symptoms, and physical activity.

RESULTS: The analyses included 773 patients (median age [interquartile range (IQR)]: 44 [36-55] years; 64% women). QoL was markedly impaired (median PCS [IQR]: 44 [31-60]; median MCS [IQR]: 39 [31-49]). A diagnosis of FSD (76.5% of patients) was not associated with MCS (β [95% CI]: 1.11 [-1.30, 3.53]) or PCS (β [95% CI]: -1.60 [-3.88, 0.67]) scores in adjusted analyses. Lower PCS and MCS scores were associated with higher depressive and anxiety symptoms, lower physical activity levels, and pain. In addition, lower PCS scores were associated with female gender, hospitalization for acute COVID-19 and longer symptom duration.

CONCLUSION: In patients seeking care for long COVID in a tertiary care setting, QoL did not differ significantly between those diagnosed with FSD and other patients.},
}

Humans
*Quality of Life
Female
*COVID-19/complications/psychology
Middle Aged
Male
Cross-Sectional Studies
Adult
Post-Acute COVID-19 Syndrome
SARS-CoV-2
*Somatoform Disorders/diagnosis/psychology/epidemiology/complications
Pandemics
Depression
Anxiety

@article {pmid42557063,
year = {2026},
author = {Baldwin, MM and Daynes, E and Evans, RA and Singh, SJ},
title = {Minimum important difference for the incremental shuttle walk test in long covid rehabilitation.},
journal = {Thorax},
volume = {},
number = {},
pages = {},
doi = {10.1136/thorax-2026-225151},
pmid = {42557063},
issn = {1468-3296},
abstract = {The minimum important difference (MID) for the incremental shuttle walk test (ISWT) in individuals with long covid was estimated using anchor-based and distribution-based methods. 397 participants (56 ± 13 years; 63.7% male) with long covid completed a 6-week rehabilitation programme and rated perceived change using the Global Rating of Change Scale (GRCS). Change in ISWT distance differed across GCRS categories (p<0.05); participants reporting slight improvement increased ISWT distance by 60.7±85.9 m. Receiver operating characteristic analysis identified an optimal cut-off of 35 m (area under the curve 0.70, 95% CI 0.61 to 0.79; p<0.05). Distribution-based methods yielded MID estimates of 40.1 m and 52.5 m, supporting an MID range of 35-60.7 m.},
}

@article {pmid42557313,
year = {2026},
author = {Maguire, C and Chen, J and Rouphael, N and Morse, BA and Hoch, A and Pickering, H and Phan, HV and Glascock, A and Chu, V and Dandekar, R and , and Corry, D and Kheradmand, F and Baden, LR and Sekaly, RP and McComsey, GA and Haddad, EK and Cairns, CB and Pulendran, B and Fernandez-Sesma, A and Simon, V and Metcalf, JP and Agudelo Higuita, NI and Messer, WB and Davis, MM and Nadeau, KC and Kraft, M and Bime, C and Schaenman, J and Erle, D and Calfee, CS and Atkinson, MA and Brakenridge, SC and Ehrlich, LIR and Montgomery, RR and Shaw, A and Hough, CL and Hafler, D and Augustine, AD and Becker, PM and Peters, B and Ozonoff, A and Kim-Schulze, S and Krammer, F and Bosinger, SE and Eckalbar, W and Altman, MC and Wilson, M and Guan, L and Kleinstein, SH and Smolen, KK and Reed, EF and Levy, O and Maecker, H and Hunt, P and Steen, H and Diray-Arce, J and Langelier, CR and Melamed, E},
title = {Virus reactivation in acute and long COVID-19.},
journal = {Nature},
volume = {},
number = {},
pages = {},
pmid = {42557313},
issn = {1476-4687},
abstract = {Chronic viral infections are ubiquitous in humans, with individuals carrying multiple viruses that can reactivate during physiological stress, including severe illness[1]. Notably, SARS-CoV-2 infection has been shown to reactivate chronic viruses such as Epstein-Barr virus and cytomegalovirus, yet the full extent, temporal dynamics and immunological impact of viral reactivation in COVID-19 remain incompletely understood[2-7]. Here, leveraging multi-omic longitudinal data from 1,154 hospitalized patients with COVID-19 from the Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) study, we reveal significant reactivation of Herpesviridae and Anelloviridae during acute COVID-19, with distinct temporal dynamics for different viruses, and demonstrate that reactivation correlates with disease severity, host immune effects and clinical outcomes. Although our results do not establish causation between virus reactivation and clinical outcomes, we highlight the prevalence of chronic viral reactivation during acute COVID-19 and long COVID. Our findings challenge the prevailing view that chronic viral reactivation is primarily a consequence of immunosuppression, demonstrating that reactivations occur frequently in immunocompetent individuals during severe illness and in association with increased systemic inflammation. Additionally, we demonstrate persistence of viral reactivation in convalescence, and report an association of Anelloviridae with long COVID. This study provides immune, transcriptomic and metabolomic signatures of viral reactivation that could inform future strategies to prognosticate and treat acute COVID-19 and long COVID.},
}

@article {pmid42549126,
year = {2026},
author = {Janaudis-Ferreira, T and Beauchamp, MK and Rizk, AK and Tansey, CM and Ross, BA and Sedeno, M and Bourbeau, J and Benedetti, A and Barreto, L and Li, PZ and Agarwal, K and Zucco, R and Lopez, J and Crowley, E and Cloutier, J},
title = {Tele-rehabilitation for individuals with long COVID: a randomised clinical trial.},
journal = {ERJ open research},
volume = {12},
number = {4},
pages = {},
pmid = {42549126},
issn = {2312-0541},
abstract = {BACKGROUND: Most trials in long COVID rehabilitation included only previously hospitalised patients and omitted outcome measures such as mobility, an important outcome for assessing life impact. The primary objective was to investigate whether an 8-week tele-rehabilitation programme for individuals with long COVID improves functional mobility compared with usual care.

METHODS: This was a randomised controlled trial involving individuals with long COVID and persistent symptoms of reduced mobility, muscle weakness, dyspnoea or fatigue. Participants were randomised to either an individualised 8-week tele-rehabilitation programme plus usual care or usual care. In both groups, usual care was supplemented with generic guidance on physical activity and symptom management. The primary outcome was activity measure for post-acute care (AM-PAC) mobility. The secondary outcomes were dyspnoea, fatigue, quality of life, physical function, mental health, acceptability and adverse events.

RESULTS: 132 participants were randomised (65 intervention; 67 control; 48±11.8 years; 75% female), with 78% not previously hospitalised. Adherence was high (96%), although 39% of intervention participants were unable to progress their exercises. No significant between-group differences were found in AM-PAC mobility (mean difference (MD) 0.61; 95% CI -0.91-2.13). The intervention group showed greater improvements in EQ-5D-5L pain (MD -0.36; 95% CI -0.70- -0.03), health status (MD 7.74; 95% CI 1.05-14.43), fatigue (MD -0.90; 95% CI -1.78- -0.02) and dyspnoea (MD 1.24; 95% CI 0.10-2.37). No serious adverse events occurred.

CONCLUSIONS: In the context of limited evidence around exercise in non-hospitalised individuals with long COVID, our study offers important insights into feasibility, safety and clinical relevance.},
}

@article {pmid42549191,
year = {2026},
author = {Montgomery, AP and Erdmann, N and Hall, W and Pilco, JP and Levitan, EB},
title = {Post-Acute COVID-19 Symptoms Clusters and Work Status.},
journal = {Occupational Health},
volume = {1},
number = {3},
pages = {},
pmid = {42549191},
abstract = {Long COVID affects an estimated 10-20% of SARS-CoV-2 survivors with heterogeneous, multi-system symptoms persisting for months to years, contributing to significant workforce disruption and reduced functional capacity. This exploratory study identified symptom clusters following SARS-CoV-2 infection, examined associated personal and clinical characteristics, and assessed work status across clusters. Among 273 individuals from a single clinical site, we used baseline surveys to capture long COVID symptoms and 2-week follow-up surveys to assess work status, and applied K-means clustering to identify symptom groupings. Three preliminary clusters emerged: Cluster 1 ("brain fog"), characterized by fatigue (96%), difficulty remembering (97%), and difficulty concentrating (94%); Cluster 2 ("undifferentiated"), with low prevalence across all symptoms; and Cluster 3 ("persistent acute"), marked by cough (92%), congestion (80%), headaches (78%), and body aches (78%). Notably, among Cluster 1 ("brain fog") respondents, 44% reported not working, and approximately half attributed their work absence to COVID-related symptoms. These hypothesis-generating findings suggest that neurocognitive symptom clusters may be associated with greater work absence in some individuals, though the small number of respondents limits firm conclusions. The findings suggest that targeted occupational rehabilitation strategies may warrant further investigation as potential strategies for individuals experiencing post-infectious cognitive impairment following SARS-CoV-2 infection.},
}

@article {pmid42550964,
year = {2026},
author = {Papantoniou, K and Espinosa, A and Karachaliou, M and Lassale, C and Castaño-Vinyals, G and Harding, BN and De Matteis, S and Straif, K and Alonso-Nogués, E and Dobaño, C and Moncunill, G and Blay, N and Iraola-Guzmán, S and de Cid, R and Garcia-Aymerich, J and Kogevinas, M},
title = {Night work, sleep disruption and long-COVID risk: a population-based cohort study.},
journal = {Scandinavian journal of work, environment & health},
volume = {},
number = {},
pages = {},
doi = {10.5271/sjweh.4318},
pmid = {42550964},
issn = {1795-990X},
abstract = {OBJECTIVE: Circadian and sleep disruption may increase the risk and severity of SARS-CoV-2 infections, but the role of night shift work and disturbed sleep in the development of long-COVID remains inadequately investigated. We prospectively examined the association of night work and sleep disturbances with risk of long-COVID.

METHODS: We followed participants of the COVICAT study, a population-based cohort of adults in Catalonia, Spain between 2021 and 2023. Night shift work and sleep characteristics were assessed in 2021. Long-COVID was defined as the report of persistent symptoms (>3 months) after a SARS-CoV-2 infection. Poisson regression analysis was performed to evaluate the independent and joint effects of night shift work and sleep disturbances including chronic insomnia with risk of long-COVID. Analyses were stratified by sex, body mass index and chronotype.

RESULTS: During the two-year follow-up, 284 of the 1899 newly infected participants reported long-COVID symptoms. Compared to day workers, night shift workers had 88% higher risk of developing long-COVID [95% confidence interval (CI) 1.29-2.72], after adjusting for potential confounders. The risk further increased among night workers with obesity. Chronic insomnia in the general population was associated with 42% increased risk of long-COVID (95% CI 1.12-1.78). Night workers with chronic insomnia had a 2.7 fold higher long-COVID risk (95% CI 1.60-4.51) compared to day workers without chronic insomnia. Associations persisted in various sensitivity analyses.

CONCLUSIONS: Our findings from a large prospective cohort indicate that night shift work and poor sleep are independently and jointly associated with a higher risk of long-COVID.},
}

@article {pmid42543989,
year = {2026},
author = {Mehta, N and Banerjee, TS and Karnavat, CO and Parikh, RM and Kashikar, R and Sinhasan, S and Tandan-Pardasani, S and Bindroo, S and Bhabhor, A and Raut, I and Shah, N and Desai, SB and Kapadia, M and Desai, M and Kapoor, A},
title = {Cardiac Magnetic Resonance Imaging Study on Cardiovascular Involvement >60 Days Post COVID-19 Recovery.},
journal = {The Journal of the Association of Physicians of India},
volume = {74},
number = {7},
pages = {32-37},
doi = {10.59556/japi.74.1609},
pmid = {42543989},
issn = {0004-5772},
mesh = {Humans ; Female ; *COVID-19/complications ; Male ; Prospective Studies ; *Magnetic Resonance Imaging/methods ; Adult ; Middle Aged ; Post-Acute COVID-19 Syndrome ; India/epidemiology ; *Cardiovascular Diseases/diagnostic imaging/epidemiology ; SARS-CoV-2 ; *Heart Diseases/diagnostic imaging/epidemiology ; Time Factors ; },
abstract = {CONTEXT: This study evaluates individuals who have recovered from coronavirus disease 2019 (COVID-19) for cardiac manifestations at least 60 days postrecovery, using cardiac magnetic resonance (CMR) imaging. Native T1, native T2, and late gadolinium enhancement (LGE) were used as parameters to detect potential cardiac pathologies.

AIM: To study the incidence and nature of cardiac manifestations in long COVID using CMR.

STUDY DESIGN: Prospective observational study.

METHODS: A total of 54 COVID-19-recovered patients and 50 healthy matched controls (age- and sex-based) underwent CMR using a 3 T scanner. Pathologies were assessed through native T1 and T2 mapping and LGE imaging. Data analysis was conducted using SPSS version 23.

RESULTS: Only 1 patient (1.85%) showed midmyocardial LGE in the basal and midinferior segments, along with raised native T1 and T2 values. The remaining 53 recovered patients (98.15%) revealed no LGE or elevated T1/T2 values compared to controls. Native T1 and T2 values did not significantly differ between the post-COVID participants and healthy controls. Mild concentric hypertrophy was observed in six patients, which appeared incidental and unrelated to COVID-19. None of the patients exhibited elevated troponin T levels.

CONCLUSION: In this study, CMR imaging did not find a significant increase in cardiac manifestations that may be attributed to long COVID in patients who had recovered from COVID-19 compared with uninfected controls. We believe the incidence of cardiovascular comorbidities related to long COVID syndrome is much lower in the Indian population than reported in Western literature. These findings are reassuring and may help alleviate concerns among the Indian population regarding long-term cardiovascular involvement of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.},
}

Humans
Female
*COVID-19/complications
Male
Prospective Studies
*Magnetic Resonance Imaging/methods
Adult
Middle Aged
Post-Acute COVID-19 Syndrome
India/epidemiology
*Cardiovascular Diseases/diagnostic imaging/epidemiology
SARS-CoV-2
*Heart Diseases/diagnostic imaging/epidemiology
Time Factors

@article {pmid42544023,
year = {2026},
author = {Mikolajczyk, R},
title = {Post-Infectious Syndromes in the Post-Pandemic Phase Among the German General Population.},
journal = {Deutsches Arzteblatt international},
volume = {123},
number = {19},
pages = {},
doi = {10.3238/arztebl.m2026.0134},
pmid = {42544023},
issn = {1866-0452},
abstract = {BACKGROUND: Persistent symptoms after a respiratory infection can impair daily life, as has been shown, for example, for "long COVID." In this study, we determined the frequency and impact of symptoms that persisted for 12 weeks or more after a respiratory infection. A further endpoint was health care utilization for such symptoms in the general population.

METHODS: A cross-sectional study was conducted within the population-based digital cohort DigiHero in Germany (DRKS00025600). 39.3% of invited participants responded by completing an online questionnaire. 46 915 adults were included in the analysis. Participants were asked about symptoms that persisted 12 weeks or longer after a respiratory infection between September 2024 and August 2025.

RESULTS: 48.3% of participants (95% confidence interval: [47.9; 48.8]) reported having had at least one respiratory infection during the study period. Among them, 18.8% [18.3; 19.3] stated that they still had symptoms 12 weeks or more afterward. The frequency of persistent symptoms was higher in older persons (13.1% for ages 20 to 29, 21.4% for ages 60 to 69). Most (86.8%) of those affected reported at least moderate functional impairment, and 57.9% consulted a physician. The pathogen causing the original infection was known for 24.3% of those reporting persistent symptoms: there were 483 cases of SARS-CoV-2 infection, 102 of influenza, and 36 of RSV. The symptom duration, functional impairment, and symptom pattern were similar after infection with SARS-CoV-2 and influenza. The most common symptoms in all pathogen groups were impaired physical performance, shortness of breath, rapid exhaustion, and fatigue.

CONCLUSIONS: Persistent symptoms after respiratory infections are common and similar across pathogens in frequency and severity.},
}