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At-Home Telemedicine Controlled taVNS Twice Daily for 4 weeks is Feasible and Safe for Long COVID Symptoms.

      Abstract
      Coronavirus disease of 2019 (COVID-19) can enter and directly infect the brain, creating several neurologic and psychiatric symptoms. Some have coined the term ‘Long Covid’ to describe this direct CNS infection and damage and differentiate this aspect of the disease from the more widely discussed systemic pulmonary and cardiovascular effects. Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive alternative to implanted VNS and both may have anti-inflammatory effects. We wanted to test whether we could administer taVNS entirely at home to long Covid patients using online recruitment and screening and then training and monitoring them through telemedicine platforms.
      We enrolled 13 subjects (mean age 48.5±11.3, 8 female) with long COVID symptoms. Subjects received two treatment sessions/day, 6 days per week, for 2 weeks (randomized) followed by 2 weeks open label (active). Each treatment session lasted 60 minutes. Subjects thus received either 24 or 48 active taVNS sessions over 4 weeks. Subjects were provided videos showing how to use the devices included in the treatment kit and were trained and monitored prior to self-administering.
      Subjects were able to self-administer taVNS with 1 training session (i.e., session with no stimulation) and 4 monitored treatment sessions. The mean stimulation perceptual threshold was 0.3mA ±0.1mA, with treatment mean at 0.6mA ±0.2mA. Two subjects reported minor and transient skin irritation around the tragus. There were no dropouts. For the first four sessions, patients were monitored for blood pressure, heart rate, and respirations. There were no problems with syncope or lowered heart rate or blood pressure. Clinical outcomes are presented in a separate poster (Austelle et al.).
      This double-blind, at home taVNS treatment pilot study demonstrates that it is feasible and safe to train long Covid subjects to self-administer taVNS solely at home.
      Keywords: taVNS, COVID-19, telemedicine