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COVID-19 can cause lasting lung damage – 3 ways long COVID patients’ respiration can suffer

Understanding how injury and disease, including COVID-19, can impair lung function can help researchers and clinicians better help patients who are experiencing…

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Lung disease can manifest in a number of ways. Mr. Suphachai Praserdumrongchai/iStock via Getty Images Plus

“I just can’t do what I used to anymore.”

As pulmonologists and critical care doctors treating patients with lung disease, we have heard many of our patients recovering from COVID-19 tell us this even months after their initial diagnosis. Though they may have survived the most life-threatening phase of their illness, they have yet to return to their pre-COVID-19 baseline, struggling with activities ranging from strenuous exercise to doing laundry.

These lingering effects, called long COVID, have affected as many as 1 in 5 American adults diagnosed with COVID-19. Long COVID includes a wide range of symptoms such as brain fog, fatigue, cough and shortness of breath. These symptoms can result from damage to or malfunctioning of multiple organ systems, and understanding the causes of long COVID is a special research focus of the Biden-Harris administration.

Not all breathing problems are related to the lungs, but in many cases the lungs are affected. Looking at the lungs’ basic functions and how they can be affected by disease may help clarify what is on the horizon for some patients after a COVID-19 infection.

Normal lung function

The main function of the lungs is to bring oxygen-rich air into the body and expel carbon dioxide. When air flows into the lungs, it is brought into close proximity with the blood, where oxygen diffuses into the body and carbon dioxide diffuses out.

The lungs bring oxygen into and carbon dioxide out of the body.

This process, as simple as it sounds, requires an extraordinary coordination of air flow, or ventilation, and blood flow, or perfusion. There are over 20 divisions in your airway, starting at the main windpipe, or the trachea, all the way out to the little balloons at end of the airway, called alveoli, that are in close contact with your blood vessels.

By the time a molecule of oxygen gets down to the end of the airway, there are about 300 million of these little alveoli it could end up in, with a total surface area of over 1,000 square feet (100 square meters) where gas exchange occurs.

Matching ventilation and perfusion rates is critical for basic lung function, and damage anywhere along the airway can lead to difficulty breathing in a number of ways.

Obstruction – decreased airflow

One form of lung disease is obstruction of airflow in and out of the body.

Two common causes of impairments like these are chronic obstructive pulmonary disease and asthma. In these diseases, the airways become narrowed because of either damage from smoking, as is common in COPD, or allergic inflammation, as is common in asthma. In either case, patients experience difficulty blowing air out of their lungs.

Researchers have observed ongoing airflow obstruction in some patients who have recovered from COVID-19. This condition is typically treated with inhalers that deliver medications that open up the airways. Such treatments may also be helpful while recovering from COVID-19.

Restriction – reduced lung volume

Another form of lung disease is referred to as restriction, or difficulty expanding the lungs. Restriction decreases the volume of the lungs and, subsequently, the amount of air they can take in. Restriction often results from the formation of scar tissue, also called fibrosis, in the lungs due to injury.

Fibrosis thickens the walls of the alveoli, which makes gas exchange with the blood more difficult. This type of scarring can occur in chronic lung diseases, such as idiopathic pulmonary fibrosis, or as a result of severe lung damage in a condition called acute respiratory distress syndrome, or ARDS.

Health care provider tests a ventilation helmet on a patient.
Patients with acute respiratory distress syndrome due to COVID-19 may be treated with a helmet that provides oxygen, reducing the need for intubation. Guillermo Legaria/Stringer via Getty Images News

ARDS can be caused by injuries originating in the lungs, like pneumonia, or severe disease in other organs, like pancreatitis. Around 25% of patients who recover from ARDS go on to develop restrictive lung disease.

Researchers have also found that patients who have recovered from COVID-19, especially those who had severe disease, can later develop restrictive lung disease. COVID-19 patients who require a ventilator may also have recovery rates similar to those who require a ventilator for other conditions. Long-term recovery of lung function in these patients is still unknown. Drugs treating fibrotic lung disease after COVID-19 are currently undergoing clinical trials.

Impaired perfusion – decreased blood flow

Finally, even when air flow and lung volume are unaffected, the lungs cannot complete their function if blood flow to the alveoli, where gas exchange occurs, is impaired.

COVID-19 is associated with an increased risk for blood clots. If blood clots travel to the lungs, they can cause a life-threatening pulmonary embolism that restricts blood flow to the lungs.

Diagram of alveolus and gas exchange, where oxygen diffuses into the bloodstream and carbon dioxide diffuses out
The alveoli of the lungs are where oxygen diffuses into the bloodstream and carbon dioxide diffuses out. ttsz/iStock via Getty Images Plus

In the long term, blood clots can also cause chronic problems with blood flow to the lungs, a condition called chronic thromboembolic pulmonary hypertension, or CTEPH. Only 0.5% to 3% of patients who develop a pulmonary embolism for reasons other than COVID-19 go on to develop this chronic problem. However, there is evidence that severe COVID-19 infections can damage the blood vessels of the lung directly and impair blood flow during recovery.

What’s next?

Lungs can work less optimally in these three general ways, and COVID-19 can lead to all of them. Researchers and clinicians are still figuring out ways to best treat the long-term lung damage seen in long COVID.

For clinicians, closely following up with patients who have recovered from COVID-19, particularly those with persistent symptoms, can lead to quicker diagnoses of long COVID. Severe cases of COVID-19 are associated with higher rates of long COVID. Other risk factors for development of long COVID include preexisting Type 2 diabetes, presence of virus particles in the blood after the initial infection and certain types of abnormal immune function.

For researchers, long COVID is an opportunity to study the underlying mechanisms of how different types of lung-related conditions that result from COVID-19 infection develop. Uncovering these mechanisms would allow researchers to develop targeted treatments to speed recovery and get more patients feeling and breathing like their pre-pandemic selves once again.

In the meantime, everyone can stay up to date on recommended vaccinations and use preventive measures such as good hand hygiene and masking when appropriate.

Jeffrey M. Sturek has received funding from the National Institutes of Health.

Alexandra Kadl does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Economics

Why WWE could be a good stock to buy/hold in October

World Wrestling Entertainment Inc. (NYSE:WWE) remains in defensive mode as the stock market crumbles. A year-to-date return of 37.40% makes the stock one…

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World Wrestling Entertainment Inc. (NYSE:WWE) remains in defensive mode as the stock market crumbles. A year-to-date return of 37.40% makes the stock one to hold for value preservation. This article finds WWE a good stock to trade when keenness and proper risk management are exercised.

WWE, as it is popularly known, is an integrated media and entertainment entity. It’s known for wrestling promotion, but related fields of film and American football widen its scope. 

Just like other entertainment companies, WWE was grounded by the Covid-19 disruption. As recovery began, the stock has never looked back. It has acted as a true momentum stock while maintaining an uptrend since the beginning of the year. There are clear fundamentals too.

In its second quarter, the company’s net revenue rose 24% to $328.2 million or £309.6 million. The revenue was above $322.4 million or £304.15 estimates. The earnings per share increased from $0.42 to $0.59. The company projects “strong revenue growth” in the third quarter. The raised guidance reflects rising content monetization, local media rights fees, and international ticket sales increases. 

WWE touches the bottom of the ascending channel

Source – TradingView

On the daily chart, momentum is weak on WWE as it corrected to $67. However, we can see that WWE is still maintaining the upside channel. 

Should you buy WWE

WWE has maintained momentum and recovers each time it hits the bottom of the ascending channel. The stock is a buy at the current level, preferably after recovering above the 50-day MA. Short-term traders can exit at the top of the ascending channel.

The post Why WWE could be a good stock to buy/hold in October appeared first on Invezz.

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Economics

Cities With Good Neighbors Have Lower-Than-Average Home Values

New York’s Rochester was identified took the top spot as the most neighborly city in the country.

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New York's Rochester was identified took the top spot as the most neighborly city in the country.

Many want the kind of neighbor who will stop by with fresh-baked cookies, offer gardening tips and take out the mail while they're away — a thing that, if you live in an urban mecca like New York, is just as likely as finding a spacious apartment that's available and within budget.

In honor of National Neighbor Day on Sept. 28, self-storage company Neighbor.com identified Rochester in the Finger Lakes region of New York state as the most neighborly city in the country.

The study analyzed both big and small cities through factors such as resident happiness levels and number of people volunteering their time to the community.

"It's not a surprise that Rochester is the most neighborly city this year, it's made this list each year," Joseph Woodbury, CEO and co-founder of Neighbor.com, said of the findings. "Oftentimes, we connect hospitality with small cities, but you’ll find that people in large cities are just as likely to go out of their way to help one another."

Correlation Between Neighborliness and Home Values

While Federal Reserve economic data pegs the median price of homes sold in 2022 at $428,000, the median list price identified by Realtor.com for Rochester is $150,000. 

Madison, Wis., and Provo, Utah followed Rochester as the most "neighborly" cities in the U.S. and have respective median list prices of $360,000 and $495,000.

Along with Provo, California's Oxnard breaks the list's mold with its high real estate prices — amid proximity to the beach (the city is about 60 miles from Los Angeles) and quaint Victoria architecture, the city has a median list price of $794,500.

Getty Images

Other cities on the list generally fall below the national average for a standard single-family home. Grand Rapids in Michigan has a median list price of $307,500 while that number is only $175,000 in Milwaukee, Wis.

Harrisburg, Pa., and Des Moines, Iowa are two other neighborly cities with respective list prices of $215,000 and $227,500. 

Good neighbors have long been a hallmark of smaller cities with a quieter way of life — metropolises like New York and Los Angeles have very high property values, they are not exactly known for being "friendly" or "welcoming."

With a median list price of $495,000, North Carolina's Raleigh is the largest city to make the list.

Those who think New Yorkers are unfriendly need only to look outside the five boroughs — with a median list price of $334,000, Poughkeepsie also made the list for its neighborliness.

Search For the Next Big Real Estate City

As sleepy towns that paint a TV image of "neighborliness" tend to have lower demand, they may not offer the kind of real estate growth potential that many investors are specifically looking for. 

But exceptions do exist — many small cities are currently in the midst of a real estate boon and, subsequently, an explosion in real estate values.

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According to the study's authors, many homebuyers looking to move have specifically started looking for "friendlier" cities after the pandemic and are driving up demand for formerly quiet places.

Realtor.com identified Utah's Salt Lake City, Idaho's Boise and Washington state's Spokane as 2022's fastest-growing real estate markets.

"Being neighborly goes beyond a friendly wave while driving down the street or offering to water plants while on vacation," Woodbury said. "To be neighborly is opening yourself up to building relationships and ultimately a community that is rooted in compassion, trust, and care."

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Economics

Here’s Why Your Boss May Reject Your Business Travel Request

People are taking vacations again, but a once dominant travel sector is struggling to recover.

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People are taking vacations again, but a once dominant travel sector is struggling to recover.

Now that vaccines are readily available and President Joe Biden has declared that the pandemic is officially over, people are flying again. But they’re really not happy about it.

The research firm J.D. Power found that last year, when the airline industry first started to cautiously rebound, consumer satisfaction with airports reached an all-time high. But this was very likely both because of a relatively smaller sample size and that so many people were happy to fly again that they were willing to overlook a lot of what has become headache-inducing about modern airfare travel.

J.D. Power  (JD) - Get JD.com Inc. Report has found that this year, global passenger levels are nearly back up to 91% of pre-pandemic levels. 

Customer satisfaction has dropped sharply, 25 points on a 1,000-point scale, to 777, as more people have returned to airports, for reasons ranging from an increase in flight cancellations and delays to inflation-driven increases in the cost of airport food.

But while airlines are aware that customers aren’t happy, and that the Biden Administration might try to right the ship with proposals that airlines likely won’t care for, at least people are flying again.

But an additional survey by J.D. Power has revealed that while people are flying again, traveling for business (be it for in-person meetings or industry conferences), has been lagging behind and recovering at nearly the rate of traveling for pleasure. 

Is Traveling for Business on the Way Out?

J.D. Power’s research has found that many travelers doubt that travel levels will increase dramatically from where they are now, and that “a strong majority of executives believe their companies will spend less in the next six months compared to the same period in 2019, for instance, due to things like fewer trips overall or fewer employees sent when there is a trip scheduled,” according to their data.

Overall, business travel has returned to “about 81% of 2019 levels,” notes Managing Director Michael Taylor. “83% was our prediction for this quarter, we’ll see how well we did in a few weeks and add a predication for Q4.”

J.D. Power

Fears of recession and the rising costs of air tickets from inflation play a factor in the decline of business travel. But overall, the main reason is that many of us have gotten so used to working at home that two-thirds of employees would rather find a new job than go back to the pre-pandemic status quo. If employees feel they can get work done from home and don’t feel like braving traffic to return to the office, why would they feel they need to get on a plane?

So have services like Zoom (ZM) - Get Zoom Video Communications Inc. Report and Slack made the business trip redundant? Taylor has his doubts.

“But will people be meeting exclusively in the 'Metaverse' rather than in person? I do not think that will happen,” he says. “There is too much information to be gathered in face-to-face meetings, spoken and unspoken, to be replaced completely by virtual ‘reality.’”

Getty Images

So is This It for Business Travel?

Back in the heady pre-pandemic days three years ago, airlines could rely on the extra income from people whose jobs entailed a great deal of travel, and who had come to the realization that if they were going to spend a chunk of their lives on the road, they could splurge to make it a more comfortable experience. 

But if airlines want this sector to return, Taylor thinks it’s their duty to make it a more appealing option, because frequent delays and other headaches are enough to make anyone stick to Zoom.

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Airlines, Taylor says, must “create more of a “living room” experience for travelers, one that “makes travelers feel valued as patrons of the airlines, and makes people feel like individuals rather than cattle.”

Because while it’s hard to argue with the convenience, Taylor insists there is still something to be said for the occasional in-person meeting. 

“Millenia of evolution in mankind has created an awareness that can’t be described with words on a page or pixels on a screen,” he says. “People will still find advantages in meeting in-person rather than online.”

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