Tag: long covid prevalence

Post-COVID Syndrome

Abstract:

Background: As defined by the WHO, the term post-COVID syndrome (PCS) embraces a group of symptoms that can occur following the acute phase of a SARS-CoV-2 infection and as a consequence thereof. PCS is found mainly in adults, less frequently in children and adolescents. It can develop both in patients who initially had only mild symptoms or none at all and in those who had a severe course of coronavirus disease 2019 (COVID-19).

Methods: The data presented here were derived from a systematic literature review.

Results: PCS occurs in up to 15% of unvaccinated adults infected with SARS-CoV-2. The prevalence has decreased in the most recent phase of the pandemic and is lower after vaccination. The pathogenesis of PCS has not yet been fully elucidated. Virus triggered inflammation, autoimmunity, endothelial damage (to blood vessels), and persistence of virus are thought to be causative. Owing to the broad viral tropism, different organs are involved and the symptoms vary. To date, there are hardly any evidence-based recommendations for definitive diagnosis of PCS or its treatment.

Conclusion: The gaps in our knowledge mean that better documentation of the prevalence of PCS is necessary to compile the data on which early detection, diagnosis, and treatment can be based. To ensure the best possible care of patients with PCS, regional PCS centers and networks embracing existing structures from all healthcare system sectors and providers should be set up and structured diagnosis and treatment algorithms should be established. Given the sometimes serious consequences of PCS for those affected, it seems advisable to keep the number of SARS-CoV-2 infections low by protective measures tailored to the prevailing pandemic situation.

Source: Hallek M, Adorjan K, Behrends U, Ertl G, Suttorp N, Lehmann C. Post-COVID Syndrome. Dtsch Arztebl Int. 2023 Jan 27;120(4):48-55. doi: 10.3238/arztebl.m2022.0409. PMID: 36633452; PMCID: PMC10060997. https://www.aerzteblatt.de/int/archive/article/229208 (Full text)

Pooled Prevalence of Long COVID-19 Symptoms at 12 Months and Above Follow-Up Period: A Systematic Review and Meta-Analysis

Abstract:

Current data suggests that coronavirus disease 2019 (COVID-19) survivors experience long-lasting problems. It is not yet understood how long these symptoms last. The goal of this study was to compile all the data that was currently available to evaluate COVID-19’s long-term effects at 12 months and above.

We looked for studies published by December 15, 2022, in PubMed and Embase that discussed follow-up findings for COVID-19 survivors who had been alive for at least a year. A random-effect model was carried out to determine the combined prevalence of different long-COVID symptoms. The Joanna Briggs Institute tool was used to assess the risk of bias for the included studies, and the I2 statistics were used to evaluate the heterogeneity. After reviewing 3,209 studies, 46 were deemed admissible, with an aggregate COVID-19 population of 17976.

At 12 months and above, 57% of patients reported a minimum of one symptom, and the five most prevalent symptoms were: dyspnea on exertion (34%, 95% CI 0.2; 0.94); difficulty in concentration (32%, 95% CI 0.16; 0.52); fatigue (31%, 95% CI 0.22; 0.40); frailty (31%, 95% CI 0.06; 0.78); and arthromyalgia (28%, 95% CI 0.09; 0.6). The findings of the present study showed that at 12 months and beyond, a sizable fraction of COVID-19 survivors still have lasting symptoms that impair several body systems. Long-COVID patients require an urgent understanding of pathophysiological processes and the development of tailored treatments.

Source: Mudgal S K, Gaur R, Rulaniya S, et al. (March 18, 2023) Pooled Prevalence of Long COVID-19 Symptoms at 12 Months and Above Follow-Up Period: A Systematic Review and Meta-Analysis. Cureus 15(3): e36325. doi:10.7759/cureus.36325 https://www.cureus.com/articles/143288-pooled-prevalence-of-long-covid-19-symptoms-at-12-months-and-above-follow-up-period-a-systematic-review-and-meta-analysis#!/ (Full text)

Epidemiological and clinical perspectives of long COVID syndrome

Abstract:

Long COVID, or post-acute COVID-19 syndrome, is characterized by multi-organ symptoms lasting 2+ months after initial COVID-19 virus infection. This review presents the current state of evidence for long COVID syndrome, including the global public health context, incidence, prevalence, cardiopulmonary sequelae, physical and mental symptoms, recovery time, prognosis, risk factors, rehospitalization rates, and the impact of vaccination on long COVID outcomes. Results are presented by clinically relevant subgroups.

Overall, 10-35% of COVID survivors develop long COVID, with common symptoms including fatigue, dyspnea, chest pain, cough, depression, anxiety, post-traumatic stress disorder, memory loss, and difficulty concentrating. Delineating these issues will be crucial to inform appropriate post-pandemic health policy and protect the health of COVID-19 survivors, including potentially vulnerable or underrepresented groups. Directed to policymakers, health practitioners, and the general public, we provide recommendations and suggest avenues for future research with the larger goal of reducing harms associated with long COVID syndrome.

Source: Huerne K, Filion KB, Grad R, Ernst P, Gershon AS, Eisenberg MJ. Epidemiological and clinical perspectives of long COVID syndrome. Am J Med Open. 2023 Jun;9:100033. doi: 10.1016/j.ajmo.2023.100033. Epub 2023 Jan 18. PMID: 36685609; PMCID: PMC9846887. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846887/ (Full text)

Long-COVID Rates Vary Throughout the SARS-CoV-2 Pandemic

Abstract:

The infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) frequently causes a broad range of long-lasting symptoms. This condition, termed long-COVID, influences everyday life of affected individuals in many ways and causes a high economic burden. There is urgent need to obtain better understanding of the risk factors that contribute to the development of long-COVID.

Aim of this study was to investigate the long-COVID rate of supposedly healthy adults during different phases of the pandemic. Therefore, 71,670 blood donations were screened for SARS-CoV-2 total anti-N antibodies between 5 th June 2020 and 30 th November 2022. 351 individuals could be recruited for our study to monitor long-COVID symptoms and their duration. Despite immense worldwide efforts to stop virus dissemination, our data reveal a constantly rising SARS-CoV-2 anti-N seroprevalence rate in Salzburg, Austria, peaking at 84.9% in October 2022.

In addition, our data demonstrate varying rates of long-COVID in the course of the pandemic. While long-COVID rates were about 20% for the time span between March 2020 and August 2021, long-COVID was reported by 12% for infections from September 2021 to August 2022. This could be attributed to different virus variants, but also to increasing vaccination rates. We further found that long-COVID symptoms decline over time: while 18% of our study participants described persisting symptoms 3 months after the seropositive blood donation, 14% reported persisting symptoms 9 months afterwards and 3% after 18 months.

In conclusion, our data reveal that long-COVID symptoms may persist for more than a year after a SARS-CoV-2 infection and that long-COVID rates are varying in the course of the SARS-CoV-2 pandemic.

Source: Nunhofer, et al. Long-COVID Rates Vary Throughout the SARS-CoV-2 Pandemic. Journal of Infectious Diseases & Therapy. Volume 11 • Issue 01 • 1000520. ISSN: 2332-0877.  https://www.researchgate.net/profile/Sandra-Laner-Plamberger/publication/368293143_Long-COVID_Rates_Vary_Throughout_the_SARS-CoV-2_Pandemic/links/63e0dd9062d2a24f920a4d24/Long-COVID-Rates-Vary-Throughout-the-SARS-CoV-2-Pandemic.pdf (Full text)

Epidemiology, symptomatology, and risk factors for long COVID symptoms: Multi-centre study

Abstract:

Background: Long COVID induces a substantial global burden of disease. The pathogenesis, complications, epidemiological and clinical characteristics of COVID-19 patients in the acute phase have been evaluated, while few studies have characterized the epidemiology, symptomatology and risk factors of long COVID symptoms. Its characteristics among coronavirus disease 2019 (COVID-19) patients in the general population remain unaddressed.

Objective: We examined the prevalence of long COVID symptoms, its symptom patterns, and its risk factors. we aimed to fill the knowledge gaps by evaluating the prevalence of long COVID symptoms in four major Chinese cities.

Methods: We performed a population-based, multi-centre survey by a representative sampling strategy via the Qualtrics platform in Beijing, Shanghai, Guangzhou and Hong Kong (June 2022). We included 2,712 community-dwelling, COVID-19 patients, and measured the prevalence of long COVID symptoms defined by the WHO, and their risk factors. The primary outcomes were the symptoms of long COVID with various levels of impact. A descriptive analysis was conducted on the prevalence and distribution of the long COVID symptoms according to disease severity. A sensitivity analysis of increasing the number of long COVID symptoms was also conducted. A univariate and multivariate regression analysis was performed to examine the risk factors of severe long COVID symptoms, including age, gender, marital status, current occupation, educational level, living status, smoking habits, monthly household income, self-perceived health status, presence of chronic diseases, use of chronic medication, COVID-19 vaccination status, and severity of COVID-19.

Results: The response rate was 63.6%. The prevalence of long COVID, moderate or severe long COVID, and severe long COVID was 90.4%, 62.4%, and 31.0%, respectively. Fatigue (33.7%), cough (31.9%), sore throat (31.0%), difficulty in concentration (30.5%), feeling of anxiety (30.2%), myalgia (29.9%), and arthralgia (29.9%) were the most common severe long COVID symptoms. From multivariate regression analysis, female gender (adjusted odds ratio [aOR]=1.49, 95% C.I.=1.13-1.95), engagement in transportation, logistics, or discipline workforce (aOR=2.52, 95% C.I.=1.58-4.03), living with domestic workers (aOR=2.37, 95% C.I.=1.39-4.03), smoking (aOR=1.55, 95% C.I.=1.17-2.05), poor self-perceived health status (aOR 5.06 to 15.38), chronic diseases (aOR 1.92 to 2.71), chronic medication use (aOR=4.38, 95% C.I.=1.66-11.53), and critical severity of COVID-19 (aOR=1.52, 95% C.I.=1.07-2.15) were associated with severe long COVID. Prior vaccination for ≥2 doses of COVID-19 was a protective factor (aOR=0.35-0.22, 95% C.I.=0.08-0.90).

Conclusions: We have examined the prevalence of long COVID symptoms in four Chinese cities according to the severity of COVID-19. We also evaluated the pattern of long COVID symptoms, and their risk factors. These findings may inform early identification of COVID-19 patients at risk of long COVID and planning of rehabilitative services.

Source: Wong MC, Huang J, Wong NY, Wong GL, Yip TC, Chan RN, Chau SW, Ng SC, Wing YK, Chan FK. Epidemiology, symptomatology, and risk factors for long COVID symptoms: Multi-centre study. JMIR Public Health Surveill. 2023 Jan 12. doi: 10.2196/42315. Epub ahead of print. PMID: 36645453. https://pubmed.ncbi.nlm.nih.gov/36645453/

“Living like an empty gas tank with a leak”: Mixed methods study on post-acute sequelae of COVID-19

Abstract:

Background: The burden and presentation of post-acute sequela of SARS-CoV-2 infection (PASC) are a developing major public health concern.

Objectives: To characterize the burden of PASC in community-dwelling individuals and understand the experiences of people living with PASC.

Methods: This mixed-methods study of COVID-19 positive community-dwelling persons involved surveys and in-depth interviews. Main outcome was self-report of possible PASC symptoms 3 weeks or longer after positive COVID-19 test. In-depth interviews were guided by a semi-structured interview guide with open-ended questions and probes based on emerging literature on PASC and the impact of COVID-19.

Results: With a survey response rate of 70%, 442 participants were included in this analysis, mean (SD) age 45.4 (16.2) years, 71% female, 12% Black/African American. Compared to those with no PASC symptoms, persons who reported PASC symptoms were more likely to be older (mean age: 46.5 vs. 42; p = 0.013), female (74.3% vs. 61.2%; p = 0.010), to have pre-existing conditions (49.6% vs. 34%; p = 0.005), and to have been hospitalized for COVID-19 (14.2% vs. 2.9%; p = 0.002). About 30% of the participants experienced severe fatigue; the proportion of persons reporting severe fatigue was 7-fold greater in those with PASC symptoms (Adjusted Prevalence Ratio [aPR] 6.73, 95%CI: 2.80-16.18). Persons with PASC symptoms were more likely to report poor quality of life (16% vs. 5%, p<0.001) and worse mental health functioning (Mean difference: -1.87 95%CI: -2.38, -1.37, p<0.001). Themes from in-depth interviews revealed PASC was experienced as debilitating.

Conclusions: In this study, the prevalence of PASC among community-dwelling adults was substantial. Participants reported considerable coping difficulties, restrictions in everyday activities, invisibility of symptoms and experiences, and impediments to getting and receiving PASC care.

Source: Ogungbe O, Slone S, Alharthi A, Tomiwa T, Kumbe B, Bergman A, McNabb K, Smith Wright R, Farley JE, Dennison Himmelfarb CR, Cooper LA, Post WS, Davidson PM, Commodore-Mensah Y. “Living like an empty gas tank with a leak”: Mixed methods study on post-acute sequelae of COVID-19. PLoS One. 2022 Dec 30;17(12):e0279684. doi: 10.1371/journal.pone.0279684. PMID: 36584125; PMCID: PMC9803174. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9803174/ (Full text)

Prevalence of Post–COVID-19 Conditions Depends on the Method of Assessment

To the Editor—In their systematic review and meta-analysis on the global prevalence of long coronavirus disease 2019 (COVID-19), Chen et al report that a significant share of patients with COVID-19 suffer from sequelae of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection [1]. The authors performed a database search in PubMed, Embase, and iSearch and included 50 studies comprising hospitalized and nonhospitalized patients from the Americas, Europe, and Asia, of which 41 studies were meta-analyzed. The estimated pooled prevalence of a post–COVID-19 condition was 0.43 (95% confidence interval, .39–.46) [1].

Concerning a post–COVID-19 condition, or long COVID, and their global burden of disease, we think it is important to bear in mind that many studies (including our own [2], which was in the meta-analysis) assess long COVID symptoms via self-report/questionnaires. Self-reported outcomes do not necessarily match clinical reports that are based on physical and/or technical examinations. Thus, there is a difference between functional impairment based on objective medical findings and self-estimation, giving rise to potential detection bias, as the authors briefly mention in the supplement. Moreover, possible bias through elevated media attention, resulting in potentially altered response behavior, must be considered.

Making causal links between nonspecific symptoms, such as dizziness, headache, or fatigue, to SARS-CoV-2 or acute COVID-19 remains challenging [3]. Furthermore, precise pathophysiological mechanisms underlying specific long COVID symptoms have not been fully elucidated [4, 5]. Fatigue, for example, is associated with several chronic conditions and its prevalence in the population is estimated to be in the same range as found in SARS-CoV-2 cases in the present meta-analysis [6]. With regard to the World Health Organization definition, a post–COVID-19 condition may represent a diagnosis per exclusion in many cases [7]. Nonetheless, even if the prevalence of long COVID was overestimated in the underlying studies, COVID-19 sequelae pose a considerable burden on health, social insurance systems, and economies worldwide given the high attack rate of SARS-CoV-2 [8].

Source: Lampl BMJ, Leitzmann MF, Salzberger B. Prevalence of Post-COVID-19 Conditions Depends on the Method of Assessment. J Infect Dis. 2023 Jan 11;227(2):306. doi: 10.1093/infdis/jiac467. PMID: 36546758. https://academic.oup.com/jid/article/227/2/306/6853665 (Full text)

The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis

Abstract:

Background: The aim of this study was to systematically synthesise the global evidence on the prevalence of persistent symptoms in a general post COVID-19 population.

Methods: A systematic literature search was conducted using multiple electronic databases (MEDLINE and The Cochrane Library, Scopus, CINAHL, and medRxiv) until January 2022. Studies with at least 100 people with confirmed or self-reported COVID-19 symptoms at ≥28 days following infection onset were included. Patient-reported outcome measures and clinical investigations were both assessed. Results were analysed descriptively, and meta-analyses were conducted to derive prevalence estimates. This study was pre-registered (PROSPERO-ID: CRD42021238247).

Findings: 194 studies totalling 735,006 participants were included, with five studies conducted in those <18 years of age. Most studies were conducted in Europe (n = 106) or Asia (n = 49), and the time to follow-up ranged from ≥28 days to 387 days. 122 studies reported data on hospitalised patients, 18 on non-hospitalised, and 54 on hospitalised and non-hospitalised combined (mixed). On average, at least 45% of COVID-19 survivors, regardless of hospitalisation status, went on to experience at least one unresolved symptom (mean follow-up 126 days). Fatigue was frequently reported across hospitalised (28.4%; 95% CI 24.7%-32.5%), non-hospitalised (34.8%; 95% CI 17.6%-57.2%), and mixed (25.2%; 95% CI 17.7%-34.6%) cohorts. Amongst the hospitalised cohort, abnormal CT patterns/x-rays were frequently reported (45.3%; 95% CI 35.3%-55.7%), alongside ground glass opacification (41.1%; 95% CI 25.7%-58.5%), and impaired diffusion capacity for carbon monoxide (31.7%; 95% CI 25.8%-3.2%).

Interpretation: Our work shows that 45% of COVID-19 survivors, regardless of hospitalisation status, were experiencing a range of unresolved symptoms at ∼ 4 months. Current understanding is limited by heterogeneous study design, follow-up durations, and measurement methods. Definition of subtypes of Long Covid is unclear, subsequently hampering effective treatment/management strategies.

Source: O’Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, Karamchandani U, Simms-Williams N, Cassambai S, Ardavani A, Wilkinson TJ, Hawthorne G, Curtis F, Kingsnorth AP, Almaqhawi A, Ward T, Ayoubkhani D, Banerjee A, Calvert M, Shafran R, Stephenson T, Sterne J, Ward H, Evans RA, Zaccardi F, Wright S, Khunti K. The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: A systematic review and meta-analysis. EClinicalMedicine. 2022 Dec 1;55:101762. doi: 10.1016/j.eclinm.2022.101762. PMID: 36474804; PMCID: PMC9714474. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714474/ (Full text)

Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients

Abstract:

Importance  Identification of long-term post–COVID-19 symptoms among hospitalized and nonhospitalized patients is needed.

Objective  To compare the presence of post–COVID-19 symptoms 2 years after acute SARS-CoV-2 infection between hospitalized and nonhospitalized patients.

Design, Setting, and Participants  A cross-sectional cohort study was conducted at 2 urban hospitals and general practitioner centers from March 20 to April 30, 2020, among 360 hospitalized patients and 308 nonhospitalized patients with acute SARS-CoV-2 infection during the first wave of the pandemic. Follow-up was conducted 2 years later.

Main Outcomes and Measures  Participants were scheduled for a telephone interview 2 years after acute infection. The presence of post–COVID-19 symptoms was systematically assessed, with particular attention to symptoms starting after infection. Hospitalization and clinical data were collected from medical records. Between-group comparisons and multivariate logistic regressions were conducted.

Results  A total of 360 hospitalized patients (162 women [45.0%]; mean [SD] age, 60.7 [16.1] years) and 308 nonhospitalized patients (183 women [59.4%]; mean [SD] age, 56.7 [14.7] years) were included. Dyspnea was more prevalent at the onset of illness among hospitalized than among nonhospitalized patients (112 [31.1%] vs 36 [11.7%]; P < .001), whereas anosmia was more prevalent among nonhospitalized than among hospitalized patients (66 [21.4%] vs 36 [10.0%]; P = .003). Hospitalized patients were assessed at a mean (SD) of 23.8 (0.6) months after hospital discharge, and nonhospitalized patients were assessed at a mean (SD) of 23.4 (0.7) months after the onset of symptoms. The number of patients who exhibited at least 1 post–COVID-19 symptom 2 years after infection was 215 (59.7%) among hospitalized patients and 208 (67.5%) among nonhospitalized patients (P = .01). Among hospitalized and nonhospitalized patients, fatigue (161 [44.7%] vs 147 [47.7%]), pain (129 [35.8%] vs 92 [29.9%]), and memory loss (72 [20.0%] vs 49 [15.9%]) were the most prevalent post–COVID-19 symptoms 2 years after SARS-CoV-2 infection. No significant differences in post–COVID-19 symptoms were observed between hospitalized and nonhospitalized patients. The number of preexisting medical comorbidities was associated with post–COVID-19 fatigue (odds ratio [OR], 1.93; 95% CI, 1.09-3.42; P = .02) and dyspnea (OR, 1.91; 95% CI, 1.04-3.48; P = .03) among hospitalized patients. The number of preexisting medical comorbidities (OR, 3.75; 95% CI, 1.67-8.42; P = .001) and the number of symptoms at the onset of illness (OR, 3.84; 95% CI, 1.33-11.05; P = .01) were associated with post–COVID-19 fatigue among nonhospitalized patients.

Conclusions and Relevance  This cross-sectional study suggested the presence of at least 1 post–COVID-19 symptom in 59.7% of hospitalized patients and 67.5% of nonhospitalized patients 2 years after infection. Small differences in symptoms at onset of COVID-19 were identified between hospitalized and nonhospitalized patients. Post–COVID-19 symptoms were similar between hospitalized and nonhospitalized patients; however, lack of inclusion of uninfected controls limits the ability to assess the association of SARS-CoV-2 infection with overall and specific post–COVID-19 symptoms 2 years after acute infection. Future studies should include uninfected control populations.

Source: Fernández-de-las-Peñas, Martín-Guerrero, Hernández-Barrera. Post–COVID-19 Symptoms 2 Years After SARS-CoV-2 Infection Among Hospitalized vs Nonhospitalized Patients. November 15, 2022. doi:10.1001/jamanetworkopen.2022.42106 (Full text)

Global prevalence of chronic fatigue syndrome among long COVID-19 patients: A systematic review and meta-analysis

Abstract:

Background: Chronic fatigue syndrome is a persistent and debilitating disorder. According to several studies, chronic fatigue syndrome has been identified among recovered COVID-19 patients as the most common symptom of long COVID. The aim of this systematic review and meta-analysis study was to obtain the prevalence of chronic fatigue syndrome in long COVID cases.

Methods: In this systematic review and meta-analysis, we analysed reported results of studies that assessed the occurrence of chronic fatigue syndrome among COVID-19 patients four weeks after the onset of symptoms. The study selection was commenced by searching PubMed, Web of Science, Science Direct, Scopus, Embase, and Google scholar using the keywords of Chronic fatigue syndrome, COVID-19, and post-COVID-19 syndrome. The searches were without a lower time limit and until April 2022. Heterogeneity of studies was assessed using the I2 index, and a random effects model was used for analysis. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2).

Results: The pooled prevalence of chronic fatigue syndrome four weeks after the onset of COVID-19 symptoms, in 52 studies with a sample size of 127,117, was 45.2% (95% CI: 34.1-56.9%). Meta-regression analysis in examining the effects of the two factors of sample size, and year of study on the changes in the overall prevalence, showed that with increasing sample size, and year of study, the prevalence of chronic fatigue syndrome among long COVID patients (p < 0.05).

Conclusion: Our results show that the overall prevalence of chronic fatigue syndrome as a long COVID symptom is 45.2%. Chronic fatigue after infection with COVID-19 can negatively affect personal and social lives. Given such significant negative consequences caused by the syndrome, it is recommended that health policymakers allocate funds to reduce the adverse effects of this syndrome, by creating programs to support long COVID patients.

Source: Salari N, Khodayari Y, Hosseinian-Far A, Zarei H, Rasoulpoor S, Akbari H, Mohammadi M. Global prevalence of chronic fatigue syndrome among long COVID-19 patients: A systematic review and meta-analysis. Biopsychosoc Med. 2022 Oct 23;16(1):21. doi: 10.1186/s13030-022-00250-5. PMID: 36274177; PMCID: PMC9589726. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9589726/ (Full text)