Study identifications Most common persistent symptoms 8 months after mild COVID

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Loss of smell, loss of taste, dyspnea and fatigue are the four most common symptoms that Swedish health professionals report eight months after mild COVID-19 disease, according to new evidence.

According to the study, approximately one in ten health workers experiences one or more moderate to severe symptoms that negatively affect their quality of life.

“We see a substantial portion of health care workers suffering from long-term symptoms after a mild COVID-19,” said Charlotte Thålin, PhD, lead author. Medscape Medical News. He added that the loss of smell and taste “may seem trivial, but in the long run it has a negative impact on work, social and family life.”

The study stands out not only for tracking COVID-19-related experiences of health care workers over time, but also for what it did not find. There was no higher prevalence of cognitive problems (including memory or concentration) that others have related to what is often called long-term COVID-19.

The research letter was published online on April 7, 2021 a JAMA.

“Even if you are young and previously healthy, a mild COVID-19 infection can have long-term consequences,” said Thålin, of the clinical sciences department at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.

The researchers did not observe an increased risk of long-term symptoms after asymptomatic COVID-19.

Addition to existing evidence

This research letter “adds to the growing literature showing that people recovering from COVID have reported a variety of symptoms that last months after the initial infection,” said Lekshmi Santhosh, MD Medscape Medical News when asked to comment. He is head of the medical school at the Optimal Post-Covid Clinic of the University of California, San Francisco (UCSF).

Previous research revealed severe long-term symptoms, including heart palpitations and neurological alterations, among people hospitalized with COVID-19. However, “there are limited data on long-term effects after mild COVID-19, and these studies are often hampered by selection bias and without adequate control groups,” Thålin said.

The absence of these more severe symptoms after a mild COVID-19 is “reassuring,” he added.

The current findings are part of the ongoing COMMUNITY study (COVID-19 Biomarker and Immunity) that studies long-term immunity. Healthcare professionals enrolled in the research between April 15 and May 8, 2020 and who repeat the initial blood tests every 4 months.

Thålin, lead author Sebastian Havervall, MD, and colleagues compared symptoms among 323 hospital employees who had mild COVID-19 at least 8 months earlier with 1,072 employees who did not have COVID-19 at all. the study.

The results show that 26% of those who previously had COVID-19 had at least one moderate to severe symptom that lasted more than 2 months, compared with 9% of the control group.

The group with a history of mild COVID-19 had a mean age of 43 years and 83% were female. The controls were on average 47 years old and 86% were women.

“These data reflect what we have seen across long-term cohorts of patients with COVID-19 infection. In particular, mild disease among previously healthy individuals may be associated with long-term persistent symptoms,” said Sarah Jolley , MD, pulmonologist specializing in care at UCHealth University of Colorado Hospital in Aurora and director of the Post-COVID Clinic Medscape Medical News.

“In this cohort, similar to others, this seems to be more pronounced in women,” Jolley added.

Main conclusions about the operation

At eight months, using a smartphone app, participants reported the presence, duration, and severity of 23 predefined symptoms. The researchers used the Sheehan disability scale to assess functional impairment.

A total of 11% of participants reported at least one symptom that negatively affected work or social life at home at 8 months compared to only 2% of the control group.

HIV-positive participants were almost twice as likely to report that their long-term symptoms moderately altered their working life, 8% versus 4% of seronegative health workers (relative risk [RR], 1.8; 95%; confidence interval [CI], 1.2 – 2.9).

Alterations in social life due to long-term symptoms were 2.5 times more likely in the HIV-positive group. A total of 15% of this cohort reported moderate to marked effects, compared with 6% of the seronegative group (RR, 2.5; 95% CI, 1.8 – 3.6).

The researchers also asked about alterations in home life, which were reported by 12% of HIV-positive health workers and 5% of seronegative participants (RR, 2.3; 95% CI, 1.6 – 3). , 4).

The results of the study “track a lot of other work we’re seeing,” said David Putrino, PT, PhD, director of innovation in rehabilitation at New York City’s Mount Sinai Health System. Medscape Medical News. He and his colleagues are in charge of managing the rehabilitation of patients with long COVID.

Interestingly, the proportion of people with persistent symptoms in this research can be underestimated, Putrino said. “Antibodies are not a completely reliable biomarker. So what researchers are using here is the most conservative measure of who may have had the virus.”

Potential memory bias and subjective assessment of symptoms were possible limitations of the study.

When asked why researchers did not find higher levels of cognitive dysfunction, Putrino said self-reports are usually less reliable than measures such as MoCA (Montreal Cognitive Assessment) to detect cognitive impairment.

Also, unlike many of the people with long-term COVID-19 who are treated clinically (people who are “really struggling”), health workers studied in Sweden work well enough to perform their duties in the hospital. , so that the population studied may not represent the general population.

More research is required

“More research needs to be done to investigate the mechanisms underlying these persistent symptoms and several centers, including UCSF, are investigating why it could be,” Santhosh said.

Thålin and her colleagues plan to continue following the participants. “The main goal of the COMMUNITY study is to investigate long-term immunity after COVID-19, but we will also study possible underlying pathophysiological mechanisms behind long-term symptoms related to COVID-19,” he said.

“I hope to see the taste and smell come back,” Thålin added.

“We’re really just beginning to understand the long-term effects of COVID-19,” Putrino said. “That’s something we’ll see a lot going forward.”

Thålin, Santhosh, Jolley and Putrino did not disclose any relevant financial relationships. Grants from the Knut and Alice Wallenberg Foundation, the Jonas and Christina af Jochnick Foundation, the Leif Lundblad Family Foundation, the Stockholm Region, and the Erling-Persson Family Foundation funded the research.

Damian McNamara is a Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.

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