Long covid outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study 2023, Mizrahi et al

Sly Saint

Sly Saint

Senior Member (Voting Rights)
Abstract
Objectives To determine the clinical sequelae of long covid for a year after infection in patients with mild disease and to evaluate its association with age, sex, SARS-CoV-2 variants, and vaccination status.

Design Retrospective nationwide cohort study.

Setting Electronic medical records from an Israeli nationwide healthcare organisation.

Population 1 913 234 Maccabi Healthcare Services members of all ages who did a polymerase chain reaction test for SARS-CoV-2 between 1 March 2020 and 1 October 2021.

Main outcome measures Risk of an evidence based list of 70 reported long covid outcomes in unvaccinated patients infected with SARS-CoV-2 matched to uninfected people, adjusted for age and sex and stratified by SARS-CoV-2 variants, and risk in patients with a breakthrough SARS-CoV-2 infection compared with unvaccinated infected controls. Risks were compared using hazard ratios and risk differences per 10 000 patients measured during the early (30-180 days) and late (180-360 days) time periods after infection.

Results Covid-19 infection was significantly associated with increased risks in early and late periods for anosmia and dysgeusia (hazard ratio 4.59 (95% confidence interval 3.63 to 5.80), risk difference 19.6 (95% confidence interval 16.9 to 22.4) in early period; 2.96 (2.29 to 3.82), 11.0 (8.5 to 13.6) in late period), cognitive impairment (1.85 (1.58 to 2.17), 12.8, (9.6 to 16.1); 1.69 (1.45 to 1.96), 13.3 (9.4 to 17.3)), dyspnoea (1.79 (1.68 to 1.90), 85.7 (76.9 to 94.5); 1.30 (1.22 to 1.38), 35.4 (26.3 to 44.6)), weakness (1.78 (1.69 to 1.88), 108.5, 98.4 to 118.6; 1.30 (1.22 to 1.37), 50.2 (39.4 to 61.1)), and palpitations (1.49 (1.35 to 1.64), 22.1 (16.8 to 27.4); 1.16 (1.05 to 1.27), 8.3 (2.4 to 14.1)) and with significant but lower excess risk for streptococcal tonsillitis and dizziness. Hair loss, chest pain, cough, myalgia, and respiratory disorders were significantly increased only during the early phase. Male and female patients showed minor differences, and children had fewer outcomes than adults during the early phase of covid-19, which mostly resolved in the late period. Findings remained consistent across SARS-CoV-2 variants. Vaccinated patients with a breakthrough SARS-CoV-2 infection had a lower risk for dyspnoea and similar risk for other outcomes compared with unvaccinated infected patients.

Conclusions This nationwide study suggests that patients with mild covid-19 are at risk for a small number of health outcomes, most of which are resolved within a year from diagnosis.

https://www.bmj.com/content/380/bmj-2022-072529
 
article:
Long Covid resolves within year for many with mild Covid, study says

The majority of long Covid symptoms resolve within the first year after infection for people with mild cases of Covid-19, according to a large study conducted in Israel.

“Mild disease does not lead to serious or chronic long term morbidity in the vast majority of patients,” said study coauthor Barak Mizrahi, a senior researcher at KI Research Institute in Kfar Malal, via email.

The study, published Wednesday in the journal The BMJ, compared thousands of vaccinated and unvaccinated people with mild Covid symptoms who were not hospitalized with people who tested negative for the virus. Long Covid was defined as symptoms that continue or appear more than four weeks after an initial Covid-19 infection.

“I think this study is reassuring in that most ongoing symptoms following COVID do improve over the first several months following the acute infection,” said Dr. Benjamin Abramoff, director of the Penn Medicine Post-COVID Assessment and Recovery Clinic, via email. He was not involved in the study.

But not for everyone. Abramoff said his clinic continues to see many patients with severe long Covid symptoms lasting longer than one year following their infection.

Long Covid is a debilitating condition that can include breathing problems, brain fog, chronic coughing and overwhelming fatigue.
“This is particularly true in those individuals who had severe persistent symptoms early after their acute infection,” said Abramoff, who leads the American Academy of Physical Medicine and Rehabilitation’s long Covid collaborative.

Dr. Jonathan Whiteson, an associate professor of rehabilitation medicine at the NYU Grossman School of Medicine, sees the same in his clinic.

“I continue to see many patients from the ‘first wave’ of COVID who had mild to moderate acute COVID (and were) never hospitalized who have significant persistent and functionally limiting symptoms nearly 3 years later,” said Whiteson via email. He was not involved with the study.
Click to expand...

https://edition.cnn.com/2023/01/11/health/long-covid-symptoms-study-wellness/index.html
 
The CNN article about this study (https://www.cnn.com/2023/01/11/health/long-covid-symptoms-study-wellness/index.html ) includes a section talking about the limitations of the study.
CNN article said:
Researchers pointed to certain limitations in the study, such as the possibility of diagnostic errors or failure to record some milder symptoms over time. Abramoff agreed.

“This design of this study is not able to detect the severity of these symptoms, and there are potentially other missed patients due to using medical coding to detect persistent Long COVID symptoms,” Abramoff said.

It could also be difficult to apply the findings of the study to other countries, such as the United States, due to differences in how doctors code symptoms. For example, the study did not identify several conditions frequently found in long Covid clinics in the US, said Dr. Monica Verduzco-Gutierrez, professor and chair of the department of rehabilitation medicine at the Long School of Medicine at UT Health, San Antonio.

“The most common symptom of Long COVID is fatigue, and that was not on this list. Also missing was post-exertional malaise, dysautonomia/POTS, or ME/CFS. These are some of the major presentations I am seeing in my clinic population, so it is a major limitation of this study to not have those outcomes,” said Verduzco-Gutierrez, who was not involved in the new study.

Post-exertional malaise is an overwhelming exhaustion after even a minimal amount of effort. Unlike regular exhaustion, it can take days to weeks for a person to recover, and the malaise can be reactivated if activity is resumed too quickly.

Postural orthostatic tachycardia syndrome, or POTS, is a bump in heart rate after sitting up or standing that can lead to dizziness or fainting. It’s a form of dysautonomia, a disorder of the autonomic nervous system. “There is usually no cure for dysautonomia,” according to the National Institute of Neurological Disorders and Stroke.

Myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS, is a serious long-term illness, in which people have overwhelming fatigue that is not improved by rest. The condition can impact sleep and thinking processes, cause pain in many parts of the body, and keep people from doing most daily activities.

Responding to this concern, Mizrahi told CNN that “post exertional malaise was not included in this study as it is not a diagnosis that commonly prescribed in Israel.” In addition, he said, dysautonomia/POTS was only assigned an International Classification of Diseases, or ICD medical code, as of October 2022, so it too was not included in the study.

However, symptoms of POTS and other conditions may have been included under more general categories such as cardiac arrhythmias or palpitations, he said.
Click to expand...
 
It's safe to say that we literally exist in different universes than physicians work in, and that they can simply lie with impunity and no one else but us will care.

Most long COVID symptoms subside within a year of mild infection: Study
https://www1.racgp.org.au/newsgp/clinical/most-long-covid-symptoms-subside-within-a-year-of

‘It shouldn’t be interpreted that we should downplay the significant post-COVID morbidity and symptoms we [are] and will be seeing – just like the other long-term chronic fatigue, vasculitis, autoimmune diseases that GPs have been managing as well over the years,’ Dr McCroary said.
...
‘GPs are the best group to be managing and leading the decision-making moving forward as we are the ones with experience in post-viral syndromes and chronic disease, and with the scale we will be doing most of the work,’ he said.
...
‘I prefer “post-COVID symptoms”, just like we have dealt with “post-viral syndromes” with influenza and glandular fever … that we have been managing well in general practice for decades,’ he said.​

Again, they literally cannot tell the difference between complete failure and success, or don't care, or can't be bothered to do anything but lie about it. Medicine has completely failed us, and they think they're doing great. They have no treatments, cannot diagnose reliably, are always complaining about how they don't know what to do, but they think they know what to do well enough to not bother any further. It's not even taught in medical school, and somehow they think they're doing great.

If you don't count the patients, and they sure don't, then things are going great. And that's why they're not counting anything, even praise studies doing exactly that, the study did not include anything specific about post-infectious chronic illness.
 
Mij said:
The M.E doctor I saw told me based on his 20- yrs experience that PVFS often resolves for most people after 2-3 years.
Click to expand...
This has been common wisdom for at least two and a half decades. Outliers can resolve up to 5 years. However its not a proven thing that LC, and especially ME, are just PVFS. This hang-up on fatigue is part of the issue. Other things like PEM are very important. How many with both LC and PEM resolve within one year?

What has been long recognized is that most people with ME who recover do so in the first year. It would be surprising if many with LC did not recover in the first year.
 
alex3619 said:
This has been common wisdom for at least two and a half decades. Outliers can resolve up to 5 years. However its not a proven thing that LC, and especially ME, are just PVFS. This hang-up on fatigue is part of the issue. Other things like PEM are very important.
Click to expand...

Can PVFS be defined to include PEM - at least the subset of symptom exacerbation that is essentially confined to fatigue or things that might look like fatigue? Perhaps where orthostatic intolerance and cognitive dysfunction are misattributed and rolled into "fatigue" (i.e. "too tired to stand up or think straight"). Or is PVFS purely fatigue without any of the non-fatigue symptoms of ME/CFS?
 
SNT Gatchaman said:
Or is PVFS purely fatigue without any of the non-fatigue symptoms of ME/CFS?
Click to expand...
My understanding is PVFS does include other symptoms, including a post viral cough. The list is short though, or at least any I have read, and I have not read anything about PEM or OI that I recall. However those who want to stretch a definition will possibly come up with reasons. I mean they have been somewhat getting away with calling ME=CFS, and CFS=CF, for decades.
 
You must log in or register to reply here.
Back
Top Bottom