To investigate the reactivation of chronic viruses in patients hospitalized with COVID-19.
Approach:
Study Design: A longitudinal study involving 1,154 unvaccinated patients hospitalized with COVID-19 across 20 US hospitals from May 2020 to March 2021.
Data Collection: Nasal swabs, peripheral blood mononuclear cells, and endotracheal aspirates were collected for up to one year.
Analysis Method: RNA sequencing was used to identify transcripts from actively replicating viruses and assess immune cell populations, antibody levels, cytokines, proteins, and metabolites.
Key Findings:
Nearly half of patients had detectable reactivation of at least one chronic virus during acute illness.
Chronic viral transcripts were found in 550 of 1,148 evaluable patients within the first 40 days.
Epstein-Barr virus reactivated early in 24% of patients during days one to eight.
Human alphaherpesvirus 1 and cytomegalovirus appeared later, with varying detection rates.
Herpesvirus and Anelloviridae transcripts were associated with greater COVID-19 severity.
Cytomegalovirus and Epstein-Barr virus were linked to one-year mortality in critically ill patients.
Anelloviridae transcripts were more common among patients reporting persistent physical disability or fatigue.
Interpretation:
The study provides potential laboratory markers for further investigation but does not establish causation between viral reactivation and severe disease or long COVID.
Limitations:
Sampling limited to three specimen types.
Participant loss during follow-up.
Cohort limited to unvaccinated, hospitalized patients infected with early SARS-CoV-2 variants.
Conclusion:
The findings suggest that viral transcript detection can characterize reactivation timing, but routine monitoring's impact on patient care remains unestablished.
Automated lesion measurements increased agreement on treatment response, although expert-generated proposals were accepted more often and required fewer adjustments.
A 20-minute exercise bout and 90-minute nap produced similar episodic memory performance following 30 hours of wakefulness but engaged distinct neural mechanisms.
Women reported improvement across 6 cognitive domains during 12 months of estriol-based treatment, while murine models suggested a potential astrocyte-mediated mechanism.
