Studies find long COVID symptoms, including joint pain, at 1 year
Two new studies detail long COVID symptoms, with one from France showing that 85% of patients who had symptoms 2 months after illness onset still had them at 1 year and some symptoms worsened, and one from China revealing that 12% of patients reported rheumatic symptoms at 1-year follow-up.
In the first study, researchers in Paris analyzed data from 968 adult COVID-19 participants in an ongoing prospective cohort study in France, including their responses to the online Long COVID Symptom Tool questionnaire about daily occurrence of 53 symptoms from December 2020 to October 2021. The data were published today in Nature Communications.
Of patients with symptoms 2 months after symptom onset, 85% still had them at 1 year. The prevalence of 27 symptoms such as a loss of taste or smell declined over time, while 18 symptoms (eg, shortness of breath) remained stable, and 8 (eg, abnormal sensations due to nerve damage) increased.
Symptoms had a greater effect on patients' lives starting at 6 months. "Our results are of importance to understand the natural history of post COVID-19 disease," the researchers concluded.
Apr 5 Nat Commun study
The second study, conducted by researchers in Harbin and Beijing, involved face-to-face interviews of 1,296 COVID-19 survivors 1 year after they were released from the hospital from Jan 7 to May 29, 2020. The findings were published yesterday in Open Forum Infectious Diseases.
Of the 1,296 patients, 12.3% still reported rheumatic symptoms at 1 year. The most common symptoms involved joints in the knee (38%), hand (25%), and shoulder (19%). The symptoms were independent of illness severity and corticosteroid therapy during the initial illness. Older age (odds ratio [OR], 1.22) and female sex (OR, 1.58) were risk factors for these symptoms.
"Our investigation showed a considerable proportion of rheumatic symptoms following COVID-19 in discharged patients, which highlights the need for continuing attention," the study authors wrote.
Apr 4 Open Forum Infect Dis study
COVID-19 sped up adoption of new clinical guidelines
A survey of 52 US hospitals—mostly academic medical centers—shows the COVID-19 pandemic drastically sped up the rate at which clinicians adopted new clinical treatment guidelines, shortening the duration from years to months. The study was published yesterday in JAMA Network Open.
The researchers looked at survey results from 52 hospitals in the Hospital Medicine Reengineering Network and how they treated COVID-19 patients from Dec 17, 2020, to Feb 10, 2021.
Over the course of 6 to 8 months, 94% to 100% of sites began recommending dexamethasone for patients requiring at least 4 liters (L) of oxygen, and 69% began recommending remdesivir for patients receiving mechanical ventilation. A total of 81% of hospitals surveyed began recommending dexamethasone for patients requiring 1 to 2 L of oxygen, and 67% began implementing awake proning (having patients lie face down).
The dexamethasone use was recommended following one randomized control trial. Previous analyses demonstrate it can take institutions as many as 17 years following one trial before use becomes standard practice. But the pandemic forced action, the authors said.
"Institutions favored treatment over not treatment, particularly when guidelines diverged from each other or from the underlying evidence, as exemplified by 69% to 81% of sites recommending remdesivir or dexamethasone, respectively, when evidence or guidelines conflicted," the authors wrote.
Apr 4 JAMA Netw Open study