Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study, 2022, Ballering et al

Summary

Background
Patients often report various symptoms after recovery from acute COVID-19. Previous studies on post-COVID-19 condition have not corrected for the prevalence and severity of these common symptoms before COVID-19 and in populations without SARS-CoV-2 infection. We aimed to analyse the nature, prevalence, and severity of long-term symptoms related to COVID-19, while correcting for symptoms present before SARS-CoV-2 infection and controlling for the symptom dynamics in the population without infection.

Methods
This study is based on data collected within Lifelines, a multidisciplinary, prospective, population-based, observational cohort study examining the health and health-related behaviours of people living in the north of the Netherlands. All Lifelines participants aged 18 years or older received invitations to digital COVID-19 questionnaires. Longitudinal dynamics of 23 somatic symptoms surrounding COVID-19 diagnoses (due to SARS-CoV-2 alpha [B.1.1.7] variant or previous variants) were assessed using 24 repeated measurements between March 31, 2020, and Aug 2, 2021. Participants with COVID-19 (a positive SARS-CoV-2 test or a physician's diagnosis of COVID-19) were matched by age, sex, and time to COVID-19-negative controls. We recorded symptom severity before and after COVID-19 in participants with COVID-19 and compared that with matched controls.

Findings
76 422 participants (mean age 53·7 years [SD 12·9], 46 329 [60·8%] were female) completed a total of 883 973 questionnaires. Of these, 4231 (5·5%) participants had COVID-19 and were matched to 8462 controls. Persistent symptoms in COVID-19-positive participants at 90–150 days after COVID-19 compared with before COVID-19 and compared with matched controls included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. In 12·7% of patients, these symptoms could be attributed to COVID-19, as 381 (21·4%) of 1782 COVID-19-positive participants versus 361 (8·7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90–150 days after COVID-19 diagnosis or matched timepoint.

Interpretation
To our knowledge, this is the first study to report the nature and prevalence of post-COVID-19 condition, while correcting for individual symptoms present before COVID-19 and the symptom dynamics in the population without SARS-CoV-2 infection during the pandemic. Further research that distinguishes potential mechanisms driving post-COVID-19-related symptomatology is required.

Open access, https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01214-4/fulltext

 

Both Judith Rosmalen en Tim Olde Hartman were part of the Dutch Health Council for 2 years. They should've seen PEM coming. Good they've mentioned it as a limitation but I see this as negligence. Oh they are also CBT proponents and MUS scientists so I'm a bit biased and not a fan.

 

Absurd that we are still at this point 2.5 years into this, but at least this coming from excessively biased people in a biased political environment means this is about the most conservative estimate you can get and it's still missing key questions about functional status that recognize that chronic illness after infectious diseases is and has always been a thing. The elephant in the room is trashing the whole building and still everyone is looking everywhere but at it. Madness.

Right now we're basically both seeing significant % of people unable to work for health reasons and many clinics swamped with demand but most aren't hospitalized and don't have recognized diagnoses so they are around, but they don't exist, basically ghosts in the machine.

Again the issue is over questions asked. Asking the right questions is the hardest part of science and most are still refusing to ask questions that recognize chronic illness. The same dynamic as always, basically quasi-religious taboos, you do not speak those words, those words are forbidden or they bring out the devil. Or something.

And of course the issue that controls have become unusable for the most part, as a solid majority of the population has been infected already. Given the numbers being in the single digit %, this means that the first waves of infections were enormous and went largely unnoticed because of lack of testing.

It's getting extra annoying all the physicians saying "this isn't the flu", now the other way around, when the flu is in fact also a significant risk factor for those issues, the main difference is that Covid is massively more infectious so it's a similar % of a far greater number.

Medicine still unable to just tell the plain truth. Everything is managed for PR as if the single most important thing is to avoid telling people the truth because they can't handle it. Lockdowns have been over for well over a year now and still there are many who cling to pretending it's a valid explanation. There are simply no consequences for spreading blatant BS, even getting everything wrong.

Just like in politics. Exactly like in politics. Where everything is about connections and influence and the truth is something to manage, not something to discover and educate about.

 

Agree it is quite absurd that we had to wait 2.5 years to get a decent epidemiological study on Long Covid.

I doubt that the authors can be seen as biased in getting a low estimate. MUS and BPS proponents are usually not those who deny the existence of long covid (or ME/CFS). They usually highlight the problem because they can present themselves as experts and their psychosomatic approach as the solution.

The main estimate given here is 12.7% but it's still quite broad definition. It refers to people who had at least one of the core symptom of Long COVID increased to at least moderate severity, 3-5 months post-infection.

In the COVID-19-positive participants this was 21.4% compared to only 8.7% in the control group. So the severity and duration of these symptoms might be very different those seen in patients with ME/CFS.

And if I understand correctly, those 'core symptoms' where chose because they resulted in the biggest difference. The authors mention that "including a broader range of symptoms, the ratio between patients with symptoms due to SARS-CoV-2 infection and those with unrelated symptoms decreased."

 

I'm not getting the impression that the authors are biased towards psychogenic explanations. The questionnaire they used initially was developed for somatization. Maybe they were expecting to find evidence for psychogenic causes but changed their mind as the data came in?

Anyway, one concern is that this study may still be underestimating the problem somewhat due to the issue of control group likely being contamined with long covid cases that weren't recognized as such for various reasons. This isn't the fault of the authors, just a limitation of large studies that cannot deeply investigate all patients to arrive at a more precise classification.

On the other hand, maybe in a more vaccinated population long covid would be less common. As far as I know vaccination doesn't seem to have a great effect on chance of developing LC (I remember seeing a 15% decreased risk, and some studies with no change in risk) and there seems to be a bit of wishful thinking in some corners that vaccination will radically change the risks.

The absence of postexertional malaise in the symptoms included in the analysis is very disappointing, and I can't help but suspect that it might be intentional.

The study looks like the kind of evidence that is hard to ignore. Society needs to find better solutions for long covid and stop listening to minimizers.