As inconvenient as it may be for a COVID-weary society, the evidence continues to mount that a significant percentage of people who get - and `recover' from - a SARS-CoV-2 infection, experience long-term, and sometimes even permanent health issues.
Worse, evidence suggests that subsequent reinfections increase the odds of developing post-COVID sequelae (see Nature: Acute and Postacute Sequelae Associated with SARS-CoV-2 Reinfection).
During the spring of 2020 we saw initial reports of neurological symptoms among 1/3rd of a cohort of hospitalized patients in China (see JAMA: Neurologic Manifestations Of Patients With Severe Coronavirus Disease).
Neurological manifestations ranged from relatively mild (headaches, dizziness, anosmia, mild confusion, etc.) to more profound (seizures, stupor, loss of consciousness, etc.) to potentially fatal (ischemic stroke, cerebral hemorrhage, muscle injury (rhabdomyolysis), etc.).
This was followed in June of 2020 by a JAMA original investigation which found a 3-fold increase in out-of-hospital cardiac arrests in New York City during the peak of their spring COVID-19 epidemic, finding:
From March 1 to April 25, 2020, New York City, New York (NYC), reported 17 118 COVID-19–related deaths. On April 6, 2020, out-of-hospital cardiac arrests peaked at 305 cases, nearly a 10-fold increase from the prior year.
The following month, in JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury, we saw physical evidence of cardiac injury due to COVID infection, even among a relatively young cohort of previously healthy adults.
Since then we've seen a long procession of studies, all finding that for a significant portion of COVID survivors - even those who had mild illness - there are lingering, and sometimes permanent, health consequences. A small sampling includes:
To this list we can add another study, published today in Nature Comms, on long-term gastrointestinal issues in COVID survivors. After which we'll look at press release on an unpublished study on recurrent chest pain in COVID survivors.
I've only posted the Abstract, follow the link to read it in its entirety.
Long-term gastrointestinal outcomes of COVID-19
Nature Communications 14, Article number: 983 (2023)
In a similar post-COVID vein, we also have a press release on a study, presented at the American College of Cardiology’s 2023 Scientific Conference in New Orleans over the weekend, that finds increased reports of chest pain in those infected with COVID.A comprehensive evaluation of the risks and 1-year burdens of gastrointestinal disorders in the post-acute phase of COVID-19 is needed but is not yet available. Here we use the US Department of Veterans Affairs national health care databases to build a cohort of 154,068 people with COVID-19, 5,638,795 contemporary controls, and 5,859,621 historical controls to estimate the risks and 1-year burdens of a set of pre-specified incident gastrointestinal outcomes.
We show that beyond the first 30 days of infection, people with COVID-19 exhibited increased risks and 1-year burdens of incident gastrointestinal disorders spanning several disease categories including motility disorders, acid related disorders (dyspepsia, gastroesophageal reflux disease, peptic ulcer disease), functional intestinal disorders, acute pancreatitis, hepatic and biliary disease.
The risks were evident in people who were not hospitalized during the acute phase of COVID-19 and increased in a graded fashion across the severity spectrum of the acute phase of COVID-19 (non-hospitalized, hospitalized, and admitted to intensive care). The risks were consistent in comparisons including the COVID-19 vs the contemporary control group and COVID-19 vs the historical control group as the referent category.
Altogether, our results show that people with SARS-CoV-2 infection are at increased risk of gastrointestinal disorders in the post-acute phase of COVID-19. Post-covid care should involve attention to gastrointestinal health and disease.
(Continue . . . )
Reports and Proceedings
INTERMOUNTAIN HEALTHCARE
IMAGE: EVEN PATIENTS WITH MILD COVID-19 INFECTIONS CAN SUFFER FROM HEALTH COMPLICATIONS FOR MONTHS, EVEN YEARS, POST INFECTION. NEARLY 19% OF U.S. ADULTS WHO HAD PREVIOUSLY TESTED POSITIVE FOR COVID-19 REPORT HAVING “LONG COVID,” WHERE THEY EXPERIENCE SIGNS AND SYMPTOMS FOR FOUR WEEKS OR MORE AFTER THE INITIAL PHASE OF INFECTION. IN AN EFFORT TO QUANTIFY WHAT LONG COVID MEANS NOW, AND COULD MEAN IN THE FUTURE FOR THESE PATIENTS, RESEARCHERS FROM INTERMOUNTAIN HEALTH IN SALT LAKE CITY STUDIED NEARLY 150,000 PATIENTS FOR CARDIOVASCULAR SYMPTOMS. THEY FOUND THAT PATIENTS WHO TESTED POSITIVE FOR COVID-19 HAD HIGHER RATES OF CHEST PAIN IN THE SIX MONTHS TO A YEAR AFTER THE INFECTION. view more
CREDIT: INTERMOUNTAIN HEALTH
Even patients with mild COVID-19 infections can suffer from health complications for months, even years, post infection. Nearly 19% of U.S. adults who had previously tested positive for COVID-19 report having “Long COVID,” where they experience signs and symptoms for four weeks or more after the initial phase of infection.
In an effort to quantify what Long COVID means now, and could mean in the future for these patients, researchers from Intermountain Health in Salt Lake City studied nearly 150,000 patients for cardiovascular symptoms.
They found that patients who tested positive for COVID-19 had higher rates of chest pain in the six months to a year after the infection.
“Many COVID-19 patients experience symptoms well beyond the acute phase of infection,” said Heidi T. May, PhD, cardiovascular epidemiologist at Intermountain Health and principal investigator of the study. “While we didn’t see any significant rates of major events like heart attack or stroke in patients who had an initial mild initial infection, we did find chest pains to be a persistent problem, which could be a sign of future cardiovascular complications.”
Results of the Intermountain study were presented at the American College of Cardiology’s 2023 Scientific Conference in New Orleans on March 5.
In the large retrospective study, researchers compared three groups of Intermountain Health patients:
• 148,158 people ages 18 and up who tested positive for COVID and treated in an outpatient setting from March 2020 to December 31, 2021.
• 148,158 Intermountain COVID negative patients of about the same age and gender, seen in the same months, as those who tested positive for COVID-19.
• 148,158 patients seen between January 1, 2018, and August 31, 2019, as a historical control, to account for how patients accessed healthcare different during the worst of the pandemic.
The Intermountain research team found that at six months and one-year intervals, patients who tested positive for COVID-19 had significantly higher rates of experiencing chest pain, but saw no other increases in cardiovascular events.
“As of right now, the symptoms aren’t necessary translating into hard outcomes, but that’s something that will need to be reassessed over time,” Dr. May said. “It could be that lasting effects of infection on the cardiovascular system are hard to quantify in terms of diagnoses or other events in the short-term and won’t be realized until longer follow up.”###
Two months 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 makes COVID an infection worth avoiding if at all possible.
While there are hopeful signs that the COVID threat - at least for the moment - is receding, its impact on public health is something that individuals, doctors - and ultimately society - will have to deal with for years to come.
