21. van Alfen N. Clinical and pathophysiological concepts of neuralgic amyotrophy. We don't have any specific therapies for it yet. Your breathing, heart rate, blood pressure, body temperature, sweating, digestion, sensations, etc., are all part of this complex system. 2023 BioMed Central Ltd unless otherwise stated. View Sources. on this website is designed to support, not to replace the relationship
J Clin Orthop Trauma. A normal resting heart rate is between 50 and 100 beats per minute. Article 2021;397(10270):220-232. Autonomic dysfunction in recovered severe acute respiratory syndrome patients. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. We have seen evidence in several post-COVID patients and in the literature of varying degrees of autonomic dysfunction. This happens because your body is desperately trying to remedy the dip in your blood pressure by increasing the heart rate to help maintain blood flow to the head and heart. Sinus tachycardia is the most common arrhythmia in Covid-19 patients. The emergence of dysautonomia as a consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; or COVID-19) is becoming more prevalent. A genomic and proteomic analysis showed no significant similarity between SARS-CoV-2 and human proteins.7 Other analyses demonstrated shared oligopeptides between SARS-CoV-2 and 2 human heat-shock proteins11 and up to 34 proteins that have an oligopeptide sequence shared by the SARS-CoV-2 spike glycoprotein.12 Whether heat-shock proteins or any of the other proteins with homology to SARS-CoV-2 are relevant targets of aberrant immune responses in GBS is unknown, however. University of Cologne
PubMed At a glance, this number may suggest a causal relationship between COVID-19 and neuromuscular disease, but biases could overestimate the significance and erroneously indicate causality. Specific laboratory or imaging data are available from the corresponding author on reasonable request. Gokhale Y, Patankar A, Holla U, et al. Umapathi T, Er B, Koh JS, et al. Bibliometric analysis demonstrates that this tsunami of COVID-19 publications contains a high number of poor-quality studies and a low number of studies of higher evidence (eg, clinical trials, large-cohort data registries, or meta-analysis).1,2 Most published articles related to COVID-19 and neuromuscular disorders are case series or reports. Lancet. 32. [published online ahead of print, 2021 Mar 17]. The researchers examined53 distinct symptoms over eight different symptom areas to analyze PASC heterogeneity. J Neurol Sci. An analysis of publication trends in the last 15 months reveals an ever-growing number of papers describing, analyzing, and summarizing multiple aspects of COVID-19 and neuromuscular conditions (Figure). The most prevalent symptoms were brain fog, exhaustion, shortness of breath with exercise, headache, palpitations, body pains, tachycardia, and lightheadedness, consistent with previous research that found many of the same symptoms in individuals with PASC. At the acute stage, sinus tachycardia may reflect systemic hyper-sympathetic tone. Springer Nature. Proc Natl Acad Sci U S A. In a peer-reviewed study of 284,592 people "vaccinated" against COVID researchers found the injections were associated with an increase in numerous diseases, including postural orthostatic tachycardia syndrome (POTS), myocarditis, autonomic nervous system dysfunction, and anaphylaxis. Yuki N, Susuki K, Koga M, et al. Medical Faculty
Eleven (41%) patients developed autonomic symptoms during the infection and 16 (59%) after infection. We can help figure out whats driving the condition. 2004;101(31):11404-11409. "Identifying dysautonomia in Long COVID is important because the autonomic nervous system plays a critical role in regulating immune function, inflammation, coagulation pathways, fatigue,. Im not talking about marathon running. All data generated or analyzed during this study are included in this published article. "Study finds 67% of individuals with long COVID are developing dysautonomia". The frequency of pre-COVID autoimmunity and asthma in the current cohort was far higher than the overall US population, suggesting the potential that these medical disorders might be risk factors for PASC development. Muscle Nerve. It affects the whole body from top to bottom, but the issues we see in cardiology usually deal with a persons heart rate and/or blood pressure. Additionally, more research is needed to determine susceptibility to developing dysautonomia as well as treatment tailored specifically to post-COVID patients. Anaphylaxis, a severe type of allergic reaction . PASC can manifest as a wide range of symptoms, many exhibiting autonomic characteristics. Varicella-zoster virus: another trigger of Guillain-Barr syndrome? Antiphospholipid syndrome (APS) is a systemic autoimmune condition, in which individuals make antibodies that target their own body cells. The National Institutes of Health will support a four-year follow-up study on the potential long-term effects of COVID-19 on women infected with SARS-CoV-2 during pregnancy. A previous autonomic dysfunction diagnosis was documented in 8.3% of test-unconfirmed COVID-19 patients and 5.1% of test-confirmed patients. FM studies have typically found narrowed small nerve fibers and lowered numbers of small nerve fibers in around 40% of patients. "We need the National Institutes of Health to immediately address this crisis and begin funding research aimed at developing effective treatments for Long COVID dysautonomia, says Jacqueline Rutter, a Dysautonomia International Board Member whose family has been impacted by Long COVID. Exam was significant for orthostasis; laboratory workup unremarkable. While the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has slowed, many people suffer long-lasting symptoms, a condition known as post-acute sequelae of COVID 2019 (COVID-19) (PASC), or long COVID. In addition, experimental evidence derived from preclinical studies would be highly desirable. Please take all of these words into consideration and if you are a physician please do more work into it go to The dishonomia institute learn more about this because there's so much information that is free online for these conditions it is an umbrella term so there are many conditions under the dysautonomia umbrella including pots the condition that I suffer from. Autonomic dysfunction in long COVID: rationale, physiology and management strategies. COVID-19 Real Time Learning Network. 33. Many patients with autonomic dysfunction symptoms of Long COVID appear to tolerate physical activity during the activity, but symptoms may be triggered in the hours or days following exertion. Lehmann HC, Hartung HP. We present a case of severe dysautonomia in a previously healthy young patient. The autonomic nervous system regulates functions we don't consciously control, such as heart rate, blood pressure, sweating and body temperature. Rhabdomyolysis has been described in MERS and SARS, fulfilling criteria for analogy, and coherence may apply. The two wings of the autonomic nervous system act together automatically to regulate vital functions such as heart rate and breathing. Lancet. Weve definitely seen an uptick in this condition since COVID-19. BMC Infectious Diseases One of them, dysautonomia, involves a "dysfunction of the autonomic nerves," as Davis explained. Joan Bosco. All interventions were done as part of standard clinical care, not for research purposes. Sign up for our e-newsletter and have wellness tips, inspirational articles and smart recipes from our team of professionals sent straight to your inbox! Since the pandemic began last March, physicians are just now beginning to see patients with post-COVID POTS. Consistency is yet not clear, however, because only the Finnish study evaluated ICUAW.38. But if your symptoms last for an extended period and affect your daily life, you should speak with your primary care provider or a cardiologist. 2016;53(3):337-350. What It Means for You. A copy of the consent form is available for review by the editor of this journal. The most important thing we can do for most of our patients is to have them exercise, which is great for many reasons. So, for the past few years, weve seen lots of tachycardia (fast heart rate), bradycardia (slow heart rate) and blood pressure lability with the virus in the acute and the long haul or long-term phases. Theres also a condition called postural orthostatic tachycardia syndrome (POTS), an autonomic dysfunction abnormality where theres a drop in blood pressure, but an increase in heart rate. Only 25% of more than 2,000 papers published on COVID-19 in the first quarter of 2020 contained original data.3 Although case reports are important to raise awareness of rare and novel associations, they are, in most instances, insufficient to establish causality. Notably, at this time she was found to have a positive Epstein Barr Virus Viral Capsid Antigen (EBV-VCA) IgG antibody (416.00 U/mL; positive is >21.99 U/mL); an equivocal EBV-VCA IgM antibody (36.70 U/mL; equivocal is 36-43.99 U/mL) and a negative EBV Nuclear Antigen IgG antibody. Dysautonomia as a consequence of infection with COVID-19 is becoming increasingly discussed, especially as more patients recover from COVID-19. There was also rapid recovery to baseline resting heart rate within one minute of lying down in a supine position after upright testing. Susan Alex, Shanet. COVID-19-related stress, anxiety, and depression can also impact sexual health and possibly . Could symptom overlap of COVID-19 and Guillain-Barr syndrome mask an epidemiological association? The researchers conclude that this result is consistent with underlying autonomic dysfunction after COVID-19. J Peripher Nerv Syst. 2021;S1388-2457(21)00551-4. doi:10.1016/j.clinph.2021.04.009. Thats a normal physiological reaction. Augustin M, Schommers P, Stecher M, et al. The analogy criterion might be strong for GBS because numerous viruses are commonly accepted as triggers for GBS including human herpes viruses, cytomegalovirus, varicella zoster and influenza.13,14 Whether existing evidence is coherent is debatable. It has many neurologic effects. So I have dysautonomia I have pots it was not due to anything other than other medical conditions I have like ehlers-danlos but I will say that people with pots no genuinely that pots can be caused by a car accident it can be caused by giving birth it could be caused by any type of sickness including a common cold or the flu so people getting pots or dysautonomia (which is the umbrella term for many autonomic nervous system disorders) is not something that we're actually surprised about in our own community this is something that we have expected to happen when we heard about covid-19 from the beginning that's why we were very vigilant about how important it was to wear our mask and that's why some of us are still wearing our mask even though we got vaccinated because we know that if we get sick we will become severely disabled. Mehan WA, Yoon BC, Lang M, Li MD, Rincon S, Buch K. Paraspinal myositis in patients with COVID-19 infection. But if the autonomic nervous system isnt doing its job, the blood vessels dont squeeze down, your blood pressure drops, and you can become dizzy, lightheaded, and even pass out. Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. She noted frequent muscle spasms and twitches and burning in her feet at night. In the current sample, the severity of COVID-19 did not link with the degree of autonomic dysfunction, implying that even mild SARS-CoV-2 infections can cause considerable autonomic dysfunction. Carbohydrate mimicry between human ganglioside GM1 and Campylobacter jejuni lipooligosaccharide causes Guillain-Barre syndrome. 1965;58(5):295-300. We use cookies to enhance your experience. 2005;84(6):377-385. (2023, February 22). In severe cases, medications such as beta blockers, ivabradine, fludrocortisone or midodrine can be used for symptomatic management of heart rate and blood pressure dysregulation. Virally mediated rhabdomyolysis is thought to be caused by direct viral invasion of muscle, and as noted, muscle cells do express the ACE2 receptor through which SARS-CoV-2 infects the host, making SARS-COV-2-induced rhabdomyolysis plausible. This article reviews the case series reported from several countries describing patients with suspected severe side effects to the HPV vaccines. TOPLINE. News-Medical. While autonomic dysfunction can affect just one part of the entire autonomic nervous system, the most common symptoms we tend to see as a result of the condition, from a cardiovascular standpoint, typically include: If its cardiovascular, we will do an assessment, get a health history and perform a physical exam to see what your symptoms are based on your symptom complex and how its presenting. 2020;10.1111/ene.14564. Mental issues. This article discusses possible pathogenic mechanisms of brain dysfunction in patients with COVID-19. Department of Neurology
25. Through further investigation by the . Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others. According to the authors, this was the broadest study that used validated autonomic questionnaire scores to show that autonomic dysfunction was frequent in PASC yet available. Thats why increasing your intravascular volume (how much blood and water are in your system) is vital to help fill that tank. We found a high incidence of hypertension in a group of 117 patients with severe disabling autonomic failure. The interesting thing about COVID is its an unpredictable disease. 40. These findings are not indicative of active inflammation or fibrosis such as with acute or subacute myocarditis or residual scarring. Respiratory and gastrointestinal symptoms are accompanied by short- and long-term neuropsychiatric symptoms (NPs) and long-term brain . Your blood pressure should drop slightly when standing, but not drastically. Kambhampati SBS, Vaishya R, Vaish A. Her academic background is in clinical pharmacy and research, and she is passionate about medical writing. 2005;32:264. Ultimately, we aim to treat the underlying issue for the patient, and from a cardiac standpoint, we can do several things. A debilitating chronic condition is being linked to COVID-19. Shanet Susan Alex, a medical writer, based in Kerala, India, is a Doctor of Pharmacy graduate from Kerala University of Health Sciences. 2010;34(3):171-183. doi:10.1111/ene.14564. People who have recovered from COVID-19 frequently complain about muscle weakness, as long as 6 months after the disease,26 which may point to a relevant proportion of individuals who develop ICUAW. Yet even today, some physicians discount conditions like POTS and CFS, both much more . About five weeks after the start of her initial symptoms, she visited the emergency department (ED) due to two weeks of progressive generalized weakness affecting her ability to move her extremities and ambulate. Find useful tools to help you on a day-to-day basis. 15. between patient and physician/doctor and the medical advice they may provide. It's very hard to grasp what's going on so deep inside. Methods: We conducted a retrospective review of all patients with confirmed history of COVID-19 infection referred for autonomic testing for symptoms concerning for para-/postinfectious autonomic dysfunction at Mayo Clinic Rochester or Jacksonville between March 2020 and January 2021. To further prove or exclude causality, cohort studies are warranted. There is no funding to be declared. The test-confirmed SARS-CoV-2 cohort was more probable than the test-unconfirmed group to experience loss of taste and smell. 2021;266:35-43. 9. vaccine, pfizer-biontech covid-19 vaccine, autonomic dysfunction, dysautonomia, postural orthostatic tachycardia syndrome (pots) Introduction The coronavirus disease 2019 (COVID-19) pandemic is unprecedented and resulted in greater than six million deaths worldwide [1]. Neuromuscular conditions that can affect autonomic nervous system causing problems with controlling blood pressure, heart rate, body temperature, secretion, sweating, digestions, etc. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The symptoms. 2021. https://doi.org/10.7861/clinmed.2020-0896. Indeed, the proinflammatory cytokines expressed after HPV vaccine injections can cause neuroinflammation and chronic pain, and we hypothesize that the aforementioned cytokines are capable of producing a post-vaccination inflammatory syndrome in which chronic pain and neuroinflammation are practically always present. Haroun MW, Dieiev V, Kang J, et al. 2020;39(4):289-301. Thus, the World Health Organization . Moving toward a better definition of long haulers -- and a new name. K.K . PERSISTENT ORTHOSTATIC HYPOTENSION AFTER ACUTE COVID-19 INFECTION: A CASE OF POST-ACUTE COVID AUTONOMIC DYSFUNCTION TYPE: Case Report TOPIC: Critical Care INTRODUCTION: We present a case of orthostatic hypotension persisting two months after resolution of acute COVID-19 infection. Svaina MKR, Kohle F, Sprenger A, et al. 23. For instance, when sitting down, your heart rate is at a certain level, but as soon as you get up to walk across the room, it increases automatically. Additional cardiac workup included a normal transthoracic echocardiogram and a dobutamine stress echocardiogram that was negative for ischemia and angina, but with an exaggerated heart rate response to exercise and below average functional capacity. Lehmann HC, Burke D, Kuwabara S. Chronic inflammatory demyelinating polyneuropathy: update on diagnosis, immunopathogenesis and treatment. Although the incidence of GBS was reported to be 2.6 higher in the first wave of the pandemic in Italy,6 studies from the United Kingdom7 and Singapore8 reported a lower incidence of GBS during the pandemic. The occurrence of GBS within 2 to 4 weeks after SARS-CoV-2 infection does meet the criteria of temporality.9 The time interval between SARS-CoV-2 infection and onset of GBS varies and is sometimes impossible to determine because GBS has been observed after asymptomatic SARS-CoV-2 infection. COVID-19 has resulted in more than 120 million cases and 2.6 million deaths to date. A vaccine to prevent coronavirus disease 2019 (COVID-19) is perhaps the best hope for ending the pandemic. There are a number of things outside of autonomic dysfunction that could cause your heart rate to increase, including anemia, thyroid abnormalities, various diseases, conditions, illnesses and viruses such as COVID-19. Initial workup done at our office visit included normal complete blood count, comprehensive metabolic panel, estimated sedimentation rate, C-reactive protein, urinalysis, thyroid function panel, Vitamin B12 and Vitamin D levels, serum protein electrophoresis and immunofixation panel, rapid plasma reagin, iron and ferritin levels, hemoglobin A1C, beta-2-glycoprotein antibodies, cardiolipin antibodies and electrocardiogram. 2020;11(Suppl 3):S304-S306. Characteristics of academic publications, preprints, and registered clinical trials on the COVID-19 pandemic. Image Credit:Rolling Stones/ Shutterstock. CFS/ME has been associated with several viruses, including the 2003 severe acute respiratory syndrome coronavirus (SARS-CoV; 6), and has been recently garnering media attention as a post-acute consequence of SARS-CoV-2 infection. 38. 1987;110(Pt 6):1617-1630. Multiple sclerosis. Huang C, Wang Y, Li X, et al. It [] Lo YL, Leong HN, Hsu LY, et al. When the body perceives a life threatening situation, the. Acta Myol. Post-Acute Sequelae of COVID-19 infection, Postural Orthostatic Tachycardia Syndrome, Severe Acute Respiratory Syndrome Coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2. Some of those symptoms are related to the body's autonomic nervous system, which plays a role in involuntary body processes including heartbeat, blood flow, digestion and breathing. The preliminary data also indicated that ED is a marker of increased susceptibility to SARS-CoV-2 infection. AJNR Am J Neuroradiol. 22. Defining causality in COVID-19 and neurological disorders. One day after receiving her first dose of Moderna's Covid vaccine, Luz Legaspi, 72, woke up with bruises on her arms and legs, and blisters that bled . They include Lambert-Eaton myasthenic syndrome, disorders related to voltage-gated potassium channel (VGKC) complex antibodies, and Guillain-Barr syndrome. 2020;25(5):731-735. Even though PASC is not widely described, it is most commonly defined as COVID-19 symptoms that continue longer than 30 days. The Moderna COVID-19 vaccine reduced symptomatic laboratory-confirmed COVID-19 when compared to no COVID-19 vaccination (vaccine efficacy: 94.1%; 95% . Orthostatic Intolerance 1.00 Myopathic changes in patients with long-term fatigue after COVID-19. Theres still a drop in blood pressure when a change in position occurs, but the heart rate increases in this case. Terms and Conditions, Am J Med Sci. 29. The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical. Her initial symptoms lasted about two weeks and were mild; she was not hospitalized and did not receive any medical interventions. 19. GBS after SARS-CoV-2 infection is biologically plausible, based on the conception of GBS as a postinfectious disorder in which molecular mimicry is essential. Medicine (Baltimore). But those things are lifestyle modifications. It can cause orthostatic intolerance and, less commonly, an autonomic neuropathy. Can the gut microbiota and metabolome explain variation in anti-SARS-CoV-2 vaccination responses in immunosuppressed IBD patients? Dysfunction of the autonomic nervous system has also been suggested to be among extrapulmonary manifestations of COVID-19 and postacute sequelae of SARS-CoV-2 infection (PASC) (also termed long COVID). She had a positive COVID-19 polymerase chain reaction (PCR) by nasal swab five days into her illness. We hope that this report will add to the ever-growing body of literature on Post-Acute Sequelae of COVID-19 infection (PASC) that may be overlooked or mistaken for another etiology. Other individuals will get it, especially older individuals, and it will never go away. Shanet has published papers in the International Journal of Medical Science and Current Research (IJMSCR), the International Journal of Pharmacy (IJP), and the International Journal of Medical Science and Applied Research (IJMSAR). Ellul M, Varatharaj A, Nicholson TR, et al. The described symptom clusters are remarkably similar . 2020;395(10239):1763-1770. Stiles said that 78% of COVID-19 patients, even with mild cases, appear to have some sort of heart damage. From the onset of the Coronavirus (COVID-19) pandemic, The Ehlers-Danlos Society learned from its Helpline and Support Group program that members of the EDS and HSD community were experiencing a deterioration in well-being considered to be a consequence of disruption to normal levels of care, and, imposed social restrictions. With that said, many people have difficulty exercising because the heart rate is fast, but you have to keep at it. Jacobs BC, Rothbarth PH, van der Mech FG, et al. Int J Clin Pract. I had to redo months almost a Year's worth of work to get back to where I was it was horrific. A clinical and electrophysiological study of 92 cases. The concept of postinfectious MG, however, is not well developed. 27. Thus, various COVID-19 vaccines were shown to have a protective potential against SARS-CoV-2 in real-world settings, and to decrease the risk of severe illness . Longer term effects of COVID-19 have been reported in all age groups and demographics and in persons with asymptomatic, mild, or severe initial COVID-19 illness. Postural orthostatic tachycardia syndrome (POTS) is an impaction of the autonomic nervous system initiating orthostatic tachycardia. COVID-19 vaccines can cause mild side effects after the first or second dose, including: Pain, redness or swelling where the shot was given Fever Fatigue Headache Muscle pain Chills Joint pain Nausea and vomiting Swollen lymph nodes Feeling unwell Most side effects go away in a few days. This hypothesis, however, needs confirmation and therefore Hills criterion of analogy does not apply. Rhabdomyolysis in COVID-19 patients: a retrospective observational study. COVID-19 as a trigger of recurrent GuillainBarr syndrome. The coronavirus 2019 (COVID-19) pandemic has potential to disproportionately and severely affect patients with neuromuscular disorders. Although autonomic dysfunction is a common consequence of long COVID, the PASC frequency and severity rates remain unclear. Muscle Nerve. PubMed In our practice, this was the index case of a non-hospitalized patient with a mild initial COVID-19 presentation and significant, debilitating dysautonomia symptoms. 39. 34. Google Scholar. On a cautionary note, the overall number of infected individuals for SARS and MERS is low, thus these epidemics may not serve as good models to study rare complications. Considering there is a background incidence for MG of 2 to 3 per 100,000 per year (see Myasthenia Gravis in this issue),20 a much higher number of postCOVID-19 cases of MG than have been reported would be expected to fulfill the causality criteria of strength, consistency, and biologic gradient. 2021;397(10280):1214-1228. We base it on a clinical diagnosis and a patients symptoms. However, when these systems malfunction, your heart rate can increase or decrease to an unacceptable level for the activity youre performing. News-Medical. In addition to the infectious disease mononucleosis (mono), the Epstein-Barr virus (EBV) is associated with an increased risk of seven different autoimmune diseases: 1. Cummings MJ, Baldwin MR, Abrams D, et al. With rhabdomyolysis, clinically significant myoglobinuria may occur and leads to renal failure in 15% to 33% of cases.34 Rhabdomyolysis has many causes, including substance abuse, trauma, extreme overexertion, epileptic seizures, and less frequently, viral infections. In this interview, we speak to Ceri Wiggins, a Director at AstraZeneca, about the many applications of CRISPR and its role in discovering new COPD therapies. First, it makes you feel better and helps your cholesterol, along with a host of other health benefits. Systemic lupus erythematosus. Neuralgic amyotrophy (ie, Parsonage Turner syndrome) is an idiopathic inflammatory neuropathy of the upper limbs that usually affects the upper part of the brachial plexus.21 Therefore, a brachial plexus neuritis preceded by SARS-CoV-2 infection appears principally plausible. The number of new articles and preprints indexed in the US National Library of Medicine (pubmed.gov) related to COVID-19 overall (green line) increased rapidly in the first 3 quarters of 2020, plateaued in the 4th quarter and then began to decline in the first quarter of 2021. Please use one of the following formats to cite this article in your essay, paper or report: Susan Alex, Shanet. If that doesnt work, or youre passing out all the time because of low blood pressure, the first thing Im going to tell you to do is the simplest. Rhabdomyolysis is associated with in-hospital mortality in patients with COVID-19. Posted in: Medical Research News | Medical Condition News | Disease/Infection News, Tags: Anxiety, Asthma, Autoimmune Disease, Autoimmunity, Autonomic Nervous System, Brain, Brain Fog, Coronavirus, Coronavirus Disease COVID-19, covid-19, Depression, Disability, Exercise, Exhaustion, Fatigue, Food, Frequency, Headache, Hypotension, Inflammation, Nervous System, Neurology, Neuropathic Pain, Obesity, Orthostatic Hypotension, Pain, Research, Respiratory, SARS, SARS-CoV-2, Severe Acute Respiratory, Severe Acute Respiratory Syndrome, Smoking, Syndrome, Vaping. "All trauma is preverbal," Dr. Bessel van der Kolk . In contrast, papers related to neurologic disease and COVID-19 (blue line) or neuromuscular disease and COVID-19 (red line) continue to expand rapidly. Depression, anxiety, history of vaping or smoking, environmental food or allergies, asthma, hypertension, autoimmune disease history, and obesity were the most often reported pre-existing illnesses in this sample.
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