Large-scale phenotyping of patients with long COVID post-hospitalization reveals mechanistic subtypes of disease

One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood1. Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered. Elevated markers of myeloid inflammation and complement activation were associated with long COVID. IL-1R2, MATN2 and COLEC12 were associated with cardiorespiratory symptoms, fatigue and anxiety/depression; MATN2, CSF3 and C1QA were elevated in gastrointestinal symptoms and C1QA was elevated in cognitive impairment. Additional markers of alterations in nerve tissue repair (SPON-1 and NFASC) were elevated in those with cognitive impairment and SCG3, suggestive of brain–gut axis disturbance, was elevated in gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G (IgG) was persistently elevated in some individuals with long COVID, but virus was not detected in sputum. Analysis of inflammatory markers in nasal fluids showed no association with symptoms. Our study aimed to understand inflammatory processes that underlie long COVID and was not designed for biomarker discovery. Our findings suggest that specific inflammatory pathways related to tissue damage are implicated in subtypes of long COVID, which might be targeted in future therapeutic trials

SARS-CoV-2-specific nasal IgA wanes 9 months after hospitalisation with COVID-19 and is not induced by subsequent vaccination

BACKGROUND: Most studies of immunity to SARS-CoV-2 focus on circulating antibody, giving limited insights into mucosal defences that prevent viral replication and onward transmission. We studied nasal and plasma antibody responses one year after hospitalisation for COVID-19, including a period when SARS-CoV-2 vaccination was introduced. METHODS: In this follow up study, plasma and nasosorption samples were prospectively collected from 446 adults hospitalised for COVID-19 between February 2020 and March 2021 via the ISARIC4C and PHOSP-COVID consortia. IgA and IgG responses to NP and S of ancestral SARS-CoV-2, Delta and Omicron (BA.1) variants were measured by electrochemiluminescence and compared with plasma neutralisation data. FINDINGS: Strong and consistent nasal anti-NP and anti-S IgA responses were demonstrated, which remained elevated for nine months (p < 0.0001). Nasal and plasma anti-S IgG remained elevated for at least 12 months (p < 0.0001) with plasma neutralising titres that were raised against all variants compared to controls (p < 0.0001). Of 323 with complete data, 307 were vaccinated between 6 and 12 months; coinciding with rises in nasal and plasma IgA and IgG anti-S titres for all SARS-CoV-2 variants, although the change in nasal IgA was minimal (1.46-fold change after 10 months, p = 0.011) and the median remained below the positive threshold determined by pre-pandemic controls. Samples 12 months after admission showed no association between nasal IgA and plasma IgG anti-S responses (R = 0.05, p = 0.18), indicating that nasal IgA responses are distinct from those in plasma and minimally boosted by vaccination. INTERPRETATION: The decline in nasal IgA responses 9 months after infection and minimal impact of subsequent vaccination may explain the lack of long-lasting nasal defence against reinfection and the limited effects of vaccination on transmission. These findings highlight the need to develop vaccines that enhance nasal immunity. FUNDING: This study has been supported by ISARIC4C and PHOSP-COVID consortia. ISARIC4C is supported by grants from the National Institute for Health and Care Research and the Medical Research Council. Liverpool Experimental Cancer Medicine Centre provided infrastructure support for this research. The PHOSP-COVD study is jointly funded by UK Research and Innovation and National Institute of Health and Care Research. The funders were not involved in the study design, interpretation of data or the writing of this manuscript

Homosexual Identity: A concept in need of definition

Despite the fact that the concept homosexual identity has been used extensively in the literature on homosexuality since the late 1960s, investigators have shown little concern for defining or discussing the manner in which it is used. As a result, the study of homosexual identify has been characterized by confusion, disarray, and ambiguity. A multiplicity of terminologies makes comparisons between studies difficult. There has been little attempt to place theoretical proposals or data within the framework of existing psychological literature on identity. A number of assumptions critical to an understanding of homosexual identity are commonly made, and several of these are discussed: The synonymity of homosexual identity and self-concept; homosexual identity as childhood identity; homosexual identity as sexual identity; and homosexuality as distinct essence. This review also considers the following issues: The distinction between identity and behavior; the utility of an identity construct as applied to the study of homosexuals; the definition of identity in developmental theories of homosexual identity; and homosexual group identity

Homosexual identity: A concept in need of definition

Despite the fact that the concept homosexual identity has been used extensively in the literature on homosexuality since the late 1960s, investigators have shown little concern for defining or discussing the manner in which it is used. As a result, the study of homosexual identity has been characterized by confusion, disarray, and ambiguity. A multiplicity of terminologies makes comparisons between studies difficult. There has been little attempt to place theoretical proposals or data within the framework of existing psychological literature on identity. A number of assumptions critical to an understanding of homosexual identity are commonly made, and several of these are discussed: The synonymity of homosexual identity and self-concept: homosexual identity as childhood identity; homosexual identity as sexual identity; and homosexuality as a distinct essence. This review also considers the following issues: The distinction between identity and behavior; the utility of an identity construct as applied to the study of homosexuals; the definition of identity in developmental theories of homosexual identity; and homosexual group identity

Homosexual identity formation: Testing a theoretical model

Of late, researchers in the area of homosexuality have emphasized the study of homosexual identity formation. Several models have been put forward depicting the process of identity acquisition, but little attempt has been made to test either their accuracy or generality. The study outlined in this paper assesses the validity of several important aspects of my six-stage model of homosexual identity acquisition. To this end, a questionnaire was constructed to measure a number of factors believed to be critical to homosexual identity development. Responses of subjects at each stage were examined to ascertain the degree to which they corresponded with ideal stage descriptions predicted from the model. Results provided some support for the validity of these descriptions and. for the order of the stages. The data describe a four-stage, rather than a six-stage model. To check that these findings were not the result of researcher bias, a discriminant analysis was carried out. This indicated that the postulated six-stage groups could be distinguished. Ways of revising the scoring keys so as to maximize group differences are discussed. Both similarities and differences were apparent between male and female subjects, but the small sample limited the degree to which conclusions could be drawn about these. Implications of these findings for other models of homosexual identity formation are discussed