Population-Based Evaluation of Postacute Coronavirus Disease-2019 (COVID-19) Chronic Sequelae in Patients Who Tested Positive 2022 Goldhaber et al

Full title: Population-Based Evaluation of Postacute Coronavirus Disease-2019 (COVID-19) Chronic Sequelae in Patients Who Tested Positive for Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)

Abstract
The true incidence and comprehensive characteristics of Long Coronavirus Disease-19 (COVID-19) are currently unknown. This is the first population-based outreach study of Long COVID within an entire health system, conducted to determine operational needs to care for patients with Long COVID.

Open access, https://academic.oup.com/ofid/article/9/10/ofac495/6730260

 

Ahem, "within an entire health system" is doing a lot of work, when it accounts for 10% of a subset of that population. I don't know why they call this a population survey when only 10% of a subset of that population gave data.

This is sort of useful but it's far less comprehensive than some of the first studies that came out, not even as good as most of the patient-led studies who didn't have any of the giant resources healthcare systems have to do this kind of tracking. But I guess putting some "this is the first" sounds impressive to some.

Why can't data be systematic within the system at the point of delivery? Almost every single industry out there has figured out to do this, it's not even hard. Surveys and statistical data are nice and everything but real comprehensive data are needed, not just a small sampling from a subset and only then out of those who do reply.

 

Its notable I think for being the first health care organisation to even bother to ask the question about Long Covid. The NHS certainly hasn't done so and most of the data we have is from statistics companies asking samples of the population like the ONS from across the globe which the press keeps repeating the stats from as the numbers climb ever higher every month. This is the first health care organisation I have seen in 2.5 years of the pandemic to even ask about Long Covid symptoms and 50% said they do. Their methods are bad because its a self selecting poll and only on people who tested positive directly with them so it will have missed all the asymptomatic people and biases heavily towards those hospitalised with Covid. Its impressive that its the first health organisation to look at the news and wonder if maybe Long Covid might be real. They don't get the name right, or the symptoms, nor do they design a study well but they are certainly the first health organistion to wonder if maybe this is a real condition and not just mass anxiety caused by influencers. Says very little about what their doctors think of course.

All but two of the authors are "biomedical infomatics", so its basically the stats team with senior member of staff on team, so we can't get too excited that its had any wider impact on their belief in the condition being real.

 

This was a survey of 999 people in California who got Covid.

What they found:

• 46.3% had at least one symptom they believed was definitely or maybe caused by Covid.
• 34.7% missed work or school due to what they thought was long Covid
• 66.2% reported that their daily activities were affected
• 56.9% sought medical care

Let's look at the good and bad points of the methodology.

The good: they sent a survey to everyone in the whole health system who tested positive, giving them a decent cross-section of cases. Over 85% of those they asked to do the survey were not hospitalized. The number of responses was decently large at 999, and they were reasonably diverse in terms of age, gender, and race. Their results broadly align with previous research. The symptoms the most people sometimes, often, or always had: Weakness/tiredness, sleep disturbances, brain fog, joint pain, and muscle aches.

The bad: They got only a 10% response rate. I'd expect people with LC to be more likely to reply, biasing symptom prevalence upwards. That could explain why this particular study came in hot at 46%. There's also no control group. They didn't ask if people experienced PEM. I would have liked to see them ask about OI and unrefreshing sleep too.