Post-COVID-19 condition symptoms among emergency department patients tested for SARS-CoV-2 infection, 2024, Archambault et al.

[SNT Gatchaman]

Post-COVID-19 condition symptoms among emergency department patients tested for SARS-CoV-2 infection
Archambault, Patrick M.; Rosychuk, Rhonda J.; Audet, Martyne; Hau, Jeffrey P.; Graves, Lorraine; Décary, Simon; Perry, Jeffrey J.; Brooks, Steven C.; Morrison, Laurie J.; Daoust, Raoul; Yeom, David Seonguk; Wiemer, Hana; Fok, Patrick T.; McRae, Andrew D.; Chandra, Kavish; Kho, Michelle E.; Stacey, Dawn; Vissandjée, Bilkis; Menear, Matthew; Mercier, Eric; Vaillancourt, Samuel; Aziz, Samina; Zakaria, Dianne; Davis, Phil; Dainty, Katie N.; Paquette, Jean-Sébastien; Leeies, Murdoch; Goulding, Susie; Berger Pelletier, Elyse; Hohl, Corinne M.

Symptoms of the Post-COVID-19 Condition are often non-specific making it a challenge to distinguish them from symptoms due to other medical conditions. In this study, we compare the proportion of emergency department patients who developed symptoms consistent with the World Health Organization’s Post-COVID-19 Condition clinical case definition between those who tested positive for Severe Acute Respiratory Syndrome Coronavirus-2 infection and time-matched patients who tested negative.

Our results show that over one-third of emergency department patients with a proven acute infection meet Post-COVID-19 Condition criteria 3 months post-index visit. However, one in five test-negative patients who claim never having been infected also report symptoms consistent with Post-COVID-19 Condition highlighting the lack of specificity of the clinical case definition.

Testing for SARS-CoV-2 during the acute phase of a suspected infection should continue until specific biomarkers of Post-COVID-19 Condition become available for diagnosis and treatment.

Link | PDF (Nature Communications) [Open Access]

 

[SNT Gatchaman]

our study is unique because it is the largest and longest-running ED prospective cohort that spans pre-Omicron and post-Omicron waves with consecutive patients including time-concurrent negative controls that limits selection bias found in other large cohorts that included self-referred patients.

although we aimed to recruit 4 test-negative controls for each test-positive case, our final ratio was less than 1:1 (3933 cases for 2790 controls)because of periods where the rate of test positivity was very high

In this work, we show that PCC as defined by the WHO is a nonspecific syndrome that occurs in many patients who present to the ED for an acute illness requiring SARS-CoV-2 testing. While a proven acute SARS-CoV-2 infection was the single most important risk factor, one in five patients with no evidence of acute or subsequent SARS-CoV-2 infection met PCC criteria. The current WHO definition for suspected SARS-CoV-2 infections will lead to overdiagnosis of PCC among patients with suspected infections who are currently not being tested.

At three months, test-positive patients reported each individual PCC-consistent symptom at least twice as often as negative patients. While a positive SARS-CoV-2 test during the index ED visit was the main risk factor for developing PCC, other risk factors included female sex, arriving by ambulance, ICU admission, exposure to dexamethasone, and reporting fatigue and olfactory symptoms at baseline.

Our high rate of PCC-consistent symptoms in test-negative patients is unlikely to be explained by asymptomatic SARS-CoV-2 infections or missed infections from the early pandemic when SARSCoV-2 testing was limited. Data from Canadian seroprevalence studies confirmed that fewer than 9% of Canadians had serological evidence of SARS-CoV-2 infection prior to the Omicron wave that started on November 28, 2021, when 94% of our cohort was recruited. Very few patients in our cohort were tested for other viruses, making it possible that we identified other post-viral syndromes. However, strict COVID-19 public health restrictions in Canada during the study period reduced the circulation of other viruses, making this less likely. Thus, our data indicate that the development of PCC after suspected but not confirmed SARS-CoV-2 infection is nonspecific and can occur in SARS-CoV-2 naïve patients.

(They're assuming that antigen and later antibody testing has a zero false negative rate.)

Contrary to other studies that show that higher education protects against severe COVID-19 and PCC59,60 , we found that patients with lower education reported fewer PCC symptoms, consistent with other studies. Researchers have raised the possibility that initial lack of awareness of the range of symptoms associated with acute COVID-19 could lead patients with lower education to seek out SARS-CoV-2 testing less frequently. Patients with lower education and socio-economic status also face stigma related to PCC that might lead to underreporting of their symptoms.

Although several studies reported that vaccination decreased the rates of PCC symptoms, our study did not confirm this protective effect.

 

[rvallee]

3 months post-index visit

longest-running ED prospective cohort

Good grief we deserve so much better research than this. It's all been so underwhelming. Even closing in on 5 years all the research is so small. Everything is small. They think small and act even smaller.