Long COVID exhibits clinically distinct phenotypes at 3–6 months post-SARSCoV-2 infection: results from the P4O2 consortium

Background Four months after SARS-CoV-2 infection, 22%–50% of COVID-19 patients still experience complaints. Long COVID is a heterogeneous disease and finding subtypes could aid in optimising and developing treatment for the individual patient. Methods Data were collected from 95 patients in the P4O2 COVID-19 cohort at 3–6 months after infection. Unsupervised hierarchical clustering was performed on patient characteristics, characteristics from acute SARSCoV-2 infection, long COVID symptom data, lung function and questionnaires describing the impact and severity of long COVID. To assess robustness, partitioning around medoids was used as alternative clustering. Results Three distinct clusters of patients with long COVID were revealed. Cluster 1 (44%) represented predominantly female patients (93%) with pre-existing asthma and suffered from a median of four symptom categories, including fatigue and respiratory and neurological symptoms. They showed a milder SARS-CoV-2 infection. Cluster 2 (38%) consisted of predominantly male patients (83%) with cardiovascular disease (CVD) and suffered from a median of three symptom categories, most commonly respiratory and neurological symptoms. This cluster also showed a significantly lower forced expiratory volume within 1 s and diffusion capacity of the lung for carbon monoxide. Cluster 3 (18%) was predominantly male (88%) with pre-existing CVD and diabetes. This cluster showed the mildest long COVID, and suffered from symptoms in a median of one symptom category. Conclusions Long COVID patients can be clustered into three distinct phenotypes based on their clinical presentation and easily obtainable information. These clusters show distinction in patient characteristics, lung function, long COVID severity and acute SARS-CoV-2 infection severity. This clustering can help in selecting the most beneficial monitoring and/or treatment strategies for patients suffering from long COVID. Follow-up research is needed to reveal the underlying molecular mechanisms implicated in the different phenotypes and determine the efficacy of treatment

Building materials and construction:Constructing a quality of life

\u3cp\u3eCatastrophes and new societal ambitions energized the huge construction effort undertaken between 1910 and 1970. The floods of 1917 and 1953 led to enormous investments in coastal defences. The government also undertook major investments in the construction of roadways and other infrastructural works. New building codes, damage incurred during the Second World War and population growth incited new housing construction on a colossal scale. Demand for building materials grew apace. The need for wood and mineral subsoil resources transformed nature and landscapes in the Netherlands and at foreign sites. Dutch forestry practices were rationalised. Imports from the Baltic regions by and large met the Dutch demand for wood. But the creation of monocultures and production forests in these regions reduced local biodiversity. Gravel and marl were mined above all in the province of Limburg. That led to tensions with local stakeholders. Gravel extraction transformed the floodplains of the Meuse into a lake landscape. It led directly to the Excavation Law, the first environmental law in the area of land-use. After 1970, regulations concerning land-use and new landscape values would regularly inspire conflicts in the national supply of building materials (see Chap. 19).\u3c/p\u3