Slide From June 17th CDC COCA Call on `Post-COVID' Syndrome
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For more than a year we've been following reports of persistent sequelae resulting from COVID infection. While the case fatality rate remains moderately low (1%-2%), many COVID patients have `recovered' with permanent damage, due to pulmonary embolisms, thrombotic events, strokes, kidney damage, and heart attacks.
While less dramatic, others have reported `brain fog', fatigue, and other debilitating symptoms lingering long after the virus had cleared their body.
In early July of 2020, Dr. Anthony Fauci expressed concerns that many COVID patients were suffering from a post-viral syndrome - similar to ME/CFS - which has disabled and traumatized as many as two and half million Americans over the past 3 decades (see NIH About CFS/ME).
Often dubbed `Long COVID', this post-COVID syndrome is poorly understood, and is likely due to more than just one cause. The CDC describes these conditions as:
Updated July 12, 2021LanguagesThis information is intended for a general audience. Healthcare providers should see the Post-COVID Conditions: Information for Healthcare Providers webpage and the interim guidance on evaluating and caring for patients with post-COVID conditions for more detailed information.OverviewAlthough most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19. Even people who did not have COVID-19 symptoms in the days or weeks after they were infected can have post-COVID conditions. These conditions can have different types and combinations of health problems for different lengths of time.These post-COVID conditions may also be known as long COVID, long-haul COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID. 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.Types of Post-COVID ConditionsNew or Ongoing SymptomsSome people are experiencing a range of new or ongoing symptoms that can last weeks or months after first being infected with the virus that causes COVID-19. Unlike some of the other types of post-COVID conditions that only tend to occur in people who have had severe illness, these symptoms can happen to anyone who has had COVID-19, even if the illness was mild, or if they had no initial symptoms. People commonly report experiencing different combinations of the following symptoms:
- Difficulty breathing or shortness of breath
- Tiredness or fatigue
- Symptoms that get worse after physical or mental activities
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Cough
- Chest or stomach pain
- Headache
- Fast-beating or pounding heart (also known as heart palpitations)
- Joint or muscle pain
- Pins-and-needles feeling
- Diarrhea
- Sleep problems
- Fever
- Dizziness on standing (lightheadedness)
- Rash
- Mood changes
- Change in smell or taste
- Changes in period cycles
Exactly what percentage of people experience `Long COVID' symptoms, and its incidence following mild vs. severe illness, remains largely unquantified, although early studies suggest both of those numbers are significant (see Characterizing long COVID in an international cohort: 7 months of symptoms and their impact).
Late this week the CDC published a new round of COVID science updates, with the first two studies focusing on persistent COVID Symptoms. I've included some brief excerpts, but you'll want to follow the link to read them in their entirety.
COVID-19 Science Update released: July 16, 2021 Edition 98
A. Persistent symptoms in adult patients one year after COVID-19: a prospective cohort study
Seeßle et al. Clinical Infectious Diseases. (July 5, 2021).
Key findings:Methods: Prospective cohort study tracked symptoms, quality of life, and antibody levels in 96 patients in Germany treated for acute COVID-19 between February 22, 2020 and April 18, 2020. Both in- and outpatients were enrolled.
- 77.1% of patients reported 1 or more COVID-19 symptoms persisting up to 12 months post infection.
- 56.3% reported reduced exercise capacity, 53.1% fatigue, 37.5% trouble breathing and 39.6% concentration problems (Figure).
- At 12 months post COVID-19 symptom onset, antinuclear antibody (ANA) titers were ≥1:160 in 43.6% of patients.
- Women with ANA titers ≥1:160 had a higher frequency of problems concentrating compared with than those with lower titers (66.7% vs. 26.1%).
Limitations: 50 patients of the original 146 were lost to follow-up after 5 months, which may lead to overestimation of symptom frequency at 12 months if those lost to follow-up had fewer symptoms.
(Continue . . . )
Nehme et al. Annals of Internal Medicine (July 6, 2021).
Key findings:
- 44% (95% CI 39.5-48.6%) of COVID-19 outpatients (n = 479) reported symptoms 30–45 days post-diagnosis; 39% (95% CI 34.3-43.9%) reported symptoms at 7–9 months (n = 410).
- Fatigue was the most common symptom (20.7%, 95% CI 16.9-25.0%) 7-9 months after diagnosis.
- Most participants with symptoms 7–9 months post-diagnosis categorized them as mild to moderate in severity (Figure).
Methods: Between March 18 and May 15, 2020, 629 symptomatic SARS-Cov-2 positive outpatients in Geneva, Switzerland were enrolled in a follow-up program, reporting COVID-19 symptoms at the time of diagnosis, 30–45 days post-diagnosis and 7–9 months post-diagnosis using a Likert scale for intensity of symptoms. Limitations: Only 65.2% of the initial cohort completed the follow-up survey at 7–9 months post-diagnosis.
Note: Adapted from Nehme et al. COVID-19 symptoms among outpatients 7–9 months following diagnosis. Total number of patients reporting symptoms is listed. Fatigue and dyspnea were stratified into Grade 0 through Grade 4, with 0 representing little impact of these symptoms to 4 representing disability. All other symptoms were defined as being Mild, Moderate, or Severe. Permission request in progress.
Implications for Seeßle et al. and Nehme et al.: Symptoms can remain for months after initial COVID-19 diagnosis. Healthcare systems may have increased burden from persistent symptoms in COVID-19 patients.
Beyond known `Long COVID' there are also concerns that COVID survivors may be susceptible to a number of neurological, pulmonary, cardiac, and renal complications over the next 5 to 10 years. A few papers include:
Emily A. Troyer, Jordan N. Kohn, and Suzi Hong
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
Review Article: Parkinsonism as a Third Wave of the COVID-19 Pandemic?
While some people apparently look at the +98% survival rate of COVID patients and deem it to be a relatively innocuous disease in all but the elderly and infirmed, the reality is that a mild COVID infection - even in a young and previously healthy individual - can lead to persistent, perhaps even chronic, sequelae.
While we probably won't begin to know the full impact of Long COVID for some time, these are all good reasons to do whatever you can (wear face covers, avoid crowds, get vaccinated) to prevent COVID infection - even if you are young and healthy - and you consider your odds of dying to be infinitesimally low.
