Trial Report “The burden of post-acute COVID-19 symptoms in a multinational network cohort analysis”, 2023, Kostka et al.

[SNT Gatchaman]

“The burden of post-acute COVID-19 symptoms in a multinational network cohort analysis”
Kostka, Kristin; Roel, Elena; Trinh, Nhung T. H.; Mercadé-Besora, Núria; Delmestri, Antonella; Mateu, Lourdes; Paredes, Roger; Duarte-Salles, Talita; Prieto-Alhambra, Daniel; Català, Martí; Jödicke, Annika M.

Persistent symptoms following the acute phase of COVID-19 present a major burden to both the affected and the wider community.

We conducted a cohort study including over 856,840 first COVID-19 cases, 72,422 re-infections and more than 3.1 million first negative-test controls from primary care electronic health records from Spain and the UK (Sept 2020 to Jan 2022 (UK)/March 2022 (Spain)). We characterised post-acute COVID-19 symptoms and identified key symptoms associated with persistent disease. We estimated incidence rates of persisting symptoms in the general population and among COVID-19 patients over time. Subsequently, we investigated which WHO-listed symptoms were particularly differential by comparing their frequency in COVID-19 cases vs. matched test-negative controls. Lastly, we compared persistent symptoms after first infections vs. reinfections.

Our study shows that the proportion of COVID-19 cases affected by persistent post-acute COVID-19 symptoms declined over the study period. Risk for altered smell/taste was consistently higher in patients with COVID-19 vs test-negative controls. Persistent symptoms were more common after reinfection than following a first infection.

More research is needed into the definition of long COVID, and the effect of interventions to minimise the risk and impact of persistent symptoms.

Link | PDF (Nature Communications)

 

[SNT Gatchaman]

This multinational cohort study characterises the presentation of long COVID, including over 856,840 first COVID-19 cases, 72,422 re-infections and more than 3.1 million first negative-test controls from Spain and the UK. We found high proportions of post-acute COVID-19 symptoms for ≥90 days, i.e. after almost 22.5% of infections in Spain and 21% in the UK. At the population level, waves of post-acute COVID-19 symptoms followed each wave of community transmission in the study period, affecting predominantly young adults.

We report a consistent increase in the risk of persistent symptoms after reinfection compared to first infection.

 

[Hutan]

I'm always keen to see good epidemiological studies of Long Covid/PCS. I haven't read very far, but I am already doubting that this is one.

Among those with a SARS-CoV-2 infection, 22.5% in SIDIAP and 21.0% in CPRD had post-acute COVID-19 symptoms, as defined by the presence of at least one of the 25 WHO-listed symptoms recorded ≥90 days after infection (and without a history of the symptoms in the 180 days before SARS-CoV-2 infection). In comparison, 21.3% of participants in the first negative test cohort in SIDIAP and 23.0% in CPRD had at least one persistent symptom recorded ≥90 days after the test (despite no infection). Across all cohorts and databases, more than ~60% of individuals with post-acute COVID-19 symptoms had only one symptom recorded. Overall, the most common symptoms were joint pain, abdominal pain, gastrointestinal issues, and anxiety. Cough and depression were common in CPRD.

About the same percentage of people had one or more persistent symptoms more than 90 days after SARS-CoV-2 infection as people more than 90 days after a first negative test.

These are primary care medical records, so people having a test probably had some reason to think they should be tested. Many of those for whom the test was negative will have either had a SARS-CoV-2 infection or had some other medical issue that may have caused persisting symptoms.

Requiring only one persistent symptom from a long list of symptoms to count is also a problem. The bar is hopelessly low. The list of most common symptoms does not engender confidence: joint pain, abdominal pain, gastrointestinal issues and anxiety.

I think there might be other problems too e.g. people in the 'first negative test' cohort may have subsequently had a SARS-CoV-2 infection, but I haven't checked.

I may have things wrong, I'm not motivated to read on and look more closely. Interested to hear what others think. Can anyone recall a good large study of incidence?

 

[Jonathan Edwards]

I agree. Counting symptoms is hopeless.
I would have thought it more useful to go for something like newly being off work from time of Covid without other explanation.

 

[FMMM1]

I'm always keen to see good epidemiological studies of Long Covid/PCS. I haven't read very far, but I am already doubting that this is one.

I may have things wrong, I'm not motivated to read on and look more closely. Interested to hear what others think. Can anyone recall a good large study of incidence?

Thanks Hutan - if you, or anyone else, is aware of a:

• "good epidemiological studies of Long Covid/PCS";
• "Can anyone recall a good large study of incidence?"

then I'd be interested.

@ME/CFS Skeptic

 

[ME/CFS Skeptic]

Can anyone recall a good large study of incidence?

I think, at the moment, the one by Rosmalen and her Lifelines cohort is one of the best, unfortunately.
Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study - The Lancet

Still haven't seen a good epidemiological study that tested for ME/CFS following COVID-19, unless I overlooked?

 

[alex3619]

I agree. Counting symptoms is hopeless.
I would have thought it more useful to go for something like newly being off work from time of Covid without other explanation.

This kind of objective outcome needs to be more prevalent in a lot of research. We need to see it more often in ME research too.

 

[alex3619]

Still haven't seen a good epidemiological study that tested for ME/CFS following COVID-19

I keep thinking about this. It might be urgently needed, we wont know until after it happens and we see the data. Given the incidence of infection and re-infection that we know of, planning future studiers and public health options may require this.

As a guesstimate, not nearly reliable, I suspect that the new prevalence of ME may approach 3% over time, with perhaps 10% as a ceiling. I really hope this is not the case, and we need good epidemiology to figure it out. I do think there are probably two categories of post COVID, one with ME and one without. I also think the sometimes prevalence in some studies of 6-7% may be highly misleading. A good percentage of these patients is likely to be from prolonged recovery from all the damage COVID did, not ME.

 

[FMMM1]

Still haven't seen a good epidemiological study that tested for ME/CFS following COVID-19, unless I overlooked?

You'd need a reliable way to measure ME/CFS pre & post covid - essentially biomarkers?

 

[LarsSG]

Yes, this one is definitely hopeless. If you look at their risk ratios, it's pretty clear that there is some kind of selection problem with their infected versus negative cohorts. Sure looks like the infected cohort is somehow healthier and having fewer symptoms than the negative cohort (aside from the altered smell or taste):


I doubt their claim about the risk of symptoms being higher after reinfections is meaningful in this context.