Cognitive behavioral therapy reduces severe fatigue in long-COVID patients

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Woman with long COVIDCognitive behavioral therapy (CBT) lessens fatigue and improves concentration among long-COVID patients, finds a Dutch randomized controlled trial published yesterday in Clinical Infectious Diseases.

The Amsterdam University Medical Centers–led study involved 114 long-COVID patients with severe fatigue and functional impairment 3 to 12 months after infection. Participants were randomly assigned in a 1:1 ratio to receive either CBT or usual care (mainly physical therapy and/or occupational therapy) from November 12, 2020, to September 21, 2021. The average number of interactions (email and video, in-person, and phone visits) between patients and therapists was 11.8.

Participants completed two symptom-based questionnaires during the study. Most patients were nonhospitalized and self-referred from one of six centers.

CBT helps long-COVID patients better manage their symptoms, senior author Hans Knoop, PhD, said in an Amsterdam University news release. "Together with patients, we look, for example, at how they can improve their sleep-wake rhythm," he said. "We also help them become more active again with small, safe steps. For example, by going for short walks."

Improvements sustained at 6 months

Patients who received CBT were significantly less fatigued on the fatigue-severity subscale of the Checklist Individual Strength than usual-care patients both immediately after therapy completion and 6 months later (-8.8 points; 95% confidence interval [CI], -11.9 to -5.8). There were also improvements in physical and social functioning, physical symptom severity, and concentration.

"Cognitive behavioural therapy also appears to be a safe treatment," Knoop said. "Our research shows that the symptoms did not worsen, and new symptoms arose less often."

Symptoms did not worsen, and new symptoms arose less often.

The researchers said that the symptom relief achieved after CBT doesn't mean long COVID is a psychological problem and cautioned that CBT doesn't work for everyone. "We encourage research into its underlying (neuro)biological mechanisms," they concluded. "Relatedly, while the majority of patients were no longer severely fatigued following CBT, a substantial group remained severely fatigued. Research into other treatment approaches is warranted."

Quick takes: COVID infection prevention, White House seeks pandemic leader, Novavax trials findings

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  • Ahead of the national public health emergency expiring on May 11, the Centers for Disease Control and Prevention (CDC) yesterday updated its interim recommendations for infection prevention and control for healthcare personnel. The main updates pertain to procedures at nursing homes, and the CDC also added an appendix to help health facilities decide when to implement broader source control, given that the CDC is phasing out community transmission levels. It suggests other metrics to monitor local COVID activity and noted that the CDC is in the early stages of developing ones that can be used for multiple respiratory viruses.
  • In March, the Biden administration said it would disband its COVID-19 team when the public health emergency expires, but the White House is facing challenges finding someone to direct the new office tasked to handle it, the Office of Pandemic Preparedness and Response, Politico reported on May 5. The position is one of multiple public health positions to be filled, especially given that CDC Director Rochelle Walensky, MD, MPH, announced she will leave the post at the end of June.
  • Novavax today reported promising findings for phase 2 clinical trials for three of its vaccines, a flu-COVID combination product, a standalone flu version, and a high-dose COVID candidate. The protein-based vaccines include the company's proprietary Matrix M adjuvant. In a press release, it said reactogenicity was similar to findings in earlier trials for the vaccines and that they prompted robust immune response.

Experts warn widespread use of antibacterial products could promote antibiotic resistance, other health threats

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More than two dozen scientists warn that the accelerated use of antibacterial products during the COVID-19 pandemic could pose health risks, such as antimicrobial resistance, and that a comprehensive research and policy agenda is needed to understand and limit these potential impacts.

In a review published yesterday in Environmental Science & Technology, the researchers detail the expanded use of products containing quaternary ammonium compounds (QACs), which comprise hundreds of chemical and mixtures and are often found in antibacterial wipes, hand sanitizers, cleaning products, and personal care products. They note that QACs are in roughly 50% of the US Environmental Protection Agency's list of disinfectants effective against SARS-CoV-2, which has likely contributed to their increased use, even though the evidence of QAC effectiveness in reducing transmission of infectious diseases is limited.

In addition, the authors note that, despite their widespread use, most QACs have not undergone rigorous regulatory assessment for potential associations with adverse human and ecological health effects. They go on to review some of the evidence for those health effects, which include dermatitis, asthma, infertility, birth defects, and antimicrobial resistance.

"A substantial body of evidence points to QACs as exacerbating this problem, notably in drug-resistant pathogens of concern, e.g., P. aeruginosa," they wrote. "Exposure of bacteria to disinfectants is expected to result in an increase in resistance, both to QACs and clinically relevant antibiotics."

A substantial body of evidence points to QACs as exacerbating this problem, notably in drug-resistant pathogens of concern.

The authors recommend full disclosure of QACs in all products, closely monitoring their levels in people and the environment, and eliminating uses that are either unnecessary or not proven.

"Our review of the science suggests disinfecting with these chemicals in many cases is unhelpful or even harmful," study co-author Courtney Carignan, PhD, of Michigan State University, said in a press release from the Green Science Policy Institute. "We recommend regular cleaning with soap and water and disinfecting only as needed with safer products."

USDA green-lights Lyme disease vaccine that targets mice hosts

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White-footed mouse
J. N. Stuart / Flickr cc

The US Department of Agriculture (USDA) has conditionally licensed an oral vaccine designed to limit the spread of Borrelia burgdorferi, the bacterium that causes Lyme disease. The vaccine is sprayed onto pellets and distributed in natural settings to be consumed by mice.

Lyme disease is the nation's most common vectorborne disease, and the US Centers for Disease Control and Prevention estimates that about 476,000 people are infected each year. Black-legged ticks that feed on blood from infected mice can than transmit the disease to people.

In its announcement, Memphis-based US Biologic said field trials by several groups showed a real-world impact and that the product meets all of the USDA's conditional licensing requirements, including that it uniquely addresses an emergency condition.

The company said it will make the product available for residential settings and public spaces, such as parks, golf courses, and other recreational facilities. It added that it will work closely with federal and state health agencies, pest control management groups, and partners including the Global Lyme Alliance and the Lyme Disease Association.

The vaccine is called Borrelia Burgdorferi Bacterin. The product, called LymeShield, includes a device or "station" that holds and applies the pellets, according to the company's website.

Probes continue into Africa's Marburg outbreaks as recent patients discharged

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Marburg viruses

The most recently confirmed patients in Marburg virus outbreaks in Equatorial Guinea and Tanzania were discharged from treatment at the end of April, with efforts under way in both countries to shore up responses and investigate the source of the virus and earlier transmission links, the World Health Organization (WHO) said yesterday in an update.

Both countries have been battling their first outbreaks of Marburg virus, which is related to Ebola and also spreads among humans through infected body fluids.

Equatorial Guinea's last two cases were reported from Bata, the country's biggest city, and were known contacts of previous cases. The last patient was discharged from treatment on Apr 26. Tanzania's last case was the mother of a child who died from the virus in March, and she was discharged from treatment on Apr 21.

In both outbreaks, investigations are still underway, as are response efforts. In Equatorial Guinea, many cases are linked through social networks or gatherings, but earlier cases across multiple districts without clear links suggests the possibility of undetected spread, the WHO said. It added that surveillance in the country is suboptimal and that few alerts have been reported.

Meanwhile in Tanzania, the source of the virus hasn't been found, which may pose an ongoing risk to the population. All cases have been reported from Bukoba district of Kagera district, which borders Uganda, Rwanda, and Burundi.

Before starting discussions of the 42-day countdown to the end of the outbreaks, the WHO recommended that both countries complete 21-day follow-up of all listed contacts. Equatorial Guinea's total stands at 17 lab-confirmed cases, 12 fatal, and 23 fatal probable cases. Tanzania has 8 confirmed cases, 5 fatal, along with a fatal probable case.

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