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Despite the end of the pandemic, coronavirus disease 2019 (COVID-19) remains a major public health concern. The first waves of the virus led to a better understanding of its pathogenesis, highlighting the fact that there is a specific pulmonary vascular disorder. Indeed, COVID-19 may predispose patients to thrombotic disease in both venous and arterial circulation, and many cases of severe acute pulmonary embolism have been reported. The demonstrated presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within the endothelial cells suggests that direct viral effects, in addition to indirect effects of perivascular inflammation and coagulopathy, may contribute to pulmonary vasculopathy in COVID-19. In this review, we discuss the pathological mechanisms leading to pulmonary vascular damage during acute infection, which appear to be mainly related to thromboembolic events, an impaired coagulation cascade, micro- and macrovascular thrombosis, endotheliitis and hypoxic pulmonary vasoconstriction. As many patients develop post-COVID symptoms, including dyspnea, we also discuss the hypothesis of pulmonary vascular damage and pulmonary hypertension as a sequela of the infection, which may be involved in the pathophysiology of long COVID.

Neurological post-COVID condition (PCC) often involves attentional deficits that impact daily functioning. Traditional paper-based tests, like the Trail-Making Test (TMT), may inadequately capture these impairments due to their short duration and dependence on numerical and alphabetic sequencing. This study evaluates the validity of three subtests of the computerized Test for Attentional Performance (TAP) as alternatives for detecting attentional impairments in PCC. In the ongoing NEURO LC-19 DE study, 108 subjects aged 18 to 79 years, with PCC-related cognitive complaints ( n  = 67, 73% f) and healthy controls ( n  = 41, 56% f) underwent neuropsychological testing. The prevalence of impairment and classification ability of the TAP subtests were evaluated alongside standard paper-based tests, including the TMT and Montreal Cognitive Assessment, using receiver operating characteristic (ROC) analysis and regression. The TAP subtests identified significant impairments in sustained attention and processing speed in one-third of PCC patients, surpassing traditional tests in sensitivity, and classifying PCC with an AUC of 78%. Omissions in sustained attention significantly differentiated groups (OR = 1.14, p  = 0.016, 95% CI [1.02–1.26]). Fatigue correlated with poorer performance on speed and accuracy ( r  > 0.30, p  < 0.05). Cognitive slowing is prevalent in neurological PCC but is scarcely captured by conventional assessments. The TAP’s computerized format with automated norming and independence from alphanumeric stimuli shows promise in improving the discriminatory ability for identifying attentional deficits in PCC patients.

Evidence suggests that Post/Long-COVID (PLC) is associated with a reduced health-related quality of life, however little knowledge exists on the risk factors that contribute to PLC. The objective of this prospective real-world data study was to evaluate factors associated with PLC using national online survey data. Adjusted multivariable regression analyses were performed using the software R. Between 14 April and 15 June 2021, 99 registered individuals reported to have suffered from PLC symptoms and the most common PLC symptoms reported were fatigue, dyspnoea, decreased strength, hyposmia, and memory loss. The odds of individuals suffering from COVID-19-associated anxiety, hyposmia, or heart palpitations developing PLC were eight times (OR 8.28, 95% CI 1.43–47.85, p < 0.01), five times (OR 4.74, 95% CI 1.59–14.12, p < 0.005), or three times (OR 2.62, 95% CI 1.72–3.99, p < 0.01) higher, respectively, than of those who had not experienced these symptoms. Individuals who experienced fatigue while having COVID-19 were seven times more likely to develop PLC fatigue than those who had not (OR 6.52, 95% CI: 4.29–9.91, p < 0.0001). Our findings revealed that 13% of the individuals who had previously suffered from COVID-19 subsequently reported having PLC. Furthermore, COVID-19-associated anxiety, hyposmia, heart palpitations, and fatigue were, among others, significant determinants for the development of PLC symptoms. Hyposmia has not previously been reported as an independent predictive factor for PLC. We suggest closely monitoring patients with COVID-19-induced fatigue, heart palpitations, and anxiety, as these symptoms may be predictors of PLC symptoms, including fatigue.