Long-COVID Clinical Features and Risk Factors: A Retrospective Analysis of Patients from the STOP-COVID Registry of the PoLoCOV Study, 2022, Chudzik

Abstract

Despite recovering from the acute phase of coronavirus disease (COVID-19), many patients report continuing symptoms that most commonly include fatigue, cough, neurologic problems, hair loss, headache, and musculoskeletal pain, a condition termed long-COVID syndrome. Neither its etiopathogenesis, nor its clinical presentation or risk factors are fully understood. Therefore, the purpose of this study was to retrospectively evaluate the most common symptoms of long-COVID among patients from the STOP COVID registry of the PoLoCOV study, and to search for risk factors for development of the syndrome. The registry includes patients who presented to the medical center for persistent clinical symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The analysis included data from initial presentation and at three-month follow-up.

Of the 2218 patients, 1569 (70.7%) reported having at least one symptom classified as long-COVID syndrome three months after recovery from the initial SARS-CoV-2 infection. The most common symptoms included chronic fatigue (35.6%\), cough (23.0%), and a set of neurological symptoms referred to as brain fog (12.1%). Risk factors for developing long-COVID syndrome included female gender (odds ratio [OR]: 1.48, 95% confidence intervals [CI] [1.19–1.84]), severe COVID-19 (OR: 1.56, CI: 1.00–2.42), dyspnea (OR: 1.31, CI: 1.02–1.69), and chest pain (OR: 1.48, CI: 1.14–1.92). Long-COVID syndrome represents a significant clinical and social problem. The most common clinical manifestations are chronic fatigue, cough, and brain fog. Given the still-limited knowledge of long-COVID syndrome, further research and observation are needed to better understand the mechanisms and risk factors of the disease.

Open access, https://www.mdpi.com/1999-4915/14/8/1755/htm

 

With the glut of studies coming out, it's painfully obvious how seemingly every single one of them missed out on PEM. They either don't see it, don't care, don't think it's important, or else I don't know. But almost all the expert studies missed it, while all the patient-led studies emphasize it.

When experts almost universally do worse than the subjects they are studying, it's worth questioning the pertinence of that expertise, at least on this issue. It's obvious that the way forward is working with patients, as sort-of equals, but they still can't do it.

 

They do note it (passingly) —

Here, "malaise" (without the post-exertional bit) sounds like it is being used to indicate "feel bad", but is not capturing global symptom exacerbation, reduced baseline etc.

Perhaps in general, many authors think PEM is tightly coupled to "chronic fatigue" — that exertion simply makes us feel more tired/fatigued. They might think they're including it, without realising they're missing a fundamental.

 

They use the words, they clearly don't understand the concept. It's not a hard concept, but like most physicians they seem to simply reject what it means, or prefer a definition of it that deprives it of all substance.

We're used to low expectations but experts are expected to do better than this, it's basically what separates experts from the rest. The whole process of science is to follow the evidence, and the entire profession seems simply unable to do that anymore. They follow nothing, everything they do is naïve, uninformed to the point of being seemingly pathological amnesic. Nothing builds on itself, leads are ignored, there is no interest to follow them.

There are a few out there who are able to but they are drowned out by the rest who can't do any better than parroting the labels without bothering to understand anything. It's so bad that I'm fairly sure that with a reasonable budget, a group of moderately competent teenagers would do better. It really seems as if medical training is incompatible with understanding those complex issues, they indoctrinate biases that make them unable to do anything competently when it comes to chronic illness. At least for most.

 

Agree wholeheartedly for everything intersecting ME and the related diseases, and it is a cause of professional disappointment if not outright shame (which I suspect will be felt increasingly over time). But I wouldn't throw the baby out. Of course I'm not unbiased and probably a bit defensive, but I think there are large parts* of medicine that do all we would hope in the way we would hope — learning from past mistakes and successes and building on them. Possibly many fields might be externally analysed and found to be high-functioning.

But there is failure to recognise this dichotomy and overwriting the patient experience is a major part of the problem. Those who are trying to function with expertise and appropriate standards may well assume that those in other fields are also: and so are happy to let those experts continue in their (grossly sub-standard) approach.

Standards bodies need to do a universally good job. NICE self-corrected with ME finally, after much pressure. There are probably large gains still to be made with others eg Cochrane.

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* Areas that spring to mind from my own experience would be: in-hospital and community resuscitation, surgical trauma management, cardiac surgery, paediatric oncology. Over my time I've seen outcomes in these areas sometimes move from dismal to recovered with excellent life expectancy / quality of life.

 

Exactly. Repeatedly claiming that an entire profession is broken based on our experience is as ridiculous as the claims that are made elsewhere that the entire ME community are vicious anti-science trolls - if collectively we object to unfair stereotyping by others then we shouldn't do it ourselves.

 

Are we sure about the "grabbed". They may, in part, have had it thrust upon them. We must remember Sir Simon's quip about being sent a note from a well known neurologist-"Simon, will you see this patient? there's nothing wrong with her".

I seem to have ,somewhere ,come across a reference to Slater making the same comment thirty odd years earlier.