Preprint: Prevalence, determinants, and impact on general health and working capacity of PASC 6-12 m after infection..., 2022, Peter, Kern et al

Prevalence, determinants, and impact on general health and working capacity of post-acute sequelae of COVID-19 six to 12 month after infection: a population-based retrospective cohort study from southern Germany
Peter, Kern et al

https://www.medrxiv.org/content/10.1101/2022.03.14.22272316v1 (preprint)

Abstract

Background: Post-acute sequelae of SARS-CoV-2 infection have commonly been described after COVID-19, but few population-based studies have examined symptoms six to 12 months after acute SARS-CoV-2 infection and their associations with general health recovery and working capacity.

Methods: This population-based retrospective cohort study in four geographically defined regions in southern Germany included persons aged 18-65 years with PCR confirmed SARS-CoV-2 infection between October 2020 and March 2021.

Symptom frequencies (six to 12 months after versus before acute infection, expressed as prevalence differences [PD] and ratios [PR]), symptom severity and clustering, risk factors and associations with general health recovery, and working capacity were analysed.

Findings: Among a total of 11,710 subjects (mean age 44.1 years, 59.8% females, 3.5% previously admitted with COVID-19, mean follow-up time 8.5 months) the most prevalent symptoms with PDs >20% and PRs >5% were rapid physical exhaustion, shortness of breath, concentration difficulties, chronic fatigue, memory disturbance, and altered sense of smell. Female sex and severity of the initial infection were the main risk factors.

Prevalence rates, however, appeared substantial among both men and women who had a mild course of acute infection, and PCS considerably affected also younger subjects.

Fatigue (PD 37.2%) and neurocognitive impairment (PD 31.3%) as symptom clusters contributed most to reduced health recovery and working capacity, but chest symptoms, anxiety/depression, headache/dizziness and pain syndromes were also prevalent and relevant for working capacity, with some differences according to sex and age.

When considering new symptoms with at least moderate impairment of daily life and ≤80% recovered general health or working capacity, the overall estimate for post-COVID syndrome was 28.5% (age- and sex-standardised rate 26.5%).

Interpretation The burden of self-reported post-acute symptoms and possible sequelae, notably fatigue and neurocognitive impairment, remains considerable six to 12 months after acute infection even among young and middle-aged adults after mild acute SARS-CoV-2 infection, and impacts general health and working capacity.

 

Spotted the paper in a tweet by professor Kunst who comments:
One of the largest population-based studies from Germany shows a high prevalence of #LongCovid also among younger adults with a history of mild acute infection. Considerably impaired general health and work capacity. Note: Pre-print, not peer-reviewed.

 

Interesting that they differentiated fatigue from exhaustion, since when we say fatigue it's usually what we mean, rather than either of sleepy or a bit tired that people hear. Hard to say whether they basically mean PEM, since they've had plenty of time to get on with the basics and may simply be using a different term because it's not recognized.

 

I think what they mean by rapid physical exhaustion is the sort of thing you get with heart failure or respiratory failure (or my mother aged 100) - becoming unable to continue, with shortness of breath, after a minute or less of walking or climbing stairs. After ten minutes rest the problem has settled but will recur with further exercise. The exhaustion of ME sounds to me more like I have seen in people who have just recovered from septicaemia. They don't get 'rapidly exhausted' so much as being exhausted in the first place. PEM would be something different again though.

 

Some major limitations: It's retrospective, asking patients how they felt before infection when they already had the infection. It had no control group without infection and only 1 in 4 people contacted responded.

I'm a bit frustrated that we still haven't got a decent prospective study that follows up patients and a control group for a long period of time (more than a year) to see if COVID-19 increases the incidence of ME/CFS and other conditions or not. I'm beginning to worry if we will ever see one.

 

I thought dr. Avindra Nath talked about that and that NIH was going to do this? Following lots of Covid-19 patients over time and investigating differences in people who go back to normal compared with those who don't. But I don't know of any concrete research projects.

 

I echo your frustration, given the horror of Covid-19 it was a hopefully unique opportunity to undertake prospective studies on the full range of post viral conditions, including ME, but so far we have largely seen a total failure to learn from previous poor ME research.

 

I don't think I'm typical in that but the first description applies to me perfectly so it applies to ME to some degree (and I've read several from pwLC but the delayed response is more typical). There's a lot of emphasis on delayed symptoms but I have basically a few seconds to maybe a few minutes before I get like this. Rapid exhaustion is a good description, but not just physical, cognitive does the same. Like an electrical machine with a drained battery. High heart rate, shortness of breath and just complete physical, uh, molasses.

Not always though. Which is absolutely ideal when trying to figure it out...

 

Yes, this is a key point that many of the prior "studies" lacked.