Three new studies report on long-COVID symptoms and medical conditions in adults and children, with the first finding that one in eight adults experiences lingering symptoms; another detailing new cardiovascular, renal, and metabolic findings in children; and a third finding persistent loss of taste and smell after 2 years.
12.7% report long-COVID symptoms
An observational study from the Netherlands published today in The Lancet analyzed the nature, prevalence, and severity of long-COVID symptoms in 4,231 adult COVID-19 survivors and 8,462 matched controls 3 to 5 months after infection or matched date, before the COVID-19 vaccine rollout in that country.
The authors used data from Lifelines, a prospective, population-based cohort study on the health and health-related behaviors of the Dutch population. All adult participants were invited to complete the same online questionnaire 24 times on 23 physical long-COVID symptoms after recovery from infection with the SARS-CoV-2 Alpha variant or previously circulating strains from Mar 31, 2020, to Aug 2, 2021. Average participant age was 53.7 years, and 60.8% were women.
COVID-19 survivors reported chest pain, shortness of breath, painful breathing and muscles, loss of taste or smell, tingling and heaviness of the arms and legs, a lump in the throat, feeling hot and then cold, and fatigue at 3 to 5 months.
Of all patients, 12.7% had symptoms attributable to COVID-19, and 381 of 1,782 survivors (21.4%) and 361 of 4,130 (8.7%) of controls reported that at least one symptom became at least moderately severe by 3 months, then usually plateaued. Other symptoms, including headache, itchy eyes, dizziness, back pain, and nausea, didn't become more severe.
In a Lancet press release, senior author Judith Rosmalen, PhD, of the University of Groningen, said the need for data on the scale and scope of long-COVID symptoms are urgently needed. "However, most previous research into long COVID has not looked at the frequency of these symptoms in people who haven’t been diagnosed with COVID-19 or looked at individual patients’ symptoms before the diagnosis of COVID-19," she said.
First author Aranka Ballering, a PhD candidate at the same university, said in the release that the team was able to account for symptoms unrelated to infection but related to the pandemic overall, such as stress caused by lockdowns and uncertainty. "These core symptoms have major implications for future research, as these symptoms can be used to distinguish between post COVID-19 condition and non-COVID-19-related symptoms," she said.
In a related commentary, Christopher Brightling, MBBS, PhD, and Rachael Evans, MBChB, both of the University of Leicester in the United Kingdom, said that some symptoms reported in the study, such as fatigue and shortness of breath, were similar to those cited in previous research.
"But interestingly other symptoms such as chest pain were more a feature in those with long COVID versus uninfected controls," they wrote. "Current evidence supports the view that long COVID is common and can persist for at least 2 years, although severe debilitating disease is present in a minority."
Infected kids had twice rate of heart disorders
In a study published today in Morbidity and Mortality Weekly Report (MMWR), researchers with the Centers for Disease Control and Prevention (CDC) COVID-19 Emergency Response Team evaluated nine persistent signs and symptoms and 15 conditions thought to be related to COVID-19 in 781,419 previously infected US children and 2,344,257 uninfected controls aged 0 to 17 years from Mar 1, 2020, to Jan 31, 2022. Follow-up was 60 to 365 days or until the end of the study.
Median age of all participants was 12 years, and those not infected with COVID-19 had higher rates of previous hospitalization and complex chronic disease than infected patients (4.5% and 15.6% vs 3.6% and 11.7%, respectively).
After COVID-19 infection, children had higher rates of acute pulmonary embolism (adjusted hazard ratio [aHR], 2.01), myocarditis and cardiomyopathy (inflammation of the heart muscle and enlarged heart, respectively) (aHR, 1.99), venous blood clots (aHR, 1.87), acute and unspecified kidney failure (aHR, 1.32), type 1 diabetes (aHR, 1.23), coagulation and hemorrhagic disorders (aHR, 1.18), type 2 diabetes (aHR, 1.17), and abnormal heart rhythms (aHR, 1.16).
But relative to controls, COVID-19 survivors had lower odds of respiratory signs and symptoms (aHR, 0.91), mental symptoms (aHR, 0.91), muscle disorders (aHR, 0.94), neurologic conditions (aHR, 0.94), anxiety and fear-related disorders (aHR, 0.85), mood disorders (aHR, 0.78), and sleep problems (aHR, 0.91).
Compared with controls, infected children aged 2 to 4 years were at higher risk for myocarditis and cardiomyopathy (aHR, 2.39), acute and unspecified kidney failure (aHR, 1.52), and coagulation and hemorrhagic disorders (aHR, 1.47). This age-group was the only one with elevated rates of post-COVID asthma (aHR, 1.12) and respiratory signs and symptoms (aHR, 1.07).
COVID-19 survivors in the 5- to 11-year age-group were at higher risk than controls for myocarditis and cardiomyopathy (aHR, 2.84), venous blood clots (aHR, 2.69), and acute and unspecified kidney failure (aHR, 1.38). And infected patients aged 12 to 17 were at higher risk than controls for blood clots in the lungs (aHR, 2.03), myocarditis and cardiomyopathy (aHR, 1.66), and venous blood clots (aHR, 1.52).
"These findings can be used to apprise health care professionals and caregivers about new symptoms and conditions that occur among children and adolescents in the months after SARS-CoV-2 infection," the authors wrote. "COVID-19 prevention strategies, including vaccination for all eligible children and adolescents, are critical to prevent SARS-CoV-2 infection and subsequent illness, including post-COVID symptoms and conditions."
12.8% still hadn't recovered smell, taste at 2 years
In JAMA Otolaryngology-Head & Neck Surgery yesterday, researchers in Italy and the United Kingdom assessed adults diagnosed as having COVID-19 at a general hospital from Mar 19 to 22, 2020. A total of 168 respondents completed symptom questionnaires at 4 and 8 weeks, 6 months, and 2 years. Median patient age was 55 years, and 53.6% were women.
Of the 168 patients, 64.3% reported altered taste or smell at baseline, as did 64.3% at 4 weeks, 17.3% at 8 weeks, 16.1% at 6 months, and 8.3% at 2 years. The altered senses were first observed at 4-week follow-up in 11 patients who still tested positive for COVID-19.
Thirteen patients (10.9%) reported recovery of taste or smell at least 6 months after diagnosis. At 2 years, 47 patients (28.0%) reported at least one persistent symptom. The most common symptoms unrelated to taste or smell were fatigue (18.5%) and shortness of breath (10.7%).
Of the 119 patients with smell or taste dysfunction at 4 weeks, 88.2% reported complete resolution at 2 years, 9.2% said their impairment was less severe, and 2.5% said their symptom was the same or worse.
While warning that the results should be interpreted with caution owing to study limitations, the researchers said, "Contrary to what is often reported, patients should be reassured that recovery from smell or taste impairment may continue for many months after the onset. These results apply to patients infected in the pre-Omicron period. COVID-19 driven by the SARS-CoV-2 Omicron variant has been indeed observed to less frequently and less severely affect chemosensory function."
