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  1. The Triumvirate

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An excellence of Thorax podcasts

What is the collective noun for a group of podcasts? A clamour? A babble? A colloquium? The collective noun for a collection of Thorax podcasts however is clear: an ‘excellence’. To listen to these excellent podcasts go to: https://soundcloud.com/bmjpodcasts/sets/thorax or check them out at your usual podcast provider. The chief interlocutor and curator of the collection is Rachael Moses, multimedia editor for Thorax and president-elect of the British Thoracic Society. In their own words, our authors explain why they are passionate about their work. Recent additions to the collection include: the effect of meat eating on childhood asthma; why wearing a mask still matters; and the link between hormonal contraception and asthma attacks—perfect for the commute to work or for a few minutes of lockdown distraction.

This month’s issue brings you prequels and sequels. What better vehicle to explore the sequelae of COVID-19 than the multitude of prequels and sequels that is the Star Wars franchise.

Phantom menace

The Phantom Menace was the first outing for Liam Neeson and Ewan McGregor in the franchise – Neeson as the Jedi knight and McGregor his apprentice. This month in Thorax, a phantom menace of another sort is explored by Arnold et al in a study from Bristol (see page 399). The menace in question is COVID-19. The sequel of this particular phantom menace was investigated at 12 weeks following symptom onset in 110 of 131 consecutive admissions who attended for follow-up. Three quarters had persistent symptoms, the most prevalent being breathlessness, fatigue and insomnia. Also in this issue, Mandal and colleagues report their findings at rather earlier follow-up—around 50 days after discharge following COVID-19 (see page 396). In this cohort of 384 patients, just over half report breathlessness, a third are coughing and over two thirds describe fatigue. The authors of both papers rightly emphasise the need for rehabilitation. Sadly Liam Neeson’s character was beyond rehabilitation, at the close of the Phantom Menace, when he is skewered by Darth Maul’s lightsaber.

Decoding Chewbacca, imaging and physiology

One of the enduring mysteries of Star Wars is whether (and if so how) Han Solo can understand the utterances of his side kick Chewbacca. Similarly, the findings of radiological and physiological tests require some translation. This was the challenge taken up by Shah et al (see page 402) in their study of the radiological and physiological sequelae in patients hospitalised with COVID-19 at 12 week follow-up. They find that 88% of 60 patients had an abnormal chest CT scan 12 weeks after COVID-19 symptoms began. There is an association between an oxygen requirement during the initial hospitalisation and carbon monoxide diffusion capacity (DLCO%) and total CT score. They stress the importance of long term respiratory follow-up. Long term follow-up is also a feature of the Star Wars franchise with 10 sequels following the original 1977 film.

I am your father…!

The mystery of the paternity of Luke Skywalker, persists until the end of ‘The Empire Strikes Back’. The mystery of why some patients remain breathless after COVID-19 is explored by Hall and colleagues in this month’s edition (see page 408). In follow-up of 200 hospitalised patients, they found a cardiorespiratory cause in 40% including persisting lung parenchymal abnormalities (64 patients), pulmonary embolism (4) and cardiac complications (8). The cause of breathlessness in the remaining 60% remains to be discovered but expect another plot twist!

From The Rise of Skywalker to Rogue Squadron

‘The Rise of Skywalker’ was the final sequel to the original Star Wars movie and completes the franchise. To complete the franchise of brief COVID-19 communications, we bring you the work of Stavem and colleagues from Norway (see page 405) who followed up a cohort of patients after COVID-19 who had not required admission to hospital. Invitations were sent to 938 patients and 451 took part. As you might expect, full recovery was more common in this group (over half were symptom free). However intrusive symptoms were still present in a substantial proportion: 16% were breathless, 12% had lost their sense of smell and 10% had abnormal taste. Persisting symptoms at follow-up were linked with more co-morbidities and multiple symptoms during acute COVID-19. However Star Wars follow-up may have slipped into immortal time bias – rumours of a further film (‘Rogue Squadron’) abound…

‘A long time ago in a galaxy far, far away.…’

The Star Wars films begin with an omniscient narration: ‘A long time ago in a galaxy far, far away.…’ A similar omniscient narration is provided by our editorial in this month’s Thorax: ‘COVID-19 and what comes after?’ (see page 324). The editorial puts our five brief communications in context and discusses the many remaining questions about the multiple COVID-19 sequels. Enjoy!

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