A Connecticut man has pleaded guilty to offenses related to his receipt of COVID-19 relief funds, according to federal authorities.
John Matava, 59, of Coventry, pleaded guilty before U.S. District Judge Kari A. Dooley in Bridgeport to one count of wire fraud affecting a financial institution, which carries a possible sentence of up to 30 years in prison, and to one count of making an illegal monetary transaction, which carries a possible sentence of up to 10 years in prison, according to federal authorities. Dooley scheduled sentencing for March 29.
Authorities, citing court documents and statements made in court, said that, in April 2020, Matava applied to Celtic Bank for a $100,000 PPP loan for J.M. Builders LLC.
The application submission included several false representations, including that J.M. Builders LLC had eight employees and an average monthly payroll of $40,000; that the monies would be used for payroll, lease, mortgage, interest and utilities; and that the business owner was not subject to pending formal criminal charges, federal authorities said in a statement. At the time of the PPP loan application, there were no records of payroll or employees with the Connecticut Department of Labor for J.M. Builders LLC, and Matava was subject to criminal charges in two pending cases related to arrests in 2017 and 2018.
Authorities said Celtic Bank on April 22, 2020 disbursed $100,000 to a bank account for J.M. Builders LLC on which Matava was the signatory.
The account was opened on April 21, 2020, and had a balance of $0 immediately prior to the loan funds being disbursed, authorities said in the statement. Then, between April 2020 and January 2021, Matava used the funds primarily for personal expenditures, including $3,498 to pay a dog breeder, $4,777 for payments to an RV superstore in Connecticut, and legal fees, including a $2,000 retainer, for four court cases in Rockville.
Matava again in 2021 sought $100,000 in additional PPP funds from Celtic Bank, and included with the application several additional false statements and fraudulent tax documents, according to federal authorities, noting Celtic Bank then denied the application.
Matava was arrested on January 7, 2023. Following his plea, Matava is free on $60,000 bond, but is in home detention, pending sentencing, according to federal authorities.
The case was investigated by the Federal Bureau of Investigation and the Internal Revenue Service Criminal Investigation.
Authorities also noted (shared here as presented by the U.S. Attorneys Office):
Individuals with information about allegations of fraud involving COVID-19 are encouraged to report it by calling the Department of Justices National Center for Disaster Fraud Hotline at 866-720-5721, or the NCDF Web Complaint Form at:https://www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form.
Key Takeaways
Moderna Inc. (MRNA) shares soared 15% Tuesday as the vaccine maker got two pieces of positive news.
First, Chief Executive Officer (CEO) Stephane Bancel said he believes the company would experience sales growth in 2025. In a letter to shareholders Tuesday, Bancel said the company is optimistic as it expects the launch of Modernas respiratory syncytial virus (RSV) vaccine candidate this year and could potentially launch of a combination flu/COVID-19 shot as early as 2025.
Along with Bancels comments, Moderna shares got a lift Tuesday when brokerage firm Oppenheimer & Co. upgraded the stock to "outperform," arguing that Moderna could develop ways to use its mRNA technique to fight diseases beyond COVID-19 over the next few years.
Analysts at Oppenheimer led by Hartaj Singh wrote they believe the company will have five new products on the market by 2026.
Currently, Moderna's COVID-19 vaccines are its only commercially available products. Over the next two years, the company said it will focus on increasing revenue and profitability in part by targeting commercial execution.
Sales struggled as fewer people opted to get COVID-19 vaccinations or booster shots in 2023. That sent shares tumbling more than 40% last year, making it one of the stocks in the S&P 500 that struggled the most.
TradingView
Letcia Soares stepped off the plane in Brazil feeling traumatized and vulnerable. It was 2021 and she was returning home from Canada, where the final year of her postdoc in disease ecology had been marred by long COVID. The condition left her with searing migraines, intense fatigue, body aches and a variety of other ailments that came and went unpredictably, but never improved. Soares decided to return home where she felt she would have better access to medical support if she were disabled and unemployed.
Having encountered dismissive physicians in Canada, she hoped she would be better supported at home. But her arrival brought fresh disappointment. More than a year into the COVID-19 pandemic, Soares physicians, friends and family in Brazil had still not heard of long COVID. People asked me whether long COVID is an illness of the global north, says Soares, who now works from Salvador, Brazil, at the Patient-Led Research Collaborative, an international advocacy and research organization focused on long COVID and associated conditions. They had never heard of it here.
By some estimates, more than four million people in Brazil have long COVID. Yet researchers say the reaction that Soares encountered is common in many low- and middle-income countries (LMICs). Much of the worlds research on long COVID is conducted in wealthy regions, and data on the prevalence or severity of the condition in other locales are more limited (see Dearth of research). The main story about long COVID in low- and middle-income countries is that there are relatively few studies, says Theo Vos, an epidemiologist at the Institute for Health Metrics and Evaluation in Seattle, Washington. But wherever people have looked at it, they find it.
Source: J. V. A. Franco et al. Int. J. Environ. Res. Public Health 19, 9915 (2022)
Evidence so far suggests that the prevalence of long COVID in LMICs could be similar to that of wealthier countries although, in both settings, the numbers vary a lot. One review1 found that between 8% and 41% of people who had a SARS-CoV-2 infection but werent hospitalized had symptoms. But a dearth of research on the condition in less-wealthy countries creates a double curse. An absence of information about prevalence and risk factors leaves advocates hamstrung: few physicians acknowledge that long COVID exists. The lack of data also hampers efforts to search for the mechanisms of the condition and tailor treatments. You need data for action, says Waasila Jassat, a public-health specialist at Genesis Analytics, a consultancy firm in Johannesburg, South Africa. You need evidence to advocate for services, and you cannot just use data from other countries.
Long COVID is a complex condition brought on by infection with SARS-CoV-2. It has been linked to more than 200 symptoms, from brain fog or fatigue that makes it difficult to work, to debilitating pain and muscle weakness. The severity of the condition can vary, and for many people symptoms come and go; there are days when they can function as they did before or nearly so, only to find that their condition comes roaring back a day later. By some definitions, the condition includes any symptoms that appear or persist for more than three months after the initial infection.
Long COVID research risks losing momentum we need a moonshot
All of this makes the burden of long COVID difficult to measure, even in resource-rich countries. Its even harder to compare across studies, because different research groups might focus on various definitions and symptoms, or survey different groups of people.
LMICs a heterogeneous collection of more than 130 nations face even more challenges. Many have been undermined economically by a legacy of colonialism and exploitation. Health-care systems vary widely among these countries, but resources are strained in many of them relative to wealthier countries. It is already difficult to find resources for research, and thats compounded by the lack of centralized health data, says Jassat. In Brazil, for example, more than one-third of all workers are informally employed, meaning that there is no systematic way to track how many days of work people miss due to illness.
People are quietly dropping out of society, says Emma-Louise Aveling, a global public-health researcher at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts, who has interviewed health-care workers and people with long COVID in Brazil for her research.
Scientists have been trying to pin down the number of people with the condition. Worried that the burgeoning COVID-19 pandemic could worsen or lead to new cases of chronic illnesses, cardiologist Nizal Sarrafzadegan at the Isfahan University of Medical Sciences in Iran launched a long-term study in March 2020. Her team found that 60% of individuals who were hospitalized with COVID-19 in Iran had symptoms a year after their infection2.
In South Africa, Jassat and her colleagues followed 3,700 people for 6 months in a study3 of COVID-19 outcomes and found that 39% still had at least one symptom 6 months after their initial infection. People who were hospitalized owing to COVID-19 were more likely to be affected than those who were not: 46.7% versus 18.5%.
People hospitalized with COVID-19 are more likely to be affected by long COVID.Credit: Rodger Bosch/AFP/Getty
In a 2020 study, geriatricians Murilo Dias and Mrlon Aliberti at the University of So Paulo, Brazil, and their colleagues found that one in three people admitted for COVID-19 to a hospital in So Paulo still had at least one symptom a year after they were discharged4. Thats a huge problem for the health system, says Aliberti.
Even so, that problem does not include cases of long COVID that arise after mild SARS-CoV-2 infection. Soares says that most long-COVID studies in Brazil do not address this gap, and it can be particularly hard to do so when few physicians are aware of the condition, how to diagnose it or who might be at particular risk.
Another reason to study long COVID in different contexts is that the condition might manifest differently from place to place. Many researchers suspect that there are multiple mechanisms underlying long COVID. The risk of the condition might be influenced by genetic and environmental factors, says Olufemi Erinoso, a public-health researcher at the University of Nevada in Reno, who has studied long COVID in Lagos, Nigeria. We need to have a global approach to the disease to understand how genetics might affect the outcomes.
To really grasp the mechanism of long COVID, researchers need study participants with diverse genetic backgrounds so that they can work out which cellular pathways are involved and how they might vary in different people. And the more researchers know about those pathways, the more potential targets theyll have for medicines to treat long COVID. Not being able to approach the disease in a global, concerted effort is a major impediment to a better understanding and a better therapy for everyone, says Akiko Iwasaki, an immunologist at Yale University in New Haven, Connecticut.
Long COVID: answers emerge on how many people get better
One trend that looks to be consistent worldwide is that the number of people who develop long COVID seems to be tapering off with the SARS-CoV-2 variants over the past two years. In South Africa, Jassat and her colleagues found a lower incidence of long COVID among those infected with the Omicron variant, compared with the Beta or Delta variants of the virus3. UK researchers similarly found that Omicron infections were less likely than were Delta infections to lead to long COVID5. The world has long since moved on from Omicron, but researchers suspect that growing levels of immunity from vaccination and infection could also be reducing the number of people at risk of developing long COVID across the globe, says paediatrician Daniel Munblit at Imperial College London, who has studied long COVID in children in Moscow.
This is good news, with one small downside: new studies of long COVID could struggle to recruit participants. This year, Tariro Makadzange, executive director of the research organization Charles River Medical Group in Harare, and her colleagues had trouble including the condition in a study because they found so few fresh cases.
In the United States and Europe, large-scale efforts have begun the search for long-COVID treatments. The US National Institutes of Health is running the US$1.15-billion Researching COVID to Enhance Recovery (RECOVER) programme, some of which is directed at finding long-COVID therapies. In the United Kingdom, a consortium of 30 hospitals and universities is also looking for treatments under the STIMULATE-ICP programme.
But whether any resulting treatments could transfer to lower-income settings is an open question, says infectious-disease specialist Luis Felipe Reyes at the University of La Sabana in Bogot. He predicts a re-run of the inequalities that plagued the distribution of COVID-19 vaccines. Wealthier countries hoarded doses and some types, such as the mRNA vaccines, were particularly difficult for many lower-income countries to use because they were expensive to produce and difficult to transport at the low temperatures they require.
Are repeat COVID infections dangerous? What the science says
The rich countries are finding the treatments for these problems, but those solutions might not be transferable, Reyes says.
For now, treatments for long COVID often involve careful rehabilitation and, ideally, a collaborative team of specialists in different fields. Such intensive monitoring and care is difficult even for wealthy nations, let alone for countries with more strained health-care systems, says Kimberly Konono, a vaccine specialist at Charles River Medical Group. But even with limited resources, some LMICs have options that are not available in wealthier nations. For example, the public health-care system in Brazil includes a network of community health workers who are embedded in neighbourhoods and often know the occupants well. This network could be used to improve awareness, diagnosis and treatment of long COVID in these regions, says Aveling.
But even that approach relies on health-care systems taking the condition seriously, which hasnt always happened with some other post-viral illnesses. Similar conditions can follow after other viral infections, including some tropical diseases. These have long been neglected, says anthropologist Jean Segata at the Federal University of Rio Grande do Sul in Porto Alegre, Brazil, particularly when they affect marginalized communities. Often, these patients complain that they are not taken seriously by doctors, who tell them its nothing and that it will pass soon, he says. The lack of recognition for their suffering becomes an additional source of frustration and distress for long-COVID patients in impoverished countries.
Soares, who has been working with Aveling and others to characterize the impact of long COVID in Brazil, can see the effect of this: long COVID and other post-viral illnesses are effectively invisible. We need to show with data that people are going through these symptoms and the challenge that needs to be addressed, Soares says. Then she sighs. I wish that we didnt have to.
Health worker treats COVID-19 patient in an emergency COVID-19 care centre.
Health authorities in the UK have identified anxiety and sleeping trouble as new symptoms of the latest COVID-19 sub-variant JN.1, according to a report.
JN.1, from the lineage of Omicron, was first detected in August and is currently present in over 40 countries.
It has been classified as a variant of interest (VOI) by the World Health Organisation (WHO), due to its rapid spread.
JN.1 is a descendant lineage of BA.2.86. In comparison with BA.2.86, JN.1 has the additional L455S mutation in the spike protein, making it more transmissible. However, no signs of new or unusual symptoms caused by the virus have been reported yet.
So far, the symptoms reported are mostly restricted to upper respiratory tract infections such as fever, cough, sore throat, body aches, and runny nose.
However, recent data from December 2023 by the UK's Office for National Statistics (ONS) spotted two new symptoms: trouble sleeping and anxiety.
Over 10 per cent of people with COVID-19 in the UK consistently reported anxiety or excess worrying since early November, revealed the winter COVID-19 report from the ONS.
The most common COVID-19-19 symptoms are runny nose (31.1 per cent), cough (22.9 per cent), headache (20.1 per cent), fatigue (19.6 per cent), muscle pain (15.8 per cent), sore throat (13.2 per cent), trouble sleeping (10.8 per cent), and anxiety (10.5 per cent), the data showed.
Interestingly, the once-common loss of taste and smell is currently reported in only 2-3 per cent of UK cases.
But whether a person will experience some or all of these symptoms, including those that have not previously been commonly reported, largely depends on each individuals health and immunity to the virus.
The findings come at a time when there is a fresh global rise in COVID-19 infections. As per the WHO, the global number of new COVID-19 cases has increased by 52 per cent during the last one month.
The UN health body also reported an increase in hospital, ICU admissions as well as deaths globally.
Meanwhile, India recorded 573 fresh cases of COVID-19 and two deaths in the last 24 hours, the Union Ministry of Health and Family Welfare said on Tuesday.
The total number of active cases stands at 4,565. The country reportedly also has a total of 312 cases of the JN.1 from 11 states, Kerala, Goa, Gujarat, Odisha, Karnataka, Maharashtra, Rajasthan, Tamil Nadu, Telangana, Odisha, and Delhi.
"Overall cases are mild and severity is seen in only less than 10 per cent of the cases, and only when people are having previous comorbidities, involving lungs and old age," Dr Kirti Sabnis, Infectious Disease Specialist, Fortis Hospital Mulund told IANS.
"Generally, the fatality rate is less than 2 per cent, deaths are occurring very sparingly and is not a common feature," she added.
The doctor said there are also no severe illnesses seen among patients and "not many people are requiring hospitalisation, because of JN.1. Majority of the patients are getting better at home".
The doctor advised using masks, maintaining hand hygiene and to avoid public gatherings if one is sick.
**
The above article has been published from a wire agency with minimal modifications to the headline and text.
Covid-19 update: The National Centre for Disease Control (NCDC)'s Integrated Disease Surveillance Programme (IDSP) has reported five Covid-related deaths in the country in the last 24 hours. Until January 2, 2024, 511 cases of the JN.1 series variant had been reported from 11 states.
According to the Ministry of Health and Family Welfare, 602 new cases were registered in the last 24 hours, bringing the total number of cases to 4,50,15,136.
The active caseload was 4,440, a 125-case decrease since Tuesday.
In the last 24 hours, 722 people were recovered, bringing the total number of recovered cases to 4,44,77,272.
Kerala had two deaths in the last 24 hours, according to the state distribution. The deceased were identified as a 66-year-old male with Chronic Liver Disease, Multiple Organ Dysfunction Syndrome (MODS), and Sepsis and a 79-year-old female with coronary artery disease (CAD), type 2 diabetes (T2DM), and Sepsis.
In the last 24 hours, Karnataka reported one Covid death. Covid claimed the life of a 45-year-old male from Vijayanagar with hypertension (HTN).
One Covid death was reported in Punjab. The deceased was a 62-year-old male with Pulmonary Kochs, Lung injury, and MODS.
In the last 24 hours, one person died as a result of Covid in Tamil Nadu. A 74-year-old man with Interstitial Lung Disease, CAD, diabetes, and hypertension died.
The reconciliation of mortality figures in Bihar is currently underway.
India reports 573 fresh cases of Covid. Out of this, 263 were infected with Covid-19 sub-variant JN.1. Kerala reported half of the JN.1 infected cases. India also reported 2 deaths in 24 hours- one each in Karnataka and Haryana. The number of active cases has increased to 4,565. However, experts believe that the actual number of Covid-19 cases is likely to be much higher.
European Center for Disease Control (ECDC) chief Andrea Ammon spoke candidly about how her organisation is preparing itself to help the EU be prepared for the next pandemic.
Ammon has been heading up the ECDC since 2017. Trained as a medical doctor, and specialised in public health, she is an alumni of the first cohort of the field epidemiology programme (EPIET) offered by the ECDC. She joined the organisation in 2005, building the European surveillance system, and slowly making her way to the top job.
The ECDC was thrust into the spotlight during the Covid-19 pandemic, and since then has seen its mandate expand through new regulations.
Our conversation ended up revolving around communication, and what both the ECDC and the media could do better in hopefully not anytime soon the next pandemic.
EUobserver: I'd like to briefly talk about new regulations and changes to the ECDC mandate. Can you run me through some of the policy changes we've seen since the pandemic?
Andrea Ammon: The serious cross-border health threat regulation aims at regulating all the different elements connected to health emergencies. That starts with the surveillance, the laboratories, but then also the response to emergencies. So that's really the risk assessment and risk management package. Now, our regulation is really tailored for the ECDC, and it has a lot of cross-references to the serious cross-border health regulation.
So a lot of what is in the serious cross-border health regulation actually refers to us to our work. In principle, our mandate stayed the same as it was before, in terms of that we are dealing with infectious diseases. But some of the tasks have been specified. We have new aspects of our tasks. And then there are a few new elements in, for instance, of the EU reference laboratories that EU Health Task Force, the foresight and modelling, we look at determinants prevention and health system indicators. So there are a few new elements that have been added, as lessons learned from the pandemic.
What were some key lessons learned from the pandemic?
We must enhance our surveillance, and improve preparedness and risk communication. The particular emphasis now, which has been evolving in the past year, is the emphasis on the workforce. Every country has experienced the same scene that the health workforce has massive issues. There are people leaving the service due to burnout, and we have the looming crisis of people going to retire in the next five to 10 years, without sufficient supply in the pipeline.
That is verging on labour communication, or maybe workforce policy, rather than infectious diseases.
Exactly. That is where our mandate and our influence is limited. Of course, we can advocate, and it's what I'm also doing. But in the end, the real turning of the tide can only be done with policy changes in the countries that we cannot do ourselves. Although we can of course provide training for people that would like to be specialised in public health. But we cannot change the salary structure, the career perspective, or the working conditions, that is something that has to happen in the international system.
That must be frustrating to see.
Well, when you come to work for an agency like this, you know where the remits of the mandate lie. And then you have to work within these remits and see how you can advocate for anything that you find important for the mandate.
That's really interesting. The pandemic has shown that the remit of the ECDC expands quite a bit beyond the gathering of relevant data and the coordinating and communication of responses to that data. So for example, on infectious diseases, into the realm of communication the more 'soft' science of bringing across a certain scientific message or a way to evaluate risk for both public health officials but also for citizens. Has that changed the organisation a lot?
It has brought some changes, yes, especially in the way we do our work, not so much in the substance that we are dealing with. There is an article on communication that has actually not changed.
However, there are other elements in the regulation, which influenced the communication. For instance, our mission statement has been expanded not only that we identify, analyse and communicate threats to human health from infectious diseases, but we also make reports thereof available and easily accessible.
This 'accessible' doesn't mean that we put it free of charge on the website, but that it's also formulated in a language that politicians and policymakers understand. So here we have to change our communication.
We are a scientific organisation, and we have our scientific reports, but we have to now add a summary with key messages for public health decision-makers so that they can be used to actually implement and apply in public policy and practice.
Right. So messages like, for example, like 'flattening the curve', were successful, but I think maybe the communication around masking was slightly less successful.
Well, I think we have positive and negative examples, in abundance over the three years. I think it's not about slogans only. It's really about explaining. And that is why, when you have seen our lessons learned document, one of these four lessons that we put forward is Risk Communication and Community Engagement.
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And I think this community engagement was something that really did not work very well in most places. People at one point during the pandemic had not understood why they still had to wear masks, stay at home, keep that distance, get tested, and so forth.
That is what I think our messaging should help. It should help local politicians explain this to the general population, but also then to specific populations, like young people, for instance.
What do you base best practices on? Is there actually a lot of science around effective communication during public health crises and community engagement? Is there something that you can fall back on?
Yes, there is. And that's the interesting part, that the fact that it hasn't been used to its full potential is not because there is no science behind it there is science. But these scientists were not necessarily part of the crisis groups. More and more countries have recognised that scientists, risk communicators, ethicists and behavioural insight specialists should be part of the crisis team. And we have also now assembled a small team here at ECDC that deals specifically with that.
Risk communication is a very difficult thing to do I can imagine. Risk is dependent on a lot of variables, and bringing across a complex message is very challenging for the general public to understand. So for example, I didn't know the risks for someone over eighty when vaccinated are vastly different from those for a person over 60 who is also vaccinated. I think that tailoring specific messages like that must be very complicated.
Yeah, and I think that the risk communication has to evolve during the course of such a crisis, but it's important that it starts at the beginning with clarifications that everybody can understand.
At the beginning of the pandemic, these differentiations weren't even possible, because we didn't know about all these different risks to different people.
And that, I think, has to be very clearly said at the beginning. What is known, what is not known, where there is evidence and where there are decisions based on analogy with similar infections. I think people can understand that there is an evolving situation, so that the fact that one day, they hear one message, and the next day something else, is not necessarily interpreted as 'they don't know what they're doing.'
That touches on something else as well, because up to now, we're talking about proactive communication based on evidence. But another phenomenon that the pandemic showed was that the importance of reactive communication to counter explicit misinformation is also a huge part of public health communication.
That is true, part of this risk communication is also health education, in which the basics are explained to the population. In general, if we could increase the health literacy of the public, then misinformation would have a bit of a harder time getting through. But that is of course, not something that you can do in a crisis, that is something that needs to be built into the preparedness.
My background was in science journalism. And if I know one thing, it's that it's very hard to interest people in something that is not going on at that moment, but that might have importance later. Is raising the bar for public health knowledge among the citizens part of the next pandemic preparedness plan?
In my view, it should be a chapter in the pandemic preparedness plans that are now being looked at and reviewed. And in terms of people not being interested, we have to learn a bit from advertising, because in the end, it concerns them as persons. Moreover, we have health issues ongoing with mosquitoes, with climate change, with West Nile virus, with influenza, with measles. These diseases are there, and we could use each of these as opportunities to take aspects of health to help people become more in-depth informed.
Right. What role could the media play or what could they do better?
It's not just the media who could do better, but it's also from the scientist's side. Some initiatives have to go out in media briefings, so that it's not just a sensational story to report, but also to help inform the media so that they know where certain pieces of information fall into.
I think this is something that we probably will not succeed at one hundred percent. But you have to try your best and see what could reasonably be done to put out trustworthy information. Even when there is weak evidence there, so that people know that we are not fabricating things. And that is a reputation that you have to build in non-crisis time, so that you can count on this in times of crisis.
In a recent study published in JAMA Network Open, researchers assessed whether psychiatric, neurological, and cognitive complications among patients hospitalized for coronavirus disease 2019 (COVID-19) differ from those with other medical conditions of similar severity.
COVID-19s long-term effects are associated with over 200 symptoms. Besides respiratory symptoms, brain health-related symptoms are the most common, including mental and cognitive symptoms. Nevertheless, long-term neuropsychiatric and cognitive sequelae also appear after myocardial infarction, pneumonia, and other non-COVID-19 illnesses.
Studies on post-COVID-19 brain health impairment compared to that after other diseases are mainly based on surveys or health records and often focus on self-reported symptoms rather than objective clinical investigations. Therefore, longitudinal prospective studies are necessary to discern the extent, nature, and trajectories of COVID-19-specific brain health complications.
In the present study, researchers investigated whether long-term psychiatric, neurological, or cognitive complications differ between patients hospitalized for COVID-19 and those with other medical conditions. Patients hospitalized for COVID-19 between March 2020 and March 2021 were enrolled. Control patients were hospitalized for myocardial infarction, pneumonia, or other non-COVID-19 illness requiring intensive care between March 2020 and June 2021.
Additionally, healthy controls aged 18 with no history of hospitalization in the past two years were recruited. The Montreal Cognitive Assessment (MoCA) and the Screen for Cognitive Impairment in Psychiatry (SCIP) were used to assess cognition. Trial-making tests A and B were used to evaluate executive function.
The Hamilton anxiety (HAM-A) and depression (HAM-D) rating scales were used to assess anxiety and depression. Semi-structured interviews were conducted for subjective neuropsychiatric and cognitive symptoms. Further, cerebellar and sensorimotor functions and cranial nerves were evaluated. The neurological evaluation scale was used to quantify neurological signs. Physical and mental fatigue was examined using the fatigue assessment scale.
The primary outcome of the study was overall cognition. Secondary outcomes included trail-making test scores, neurological evaluation scale scores, and HAM-D and HAM-A scores. Further, exploratory outcomes were symptom frequency, number of subjective symptoms, fatigue, psychiatric diagnoses, neurological examination results, and changes in MoCA score over time.
Overall, 345 participants were examined, including 120 COVID-19 patients, 125 control patients, and 100 healthy controls. Among control patients, 50 were hospitalized for pneumonia, 50 for acute myocardial infarction, and 25 for other non-COVID-19 illnesses requiring intensive care. COVID-19 patients had a higher body mass index (BMI) than the control cohorts.
Healthy controls had fewer comorbidities and higher education levels than COVID-19 patients. The estimated SCIP scores at 18-month follow-up were 59, 61.6, and 68.8 among COVID-19 patients, hospitalized controls, and healthy controls, whereas the estimated MoCA scores were 26.5, 27.2, and 28.2, respectively.
Among COVID-19 patients, the mean HAM-A score was higher than healthy controls, but it was not significantly different compared to hospitalized controls. Further, HAM-D scores were higher among COVID-19 patients than among healthy controls but were not significantly different than hospitalized controls.
The average neurological evaluation scale score was higher among COVID-19 patients than healthy controls, indicating worse performance, but it was not significantly higher than hospitalized controls. COVID-19 patients were slower to complete both trail-making tests. They also reported a higher frequency of neurological and psychiatric symptoms than hospitalized controls.
However, only anosmia was significantly more frequent at 18 months after multiple testing. Likewise, only olfactory impairment was less frequent among healthy controls compared to COVID-19 patients after multiple testing. COVID-19 patients also had a higher incidence of new psychiatric diagnoses and scored higher on the fatigue assessment scale than healthy controls.
COVID-19 patients performed poorly on all tests 18 months post-hospitalization compared to healthy controls. COVID-19 patients more often had fatigue, impaired olfaction, and new psychiatric diagnoses than healthy controls. Nonetheless, they had similar outcomes as hospitalized controls, except for olfactory impairment and executive function.
Furthermore, depression and anxiety were more frequent in the COVID-19 group than among healthy controls but no more frequent than in hospitalized controls. Taken together, the findings suggest that patients hospitalized for COVID-19 had worse neurological, psychiatric, and cognitive outcomes at 18 months after hospitalization than healthy controls. However, there were no significant differences compared to hospitalized controls.
The team concluded that multimorbidity has a role in hospitalization and lasting associations with brain health, given that healthy controls had fewer comorbidities than hospitalized participants. Overall, post-COVID-19 brain health was comparable to the brain health after other severe diseases, albeit additional studies are required to corroborate these findings.
Design Sample and recruitment
Data were drawn from the Smoking and Alcohol Toolkit Study (STS/ATS), a monthly repeated cross-sectional survey of a representative sample of adults (aged 18+) in England.The study population consisted of adults aged 18 and over living in households in England surveyed monthly between March 2014 and June 2022. All statistical analysis was restricted to people who smoked in the past year or who used alcohol at increasing and higher risk levels as indicated by scoring 38 in the Alcohol Use Disorders Identification Test (AUDIT) [23].
The STS/ATS uses a hybrid of random location and quota sampling to select a new sample of approximately 1,800 adults (aged18years) each month in England [24]. Sample weighting uses the rim (marginal) weighting technique, an iterative sequence of weighting adjustments whereby separate nationally representative targets are set, and the process repeated until all relevant variables match the English sociodemographic population profile relevant at the time each monthly survey was collected.
Respondents with characteristics that are under-represented receive a larger weight, while those who are over-represented receive a smaller weight. Data were collected monthly through face-to-face computer assisted interviews. However, due to the COVID-19 pandemic, from April 2020 data were collected via telephone only. A series of diagnostic analyses suggested it is reasonable to compare data from before and after the lockdown, despite the change in data collection method [25, 26].
The primary outcome measure was defined using responses to the following questions:
For smoking:
Has your GP spoken to you about smoking in the past year (i.e. last 12 months)?
Yes, heshe suggested that I go to a specialist stop smoking advisor or group
Yes, heshe suggested that I see a nurse in the practice
Yes, heshe offered me a prescription for Champix, Zyban, a nicotine patch, nicotine gum or another nicotine product
Yes, heshe suggested that I use an e-cigarette
Yes, heshe advised me to stop but did not offer anything
Yes, heshe asked me about my smoking but did not advise me to stop smoking
No, I have seen my GP in the last year but heshe has not spoken to me about smoking
No, I have not seen my GP in the last year
Dont know
Respondents who answered with any of responses a-e for smoking were classified as having received a BI. Responses of h were excluded under the sensitivity analyses which cover only those who have visited their GP.
For drinking:
In the last 12 months, has a doctor or other health worker within your GP surgery discussed your drinking?
No
Yes, a doctor or other health worker within my GP surgery asked about my drinking
Yes, a doctor or other health worker within my GP surgery offered advice about cutting down on my drinking
Yes, a doctor or other health worker within my GP surgery offered help or support within the surgery to help me cut down
Yes, a doctor or other health worker within my GP surgery referred me to an alcohol service or advised me to seek specialist help.
Dont know
Refused
Respondents who answered with any of c-e, were classified as having received a brief intervention from their GP for drinking.
For the analyses including only those who visited their GP, we excluded responses of a) in response to the question below:
You said a doctor or other health worker within your GP surgery has not discussed your drinking with you in the last 12months.
a) I have not seen a doctor or health worker within my GP surgery in last 12months.
b) I have seen a doctor or health worker within my GP surgery in the last 12months but did not discuss my drinking.
As a measure of socio-economic position, we used the National Readership Surveys classification of social grade based on occupation (ABC1: higher and intermediate managerial, administrative, and professional, supervisory, clerical and junior managerial, administrative and professional; C2DE: skilled manual workers, semi-skilled and unskilled manual workers and state pensioners, casual and lowest-grade workers, unemployed with state benefits.) [27].
Respondents were classified as having a history of a mental health condition if they reported being diagnosed by a doctor or health professional.
Respondents were asked:
Since the age of 16, which of the following, if any, has a doctor or health professional ever told you that you had?
Depression
Anxiety
Obsessive Compulsive disorder
Panic disorder or a phobia
Post-traumatic stress disorder (PTSD)
Psychosis or schizophrenia
Personality disorder
Attention Deficit Hyperactivity Disorder (ADHD)
An eating disorder
Alcohol misuse or dependence
Drug use or dependence
Problem gambling
Autism or Autism Spectrum Disorder
Bipolar disorder (previously known as manic depression)
None of these
Dont know
Prefer not to say
Responses excluding the final three options above were presented in a randomised order. For our analyses, individual responses of any of the above diagnoses were dummy coded into a composite measure of History of a mental health condition. Those who selected alcohol misuse or dependence were excluded from the alcohol BI analysis given that it is likely a confounder influencing the receipt of a BI for alcohol.
Age was treated as a continuous variable in models, but categorical to summarise the sample characteristics. Other sociodemographic covariates included identified sex (Women vs other (Men and In another way/refused)), the presence of children in the household (Yes vs No), and region of England (North, Midlands and South).
In the analyses of BIs for smoking, data were collected from March 2014 to June 2022. In the analyses of BIs for alcohol, data were collected from March 2014 to March 2022 because from April 2022 the brief intervention variable was collected every other month, and only questions related to AUDIT items one to three were collected (preventing the selection of individuals according to full 10-item AUDIT score).
For all primary analyses on BIs for smoking, and BIs for alcohol, the pre-pandemic period refers to the months up to and including February 2020, and the post-pandemic period from April 2020 onwards (no data were collected in March 2020 due to the pandemic). Characteristics of the sample for the pre- and post-pandemic periods are described in Table S1.
Regarding the analyses involving mental health data, the pre-pandemic period refers to the years 2016 and 2017, and the period from October 2020 onwards as the pandemic onset period, as these were the only periods where data on the included mental health measures were collected. Moreover, for 2016/2017 mental health was only assessed in past-year smokers, so this sample did not include any people who used alcohol at increasing and higher-risk levels but did not smoke.
The analyses were conducted in R version 4.2.1 [28] using the packages survey [29] and mgcv [30]. This analysis plan was pre-registered on the Open Science Framework https://doi.org/10.17605/OSF.IO/65FRC. The STROBE reporting guidelines were used in the design and reporting of this study. Respondents with missing data on any of the covariates of interest were excluded from the analyses (less than 5% of responses). Characteristics of the sample and descriptive statistics are presented using weighted descriptive statistics for the overall sample, and for the pre-pandemic and post-pandemic periods, respectively.
A segmented regression design was used to assess the effect of the COVID-19 pandemic on receipt of BIs for smoking and alcohol, respectively. Data was analysed at the individual-level with segmented regression using generalised additive models (GAM) [31, 32]. These allow the fitting of seasonal smoothing terms and thus seasonality to be considered (which are particularly relevant in the context of delivery of interventions for smoking and alcohol use [33]). A log link function was used so that relative risks can be reported.
Each GAM modelled the trend in the overall receipt of BIs (dependent variable) for smoking and alcohol, respectively in the pre-pandemic period, and any change in the trends in the post-pandemic period. Trend is a variable coded 1n (n being the total number of time-points to the end of the series) reflecting the time trend over time. The slope variable was defined as 0 before April 2020 of the pre-pandemic period and each month from April 2020, by increments of 1 up to m where m is the number of waves from April 2020.
Models were first fit assuming a linear underlying and post-implementation trend, followed by fits using non-linear trends to explore changes in the level of BI delivery and potential rebounding in the delivery of BIs over time. Specifically, the outcome of BI delivery refers to receipt of a BI in the previous 12months. It is therefore possible that an immediate step change in delivery would not be detected in April 2020 or in the months immediately afterwards but would be reflected by changes in the trend in the longer term. In addition, after an initial drop during heightened restrictions 2020 and 2021, rates of BI delivery may have rebounded with some GP delivery returning to normal practice. Therefore, we fit further GAMs with the independent variables for slope and trend wrapped in a smooth function (model fit using the restricted maximum likelihood method with nine basis functions specified for the underlying trend and change in slope). Models accounted for seasonality in the receipt of BIs by using a smoothing term with cyclic cubic regression splines (11 knots, one for each month in the year) and were adjusted for sociodemographic characteristics (age, sex, children in the household, and region).
Interactions were tested between social grade and the post-intervention change in slope, and results reported stratified by social grade to explore whether the post-intervention slope depends on social grade. The model fit of the linear and non-linear GAMs were compared using the Akaike Information Criterion (AIC; lower values indicating better model fit) and a likelihood ratio test.
BI delivery may have declined during the pandemic due to reduced GP contact overall, rather than reduced delivery rates among those who visited their GP. To understand whether BI delivery also declined among those still visiting their GP, all analyses were repeated with the sample of only those who smoked in the past-year and those who used alcohol at increasing and higher risk levels, respectively, who reported visiting their GP in the past year (Table S2).
Models were checked for full convergence, and for randomly distributed residuals using the gam.check() function in the mgcv package [30] in R.
We constructed logistic regression models to explore whether changes in the of receipt of BIs for smoking and alcohol, respectively, from December 2016 to January 2017 and October 2020 to June (or March in the case of BIs for alcohol) 2022, depended on history of a mental health condition. Associations were reported as odds ratios (ORs) with 95% confidence intervals. Models adjusted for sociodemographic characteristics. The inclusion of the time period*mental health interaction allowed us to explore potentially differential changes in receipt of interventions over between the two time periods according to whether an individual had a history of a mental health condition.
It's been almost four years since the start of the pandemic.Since October, Mad River Valley Arts in Waitsfield has been hosting an exhibit that shares what it was like for the Vermont Abenaki tribe during COVID-19.Curator Vera Sheehan has spent multiple years creating the "Beyond The Curve: American Abenaki Covid Experience."Sheehan's mission is to educate others and spark conversation about how people heal differently. Samantha Talbot-Kelly, Mad River Valley Arts executive director, loves showcasing educational displays like this in her gallery for those very reasons, too."Its a wonderful segway to have a conversation around all of our experiences and how were healing from all our different experiences of the pandemic," Talbot-Kelly said.The exhibit is full of crowd-sourced art pieces, crafted face masks, and photographs.More than a decade ago, the Green Mountain State recognized four of its tribes.This display showed how the group chose to cope and heal while the pandemic was at its peak."How they turned to crafts, their traditional makings, and their traditional medicines," Talbot-Kelly said.It also educated people on how they felt about the vaccine."They were hesitant to participate in traditional vaccines that non-indigenous people have access to," Talbot-Kelly said.Another outlet for many to get through the pandemic was through paintings and sculptures."The arts help provide that healing," Talbot-Kelly said. "It helped to generate what was necessary to express that tough time we all experienced."Talbot-Kelly hopes to continue to share stories like this at her gallery."Hopefully, the word gets out more and more to the community that were here," Talbot-Kelly said. "People have been coming in more and more frequently."This exhibit will be up through Saturday. It's free to the public.For more information, click here.
It's been almost four years since the start of the pandemic.
Since October, Mad River Valley Arts in Waitsfield has been hosting an exhibit that shares what it was like for the Vermont Abenaki tribe during COVID-19.
Curator Vera Sheehan has spent multiple years creating the "Beyond The Curve: American Abenaki Covid Experience."
Sheehan's mission is to educate others and spark conversation about how people heal differently.
Samantha Talbot-Kelly, Mad River Valley Arts executive director, loves showcasing educational displays like this in her gallery for those very reasons, too.
"Its a wonderful segway to have a conversation around all of our experiences and how were healing from all our different experiences of the pandemic," Talbot-Kelly said.
The exhibit is full of crowd-sourced art pieces, crafted face masks, and photographs.
More than a decade ago, the Green Mountain State recognized four of its tribes.
This display showed how the group chose to cope and heal while the pandemic was at its peak.
"How they turned to crafts, their traditional makings, and their traditional medicines," Talbot-Kelly said.
It also educated people on how they felt about the vaccine.
"They were hesitant to participate in traditional vaccines that non-indigenous people have access to," Talbot-Kelly said.
Another outlet for many to get through the pandemic was through paintings and sculptures.
"The arts help provide that healing," Talbot-Kelly said. "It helped to generate what was necessary to express that tough time we all experienced."
Talbot-Kelly hopes to continue to share stories like this at her gallery.
"Hopefully, the word gets out more and more to the community that were here," Talbot-Kelly said. "People have been coming in more and more frequently."
This exhibit will be up through Saturday. It's free to the public.
For more information, click here.
