Tag: morbidity

Post-acute Sequelae of SARS-CoV-2 Infection: A Neglected Public Health Issue

Introduction:

The COVID-19 pandemic has caused at least 508,827,830 infections and is associated with a 1.2% mortality rate worldwide (). New SARS-CoV-2 variants have driven new waves of the pandemic as a result of their increased transmissibility and ability to evade the immune response (). The post-acute sequelae of SARS-CoV-2 infection (PASC) is an important but underestimated public health issue that can have a long-term impact on pulmonary and multiple extrapulmonary tissues and organs through several potential mechanisms (, ). Recent studies demonstrate that approximately 4–69% of patients (including children, adolescents, adults, and senior) suffer from PASC (–). There is considerable evidence concerning post-acute sequelae that will likely outlast the current pandemic and need to be addressed. This article reviews the clinical sequelae of COVID-19 survivors and provides valuable insights required to fill the gaps in medical knowledge.

Source: Wang Z, Yang L. Post-acute Sequelae of SARS-CoV-2 Infection: A Neglected Public Health Issue. Front Public Health. 2022 Jun 17;10:908757. doi: 10.3389/fpubh.2022.908757. PMID: 35784200; PMCID: PMC9247346. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9247346/ (Full text)

Estimating total morbidity burden of COVID-19: relative importance of death and disability

Abstract:

Objective: Calculations of disease burden of COVID-19, used to allocate scarce resources, have historically considered only mortality. However, survivors often develop postinfectious ‘long-COVID’ similar to chronic fatigue syndrome; physical sequelae such as heart damage, or both. This paper quantifies relative contributions of acute case fatality, delayed case fatality, and disability to total morbidity per COVID-19 case.

Study design and setting: Healthy life years lost per COVID-19 case were computed as the sum of (incidence*disability weight*duration) for death and long-COVID by sex and 10-year age category in three plausible scenarios.

Results: In all models, acute mortality was only a small share of total morbidity. For lifelong moderate symptoms, healthy years lost per COVID-19 case ranged from 0.92 (male in his 30s) to 5.71 (girl under 10) and were 3.5 and 3.6 for the oldest females and males. At higher symptom severities, young people and females bore larger shares of morbidity; if survivors’ later mortality increased, morbidity increased most in young people of both sexes.

Conclusions: Under most conditions most COVID-19 morbidity was in survivors. Future research should investigate incidence, risk factors, and clinical course of long-COVID to elucidate total disease burden, and decisionmakers should allocate scarce resources to minimize total morbidity. WHAT IS NEW; KEY FINDINGS: : Under most plausible model scenarios, most COVID-19 morbidity (death + disability) is likely to be due to disability (‘long-COVID’) or delayed death due to organ damage, rather than immediate death. Only if long-COVID resolves (atypical of postinfectious syndromes) is morbidity higher in old than young WHAT THIS ADDS TO WHAT IS KNOWN: : While COVID-19 deaths are numerous, they likely cause less morbidity overall than does disability or organ damage in survivors. Morbidity is highest in females, especially those infected young.

What should change now: Scarce resources such as vaccines should be allocated to minimize morbidity rather than focusing solely on mortality. Data on long-COVID, especially its sex bias, should be collected and publicized.

Source: Smith MP. Estimating total morbidity burden of COVID-19: relative importance of death and disability. J Clin Epidemiol. 2021 Oct 26:S0895-4356(21)00339-5. doi: 10.1016/j.jclinepi.2021.10.018. Epub ahead of print. PMID: 34715312. https://pubmed.ncbi.nlm.nih.gov/34715312/

Adolescent chronic fatigue syndrome: prevalence, incidence, and morbidity

Abstract:

OBJECTIVE: To determine nationwide general practitioner (GP)-diagnosed prevalence and pediatrician-diagnosed incidence rates of adolescent chronic fatigue syndrome (CFS), and to assess CFS morbidity.

DESIGN AND SETTING: We collected data from a cross-sectional national sample among GPs and prospective registration of new patients with CFS in all pediatric hospital departments in the Netherlands.

PATIENTS AND METHODS: Study participants were adolescents aged 10 to 18 years. A representative sample of GPs completed questionnaires on the prevalence of CFS in their adolescent patients. Pediatric hospital departments prospectively reported new cases of CFS in adolescent patients. For every new reported case, a questionnaire was sent to the reporting pediatrician and the reported patient to assess CFS morbidity. Prevalence was estimated through the data from GP questionnaires and incidence was estimated on the basis of cases newly reported by pediatricians from January to December 2008.

RESULTS: Prevalence was calculated as 111 per 100 000 adolescents and incidence as 12 per 100 000 adolescents per year. Of newly reported patients with CFS, 91% scored at or above cutoff points for severe fatigue and 93% at or above the cutoff points for physical impairment. Forty-five percent of patients with CFS reported >50% school absence during the previous 6 months.

CONCLUSIONS: Clinically diagnosed incidence and prevalence rates show that adolescent CFS is uncommon compared with chronic fatigue. The primary adverse impact of CFS is extreme disability associated with considerable school absence.

 

Source: Nijhof SL, Maijer K, Bleijenberg G, Uiterwaal CS, Kimpen JL, van de Putte EM. Adolescent chronic fatigue syndrome: prevalence, incidence, and morbidity. Pediatrics. 2011 May;127(5):e1169-75. doi: 10.1542/peds.2010-1147. Epub 2011 Apr 18. https://www.ncbi.nlm.nih.gov/pubmed/21502228

 

The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study

Abstract:

OBJECTIVES: This study examined the prevalence and public health impact of chronic fatigue and chronic  fatigue syndrome in primary care patients in England.

METHODS: There were 2376 subjects, aged 18 through 45 years. Of 214 subjects who fulfilled criteria for chronic fatigue, 185 (86%) were interviewed in the case-control study. Measures included chronic fatigue, psychological morbidity, depression, anxiety, somatic symptoms, symptoms of chronic fatigue syndrome, functional impairment, and psychiatric disorder.

RESULTS: The point prevalence of chronic fatigue was 11.3%, falling to 4.1% if comorbid psychological disorders were excluded. The point prevalence of chronic fatigue syndrome was 2.6%, falling to 0.5% if comorbid psychological disorders were excluded. Rates did not vary by social class. After adjustment for psychological disorder, being female was modestly associated with chronic fatigue. Functional impairment was profound and was associated with psychological disorder.

CONCLUSIONS: Both chronic fatigue and chronic fatigue syndrome are common in primary care patients and represent a considerable public health burden. Selection bias may account for previous suggestions of a link with higher socioeconomic status.

 

Source: Wessely S, Chalder T, Hirsch S, Wallace P, Wright D. The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. Am J Public Health. 1997 Sep;87(9):1449-55. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380968/ (Full article)