The Lancet: Persistence of Somatic Symptoms After COVID-19 in the Netherlands

#16,924

Although COVID vaccinations and a somewhat weaker Omicron variant have helped to reduce the risk of dying from SARS-CoV-2, we continue to see scores of studies and reports on the long-term health impact of COVID infection on those who survive the acute phase of their illness. 

Over the past 7 days we've looked at 3 studies on Post-COVID Syndrome (aka `Long COVID'):

MMWR: Post–COVID-19 Symptoms and Conditions Among Children and Adolescents

More Evidence On The Long-term Impact of SARS-CoV-2 Infection

BMJ: Prognosis and Persistence of Smell and Taste Dysfunction in Patients with Covid-19

Overnight The Lancet published a large population study from the Netherlands which attempts to define the `core' symptoms of `Long COVID', and finds roughly 1 in 8 COVID patients experiences at least one lingering symptom months, sometimes years, after their initial infection. 

The study was conducted between April 2020 and August 2021, so it does not reflect outcomes from the Omicron wave of the virus.  

Researchers identified 23 somatic symptoms (chest pain, difficulties breathing, pain when breathing, painful muscles, loss of taste and smell, tingling extremities, lump in throat, feeling hot and cold, heavy arms or legs, and general tiredness, etc.) frequently associated with `Long COVID'. 

Cognitive problems, and mental health issues, were not tracked as part of this study, and will require additional research. 

The study found that 12.7% of participants experienced increase severity of at least one core symptom in the weeks and months following infection.  You'll find the link and abstract below, but this is a lengthy and detailed report, which you'll want to read in its entirety. 

Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study

Aranka V Ballering, Sander K R van Zon, Tim C olde Hartman, Judith G M Rosmalen, for the Lifelines Corona Research Initiative* 

Summary 

Background 

Patients often report various symptoms after recovery from acute COVID-19. Previous studies on postCOVID-19 condition have not corrected for the prevalence and severity of these common symptoms before COVID-19 and in populations without SARS-CoV-2 infection. We aimed to analyse the nature, prevalence, and severity of longterm symptoms related to COVID-19, while correcting for symptoms present before SARS-CoV-2 infection and controlling for the symptom dynamics in the population without infection.

Methods 

This study is based on data collected within Lifelines, a multidisciplinary, prospective, population-based, observational cohort study examining the health and health-related behaviours of people living in the north of the Netherlands. All Lifelines participants aged 18 years or older received invitations to digital COVID-19 questionnaires. Longitudinal dynamics of 23 somatic symptoms surrounding COVID-19 diagnoses (due to SARS-CoV-2 alpha [B.1.1.7] variant or previous variants) were assessed using 24 repeated measurements between March 31, 2020, and Aug 2, 2021. Participants with COVID-19 (a positive SARS-CoV-2 test or a physician’s diagnosis of COVID-19) were matched by age, sex, and time to COVID-19-negative controls. We recorded symptom severity before and after COVID-19 in participants with COVID-19 and compared that with matched controls. 

Findings 

76422 participants (mean age 53∙7 years [SD 12∙9], 46 329 [60∙8%] were female) completed a total of 883 973 questionnaires. Of these, 4231 (5∙5%) participants had COVID-19 and were matched to 8462 controls. Persistent symptoms in COVID-19-positive participants at 90–150 days after COVID-19 compared with before COVID-19 and compared with matched controls included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. In 12∙7% of patients, these symptoms could be attributed to COVID-19, as 381 (21∙4%) of 1782 COVID-19-positive participants versus 361 (8∙7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90–150 days after COVID-19 diagnosis or matched timepoint. 

Interpretation 

To our knowledge, this is the first study to report the nature and prevalence of post-COVID-19 condition, while correcting for individual symptoms present before COVID-19 and the symptom dynamics in the population without SARS-CoV-2 infection during the pandemic. Further research that distinguishes potential mechanisms driving post-COVID-19-related symptomatology is required

 

The Lancet has also published the following related comment:

Long COVID: which symptoms can be attributed to SARS-CoV-2 infection?

Christopher E Brightling Rachael A Evans

Published:August 06, 2022 DOI:https://doi.org/10.1016/S0140-6736(22)01385-X

Despite the attempt to trivialize the virus, COVID infection for millions of people is more than a week's bout with a nasty virus.  For far too many, it is a life-changing event.