Study IDs The most common persistent symptoms at 8 months after mild COVID

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Loss of smell, loss of taste, dyspnea and fatigue are the four most common symptoms that Swedish health professionals report 8 months after mild COVID-19 disease, new evidence shows.

About one in 10 health workers has one or more moderate to severe symptoms that negatively affect their quality of life, according to the study.

“We see that a substantial proportion of health workers suffer from long-term symptoms after COVID-19 mildly,” said lead author, PhD, Dr. Charlotte Thålin. Medscape medical news. She added that the loss of smell and taste “may seem trivial, but it can have a negative impact on professional, social and long-term home life”.

The study is notable not only for tracking the COVID-19 experiences of health care workers over time, but also for what it did not find. There was no increased prevalence of cognitive problems – including memory or concentration – that others linked to what is often called long-distance COVID-19.

The research letter was published online April 7, 2021, in JAMA.

“Even if you are young and previously healthy, a mild COVID-19 infection can have long-term consequences,” said Thålin, of the clinical sciences department at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.

The researchers did not notice an increased risk of long-term symptoms after asymptomatic COVID-19.

Adding to existing evidence

This research letter “adds to more and more literature showing that people recovering from COVID have reported a wide range of symptoms that last for months after the initial infection,” said Lekshmi Santhosh, MD. Medscape medical news when asked to comment. He is a faculty member at the University of California, San Francisco (UCSF) Post-COVID OPTIMAL Clinic.

Previous research has revealed severe long-term symptoms, including heart palpitations and neurological disorders, among people hospitalized with COVID-19. However, “there are limited data on long-term effects after mild COVID-19, and these studies are often hampered by selection bias and without adequate control groups,” Thålin said.

The absence of these more severe symptoms after mild COVID-19 is “reassuring,” she added.

The current findings are part of the ongoing Community study (COVID-19 Biomarker and Immunity) on the analysis of long-term immunity. Health professionals enrolled in research between April 15 and May 8, 2020 and have initial blood tests repeated every 4 months.

Thålin, lead author Sebastian Havervall, MD, and colleagues compared symptom reporting between 323 hospital employees who had mild COVID-19 at least 8 months earlier and 1,072 employees who did not have COVID-19 throughout the study.

The results show that 26% of those who had COVID-19 had at least one moderate to severe symptom that lasted more than 2 months, compared with 9% in the control group.

The group with a history of mild COVID-19 had a median age of 43 years and 83% were women. The controls were median for 47 years and 86% were women.

“These data reflect what we have seen in the long-term cohorts of patients with COVID-19 infection. In particular, mild disease among previously healthy individuals may be associated with persistent long-term symptoms,” Sarah Jolley, MD, pulmonologist specializing in care at UCHealth University of Colorado Hospital in Aurora and director of the post-COVID clinic, said Medscape medical news.

“In this cohort, similar to others, this seems to be more pronounced in women,” Jolley added.

Key findings on operation

At 8 months, using a smartphone application, participants reported the presence, duration, and severity of 23 predefined symptoms. The researchers used the Sheehan Disability Scale to assess functional impairment.

A total of 11% of participants reported at least one symptom that negatively affected work or social life or at home at 8 months compared to only 2% in the control group.

HIV-positive participants were almost twice as likely to report that their long-term symptoms significantly disrupted their professional lives, 8% compared to 4% of seronegative health workers (relative risk [RR], 1.8; 95%; confidence interval [CI], 1.2 – 2.9).

Disruptions in social life due to long-term symptoms were 2.5 times more likely in the HIV-positive group. A total of 15% of this cohort reported moderate to marked effects, compared with 6% of the seronegative group (RR, 2.5; 95% CI, 1.8 – 3.6).

The researchers also asked about interruptions in home life, which were reported by 12% of HIV-positive health workers and 5% of seronegative participants (RR, 2.3; 95% CI, 1.6 – 3.4 ).

The study’s findings “follow many other works we see,” said David Putrino, PT, Ph.D., director of rehabilitation innovation at Mount Sinai Health System in New York City. Medscape medical news. He and his colleagues are responsible for managing the rehabilitation of patients with long-term COVID.

Interestingly, the proportion of people with persistent symptoms could be underestimated in this research, Putrino said. “Antibodies are not a completely reliable biomarker. So what the researchers are using here is the most conservative measure of those who could have had the virus.”

Possible memory bias and subjective assessment of symptoms were possible limitations of the study.

When asked to speculate why researchers did not find higher levels of cognitive dysfunction, Putrino said self-reports are generally less reliable than measures such as the MoCA (Montreal Cognitive Assessment) to detect cognitive impairment.

Moreover, unlike many of the long-distance people with COVID-19 who are treated clinically – those who are “really struggling” – health workers studied in Sweden work well enough to perform their tasks in the hospital. , so that the studied population may not represent the general population.

More research is needed

“More research is needed to investigate the mechanisms underlying these persistent symptoms, and more centers, including UCSF, are conducting research into why this might be the case,” Santhosh said.

Thålin and colleagues intend to follow the participants further. “The main purpose of the COMMUNITY study is to investigate long-term immunity after COVID-19, but we will also look at possible pathophysiological mechanisms underlying long-term symptoms related to COVID-19,” she said.

“I hope to see the taste and smell return,” Thålin added.

“We are just beginning to understand the long-term effects of COVID-19,” Putrino said. “It’s something we’re going to see a lot of progress on.”

Thålin, Santhosh, Jolley and Putrino did not disclose relevant financial reports. Grants from the Knut Foundation and Alice Wallenberg, Jonas and Christina af Jochnick Foundation, Leif Lundblad Family Foundation, the Stockholm Region and the Erling-Persson Family Foundation funded the research.

Damian McNamara is a Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter.

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