While many of these `Long COVID' symptoms are relatively mild, and often resolve over a period of weeks or months, Post-COVID sequelae can also include far more serious cardiovascular, renal, pulmonary, neurological, and endocrine disorders.
As we discussed at some length on Friday in Neuron: Virus Exposure and Neurodegenerative Disease Risk Across National Biobanks, there is growing evidence linking viral illnesses (including COVID) to neurological manifestations and neurodegenerative diseases like Parkinson's and dementia.
And nearly a year ago, in Nature: Long-term Cardiovascular Outcomes of COVID-19 by Yan Xie, Evan Xu, Benjamin Bowe & Ziyad Al-Aly we looked at a study that described long-term cardiac damage among COVID survivors.
The Lancet: Neurological and Psychiatric Risk Trajectories After SARS-CoV-2 Infection
MMWR: Post–COVID-19 Symptoms and Conditions Among Children and Adolescents
Nature: Long COVID After Breakthrough SARS-CoV-2 Infection
BMJ: Elevated Risk Of Blood Clots Up To 6 Months After COVID Infection
Diabetologia: Incidence of Newly Diagnosed Diabetes After Covid-19
Beyond the individual impact of each of these post-COVID conditions is the collective cost to society as literally millions of people are disabled (either partially or fully), unable to work, and in dire need of medical and financial support.
Our response in the past - most recently with ME/CFS and Chronic Lyme Disease - has been to ignore the problem, and even ridicule and marginalize the patient. But that becomes harder to do as the number of cases increases.
While most people who are infected (or reinfected) with COVID won't develop serious sequelae, right now we don't know how big the impact will become over time.
A little over a week ago, the AMA released a statement (see What doctors wish patients knew about COVID-19 reinfection) calling reinfection `problematic' and equating it to `. . . playing Russian roulette" with the virus.
All of which brings us to a new research article, published this week in the CDC's EID Journal, that looks at the incidence of `Long COVID' in a university setting (faculty and students), and finds that more than 1/3rd (36%) of those who tested positive for COVID reported some post-acute sequelae.
Strikingly, this study cohort was quite young (median age 23), with most reporting no underlying health problems, and had never smoked.
While follow-up surveys were limited to 30-days post-infection, not everyone could be contacted, and recall bias may have impacted the results, the incidence of self-reported sequelae in such a young and reportedly healthy cohort is concerning.
I've only posted some excerpts from a much longer report, so follow the link to read it in its entirety. I'll have a postscript after the break.
Research
Postacute Sequelae of SARS-CoV-2 in University Setting
Megan Landry, Sydney Bornstein, Nitasha Nagaraj, Gary A. Sardon, Amanda Castel, Amita Vyas, Karen McDonnell, Mira Agneshwar, Alyson Wilkinson, and Lynn Goldman
Author affiliation: The George Washington University Milliken Institute School of Public Health, Washington DC, USA
Abstract
Postacute sequelae of SARS-CoV-2 infection, commonly known as long COVID, is estimated to affect 10% to 80% of COVID-19 survivors. We examined the prevalence and predictors of long COVID from a sample of 1,338 COVID-19 cases among university members in Washington, DC, USA, during July 2021‒March 2022.
Cases were followed up after 30 days of the initial positive result with confidential electronic surveys including questions about long COVID. The prevalence of long COVID was 36%.
Long COVID was more prevalent among those who had underlying conditions, who were not fully vaccinated, who were female, who were former/current smokers, who experienced acute COVID-19 symptoms, who reported higher symptom counts, who sought medical care, or who received antibody treatment.
Understanding long COVID among university members is imperative to support persons who have ongoing symptoms and to strengthen existing services or make referrals to other services, such as mental health, exercise programs, or long-term health studies.
It is estimated that 1 in 3 Americans who have SARS-CoV-2 infection will experience symptoms related to postacute sequelae of SARS-CoV-2 (1), also referred to as long COVID (other terms include long-haul coronavirus disease, post–-COVID-19 conditions, or chronic COVID-19) (2). The length of time that a person must experience symptoms to be considered to have long COVID is not universally accepted; definitions range from 28 days to 6 months after acute SARS-CoV-2 infection (3–7). A recent World Health Organization working group used a Delphi process to conclude that “a post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis” (8).
Regardless of a universally agreed upon length of time a person must experience symptoms to be characterized as long COVID, this sequela has been suggested to be the “next national health disaster” (9), and because of discrepancies in symptoms and long-term effects on quality of life, there seem to be more questions than answers. Although long COVID manifests differently in each person, nearly 50 signs and symptoms have been linked to the condition (10).
The most common signs and symptoms are fatigue, shortness of breath, muscle pain, joint pain, headache, cough, chest pain, altered smell, altered taste, and diarrhea (11). Other reported signs and symptoms include cognitive impairment (known as brain fog), memory loss, palpitations, anxiety, sore throat, sleep disorders, runny nose, sneezing, hoarseness, ear pain, thoughts of self-harm and suicide, seizures, and bladder incontinence (8,11), as well as cardiac effects, such as myocardial inflammation (12).
Although some investigators have reported that long COVID occurs at rates that are independent of symptom severity (11–13), others have found long COVID is more common among patients hospitalized for COVID-19 or those who experienced moderate-to-severe symptoms (6,11,14–20). However, long COVID has been observed in patients who were asymptomatic (2) or only experienced mild symptoms, and it has been reported that symptoms can fluctuate or relapse (7–8,21–23). Furthermore, little is known about long COVID signs and symptoms and predictors on a college campus, where most of the population is young and healthy, but among whom potential complications of long COVID could be detrimental to academic learning and overall quality of life.
(SNIP)
Discussion
This study aimed to examine the prevalence and predictors of long COVID in a university community. This sample was unique in that it consisted of primarily young adults who had few underlying health conditions and otherwise were considered healthy. Regardless of initial symptoms, nearly 36% of COVID-19 survivors in this study reported experiencing symptoms consistent with long COVID.That result is within ranges found in other studies reporting a prevalence of long COVID of anywhere from 10% to 80% among COVID-19 survivors (3–5,7,21,29–31). Our study also found an increased odds of reporting symptoms consistent with long COVID for each additional symptom reported during the initial infection. This finding is consistent with recent studies conducted with a high proportion of young adults that also found a higher number of acute symptoms during a COVID-19 infection predicted >1 long COVID symptom (32). Monitoring symptoms of initial cases could help identify persons at risk for long COVID.
Our study also found that persons who had the fewest previous COVID-19 vaccines and boosters were at higher risk for development of symptoms consistent with long COVID, supporting other investigations suggesting that vaccination is associated with reduced risk for long COVID (33–36). Many colleges and universities required the COVID-19 vaccine before the fall 2021 semester but offered reasonable medical/religious exemptions. Our results further highlight the need for routine short- and long-term follow-up for persons who test positive for COVID-19 while continuing to advocate and monitor for vaccine and booster adherence to published recommendations.
Although prevention efforts are needed for long COVID, the findings from this study support the need to ameliorate consequences of long COVID. Based on symptomatology, recovery strategies for long COVID include physical rehabilitation, management of preexisting conditions, mental health support, social services support, and exercise programs scaled to the ability of the patient (11,37). Because long COVID can greatly interfere with the ability to learn or work, classroom or job accommodations, such as modifying academic and workplace policies, flexible scheduling, changing workplace environment, enabling remote or alternative learning, and modifying job responsibilities, are recommended for those having long COVID.
(SNIP)Future research avenues should consider following up with long COVID survivors/patients to assess long-term or long-lasting symptoms. Such analysis could explore the consequences of long COVID for 5‒10 years after the initial infection, especially to gain a better understanding of its effect on young, healthy populations. Follow-up could also occur with older populations to assess whether symptoms progress into retirement and to determine the cost of long-term care resulting from long COVID. Furthermore, research should continue to examine the effect vaccine booster doses have on long COVID symptoms. Such research is vital to clarifying long-term effects of long COVID and how universities can support those dealing with long COVID to promote health and wellness across campus communities.
Dr. Landry is the project director for the Campus COVID-19 Support Team at the George Washington University, Washington, DC. Her primary research interests are public health surveillance and maternal and child health.
The $64 question is how big of a problem this is going to become. And frankly, we don't know, and may not know for 5 or 10 years.
But the early warning signs are there, and while everyone wants to move beyond the COVID emergency and treat COVID like `seasonal flu', we ignore them at our own peril.
