#15,903
Pandemics, like wars, have a lot in common. They both can exact a high toll in lives, disrupt economies, separate loved ones, and often leave behind a trail of broken and damaged survivors. Ironically, they both also tend to spark abrupt leaps in both science and medicine.While our COVID pandemic will eventually end, the ravages of this virus will continue in some of the survivors - perhaps for the rest of their lives - due to `Post' or `Long' COVID sequelae.
We've been following these concerns for roughly a year, as evidenced by this blog (see JAMA: Neurologic Manifestations Of Patients With Severe Coronavirus Disease) published in April of 2020. In the months that would follow we'd see mounting evidence of serious - and sometimes permanent - lung, cardiac, kidney, or neurological damage due to COVID infection.
Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young
JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury
Eurosurveillance: Reduced Maximal Aerobic Capacity After COVID-19 In Young Adult Recruits
JASN: Acute Kidney Injury In Hospitalized Patients With COVID-19
Additionally, a growing number of `recovered' COVID cases have reported a wide spectrum of chronic, and often debilitating symptoms - such as fatigue, recurrent fevers, `brain fog', myalgias, etc. - that are highly reminiscent of ME/CFS - which has disabled and traumatized well over a million Americans over the past 3 decades (see NIH About CFS/ME).
The burden of COVID-19 on society, even after the pandemic has ended, is likely to be heavy and prolonged one. Hopefully we'll do better by these casualties of this pandemic than we have with those who have suffered from ME/CFS, Post-Lyme Syndrome, and other post-viral syndromes.
One positive, early sign is that the CDC, the WHO, and other agencies have recognized and acknowledged that Post-COVID syndrome is real, although it may take years of study to understand it fully.
Yesterday, the CDC updated their POST-COVID Conditions webpage for the first time since November 13th (see below), after which I'll have the results of a UK Nationwide poll - conducted by their Office of National Statistics - on the self-reported incidence of `Long COVID' in the UK as of Early March.
Post-COVID Conditions
Updated Apr. 8, 2021
Although most people with COVID-19 get better within weeks to months of illness, some do not. CDC and experts around the world are working to learn more about short- and long-term health effects associated with COVID-19, who gets them, and why. CDC uses the term post-COVID conditions to describe health issues that persist more than four weeks after first being infected with the virus that causes COVID-19.
Experts do not know why or how often some people experience post-COVID conditions. Other infectious diseases can also cause longer-term symptoms for a variety of reasons. Some post-COVID conditions are likely to be similar to those seen in other infectious diseases, but others may be more specific to COVID-19. Some post-COVID conditions involve symptoms similar to those caused by other health problems. Scientists are actively investigating the causes of post-COVID conditions.
Types of Post-COVID Conditions
Long COVID
Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:
- Tiredness or fatigue
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Headache
- Loss of smell or taste
- Dizziness on standing
- Fast-beating or pounding heart (also known as heart palpitations)
- Chest pain
- Difficulty breathing or shortness of breath
- Cough
- Joint or muscle pain
- Depression or anxiety
- Fever
- Symptoms that get worse after physical or mental activities
Multiorgan Effects of COVID-19
Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. Multiorgan effects can also include conditions that occur after COVID-19, like multisystem inflammatory syndrome (MIS) and autoimmune conditions. MIS is a condition where different body parts can become swollen. Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing painful swelling in the affected parts of the body.
It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.
Effects of COVID-19 Treatment or Hospitalization
Post-COVID conditions also can include the longer-term effects of COVID-19 treatment or hospitalization. Some of these longer-term effects are similar to those related to hospitalization for other respiratory infections or other conditions.
Effects of COVID-19 treatment and hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that remain after a critical illness. These effects can include severe weakness and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.
Treatment
There are ways to help manage post-COVID conditions, and many patients with these symptoms are getting better with time. If you think you have a post-COVID condition, talk to your healthcare provider about options for managing or treating your symptoms and resources for support. Post-COVID care clinics are opening at medical centers across the United States to address patient needs.
The best way to prevent these long-term complications is to prevent COVID-19
Important Ways to Slow the Spread of COVID-19
- Wear a mask that covers your nose and mouth to help protect yourself and others.
- Stay 6 feet apart from others who don’t live with you.
- Get a COVID-19 vaccine when it is available to you.
- Avoid crowds and poorly ventilated indoor spaces.
- Wash your hands often with soap and water. Use hand sanitizer if soap and water aren’t available.
COVID-19 and Vaccination
CDC recommends that people be vaccinated regardless of whether they already had COVID-19. Learn more about vaccination.
Although media articles have reported that some people with long COVID say their symptoms improved after being vaccinated, studies are needed to determine the effects of vaccination on post-COVID conditions.
What CDC is Doing
CDC continues to work to identify how common these longer-term effects are, who is most likely to get them, and whether symptoms eventually resolve. Multi-year studies are underway to further investigate post-COVID conditions. These studies will help us better understand post-COVID conditions and understand how to treat patients with these longer-term effects.
While perhaps more speculation than science at this time, there are concerns expressed by some researchers that hidden sequelae from COVID infection may not become apparent for 5 or 10 years.
In the decade following the 1918 pandemic, the world saw an epidemic of neurological diseases like Encephalitis Lethargica and Parkinson's disease, and while a causal link to the pandemic has never been established, a viral infection is a likely culprit (see The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?)
Emily A. Troyer, Jordan N. Kohn, and Suzi Hong
Similarly, there are concerns that what appears to be minor heart damage today may, over time, progress into something more problematic.
Coronavirus Disease 2019 (COVID-19) and the Heart—Is Heart Failure the Next Chapter?Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3575
For now, even the scope of the problem is difficult to gauge, and we've seen estimates of as few as 1 in 10 cases and as high as 1 in 3 cases reporting long-lasting symptoms following COVID infection.
A recent large retrospective cohort study from the UK, published last week in The BMJ that fonds nearly 30% of patients hospitalized with COVID were rehospitalized within 140 days of release, and over 12% had died.
Rates that were (respectively) 3.5 and 7.7 times higher than matched controls.
But even non-hospitalized, mildly affected COVID cases report post-COVID syndrome. In an attempt to quantify the impact of `Long COVID' the UK's ONS has published their first analysis of both a study group of more than 20,000 participants, and a nationwide poll, that suggest a high degree of long-lasting sequelae from COVID-19.
The ONS estimates that more than 1 million residents are currently affected by Long COVID in the UK. I've only posted their summary, follow the link to read the analysis in full.
Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021
Estimates of the prevalence of self-reported "long COVID", and the duration of ongoing symptoms following confirmed coronavirus infection, using UK Coronavirus (COVID-19) Infection Survey data to 6 March 2021.
Main points
- Over the four-week period ending 6 March 2021, an estimated 1.1 million people in private households in the UK reported experiencing long COVID (symptoms persisting more than four weeks after the first suspected coronavirus (COVID-19) episode that are not explained by something else).
- The estimates presented in this analysis relate to self-reported long COVID, as experienced by study participants, rather than clinically diagnosed ongoing symptomatic COVID-19 or post-COVID-19 syndrome. There is no universally agreed definition of long COVID, but it covers a broad range of symptoms such as fatigue, muscle pain, and difficulty concentrating.
- Self-reported long COVID symptoms were adversely affecting the day-to-day activities of 674,000 people in private households in the UK, with 196,000 of these individuals reporting that their ability to undertake their day-to-day activities had been limited a lot.
- Of people with self-reported long COVID, 697,000 first had (or suspected they had) COVID-19 at least 12 weeks previously, and 70,000 first had (or suspected they had) COVID-19 at least one year previously.
- Prevalence rates of self-reported long COVID were greatest in people aged 35 to 69 years, females, those living in the most deprived areas, those working in health or social care, and those with a pre-existing, activity-limiting health condition; however, it is not possible to say whether these patterns are because of differences in the risk of coronavirus infection or susceptibility to experiencing long COVID following infection.
- These estimates provide a measure of the prevalence of self-reported long COVID across the whole population, and reflect both the risk of being infected with coronavirus and the risk of developing long COVID following infection; to investigate the second of these components, we examined the duration of self-reported symptoms following confirmed infection.
- Among a sample of over 20,000 study participants who tested positive for COVID-19 between 26 April 2020 and 6 March 2021, 13.7% continued to experience symptoms for at least 12 weeks. This was eight times higher than in a control group of participants who are unlikely to have had COVID-19, suggesting that the prevalence of ongoing symptoms following coronavirus infection is higher than in the general population.
(Continue . . . )
