Improvement of Long COVID symptoms over one year 2023 Oliviera et al

[Andy]

Importance: Early and accurate diagnosis and treatment of Long COVID, clinically known as post-acute sequelae of COVID-19 (PASC), may mitigate progression to chronic diseases such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our objective was to determine the utility of the DePaul Symptom Questionnaire (DSQ) to assess the frequency and severity of common symptoms of ME/CFS, to diagnose and monitor symptoms in patients with PASC.

Methods: This prospective, observational cohort study enrolled 185 people that included 34 patients with PASC that had positive COVID-19 test and persistent symptoms of >3 months and 151 patients diagnosed with ME/CFS. PASC patients were followed over 1 year and responded to the DSQ at baseline and 12 months. ME/CFS patients responded to the DSQ at baseline and 1 year later. Changes in symptoms over time were analyzed using a fixed-effects model to compute difference-in-differences estimates between baseline and 1-year follow-up assessments.

Participants: Patients were defined as having PASC if they had a previous positive COVID-19 test, were experiencing symptoms of fatigue, post-exertional malaise, or other unwellness for at least 3 months, were not hospitalized for COVID-19, had no documented major medical or psychiatric diseases prior to COVID-19, and had no other active and untreated disease processes that could explain their symptoms. PASC patients were recruited in 2021. ME/CFS patients were recruited in 2017.

Results: At baseline, patients with PASC had similar symptom severity and frequency as patients with ME/CFS and satisfied ME/CFS diagnostic criteria. ME/CFS patients experienced significantly more severe unrefreshing sleep and flu-like symptoms. Five symptoms improved significantly over the course of 1 year for PASC patients including fatigue, post-exertional malaise, brain fog, irritable bowel symptoms and feeling unsteady. In contrast, there were no significant symptom improvements for ME/CFS patients.

Conclusion and relevance: There were considerable similarities between patients with PASC and ME/CFS at baseline. However, symptoms improved for PASC patients over the course of a year but not for ME/CFS patients. PASC patients with significant symptom improvement no longer met ME/CFS clinical diagnostic criteria. These findings indicate that the DSQ can be used to reliably assess and monitor PASC symptoms.

Open access, https://www.frontiersin.org/articles/10.3389/fmed.2022.1065620/full

 

[SNT Gatchaman]

In our study, while the similarities between PASC and ME/CFS at baseline were considerable, we found a substantial reduction in self-reported symptoms in PASC patients at 1- year compared to the pre-pandemic ME/CFS group. This suggests that symptoms of PASC may slowly resolve over time in many subjects.

Notably, nearly all patients with PASC met criteria for ME/CFS using the Institute of Medicine clinical diagnostic criteria for ME/CFS, and only minor differences in the relative frequency of two symptoms were detected between PASC and ME/CFS cohorts.

If you re-framed these patient groups as "ME/CFS patients 3-4 years+" vs "ME/CFS patients 0-2 years", all this seems to be showing is the potential for remission/recovery earlier in the disease course, but with longer duration the less likely this becomes. Or am I missing something?