Even after mild cases of COVID, long COVID can last for a year

For some patients with COVID-19, the initial illness is not as bad as the persistent and sometimes disabling symptoms that linger for months or years afterward. These are people with long-term COVID, a complex chronic illness that can affect regardless of age, sex, vaccination status or medical history.

A study of nearly 2 million patients in Israel offers new insights into the long-term trajectory of COVID-19, especially for younger, healthier people whose cases of COVID-19 were mild. The researchers found that while most of the lingering symptoms disappeared within a year, some of the more debilitating consequences of the syndrome, such as dizziness, loss of taste and smell, and problems with concentration and memory, still affect a minority of patients a full year after the initial infection.

For the study, published Wednesday in the medical journal BMJ, researchers examined the health records of more than 1.9 million members of Maccabi Healthcare Services, one of the largest health maintenance organizations in Israel Among them were just under 300,000 people who tested positive for the SARS-CoV-2 coronavirus between March 1, 2020 and October. 1, 2021, and that they were not hospitalized in the first month after infection, a sign that their cases were mild.

The researchers matched each coronavirus-positive subject with an uninfected person in the sample who had the same age, sex and vaccination status and a similar history of risk factors such as diabetes, cancer and obesity, among other conditions pre-existing The researchers then tracked the medical records of both members of each couple to see what health problems they experienced over the next 12 months.

“When we started this study, there was a lot of uncertainty about the long-term effects of the pandemic,” said computational scientist Maytal Bivas-Benita, who conducted the study with colleagues at the KI Research Institute of ‘Israel.

Most of the symptoms related to COVID-19 subsided sharply in the first months after infection, such as breathing difficulties, chest pain, cough, joint pain and hair loss, a side effect that often accompanies physical stress sharp

The older a patient was at the time of infection, the more likely they were to report long-term problems with COVID. And many long-term COVID patients were still struggling with their symptoms a year after becoming ill.

For example, six months after a mild bout of COVID-19, unvaccinated people were 5.5 times more likely to report problems with smell and taste than their uninfected peers. Even at 12 months, former COVID-19 patients were more than twice as likely to have problems with these senses.

Similarly, former COVID-19 patients continued to have elevated risks of shortness of breath, weakness, and problems with memory and concentration a year after they were first infected.

Other lingering symptoms of COVID tended to resolve more quickly, the study authors found. At four months, those who were infected were no more likely to struggle with a cough than those who remained infection-free. Complaints of heart palpitations and chest pain were equally likely in both groups after eight months, and so was hair loss after seven months.

The authors concluded that mild cases of COVID-19 do not lead to serious or chronic long-term illness for the vast majority of patients and add “a small ongoing burden” to the overall healthcare system.

Advocates for long-term COVID patients say the big picture glosses over the struggles of patients who are disabled by their persistent symptoms.

“Things like heart arrhythmias, memory problems, concentration — all of these types of symptoms are not only problematic medically, but also hinder a person’s ability to work and live their daily life,” said Melissa Pinto, associate professor of Nursing at UC Irvine. . who studies COVID at length. “Not all symptoms are equally problematic.”

The Israeli researchers noted that many long-term symptoms of COVID worsened during the first six months of illness before beginning any kind of decline, an observation that follows the experience of many long-term patients.

“There are some troubling findings, such as that some core neurological and cognitive symptoms do not diminish over time,” said Hannah Davis, co-founder of the Patient-Led Research Collaborative, a research group that focuses on the disease .

He added that the new study is in line with previous work showing that neurological symptoms worsen during the first four months of illness.

“This kind of finding is vital to communicate to the public for two reasons: first, so that new long-term COVID patients understand what to expect, and second, to give future researchers a clue about the possible mechanism,” Davis said.

The researchers relied on diagnosis codes to see which symptoms affected patients. This approach excluded more recently defined diseases such as postural orthostatic tachycardia syndrome, or POTS, which received a code in the US only in October.

POTS is an autonomic nervous system disorder that affects blood circulation. It can be triggered by infections, and between 2% and 14% of COVID-19 survivors have been diagnosed with POTS. Symptoms of the disease include many of the persistent ones reported in the Israeli study: heart palpitations, dizziness, weakness and trouble concentrating.

“It’s great that they’re trying to collect this kind of data. But there are inherent flaws in research based on electronic health records that would make me question it [whether] the results actually capture the lived experiences of these patients,” said Lauren Stiles, executive committee member of the Long COVID Alliance and president of Dysautonomia International, an advocacy group for patients with autonomic nervous system disorders.

“What we’re seeing in the long-term community of COVID patients is that a good subset of people are seeing some improvement within the first year,” Stiles said. “But there are a substantial number of patients who have long-standing chronic disease, who now spend three years of unrelenting disease.”

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