Tag: long Covid

Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults — United States, December 2020–March 2023

Summary:

What is already known about this topic? Post-COVID conditions, or long COVID, can persist for months or years after an acute COVID-19 illness and can include emergence of new symptoms or the occurrence of symptoms that come and go.

What is added by this report? In a multicenter study of adults with a COVID-like illness, symptom prevalence decreased over time after the acute illness. Approximately 16% of adults with COVID-like symptoms reported persistent symptoms 12 months after a positive or negative SARS-CoV-2 test result. At 3, 6, 9, and 12 months after testing, some symptomatic persons had ongoing symptoms, and others had emerging symptoms not reported during the previous period.

What are the implications for public health practice? Health care providers should be aware that symptoms can persist, emerge, reemerge, or resolve after COVID-like illness and are not unique to COVID-19 or to post-COVID conditions.

Abstract:

To further the understanding of post-COVID conditions, and provide a more nuanced description of symptom progression, resolution, emergence, and reemergence after SARS-CoV-2 infection or COVID-like illness, analysts examined data from the Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE), a prospective multicenter cohort study. This report includes analysis of data on self-reported symptoms collected from 1,296 adults with COVID-like illness who were tested for SARS-CoV-2 using a Food and Drug Administration–approved polymerase chain reaction or antigen test at the time of enrollment and reported symptoms at 3-month intervals for 12 months.

Prevalence of any symptom decreased substantially between baseline and the 3-month follow-up, from 98.4% to 48.2% for persons who received a positive SARS-CoV-2 test results (COVID test–positive participants) and from 88.2% to 36.6% for persons who received negative SARS-CoV-2 test results (COVID test–negative participants).

Persistent symptoms decreased through 12 months; no difference between the groups was observed at 12 months (prevalence among COVID test–positive and COVID test–negative participants = 18.3% and 16.1%, respectively; p>0.05).

Both groups reported symptoms that emerged or reemerged at 6, 9, and 12 months. Thus, these symptoms are not unique to COVID-19 or to post-COVID conditions. Awareness that symptoms might persist for up to 12 months, and that many symptoms might emerge or reemerge in the year after COVID-like illness, can assist health care providers in understanding the clinical signs and symptoms associated with post-COVID–like conditions.

Source: Montoy JC, Ford J, Yu H, et al. Prevalence of Symptoms ≤12 Months After Acute Illness, by COVID-19 Testing Status Among Adults — United States, December 2020–March 2023. MMWR Morb Mortal Wkly Rep 2023;72:859–865. DOI: http://dx.doi.org/10.15585/mmwr.mm7232a2 (Full text)

Long COVID and Significant Activity Limitation Among Adults, by Age — United States, June 1–13, 2022, to June 7–19, 2023

Summary:

What is already known about this topic? Long COVID includes a wide range of ongoing symptoms that can last for weeks, months, or years following SARS-CoV-2 infection.

What is added by this report? Prevalence of long COVID among noninstitutionalized U.S. adults aged ≥18 years decreased from 7.5% (95% CI = 7.1–7.9) during June 1–13, 2022 to 6.0% (95% CI = 5.7–6.3) during June 7–19, 2023 and from 18.9% (95% CI = 17.9–19.8) to 11.0% (95% CI = 10.4–11.6) among adults reporting previous COVID-19. After an initial decline, prevalence remained unchanged beginning January 4–16, 2023. Approximately one quarter of adults with long COVID report significant activity limitations.

What are the implications for public health practice? COVID-19 prevention efforts, including staying up to date with recommended COVID-19 vaccination and planning for long COVID symptom management and health care service needs, remain important.

Abstract:

Long COVID is a condition encompassing a wide range of health problems that emerge, persist, or return following COVID-19. CDC analyzed national repeat cross-sectional Household Pulse Survey data to estimate the prevalence of long COVID and significant related activity limitation among U.S. adults aged ≥18 years by age group.

Data from surveys completed between June 1–13, 2022, and June 7–19, 2023, indicated that long COVID prevalence decreased from 7.5% (95% CI = 7.1–7.9) to 6.0% (95% CI = 5.7–6.3) among the overall U.S. adult population, irrespective of history of previous COVID-19, and from 18.9% (95% CI = 17.9–19.8) to 11.0% (95% CI = 10.4–11.6) among U.S. adults reporting previous COVID-19. Among both groups, prevalence decreased from June 1–13, 2022, through January 4–16, 2023, before stabilizing.

When stratified by age, only adults aged <60 years experienced significant rates of decline (p<0.01). Among adults reporting previous COVID-19, prevalence decreased among those aged 30–79 years through fall or winter and then stabilized.

During June 7–19, 2023, 26.4% (95% CI = 24.0–28.9) of adults with long COVID reported significant activity limitation, the prevalence of which did not change over time.

These findings help guide the ongoing COVID-19 prevention efforts and planning for long COVID symptom management and future health care service needs.

Source:  Ford ND, Slaughter D, Edwards D, et al. Long COVID and Significant Activity Limitation Among Adults, by Age — United States, June 1–13, 2022, to June 7–19, 2023. MMWR Morb Mortal Wkly Rep 2023;72:866–870. DOI: http://dx.doi.org/10.15585/mmwr.mm7232a3 (Full text)

Decreased physical performance despite objective and subjective maximal exhaustion in post-COVID-19 individuals with fatigue

Abstract:

Introduction: Fatigue is a common symptom in post-COVID-19 patients. Individuals with fatigue often perform less well compared to healthy peers or without fatigue. It is not yet clear to what extent fatigue is related to the inability to reach maximum exhaustion during physical exercise.

Methods: A symptom-based questionnaire based on the Carruthers guidelines (2003) was used for reporting the presence of fatigue and further symptoms related to COVID-19 from 85 participants (60.0% male, 33.5 ± 11.9 years). Cardiopulmonary exercise testing (CPET) and lactate measurement at the end of the test were conducted. Objective and subjective exhaustion criteria according to Wasserman of physically active individuals with fatigue (FS) were compared to those without fatigue (NFS).

Results: Differences between FS and NFS were found in Peak V̇O2/BM (p < 0.001) and Max Power/BM (p < 0.001). FS were more likely to suffer from further persistent symptoms (p < 0.05). The exhaustion criterion Max. lactate was reached significantly more often by NFS individuals.

Conclusion: Although the aerobic performance (Max Power/BM) and the metabolic rate (Peak V̇O2/BM and Max. lactate) of FS were lower compared to NFS, they were equally able to reach objective exhaustion criteria. The decreased number of FS who reached the lactate criteria and the decreased V̇O2 peak indicates a change in metabolism. Other persistent post-COVID-19 symptoms besides fatigue may also impair performance, trainability and the ability to reach objective exhaustion.

Trial registration: Trial registration: DRKS00023717; date of registration: 15.06.2021 (retrospectively registered).

Source: Vollrath S, Matits L, Schellenberg J, Kirsten J, Steinacker JM, Bizjak DA. Decreased physical performance despite objective and subjective maximal exhaustion in post-COVID-19 individuals with fatigue. Eur J Med Res. 2023 Aug 26;28(1):298. doi: 10.1186/s40001-023-01274-5. PMID: 37633931; PMCID: PMC10464445. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10464445/ (Full text)

SARS-CoV-2 Reinfections and Long COVID in the Post-Omicron Phase of the Pandemic

Abstract:

We are reviewing the current state of knowledge on the virological and immunological correlates of long COVID, focusing on recent evidence for the possible association between the increasing number of SARS-CoV-2 reinfections and the parallel pandemic of long COVID. The severity of reinfections largely depends on the severity of the initial episode; in turn, this is determined both by a combination of genetic factors, particularly related to the innate immune response, and by the pathogenicity of the specific variant, especially its ability to infect and induce syncytia formation at the lower respiratory tract.

The cumulative risk of long COVID as well as of various cardiac, pulmonary, or neurological complications increases proportionally to the number of SARS-CoV-2 infections, primarily in the elderly. Therefore, the number of long COVID cases is expected to remain high in the future. Reinfections apparently increase the likelihood of long COVID, but less so if they are mild or asymptomatic as in children and adolescents.

Strategies to prevent SARS-CoV-2 reinfections are urgently needed, primarily among older adults who have a higher burden of comorbidities. Follow-up studies using an established case definition and precise diagnostic criteria of long COVID in people with or without reinfection may further elucidate the contribution of SARS-CoV-2 reinfections to the long COVID burden.

Although accumulating evidence supports vaccination, both before and after the SARS-CoV-2 infection, as a preventive strategy to reduce the risk of long COVID, more robust comparative observational studies, including randomized trials, are needed to provide conclusive evidence of the effectiveness of vaccination in preventing or mitigating long COVID in all age groups. Thankfully, answers not only on the prevention, but also on treatment options and rates of recovery from long COVID are gradually starting to emerge.

Source: Boufidou F, Medić S, Lampropoulou V, Siafakas N, Tsakris A, Anastassopoulou C. SARS-CoV-2 Reinfections and Long COVID in the Post-Omicron Phase of the Pandemic. Int J Mol Sci. 2023 Aug 19;24(16):12962. doi: 10.3390/ijms241612962. PMID: 37629143; PMCID: PMC10454552. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10454552/ (Full text)

The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study

Abstract:

Background: Cognitive impairment has been reported after many types of infection, including SARS-CoV-2. Whether deficits following SARS-CoV-2 improve over time is unclear. Studies to date have focused on hospitalised individuals with up to a year follow-up. The presence, magnitude, persistence and correlations of effects in community-based cases remain relatively unexplored.

Methods: Cognitive performance (working memory, attention, reasoning, motor control) was assessed in a prospective cohort study of participants from the United Kingdom COVID Symptom Study Biobank between July 12, 2021 and August 27, 2021 (Round 1), and between April 28, 2022 and June 21, 2022 (Round 2). Participants, recruited from the COVID Symptom Study smartphone app, comprised individuals with and without SARS-CoV-2 infection and varying symptom duration. Effects of COVID-19 exposures on cognitive accuracy and reaction time scores were estimated using multivariable ordinary least squares linear regression models weighted for inverse probability of participation, adjusting for potential confounders and mediators. The role of ongoing symptoms after COVID-19 infection was examined stratifying for self-perceived recovery. Longitudinal analysis assessed change in cognitive performance between rounds.

Findings: 3335 individuals completed Round 1, of whom 1768 also completed Round 2. At Round 1, individuals with previous positive SARS-CoV-2 tests had lower cognitive accuracy (N = 1737, β = -0.14 standard deviations, SDs, 95% confidence intervals, CI: -0.21, -0.07) than negative controls. Deficits were largest for positive individuals with ≥12 weeks of symptoms (N = 495, β = -0.22 SDs, 95% CI: -0.35, -0.09). Effects were comparable to hospital presentation during illness (N = 281, β = -0.31 SDs, 95% CI: -0.44, -0.18), and 10 years age difference (60-70 years vs. 50-60 years, β = -0.21 SDs, 95% CI: -0.30, -0.13) in the whole study population. Stratification by self-reported recovery revealed that deficits were only detectable in SARS-CoV-2 positive individuals who did not feel recovered from COVID-19, whereas individuals who reported full recovery showed no deficits. Longitudinal analysis showed no evidence of cognitive change over time, suggesting that cognitive deficits for affected individuals persisted at almost 2 years since initial infection.

Interpretation: Cognitive deficits following SARS-CoV-2 infection were detectable nearly two years post infection, and largest for individuals with longer symptom durations, ongoing symptoms, and/or more severe infection. However, no such deficits were detected in individuals who reported full recovery from COVID-19. Further work is needed to monitor and develop understanding of recovery mechanisms for those with ongoing symptoms.

Source: Cheetham NJ, Penfold R, Giunchiglia V, Bowyer V, Sudre CH, Canas LS, Deng J, Murray B, Kerfoot E, Antonelli M, Rjoob K, Molteni E, Österdahl MF, Harvey NR, Trender WR, Malim MH, Doores KJ, Hellyer PJ, Modat M, Hammers A, Ourselin S, Duncan EL, Hampshire A, Steves CJ. The effects of COVID-19 on cognitive performance in a community-based cohort: a COVID symptom study biobank prospective cohort study. EClinicalMedicine. 2023 Jul 21;62:102086. doi: 10.1016/j.eclinm.2023.102086. PMID: 37654669; PMCID: PMC10466229. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10466229/ (Full text)

Long COVID Complicated by Fatal Cytomegalovirus and Aspergillus Infection of the Lungs: An Autopsy Case Report

Abstract:

After the acute phase of COVID-19, some patients develop long COVID. This term is used for a variety of conditions with a complex, yet not fully elucidated etiology, likely including the prolonged persistence of the virus in the organism and progression to lung fibrosis. We present a unique autopsy case of a patient with severe COVID-19 with prolonged viral persistence who developed interstitial lung fibrosis complicated by a fatal combination of cytomegalovirus and Aspergillus infection. SARS-CoV-2 virus was detected at autopsy in the lungs more than two months after the acute infection, although tests from the nasopharynx were negative.
Immune dysregulation after COVID-19 and the administration of corticoid therapy created favorable conditions for the cytomegalovirus and Aspergillus infection that were uncovered at autopsy. These pathogens may represent a risk for opportunistic infections, complicating not only the acute coronavirus infection but also long COVID, as was documented in the presented case.
Source:Krivosikova L, Kuracinova T, Martanovic P, Hyblova M, Kaluzay J, Uhrinova A, Janega P, Babal P. Long COVID Complicated by Fatal Cytomegalovirus and Aspergillus Infection of the Lungs: An Autopsy Case Report. Viruses. 2023; 15(9):1810. https://doi.org/10.3390/v15091810 https://www.mdpi.com/1999-4915/15/9/1810 (Full text)

Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization

Abstract:

Post-COVID cognitive deficits, including ‘brain fog’, are clinically complex, with both objective and subjective components. They are common and debilitating, and can affect the ability to work, yet their biological underpinnings remain unknown.

In this prospective cohort study of 1,837 adults hospitalized with COVID-19, we identified two distinct biomarker profiles measured during the acute admission, which predict cognitive outcomes 6 and 12 months after COVID-19.

A first profile links elevated fibrinogen relative to C-reactive protein with both objective and subjective cognitive deficits. A second profile links elevated D-dimer relative to C-reactive protein with subjective cognitive deficits and occupational impact. This second profile was mediated by fatigue and shortness of breath. Neither profile was significantly mediated by depression or anxiety.

Results were robust across secondary analyses. They were replicated, and their specificity to COVID-19 tested, in a large-scale electronic health records dataset. These findings provide insights into the heterogeneous biology of post-COVID cognitive deficits.

Source: Taquet, M., Skorniewska, Z., Hampshire, A. et al. Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization. Nat Med (2023). https://doi.org/10.1038/s41591-023-02525-y https://www.nature.com/articles/s41591-023-02525-y (Full text)

Treatment of Brain Fog of Long COVID Syndrome: A Hypothesis

Abstract:

The emergence of the SARS-CoV-2 (COVID-19) virus has exacted a significant toll on the global population in terms of fatalities, health consequences, and economics. As of February 2023, there have been almost 800 million confirmed cases of the disorder reported to the WHO [1], although the actual case-positive rate is estimated to be much higher.

While many cases recover, the mortality rate associated with the illness is about 1% (based on the WHO data). Most patients experience the illness as a mild to moderate disorder and recover without significant sequelae. However, as the COVID-19 pandemic has continued, there has emerged a significant group of COVID-19 survivors who experience persistent symptoms beyond the acute course of the illness.

As many as one in eight patients report persistent symptoms 90 to 150 days after the initial infection [2]. These so-called Long COVID or post-COVID syndrome patients are mostly drawn from those who were hospitalised for the disorder, but both non-hospitalised and vaccinated subjects may also experience the syndrome [3]. While an agreed definition of Long COVID is yet to be settled, a multiplicity of symptoms affecting most major organ systems has been reported in patients.

Common Long COVID symptoms include fatigue, dyspnoea, headaches, myalgia, anosmia, dysgeusia, cognitive symptoms, and mental disorders such as depression and anxiety [4]. It is estimated that approximately a third of patients with Long COVID exhibit either fatigue, cognitive impairment, or both up to 12 weeks after a confirmed diagnosis of COVID-19 [5].

Source: Norman TR. Treatment of Brain Fog of Long COVID Syndrome: A Hypothesis. Psychiatry International. 2023; 4(3):242-245. https://doi.org/10.3390/psychiatryint4030024 https://www.mdpi.com/2673-5318/4/3/24 (Full text)

Mast cell activation may contribute to adverse health transitions in COVID-19 patients with frailty

Abstract:

A prominent aspect of the post-coronavirus disease-2019 (post-COVID-19) era is long-COVID. Therefore, precise patient classification and exploration of the corresponding factors affecting long-COVID are crucial for tailored treatment strategies. Frailty is a common age-related clinical syndrome characterized by deteriorated physiological functions of multiple organ systems, which increases susceptibility to stressors.

Herein, we performed an inclusion and exclusion analysis (definite COVID-19 infection diagnosis, clear underlying disease information, ≥60 years old, and repeated sampling of clinical cases) of 10,613 blood samples and identified frailty cases for further investigation. RNA-Seq data were used for differential gene expression and functional and pathway analyses.

The results revealed that patients with frailty were more prone to poor health conversions and more sequelae, and the blood transcriptome had obvious disturbances in pathways associated with immune regulation, metabolism, and stress response. These adverse health transitions were significantly associated with mast cell activation. Additionally, NCAPG, MCM10, and CDC25C were identified as hub genes in the peripheral blood differential gene cluster, which could be used as diagnostic markers of poor health conversion.

Our results indicate that healthcare measures should be prioritized to mitigate adverse health outcomes in this vulnerable patient group, COVID-19 patients with frailty, in post-COVID era.

Source: Xiangqi Li, Chaobao Zhang & Zhijun Bao (2023) Mast cell activation may contribute to adverse health transitions in COVID-19 patients with frailty, Emerging Microbes & Infections, 12:2, DOI: 10.1080/22221751.2023.2251589 https://www.tandfonline.com/doi/pdf/10.1080/22221751.2023.2251589 (Full text)

Long Covid & Antidepressants

Abstract:

Three years into this historic pandemic, the scientific and healthcare communities continue to learn agreat deal regarding COVID-19, the disease that is produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most urgent and immediate focus has been on vaccine development for diseaseprevention/mitigation and on identification of effective therapeutic interventions for acute phase of illness. However, attention is increasingly being placed on formulating treatment strategies for individuals who arepost-COVID-19 and experiencing a syndrome of persistent cognitive, somatic and behavioral symptoms that is being referred to as long COVID.

In addition to identifying novel compounds that may improve outcome ineither acute or residual COVID-19, an alternate and parallel strategy is to repurpose or reposition drugs which have been approved for other conditions and subsequently assess their safety and efficacy when applied toCOVID-19. In this light, antidepressant medications, particularly serotonin reuptake inhibitors, have garnered attention amidst evidence supporting their anti-inflammatory and anti-viral properties. Results from several preliminary studies suggest that early administration of antidepressants may prevent clinical deterioration and even death in patients with acute COVID-19.

In this article, we present purported anti-inflammatory mechanisms of the antidepressants, review results from studies that have appeared in the literature to date regarding antidepressants and acute COVID-19, and discuss the possible utility of antidepressants as a potential therapeutic resource for long COVID.

Source: Rivas-Vázquez R, Carrazana EJ, Blais MA, Rey GJ, Rivas-Vázquez E. Long Covid & Antidepressants. Med Discoveries. 2023; 2(3): 1023.  https://meddiscoveries.org/pdf/1023.pdf (Full text)