Clinical and functional assessment of SARS-CoV-2 sequelae among young marines – a panel study, 2024, Chad K Porter et al

[Mij]

Summary
Background
Long-term SARS-CoV-2 adverse health outcomes are of significant concern, especially among young adults with the potential for the greatest long-term morbidity. We sought to assess and characterize these outcomes in a cohort of Marines.
Methods
We used a cohort of US Marines from a previous longitudinal, prospective observational study of acute SARS-CoV-2, most of whom were enrolled prior to infection. A panel study was established to assess for post-acute sequelae of COVID-19 (PASC), defined as symptoms at least 4 weeks after symptom onset or diagnosis. Symptoms were assessed through questionnaires and validated quality of health metrics. Periodic US Marine Corps fitness testing metrics provided an additional standardized functional assessment and were compared to a pre-pandemic cohort.
Findings
Globally dispersed Marine participants (n = 899) seen an average of 330 days following initial enrollment were predominately male (n = 825, 91.7%), White (n = 613, 71.6%) or Black (n = 149, 17.4%) with a median age of 18 years (interquartile range: 18–19). Among 798 SARS-CoV-2 infected participants, 197 (24.7%) developed PASC. The most prevalent symptoms were loss of taste and/or smell (n = 82; 41.6%), shortness of breath (n = 74; 37.6%), and cough (n = 45; 22.8%). Those with PASC had higher rates and severity of somatic (p < 0.0001), general depressive (p < 0.0001), and anxiety (p = 0.005) symptoms. Compared to a historic cohort of Marines, participants with PASC scored worse on their physical fitness assessments due to slower run times (p = 0.002). Those with PASC continued to have decreased physical performance one year after completing initial training.
Interpretation
In this population of healthy young adult US Marines with mostly either asymptomatic or mild acute COVID-19, one fourth reported physical, cognitive, or psychiatric long-term sequelae of infection. The Marines affected with PASC showed evidence of long-term decrease in functional performance suggesting that SARS-CoV-2 infection may negatively affect health for a significant proportion of young adults.
LINK

 

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Among the 899 participants, 88.8% had a SARS-CoV2 infection. Almost a quarter (24.7%) of these individuals had at least one COVID-19 symptom that lasted for at least 4 weeks meeting the a priori definition of PASC established for this study. Among those with PASC, 10 had no acute SARS-CoV-2 symptoms after PCR-confirmed infection suggesting that PASC can occur among asymptomatic individuals. Many participants reported that lingering symptoms impaired their productivity at work, caused them to miss work, and/or limited their ability to perform normal duty/activities.

24.7% is a high percentage, recognising that the definition for PASC was liberal. It might suggest significantly higher and even extreme physical activity leads to increased likelihood of developing symptoms.

Marines with PASC had significantly decreased physical fitness test scores up to approximately one year post-infection with a three-mile run time that averaged in the 65th percentile of the reference cohort. Scores for events evaluating upper body (pull-ups, crunches, and ammo can lift) were not significantly reduced by PASC; however, overall physical fitness scores were reduced. The poorer run times and overall scores among PASC participants are indicative of ongoing functional effects.

 

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Although Marine fitness metrics might be an atypical objective measure of physical performance for the general population, they can provide insight into how PASC affects the musculoskeletal, neurologic, and cardiopulmonary systems. For example, a three-mile run evaluates aerobic exercise, overhead lifting of an ammunition can and pull-ups evaluate strength, and shooting a rifle evaluates fine-motor skills. Each event is regulated and standardized. Although effort cannot be directly measured, the United States Marine Corps creates a competitive environment to maximize performance and uses these scores as a criterion for rank promotion and subsequent pay increases, incentivizing maximal effort.

Are we sure this isn't all just a mismatch between what a US marine thinks he or she can achieve and what the marine's body performs?

Please Dr Walitt, if you are so confident in your effort preference theory (what with it being the leading point in your paper and all), I assume you'd be prepared to replicate this with these here United States marines.

 

[Turtle]

Are we sure this isn't all just a mismatch between what a US marine thinks he or she can achieve and what the marine's body performs?

Please Dr Walitt, if you are so confident in your effort preference theory (what with it being the leading point in your paper and all), I assume you'd be prepared to replicate this with these here United States marines.

Another nail in the GET theory too. Marines trying to exercise their way out of the disease and getting worse. "Fear of exercise" in a marine?
Sharpe et all could get away with not believing me, but not believing marines, he would not dare.

 

[SNT Gatchaman]

See also review article —

Musculoskeletal, Pulmonary, and Cardiovascular COVID-19 Sequelae in the Context of Firefighter Occupational Health: A Narrative Review (Oct 2024)
Graham, Elliot L.; D’Isabel, Susanne; Lofrano-Porto, Adriana; Smith, Denise L.

Spoiler: Abstract

For most individuals infected with SARS-CoV-2, the acute illness resolves completely. However, for millions of people, symptoms or sequelae from COVID-19 recur or persist for months to years after infection. Post-COVID-19 sequelae are wide-ranging, often affecting the musculoskeletal, pulmonary, and cardiovascular systems. All who experience post-COVID-19 sequelae face significant challenges navigating home and work life.

Occupations such as firefighting, however, are of particular concern given the strenuous nature of a job that relies on a healthy musculoskeletal, pulmonary, and cardiovascular system. Research has documented significant musculoskeletal impairment (including muscle weakness, pain, and fatigue), respiratory dysfunction (including reduced lung function, interstitial disease, and diffusion abnormalities), cardiovascular conditions (including cardiac events, ischemic disease, dysrhythmias, and infectious diseases), and diminished cardiorespiratory fitness that continues for months to years in some individuals. These persistent post-COVID-19 conditions may affect a firefighter’s ability to return to work, function at full capacity while at work, and potentially compromise firefighter health and public safety.

This review, therefore, explores musculoskeletal, pulmonary, and cardiovascular sequelae post-COVID-19 and the impact of these sequelae on firefighter health and occupational readiness.

Link | PDF (International Journal of Environmental Research and Public Health) [Open Access]

While post-acute COVID-19 conditions can present a serious challenge to all individuals, the sequelae explored in this review that are specific to the musculoskeletal, pulmonary, and cardiovascular systems are of particular concern for public safety personnel, like firefighters, who must perform strenuous duties as part of their work. Similarly, the health care system has been seriously challenged by dealing with the number of individuals suffering from the variety of post-acute sequelae from COVID-19, especially given the lack of clear guidance on how to successfully treat the numerous conditions presenting. Moreover, providing care to those in strenuous, tactical occupations may be uniquely challenging. Given the number of people affected, and the severity and complexities of the post-acute sequelae that arise after COVID-19, additional research is desperately needed.