An interesting preprint by Cirulli and Others in medRxiv looks at this important issue.
It has become increasingly apparent that a subset of infected individuals develop long term complications following SARS-CoV-2 infection.
Doctors continue to report their observations of case studies in patients who seem unable to recover from COVID-19, including long term symptoms such as shortness of breath, weakness, brain fog and fatigue.
This study showed that 36.1% of COVID-19 plus cases had symptoms lasting longer than 30 days.
14.8% still had at least one symptom after 90 days.
These numbers were higher for COVID-19 cases who were initially more ill – 44.9% at 30 days, 20.8% at 90 days.
However, even for mild and initially asymptomatic cases, 21.3% had complications which persisted for 30 days longer.
This contrasted with only 8.4% of participants from the general untested population who developed new symptoms lasting longer than 30 days due to any illness during the same study period.
The long term symptoms were anosmia, ageusia, difficulty concentrating, dyspnoea, memory loss, confusion, chest pain and pain with deep breaths.
It was also found in those individuals who were more sick who were having more long term symptoms and individuals who had an initial symptom of dyspnoea were significantly more likely to develop long term symptoms. Those who were negative tested 60% reported more than one symptom and a medium of five symptoms per person and for those remaining untested population 55.3% reported one symptom and a medium of four symptoms per sick person during this time period.
Although several of the surveyed symptoms were common to seasonal flu, the common cold and allergies, the study found that nearly all symptoms were statistically significant in their association with a positive COVID-19 test even when accounted for by age, sex, comorbidities, BMI and ethnicity.
The only symptoms not significantly related to COVID-19 plus cases were rash, red, sore, itchy eyes.
This study found that the symptoms which were significantly found in COVID-19 cases were anosmia, ageusia, fever, fatigue, decreased appetite. These were self-reported symptoms.
For those with symptoms more than 30 days, the study found that the specific long term symptoms of anosmia, ageusia, weak muscles, difficulty breathing, memory loss, confusion, difficulty concentrating, chest pain, pain with deep breaths, dry cough, decreased alertness, headache, tachycardia, bone or joint pain, heart palpitations, dizziness, nocturnal dyspnoea, fatigue, tingling, sensitive skin, back pain, acid reflux, diarrhoea and insomnia were significantly more after 30 days in COVID-19 plus cases compared with controls.
Following further progression analysis the study found that the only symptoms which were found to be associated significantly with COVID-19 were anosmia, ageusia, memory loss, chest pain, weak muscles. Interestingly enough, after 60 days, these symptoms still remained significant and following this at 60 days a difficulty concentrating became significant.
After 90 days, all of these symptoms, plus bone/joint pains and confusion were significant in COVID-19 cases.
Individuals who had more initial symptoms also had more long term symptoms, regardless of whether they were COVID-19 cases or not.
However, COVID-19 patients have the highest incidence of continuing symptoms.
Of new diagnoses, the COVID-19 patients reported approximately 6% more of a new diagnosis, 19.4% reported lung damage or scarring, 1% blood clots, 0.5% kidney damage, 0.5% heart failure, 0.5% endometrial scarring, 0.5% myocarditis, 0.5% pulmonary embolism and 0.5% stroke.
What factors predispose to long term COVID-19 symptoms?
The study sought to identify what factors other than the seriousness of the initial illness predisposed individuals to long term COVID-19 symptoms.
Although initially the study identified 23 factors that were at least nominally associated with whether a COVID-19 plus patient develop symptoms lasting longer than 30 days, the only factor that had a stronger association with symptoms after 30 days other than the total number of initial symptoms was the initial symptom of dyspnoea, shortness of breath.
Following further analysis, only five factors maintained a nominal association with long term symptoms of COVID-19 plus patients and these were the initial symptoms of dyspnoea, pain with deep breaths, sensitive skin and blood type A were associated with an increased risk.
Protective factors were found to be the initial symptom of sore muscles or nausea and higher BMI. However, at 60 to 90 days, none of these factors remained even nominally associated with long term symptoms and the only real factors were dyspnoea and the number of initial
This study highlights the need to seek help and offer help to those patients who may be suffering at home with no knowledge of the fact that the symptoms they are still experiencing are in fact long term symptoms of COVID.
Dr Paul Ettlinger
The London General Practice