Jama - Prevalence and Characteristics with Post-COVID-19 Condition Among Non-hospitalized Adolescents... - Selvakumar, Wyller et al, 2023

Prevalence and Characteristics Associated With Post-COVID-19 Condition Among Non-hospitalized Adolescents and Young Adults

Abstract
Importance The prevalence and baseline risk factors of post–COVID-19 condition (PCC) remain unresolved among the large number of young people who experienced mild COVID-19.

Objectives To determine the point prevalence of PCC 6 months after the acute infection, to determine the risk of development of PCC adjusted for possible confounders, and to explore a broad range of potential risk factors.

Design, Setting, and Participants This cohort study included nonhospitalized individuals from 2 counties in Norway between ages 12 and 25 years who underwent reverse transcription–polymerase chain reaction (RT-PCR) testing. At the early convalescent stage and at 6-month follow-up, participants underwent a clinical examination; pulmonary, cardiac, and cognitive functional testing; immunological and organ injury biomarker analyses; and completion of a questionnaire. Participants were classified according to the World Health Organization case definition of PCC at follow-up. Association analyses of 78 potential risk factors were performed.

Exposures SARS-CoV-2 infection.

Main Outcomes and Measures The point prevalence of PCC 6 months after RT-PCR testing in the SARS-CoV-2–positive and SARS-CoV-2–negative groups, and the risk difference with corresponding 95% CIs.

Results A total of 404 individuals testing positive for SARS-CoV-2 and 105 individuals testing negative were enrolled (194 male [38.1%]; 102 non-European [20.0%] ethnicity). A total of 22 of the SARS-CoV-2–positive and 4 of the SARS-CoV-2–negative individuals were lost to follow-up, and 16 SARS-CoV-2–negative individuals were excluded due to SARS-CoV-2 infection in the observational period. Hence, 382 SARS-CoV-2–positive participants (mean [SD] age, 18.0 [3.7] years; 152 male [39.8%]) and 85 SARS-CoV-2–negative participants (mean [SD] age, 17.7 [3.2] years; 31 male [36.5%]) could be evaluated. The point prevalence of PCC at 6 months was 48.5% in the SARS-CoV-2–positive group and 47.1% in the control group (risk difference, 1.5%; 95% CI, −10.2% to 13.1%). SARS-CoV-2 positivity was not associated with the development of PCC (relative risk [RR], 1.06; 95% CI, 0.83 to 1.37; final multivariable model utilizing modified Poisson regression). The main risk factor for PCC was symptom severity at baseline (RR, 1.41; 95% CI, 1.27-1.56). Low physical activity (RR, 0.96; 95% CI, 0.92-1.00) and loneliness (RR, 1.01; 95% CI, 1.00-1.02) were also associated, while biological markers were not. Symptom severity correlated with personality traits.

Conclusions and Relevance The persistent symptoms and disability that characterize PCC are associated with factors other than SARS-CoV-2 infection, including psychosocial factors. This finding raises questions about the utility of the World Health Organization case definition and has implications for the planning of health care services as well as for further research on PCC.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802893

 

Here is a summary with key points by the authors. My bold:

Key Points

Question What are the prevalence and associated risk factors of post–COVID-19 condition (PCC) in young people after mild acute infection?

Findings This cohort study included 382 SARS-CoV-2–positive individuals and a control group of 85 SARS-CoV-2–negative individuals aged 12 to 25 years who were assessed at the early convalescent stage and at 6-month follow-up. When applying the World Health Organization case definition of PCC, prevalence at 6 months was 49%, but was also comparably high (47%) in the control group. PCC was not associated with biological markers specific to viral infection, but with initial symptom severity and psychosocial factors.

Meaning These findings suggest that persistent symptoms in this age group are related to factors other than SARS-CoV-2 infection, and therefore question the usefulness of the WHO case definition of PCC.

 

Author list (my bolding of familiar names)

Joel Selvakumar
Lise Beier Havdal
Martin Drevvatne
Elias Myrstad Brodwall
Lise Lund Berven
Tonje Stiansen-Sonerud
Gunnar Einvik
Truls Michael Leegaard
Trygve Tjade
Annika E. Michelsen
Tom Eirik Mollnes
Fridtjof Lund-Johansen
Trygve Holmøy
Henrik Zetterberg
Kaj Blennow
Carolina X. Sandler
Erin Cvejic
Andrew R. Lloyd
Vegard Bruun Bratholm Wyller

Selected quotes from the paper

"When sequelae arise after mild acute infection, a subset of cases might fit the label of postinfective fatigue syndrome (PIFS), in which persistent symptoms and disability accompany scarce findings on standard clinical examination.4-7 In the aftermath of a wide array of infectious diseases, such as mononucleosis, Q fever, and giardiasis, multiple prospective cohort studies report that 10% to 15% of patients experience moderate to severe disability meeting the diagnostic criteria for PIFS, in line with current studies of PCC."

"Studies of PIFS have benefitted from an international case definition25 that is centered around the symptom of fatigue, which should be persistent from onset of the acute infectious event, severely affect daily activities, and not be caused by any other condition; diagnosed individuals must experience at least 4 of 8 additional symptoms (such as headache and concentration or memory problems). In contrast, the broad case definition of PCC established by the World Health Organization (WHO) encompasses any symptom occurring in the aftermath of acute COVID-19, does not require symptom persistence since the infectious event, and does not stipulate significant disability.1"

Reference 25 is to Fukuda definition of CFS.

This paper is basically another attempt by COFFI members and friends to push their "postinfective fatigue syndrome" agenda.

 

Even prejudiced agenda pushing researchers can occasionally happen upon a truth - the WHO classification was at best a stop gap Pandemic response and its continued usefulness has to be in doubt. There are however some weaknesses in the observations of this paper - note the differences between COVID + and COVID - in the questions re:Extraordinary Fatigue, Empty Batteries, Respiratory symptoms, Chills and Feeling hot/cold. However I don't think those issues give a basis for defending the WHO classification - but perhaps brings into question the strength of the alternate application of PIFS.

 

or perhaps they had another viral syndrome and weren't fully recovered at six months.

 

but did they rely on serology here? At a quick glance, I didn't see anything about that.

 

This has always been an issue with reporting on "long Covid." If you're measuring anyone with any symptom at 3 months or even six months, the numbers will be enormous. Early on, when everyone in ME-world predicted this, I assumed most had in mind a magnitude on the order of 5% or a bit more, on the order of the Dubbo studies and what has been generally known about the prevalence of post-viral illness. The LC minimizers are using the maximal estimates, which are certainly likely inflated, and using that to shoot down the presence of persistent pathophysiological post-viral illness. It's a clever strategy.

 

This definition is clearly ridiculous, and you therefore end up with papers like this one!

 

Sounds like they didn't apply the definition correctly because this is ridiculous. Or chose an interpretation of it that is useful to minimize, which is equally ridiculous. We already knew that Wyller is a terrible researcher, didn't need this garbage study to confirm it.

Like clockwork, I've already seen it promoted by prominent minimizers. Medicine has a huge problem with garbage studies and excessive bad faith, at a level that no other profession has to deal with. We so badly need AI medicine, at this point it's an existential need, this whole profession has hit a wall and can't get past by it. I don't think our civilization can survive with such a terrible healthcare profession, it's broken beyond repair.

 

Or more likely, they have another virus.