Preprint Determinants of the Onset and Prognosis of the Post-COVID-19 Condition: A 2-Year Prospective Cohort Study, 2023, Mateu et al.

Determinants of the Onset and Prognosis of the Post-COVID-19 Condition: A 2-Year Prospective Cohort Study
Mateu, Lourdes; Tebe, Cristian; Loste, Cora; Santos, José Ramón; Lladós, Gemma; López, Cristina; España-Cueto, Sergio; Toledo, Ruth; Font, Marta; Chamorro, Anna; Muñoz-López, Francisco; Nevot, Maria; Vallejo, Nuria; Teis, Albert; Puig, Jordi; Fumaz, Carmina Rodríguez; Muñoz-Moreno, José Antonio; Prats, Anna; Estany-Quera, Carla; Coll-Fernández, Roser; Herrero, Cristina; Casares, Patricia; Garcia, Anna; Paredes, Roger; Clotet, Bonaventura; Massanella, Marta

Background: At least 5-10% of subjects surviving COVID-19 develop the post-COVID-19 condition (PCC) or “Long COVID”. The clinical presentation of PCC is heterogeneous, its pathogenesis is being deciphered, and objective, validated biomarkers are lacking. It is unknown if PCC is a single entity or a heterogeneous syndrome with overlapping pathophysiological basis. In a large crossectional evaluation, the RECOVER study in the US identified four clusters of subjects with PCC according to their presenting symptoms. The long-term clinical implications of PCC remain unknown.

Methods: We conducted a 2-year prospective cohort study of subjects surviving COVID-19, including individuals fulfilling the WHO PCC definition and subjects with full clinical recovery. We systematically collected post-COVID-19 symptoms using prespecified questionnaires and performed additional diagnostic imaging tests when needed. Factors associated with PCC were identified and modeled using logistic regression. Unsupervised clustering analysis was used to group subjects with PCC according to their presenting symptoms. Factors associated with PCC recovery were modelled using a direct acyclic graph approach.

Findings: The study included 548 individuals, 341 with PCC, followed for a median of 23 months (IQR 16·5 – 23·5), and 207 subjects fully recovered. In the model with the best fit, subjects who were male and had tertiary studies were less likely to develop PCC, whereas a history of headache, or presence of tachycardia, fatigue, neurocognitive and neurosensitive complaints and dyspnea at COVID-19 diagnosis predicted the development of PCC. The cluster analysis revealed the presence of three symptom clusters with an additive number of symptoms. Only 26 subjects (7·6%) recovered from PCC during follow-up; almost all of them (n=24) belonged to the less symptomatic cluster A, dominated mainly by fatigue. Recovery from PCC was more likely in subjects who were male, required ICU admission, or had cardiovascular comorbidities, hyporexia and/or smell/taste alterations during acute COVID-19. Subjects presenting with muscle pain, impaired attention, dyspnea, or tachycardia, conversely, were less likely to recover from PCC.

Interpretation: Preexisting medical and socioeconomic factors, as well as acute COVID-19 symptoms, predict the development of and recovery from the PCC. Recovery is extremely rare during the first 2 years, posing a major challenge to healthcare systems.

Link (Preprint - Lancet Group)

 

Which contradicts the paper we had earlier in the year that suggested the opposite: Risk of new-onset Long Covid following reinfection with SARS-CoV-2: community-based cohort study (2023, Preprint)

 

When did we choose to leave history behind

Group A - post viral recovery , previous generations acknowledged that this could take time and rest was needed . This has been largely forgotten.
In a world where you are valued by your productivity it's more or less been denied .

medical advances have pharmacological " cures" which shorten illness periods for many afflictions - the new normal construct . We forget that not everyone fits under a curve.

 

Keyworker exposure may account for some of this. Medics apart , middle classes were more able to work from home .
Those who kept society going had little choice .

The confounder is kids who were- and still are - a very effective vector.

 

The two studies are very different in size 135,000 versus 547 and at first sight I'd say the demographics of this smaller study are somewhat different to the larger, although I really don't know enough about Catalonia's socio economic structure to match the education data of the smaller study to the deprivation quintiles of the larger. I'm inclined to think that for the whole PASC/PCC/Long Covid thing most studies are mired in noise that will never be adequately addressed - it's a mess and it's going to stay a mess.

 

Paper has now been published in The Lancet Regional Health Europe https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00143-6/fulltext# .

 

Zero mention of ME/CFS, of any context or history other than a few mentions of "post-viral" disease or syndrome, twice for each. This quote references the RECOVER initiative. This study doesn't seem to have looked or considered PEM or dysautonomia. Seems to be very limited in scope and lacking depth. Still found significant issues despite overlooking many.

This lack of context is typical and disappointing. The erasure of ME/CFS continues, despite its very high relevance and applicability. No wonder it's impossible to make progress here. This continues to be mostly political and unmotivated.