The Effects of Long COVID

June 27, 2022 — Three articles and an accompanying editorial provide information on the effects of Long COVID in the Deutsches Ärzteblatt International’s volume 10, a themed issue on the subject. 

Christian Förster and coauthors report data on persistent symptoms after COVID-19 in their original article (Dtsch Arztebl Int 2022; 119: 167–74). In a population-based cohort study they collected data on the prevalence and on risk factors. The background for this study is the observation that after recovering from infection with COVID-19, many people complain of long-term symptoms. To date, the results of epidemiological studies of this observation vary enormously. The authors used a questionnaire to collect in three rural districts data on symptoms and clinical characteristics after COVID-19, with the focus on symptoms after 12 weeks. They evaluated data from 1450 patients. The prevalence of Post-COVID-19 was 72.6% in people admitted to hospital and 46.2% in those not admitted to hospital. The most common long-term symptoms were fatigue, physical exhaustion, difficulty concentrating, and loss of smell or taste. The patients with Post-COVID-19 perceived their quality of life as notably reduced. The strongest risk factors for Post-COVID-19 were female sex, overall severity of comorbidities, and severity of acute COVID-19. According to the researchers, non-hospitalized patients also often experienced continuing symptoms. In their view, the heterogeneity of the symptoms requires a multidisciplinary, stepwise approach to care. Identifying at-risk patients, they say, is crucial. 

Another article on the prevalence of persistent symptoms after COVID-19 is presented by Korbinian Lackermair and colleagues (Dtsch Arztebl Int 2022; 119: 175–6). The authors undertook a cross sectional study of 896 patients treated exclusively on an outpatient basis. In addition to determining the prevalence, the researchers investigated the question whether less severe infection correspondingly causes fewer persistent symptoms. They collected their data from structured telephone interviews that were based on a standardized questionnaire. In the study period from March 2020 to February 2021, 1673 patients at Dachau medical center tested positive for COVID-19. For 896 patients, the complete follow-up questionnaire was available. The mean follow-up period was 6.9 months, patients’ mean age was 41.7 years. In about half of patients, comorbidities were present. 34% of patients reported persistent symptoms. The authors found that in addition to non-specific symptoms, such as fatigue or headache, typical COVID-19 symptoms—such as loss of smell or taste, or dyspnea—also often persisted. Patients with persistent symptoms were significantly older, more of them were women, and the acute phase was associated with more symptoms. 

The case–control study of postacute sequelae of SARS-CoV-2 infection reported by Mandy Schulz and coauthors also studied patients treated on an outpatient basis (Dtsch Arztebl Int 2022; 119: 177– 8). The authors aimed to characterize patients with regard to risk factors and use of healthcare services. To this end they used nationwide billing data from statutory health insurance (SHI) providers. They included patients who in the second quarter of 2021 had been coded as ICD-10 U09.9!. This was the case for 160,663 patients. The control group was a random sample of all patients treated in the second quarter of 2021 (n=321,326), which matched in terms of age, sex, and place of residence, and for whom neither a post-COVID code had been issued in 2021 nor confirmed COVID-19 infection (ICD-Code U 07.1!) documented in 2020 and 2021. The group of cases included more women and middle-aged patients than the control group as well as a higher proportion of patients who had been treated by SHI-authorized physicians as early as 2020. Patients with COVID-19 accounted for almost double the number of treatment cases compared to the control group. At least one of the post-COVID-symptoms under study occurred in 61% of the cases and in 33% of the controls. Patients with comorbidities, such as back pain, obesity, adjustment disorders, and somatoform disorders had a greater age-dependent risk for post-COVID-19. In the Post-COVID-19 group, SHI-accredited services were more commonly sought, especially GP consultations, than in the control group. 

Tobias Welte in an accompanying editorial (Dtsch Arztebl Int 2022; 119: 165–6) concludes that the post-COVID syndrome throws up more questions than it provides answers. He distinguishes between three groups of patients in post-COVID symptoms: patients who had been treated as inpatients, and partly in intensive care, for COVID-19; patients with many different symptoms who, however, were not severely impaired in their everyday lives; and patients who cannot manage their everyday lives independently because of massive exhaustion and inadequate resilience. The second group included the greatest number of patients. They presented predominantly with weariness and difficulty concentrating, together with the feeling of a lack of stamina. In Welte’s opinion, the challenge in treating these patients lies in differentiating between COVID-19 triggered medical impairments and pandemic-related psychosocial changes. The sequelae of COVID-19 can, he concludes, only be alleviated by reducing the number of infections and by changing attitudes. The pathogen is not likely to disappear in the foreseeable future, and SARS-CoV-2–related diseases will become part of our everyday lives, in the same way as other infectious diseases. For this reason, the options of prevention and therapies should be used, so as to learn to live with COVID-19. 

For more information: https://www.aerzteblatt.de/int/archive/issue?heftid=6821 

References: 

Welte T: Post-COVID syndrome—more questions than answers. Dtsch Arztebl Int 2022; 119: 165–6. DOI: 10.3238/arztebl.m2022.0154 

Förster C, Colombo MG, Wetzel AJ, Martus P, Joos S: Persisting symptoms after COVID-19—prevalence and risk factors in a population-based cohort.Dtsch Arztebl Int 2022; 119: 167–74. DOI: 10.3238/arztebl.m2022.0147 

Lackermair K, Wilhelm K, William F, Grzanna N, Lehmann E, Sams L, Fichtner S, Kellnar A, Estner H: The prevalence of persistent symptoms after COVID-19 disease—a cross-sectional study of 896 patients treated on an outpatient basis.Dtsch Arztebl Int 2022; 119: 175–6. DOI: 10.3238/arztebl.m2022.0125 

Schulz M, Mangiapane S, Scherer M, Karagiannidis C, Czihal T: Post-acute sequelae of SARS-CoV-2 infection—characterization of community-treated patients in a case–control study based on nationwide claims data. Dtsch Arztebl Int 2022; 119: 177– 8. DOI: 10.3238/arztebl.m2022.0134 

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