The debilitating effects of long-term COVID in the US

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the coronavirus disease 2019 (COVID-19) pandemic, which continues to cause significant social and economic disruption around the world. These impacts are due to the high morbidity and mortality associated with COVID-19 and the restrictions on human interaction due to public health interventions.

In addition to these acute effects, long-term symptoms have been reported by patients who have previously recovered from COVID-19. This condition is now called “long-term COVID”.New research posted on preprint server medRxiv* Learn about long-term COVID-induced chronic disability in the United States.

study: Long-term COVID-related physical and mental health impairment: Baseline results from a US national cohort. Image Credit: Anucha Naisuntorn

prologue

Most of the measures implemented to control COVID-19 were developed to prevent or limit the spread of SARS-CoV-2 and severe illness. However, more than half of those who survive COVID-19 can develop persistent symptoms that vary from person to person, often affecting multiple organ systems.

Longer COVID is usually reported among previously hospitalized patients. However, mild or moderate infections have also been shown to cause this syndrome. Similarly, both a man and a woman can suffer from her COVID for the long term, and may or may not have pre-existing medical conditions.

About research

Limited data remain on how long it lasted. COVID-symptoms It affects the daily life of affected people. However, previous studies found that up to half of COVID-19 survivors are still functioning substandard six months after recovering from acute infection, and 10% participate in independent daily activities. I found that my abilities were severely limited. Others have confirmed these observations, along with reports of further impairment of cognitive function.

Such impairments can affect an individual’s ability to be in paid employment, to become a caregiver, and to live independently. A current study at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland evaluated adults with or without a self-reported history of COVID-19.

Various outcomes evaluated in the current study included mobility-related impairments, inability to walk a quarter mile with ease, inability to climb 10 flights of stairs, light or heavy household chores, included the ability to perform instrumental activities of daily living (IADL) such as, and mental fatigue.

Researchers interviewed approximately 8,000 adults with a median age of 45, 84% female, and nearly 90% white.

What did the research show?

Most of the study participants were unimmunized at the time of their first acute infection. However, the proportion was higher in those with longer COVID. By the time the study began, about 60% of his long-term COVID patients had received their first course of adenovirus or messenger ribonucleic acid (mRNA) vaccine.

Hospitalization was required for 13% of people with prolonged COVID, compared to about 2% who cleared the infection.

About 75% of people with long-term COVID-19 were previously in good health. However, less than 6% of study participants reported that their health status had fully returned to pre-infection levels.

Physical activity was reported by about 70% of participants, regardless of whether they had COVID for a long time. However, half of patients with long-standing COVID-19 said they had decreased physical activity after being diagnosed with COVID-19.

One-third of long-term COVID patients report being sedentary instead of their previous active lifestyle, compared to just 3% of patients who fully recovered from infections who were not sedentary To do.

About two-thirds of participants who reported long-term COVID had one or more disabilities. This contrasts with her only 1 in 7 people with no history of COVID-19, and less than 5% of those who recover from COVID-19 report one or more of her disabilities. Did.

About 1% of patients with prolonged COVID had significant physical disability, compared to 5% with severe mental exhaustion. Risk factors for significant disability include older age, pre-existing medical conditions, increased body mass index (BMI), and being female. This contrasts with the male dominance seen in cases of SARS-CoV-2 infection and severe her COVID.

Patients who were hospitalized while infected with COVID-19 were at increased risk of long-term infection with COVID-19. However, his 60% of non-hospitalized patients also reported a significantly higher burden of physical disability, IADL, and mental fatigue. More than 20% of her who reported disability experienced disability in all three of her categories, whereas about 5% of her non-hospitalized long-term COVID patients had significant disability.

These data suggest that factors that predict hospitalization or severity of initial infection cannot be used to predict who will develop long-lasting COVID-related disability among those who do not require hospitalization. doing.

Mobility was impaired in more than 40% and less than 3% each in patients with prolonged and resolved COVID. This compares with her less than 5% of people with no history of COVID-19. Severe disability in this regard was reported in 6% of her.

IADL impairment and severe impairment were reported in 57% and 12% of long-term COVID patients, respectively, but less than 3% of recovered patients. People with no history of COVID-19 reported disability in 10% of cases.

Long-term COVID patients reported severe and severe mental exhaustion in 7% and 5% of cases, respectively, with 0.2% having severe disability and none in patients with unresolved COVID. .

People of non-white and multiethnic ethnicity were at increased risk of long-term COVID. In addition, dizziness during acute infection was common among hospitalized and non-hospitalized long-term COVID patients.

Among those who were not hospitalized with COVID-19, those who reported impairment in 4 of the 5 components had heavy limbs, difficulty breathing, and tremors during acute infection. Conversely, the same was true for those who needed hospitalization and had heavy limbs.

This may indicate the involvement of neural pathways that regulate posture and balance, including the autonomic nervous system. The association of limb weight may be due to cardiovascular involvement, reduced microvascular flow, thrombus formation, and damage to the endothelial layer of blood vessels. Therefore, care for these patients should begin with evaluating multiple systems.

In both cohorts, individuals vaccinated prior to infection had a 50% reduced risk of long-term COVID-related disability. This may be partly due to protection against severe infections after vaccination.

An increase in medical-seeking rates among long-term COVID patients was observed, as indicated by the number of new physician diagnoses. However, this is not synonymous with full restoration of functional capacity and quality of life, protracting restoration of everyday social and economic conditions for society as a whole.

What is the impact?

Researchers observed a high prevalence of long-term COVID-related physical and mental disabilities in this group, almost 11 times higher than those who fully recovered from viral infection. Of note, 1% of his patients were severely disabled and unable to function, whereas 5% experienced severe mental exhaustion.

These results indicate that of the 30-90 million people expected to have long-term COVID-19 infection, more than 1 million will have significant or severe impairment in their ability to live independently, earn a living and care for others. Indicates that you may be affected. This has serious implications for both individual and societal health. However, the results of this study indicate that these effects may be partially mitigated by vaccination.

Nevertheless, the effect of vaccination on disability from previous infections remains unclear. Further research should focus on follow-up of the COVID-19 patient to monitor the recovery process and prognosis to ensure timely diagnosis and care of her wide range of COVID-related disorders over the long term.

*Important Notices

medrex sib We publish a non-peer-reviewed, preliminary scientific report and should not be taken as conclusive, to guide clinical practice/health-related actions, or to be treated as established information.