New review highlights impact on cardiovascular system

 

The wide-ranging effects of Long COVID and the associated issues for healthcare providers have been revealed in a new review of the major studies into the condition, co-authored by a consultant cardiologist at Royal Brompton and Harefield hospitals.

Published in the European Heart Journal, the review specifically highlights the impact of Long COVID on the cardiovascular system. 

According to one of its co-authors, Professor Thomas Lüscher, Director of Research, Education and Development at Royal Brompton and Harefield Clinical Group, this is “the first review to summarize the diverse evidence on Long COVID and provide a balanced picture of this important issue.”

Professor Lüscher said: “The pandemic brought not only acute illness and death, it became a chronic disease of many organs, not just the lungs, but the heart, brain and kidney, among others.”

“Long COVID is, besides its huge impact for the affected individual, of great societal and economic importance as it leads to leave of absence from work, reduced work performance and hence unforeseen costs.”

The review was conducted by researchers from the University of Oxford, the University of Wisconsin School of Medicine and Public Health, Royal Brompton Hospital and Imperial College, London, and the University of Zurich, Switzerland.

The review spans each step from a patient’s original coronavirus infection and the direct impacts, such as myocardial infarction or inflammatory myocarditis, to the long-term impacts on aspects of wellbeing such as mental health and fatigue.

The researchers also concluded that current evidence for the treatment of Long COVID is lacking and that our current understanding of pathophysiological mechanisms and treatment options remains limited. They also found that the vast inequalities in healthcare provision exposed by COVID-19 continue to be magnified by Long COVID, a problem that calls for global humanitarian efforts to promote and fund equitable access to healthcare, social and welfare support and vaccines across the world.

Dr Betty Raman, of Oxford’s Radcliffe Department of Medicine, said: “Long COVID is emerging as a major public health issue, which makes it important that we better understand the long-term effects of COVID-19 to improve our treatment of it.

“This review highlights the wide range of short and long-term health impacts and the mechanisms behind them, which is key to providing treatment and ongoing care.”

Professor Stefan Neubauer, Head of the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, said: “Long COVID is a huge medical challenge. This review gives a comprehensive update on its effect on the cardiovascular system and will also be important in guiding future research into the condition and for finding new treatments.”

Dr Betty Raman is leading one of the first randomized, double-blind, placebo-controlled studies in the UK. The team’s work is supported by the NIHR Oxford Biomedical Research Centre, a partnership between Oxford University Hospitals NHS Foundation Trust and the University of Oxford. Other trials to date have been open-label or non-random assignment of therapy. 

Screen Time in First Year May Raise Autism Risk at Age 3

 

Boys exposed to at least 2 hours a day of screen time by 1 year of age were significantly more likely to have an autism spectrum disorder (ASD) diagnosis at 3 years, based on data from more than 80,000 children.

The World Health Organization and the American Academy of Pediatrics recommend against any screen time for infants up to 1 year of age and 18 months of age, respectively, wrote Megumi Kushima, MA, of the University of Yamanashi (Japan), and colleagues on behalf of the Japan Environment and Children's Study Group.

The extent to which screen time duration in infancy is associated with subsequent ASD diagnosis remains unclear, the researchers said. The ongoing COVID-19 pandemic has increased screen time among children worldwide, which makes an examination of the impact of screen time on children's health an important public health issue.

In a study published in JAMA Pediatrics, the researchers recruited pregnant women between 2011 and 2014; data were analyzed in December 2020. The final study population included 84,030 mother-child pairs. The primary exposure of screen time at 1 year of age was assessed by questionnaire, in which mothers were asked to report their number of hours they let their child watch TV or DVDs daily. Responses were none (no screen time), less than 1 hour, 1 hour or more but less than 2 hours, 2 hours or more but less than 4 hours, and 4 hours or more.

The primary outcome was ASD diagnosis at 3 years of age, and mothers were asked via questionnaire whether their 3-year-old had been diagnosed with ASD from age 2.

The study was conducted by the Japan Environment and Children's Study Group at 15 regional centers across Japan.

Overall, 330 children had received an ASD diagnosis at age 3 years, a prevalence of 0.4%. Of these, 251 (76%) were boys, and 79 (24%) were girls. Independent of ASD, the most common response for screen time was less than 1 hour, which was reported by 27,707 mothers. The proportion of children with ASD at age 3 increased as screen time at age 1 increased, the percentages were 5.8%, 22.3%, 30.2%, and 31.7% for children with no screen time, less than 1 hour, 1 to less than 2 hours, and 2 to less than 4 hours, respectively. The percentage of children with ASD diagnoses who had 4 hours or more of daily screen time was 10%.

Logistic regression analysis showed that longer screen time at age 1 year was significantly associated with higher odds of ASD at 3 years in boys, but not in girls. The researchers controlled for variables including maternal maltreatment and children's predisposition to ASD. Among boys, the adjusted odds ratios for screen times of less than 1 hour, 1 hour to less than 2 hours, 2 hours to less than 4 hours, and more than 4 hours.

 

Screen time at age 3 years was not associated with ASD diagnosis at age 3 years, potentially "because the association with environmental factors on brain development varies with age," the researchers noted.

The study findings were limited by several factors including the reliance on parental reports of screen time and potential for reporting bias, the researchers noted. Other limitations included the possible missed diagnoses of mild ASD cases at 3 years, and the inability to consider variables such as childcare environment, living conditions, diseases, genetics, and disabilities.

 

However, the results were strengthened by the large study population and examination of screen time in early childhood, they said. More research is needed to examine other factors that contribute to the association between ASD and screen time but given the rapid increase in device use in children, "it is necessary to review its health effects on infants and control excessive screen time."

Subvariant May Be More Dangerous Than Omicron

 

The Omicron subvariant, BA.2, is not only more transmissible than the original Omicron strain, BA.1, but may cause more severe disease, a lab study from Japan says.

"Our multiscale investigations suggest that the risk of BA.2 for global health is potentially higher than that of BA.1," the researchers said in the study published on the preprint server bioRxiv. The study has not been peer-reviewed yet.

The researchers infected hamsters with BA.1 and BA.2. The hamsters infected with BA.2 got sicker, with more lung damage and loss of body weight. Results were similar when mice were infected with BA.1 and BA.2.

"Infection experiments using hamsters show that BA.2 is more pathogenic than BA.1," the study said.

BA.1 and BA.2 both appear to evade immunity created by COVID-19 vaccines, the study said. But a booster shot makes illness after infection 74% less likely, CNN said.

What's more, therapeutic monoclonal antibodies used to treat people infected with COVID didn't have much effect on BA.2. 

BA.2 was "almost completely resistant" to casirivimab and imdevimab and was 35 times more resistant to sotrovimab, compared to the original B.1.1 virus, the researchers wrote. 

"In summary, our data suggest the possibility that BA.2 would be the most concerned variant to global health," the researchers wrote. "Currently, both BA.2 and BA.1 are recognised together as Omicron and these are almost undistinguishable. Based on our findings, we propose that BA.2 should be recognised as a unique variant of concern, and this SARS-CoV-2 variant should be monitored in depth."

If the World Health Organization recognized BA.2 as a "unique variant of concern," it would be given its own Greek letter.

But some scientists noted that findings in the lab don't always reflect what's happening in the real world of people.

"I think it's always hard to translate differences in animal and cell culture models to what's going on with regards to human disease," Jeremy Kamil, PhD, an associate professor of microbiology and immunology at Louisiana State University Health Shreveport, told Newsweek. "That said, the differences do look real."

"It might be, from a human's perspective, a worse virus than BA.1 and might be able to transmit better and cause worse disease," Daniel Rhoads, MD, section head of microbiology at the Cleveland Clinic in Ohio, told CNN. He reviewed the Japanese study but was not involved in it.

Another scientist who reviewed the study but was not involved in the research noted that human immune systems are evolving along with the COVID variants. 

"One of the caveats that we have to think about, as we get new variants that might seem more dangerous, is the fact that there's two sides to the story," Deborah Fuller, PhD, a virologist at the University of Washington School of Medicine, told CNN. "Our immune system is evolving as well. And so that's pushing back on things."

Scientists have already established that BA.2 is more transmissible than BA.1. The Omicron subvariant has been detected in 74 countries and 47 U.S. states, according to CNN. About 4% of Americans with COVID were infected with BA.2, the outlet reported, citing the CDC, but it's now the dominant strain in other nations.

It's not clear yet if BA.2 causes more severe illness in people. While BA.2 spreads faster than BA.1, there's no evidence the subvariant makes people any sicker, an official with the World Health Organization said, according to CNBC