Long Covid epidemiology (prevalence, incidence, recovery rates)

From a UK perspective (mine) it all looks perfectly 'normal'.

'They' do this sort of thing all the time - the first instance were I, and lots of people, noticed with a ship that they said was going one way (attacking) so they sank it, when it was actually 'running' away.

It was remarkable, to me, how the news reports from the first report (live), where it was leaving the area, was changed by the next report.

It was even more remarkable that no one, on the media, commented on this.

That was in 1982 (I think).

In the UK politics has dictated the news for a very long time.
 
This is the NHS's model for patient numbers who will experience symptoms beyond 12 weeks, and which services they will need/use.

Based on ONS stats, published in June so out of date now I don't doubt.

Screenshot_20210919-002906_Drive~2.jpg


Taken from the five point long COVID plan.
 

Attachments

Nathalie said:
This is the NHS's model for patient numbers who will experience symptoms beyond 12 weeks, and which services they will need/use.

Based on ONS stats, published in June so out of date now I don't doubt.

View attachment 15102


Taken from the five point long COVID plan.
Click to expand...

Thanks for posting that. A real lack of references to support the claims being made in there and I couldn't see who wrote it.

5. Rehabilitation to manage the most common Long
COVID symptoms
Long COVID has highlighted the importance of rehabilitation services in the
treatment of chronic conditions. Feedback from clinicians indicates that the
commonest symptoms of Long COVID are those that are most amenable to
rehabilitation therapies. Prevalence of Long COVID is highest in working age adults
(25-69),16 29% of all those reporting symptoms report that their ability to undertake
their day-day activities is significantly impacted.
Appropriate and personalised rehabilitation will have a beneficial impact on people’s
lives and their recovery. Existing rehabilitation services in well integrated systems
are best placed to provide this, especially integrated, multidisciplinary rehabilitation
services, which include access to vocational rehabilitation to support return to
occupation/work, with liaison where appropriate with the person’s employer.
People with Long COVID can often experience a multitude of complex conditions,
once assessed in a Long COVID assessment service, those identified as being in
this category should be assigned a care coordinator to help manage their
progression through the pathway.
The recently published commissioning guidance includes a rehabilitation pathway
for people with Long COVID. The purpose of rehabilitation pathways for people with
Long COVID is to improve physical, psychological and cognitive outcomes.
Pathways should be developed based on the principles in the RightCare:
Community Rehabilitation Toolkit.
Click to expand...
 
Esther12 said:
Thanks for posting that. A real lack of references to support the claims being made in there and I couldn't see who wrote it.
Click to expand...

Indeed. Lots of focus on rehabilitation, I'm wondering whether that also covers people who end up being referred to the fatigue services too - if I understand correctly I think the rehabilitation model can be inappropriate for people with ME.

I will be interested to see how their modelling changes as the pandemic progresses.
 
Merged thread
Estimating total morbidity burden of COVID-19: relative importance of death and disability, 2021, Smith

Abstract
Objective
: Calculations of disease burden of COVID-19, used to allocate scarce resources, have historically considered only mortality. However, survivors often develop postinfectious ‘long-COVID’ similar to chronic fatigue syndrome; physical sequelae such as heart damage, or both. This paper quantifies relative contributions of acute case fatality, delayed case fatality, and disability to total morbidity per COVID-19 case.
Study Design and Setting
: Healthy life years lost per COVID-19 case were computed as the sum of (incidence*disability weight*duration) for death and long-COVID by sex and 10-year age category in three plausible scenarios.
Results
: In all models, acute mortality was only a small share of total morbidity. For lifelong moderate symptoms, healthy years lost per COVID-19 case ranged from 0.92 (male in his 30s) to 5.71 (girl under 10) and were 3.5 and 3.6 for the oldest females and males. At higher symptom severities, young people and females bore larger shares of morbidity; if survivors’ later mortality increased, morbidity increased most in young people of both sexes.
Conclusions
: Under most conditions most COVID-19 morbidity was in survivors. Future research should investigate incidence, risk factors, and clinical course of long-COVID to elucidate total disease burden, and decisionmakers should allocate scarce resources to minimize total morbidity.
What is new; Key Findings
: Under most plausible model scenarios, most COVID-19 morbidity (death + disability) is likely to be due to disability (‘long-COVID’) or delayed death due to organ damage, rather than immediate death. Only if long-COVID resolves (atypical of postinfectious syndromes) is morbidity higher in old than young
What this adds to what is known
: While COVID-19 deaths are numerous, they likely cause less morbidity overall than does disability or organ damage in survivors. Morbidity is highest in females, especially those infected young.
What should change now
: Scarce resources such as vaccines should be allocated to minimize morbidity rather than focusing solely on mortality. Data on long-COVID, especially its sex bias, should be collected and publicized.

https://www.jclinepi.com/article/S0895-4356(21)00339-5/fulltext
 
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Merged thread

Free full text:
https://www.sciencedirect.com/science/article/pii/S0895435621003395

Journal of Clinical Epidemiology
Available online 26 October 2021

Original Article
Estimating total morbidity burden of COVID-19: relative importance of death and disability
Maia P.SmithPhD
https://doi.org/10.1016/j.jclinepi.2021.10.018


Highlights


• Under most plausible scenarios, most COVID-19 morbidity (death + disability) is in survivors;

• Because of combined high long-COVID risk and long remaining lifespan, females and children generally bear the highest share of morbidity burden;

• Data on long-COVID incidence, clinical course and risk factors (especially sex) are urgently needed.
 
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Moved post
Looks like a big paper that will deserve its own thread but useful Twitter summary. Published in Nature so expected to be pretty big and evaluates a roughly 7% prevalence of Long Covid. Likely a conservative underestimate, as it always is, so the floor, but not sure at which time point.



Things that shouldn't need to be said but nevertheless have to be said because ideological dogma is more persistent than black fungus and valued far above millions of lives (for now anyway):

 
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Merged thread

Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status, 2021, Xie et al

Abstract

The Post-Acute Sequelae of SARS-CoV-2 infection (PASC) have been characterized; however, the burden of PASC remains unknown. Here we used the healthcare databases of the US Department of Veterans Affairs to build a cohort of 181,384 people with COVID-19 and 4,397,509 non-infected controls and estimated that burden of PASC—defined as the presence of at least one sequela in excess of non-infected controls—was 73.43 (72.10, 74.72) per 1000 persons at 6 months. Burdens of individual sequelae varied by demographic groups (age, race, and sex) but were consistently higher in people with poorer baseline health and in those with more severe acute infection. In sum, the burden of PASC is substantial; PASC is non-monolithic with sequelae that are differentially expressed in various population groups. Collectively, our results may be useful in informing health systems capacity planning and care strategies of people with PASC.

Open access, https://www.nature.com/articles/s41467-021-26513-3
 
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Andy said:
Abstract

The Post-Acute Sequelae of SARS-CoV-2 infection (PASC) have been characterized; however, the burden of PASC remains unknown. Here we used the healthcare databases of the US Department of Veterans Affairs to build a cohort of 181,384 people with COVID-19 and 4,397,509 non-infected controls and estimated that burden of PASC—defined as the presence of at least one sequela in excess of non-infected controls—was 73.43 (72.10, 74.72) per 1000 persons at 6 months. Burdens of individual sequelae varied by demographic groups (age, race, and sex) but were consistently higher in people with poorer baseline health and in those with more severe acute infection. In sum, the burden of PASC is substantial; PASC is non-monolithic with sequelae that are differentially expressed in various population groups. Collectively, our results may be useful in informing health systems capacity planning and care strategies of people with PASC.

Open access, https://www.nature.com/articles/s41467-021-26513-3
Click to expand...

I suspect not all sequelae will prove to be equal. Some such as long term lung damage will be related to the severity of the initial infection, but others such as those experienced by patients who meet ME/CFS diagnostic criteria represent a distinct disease process or processes that, though triggered by the initial viral infection, has its own distinct momentum.
 
Peter Trewhitt said:
I suspect not all sequelae will prove to be equal. Some such as long term lung damage will be related to the severity of the initial infection, but others such as those experienced by patients who meet ME/CFS diagnostic criteria represent a distinct disease process or processes that, though triggered by the initial viral infection, has its own distinct momentum.
Click to expand...
There seem to be only 5 sequelae recorded that map to main ME/CFS symptoms - fatigue, muscle weakness, joint pain, memory problems and sleep disorder. Of these only sleep disorder does not show marked age related significance - Table 3. And interestingly all five present disproportionately as a burden for males - Table 4, 3rd column - a complete reversal of what one would expect in an ME/CFS cohort.

At 73.43 per 1000 the sequelae present cohort is 20 times the highest rate currently talked about for ME/CFS prevalence (250k per UK population) and with so many non ME/CFS specific sequelae included it seems probable that any post COVID propensity for ME/CFS is going to be drowned out. But the high prevalence of the five sequelae that are mappable across to ME/CFS perhaps shows how non specific they can be in post viral syndromes.
 
From the study that @lycaena linked to:
Utilizing comprehensive healthcare data on more than 45 percent of the German population from January 2019 through December 2020, we investigated post COVID-19 in children/adolescents and adults.

From a total of 38 million individuals, we identified all patients with laboratory confirmed diagnosis of COVID-19 through June 30, 2020. A control cohort was assigned using 1:5 exact matching on age, sex, and propensity score matching on prevalent medical conditions. COVID-19 and control cohorts were followed for incident morbidity outcomes documented at least three months after the date of COVID-19 diagnosis, which was used as the index date for both groups. Overall, 96 pre-defined outcomes were aggregated into 13 diagnosis/symptom complexes and three domains (physical health, mental health, physical/mental overlap domain).

The study population included 157,134 individuals (11,950 children/adolescents and 145,184 adults) with confirmed COVID-19.

In the COVID-19 cohort, incidence rates were significantly higher in all 13 diagnosis/symptom complexes in adults and in ten diagnosis/symptom complexes in children/adolescents. ...Incidence rates in children/adolescents were consistently lower than those in adults.

Among the specific outcomes with the highest IRR and an incidence rate of at least 1/100 person-years in the COVID-19 cohort in children and adolescents were
malaise/fatigue/exhaustion (IRR=2.28, 95%-CI=[1.71-3.06], IR COVID-19=12.58, IR Control=5.51),
cough (IRR=1.74, 95%-CI=[1.48-2.04], IR COVID-19=36.56, IR Control=21.06), and
throat/chest pain (IRR=1.72, 95%-CI=[1.39-2.12], IR COVID-19=20.01, IR Control=11.66).

In adults, these included
dysgeusia [that's a problem with taste] (IRR=6.69, 95%-CI=[5.88-7.60], IR COVID-19=12.42, IR Control=1.86),
fever (IRR=3.33, 95%-CI=[3.01-3.68], IR COVID-19=11.53, IR Control=3.46), and
dyspnea (IRR=2.88, 95%-CI=[2.74-3.02], IR COVID-19=43.91, IR Control=15.27).

This large, matched cohort study indicates substantial new-onset post COVID-19 morbidity in pediatric and adult populations based on routine health care documentation.
Click to expand...


A huge study, but with a 3 month minimum, it's a bit early to know about medium term impacts. Hopefully they will follow up.
 
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