Trajectories of persisting Covid- 19 symptoms up to 24 months after acute infection: findings from the Predi-Covid cohort study, 2025, Fischer+

[SNT Gatchaman]

Trajectories of persisting Covid- 19 symptoms up to 24 months after acute infection: findings from the Predi-Covid cohort study
Fischer, Aurélie; Zhang, Lu; Elbéji, Abir; Wilmes, Paul; Snoeck, Chantal J.; Larché, Jérôme; Oustric, Pauline; Ollert, Markus; Fagherazzi, Guy

Long COVID is a multisystemic, fluctuating condition inducing a high burden on affected people. Despite the existence of some guidelines, its management remains complicated. We aimed to demonstrate that symptoms after a COVID-19 infection evolve following different trajectories from the initial infection until 24 months after, to identify the determinants of these trajectories, and the quality of life of people in these trajectories.

Study participants from the Predi-COVID cohort were digitally followed from their acute SARS-CoV-2 infection until a maximum of 24 months. Data from 10 common symptoms collected at study inclusion, and months 12, 15, and 24 awere used to create a total symptom score. Impact of symptoms on quality of life was assessed at month 24 using standardized questionnaires and ad-hoc questions. Latent classes mixed models were used to identify total score symptom trajectories and individual symptoms trajectories.

We included 555 participants with at least 2 different time points available during follow-up (Baseline and at least one of the M12, M15 or M24 questionnaires). We identified 2 total symptom score trajectories: T1 “Mild symptoms, fast resolution” (N = 376; 67.7%), and T2 “Elevated and persisting symptoms” (N = 179; 32.3%).

The main determinants of being in T2 were: older age (OR = 1.86; p = 0.003), to be a woman (OR = 1.81; p = 0.001)), elevated BMI (OR = 3.97; p < 0.001), and the presence of multi comorbidities (OR = 2.67; p = 0.005). Symptoms impacted the quality of life more in T2 than in T1 at 24 months (high fatigue level: 64.8% vs 19.5%, altered respiratory quality of life: 42.6% vs 4.6%, anxiety: 24.1% vs 4.6%, stress: 57.4% vs 35.6%, and bad sleep: 75.9% vs 51.1%).

A third of our study population was in the T2 “Elevated and persisting symptoms” trajectory, presenting high symptom frequencies up to 24 months after initial infection, with a significant impact on quality of life. This work underlined the urgent need to better identify individuals most vulnerable to long-term complications to develop tailored interventions for them.

Clinicaltrials.gov NCT04380987 (date of registration: 2020–05-07).

Link | PDF (BMC Infectious Diseases) [Open Access]

 

[Utsikt]

This work underlined the urgent need to better identify individuals most vulnerable to long-term complications to develop tailored interventions for them.

They should have included prevention as well. It’s not like covid has disappeared.

 

[Utsikt]

Pacing stands out as the primary recommendation for managing activities, emphasizing the importance of balancing exertion with rest to prevent worsening of symptoms [12].

12 is the World Physiotherapy briefing paper:
https://world.physio/sites/default/...Covid-FINAL-English-202107.pdf?logged_in=true

 

[Utsikt]

Inclusion criteria were to be an adult person with a PCR-confirmed SARS-CoV 2 infection in Luxembourg, hospitalized or not during acute infection.

Data were collected longitudinally, from baseline to a maximum of 24 months. Baseline data were collected by phone by an experienced clinical research nurse at study inclusion, which was done in the 5 days after the PCR test result and consisted of individual characteristics and symptoms. Participants were then invited to complete detailed self-reported questionnaires on symptoms and quality of life at months 12, 15 and 24 after inclusion in the study (full questionnaire provided in supplementary file, additional file 1).

They recruited very early after a positive test, which reduces selection bias based on how long your symptoms lasted.

 

[Utsikt]

This is a bit of «the people that didn’t recover didn’t recover», but it’s interesting to see how the average symptoms increased over time in the group that did not recover.

Fig 1

Total symptom score trajectories. Total symptom score evolution in T1 “Mild symptoms, fast resolution”, and T2 “Elevated and persisting symptoms”, from baseline up to 24 months after (in days). The grey areas show the 95% confidence intervals

Fig 3

Symptom frequencies in T1 and T2 trajectories. Symptom frequencies are provided for each trajectory at baseline, M12, M15, and M24 (%)

They included more symptoms in the M12 etc. questionnaires as they learnt more about LC, but they don’t have the trajectories from baseline.

Fig 4

Individual symptoms trajectories. Individual symptom trajectories were modeled for the 555 participants from baseline until month 24 (in days). For each symptom the optimal number of classes was defined using the model with the lowest BIC and the highest entropy. Different numbers of classes (or trajectories) were obtained depending on the symptom and were named class 1, class 2, etc

And important caveat regarding the increase in symptoms later on:

This study also has some limitations. The high number of participants who did not complete the questionnaire at months 15 and 24 might have led to an overestimation of Long COVID symptoms at 24 months, as people who completed the questionnaire were experiencing more symptoms than participants who completed only the questionnaire at 12 months. However, our sensitivity analysis on participants who completed the full set of questionnaires showed similar trajectories, confirming the reliability of our results.

Edit: another drawback is that we don’t have pre-baseline symptoms.

 

[Utsikt]

I think an important take-away from this study is that LC is not just about having a long recovery time. Some simply don’t report getting better (or even get worse).

It seems to me like many politicians and society in general believes that LC is temporary so there is no rush to fix it because it will resolve on its own if we give it some time. That’s clearly wrong for a subgroup of LC patients.

 

[rvallee]

It seems to me like many politicians and society in general believes that LC is temporary so there is no rush to fix it because it will resolve on its own if we give it some time. That’s clearly wrong for a subgroup of LC patients.

That's because many physicians have simply asserted this, based on misinformation. Based mostly on us and "Imagine a world"-based medicine. False assertions made for bad reasons, amplified to cover up reality, serving the rich and making people feel better about burying millions alive.

This study seems above average, in that it describes reality far closer than usual. Usually symptom resolution for mild cases is rather quick, debunking the entire premise of those long rehabilitation programs. But of course the idea behind those isn't connected to reality, so that's expected. And of course plenty of cases start mild and go on worsening, and no one knows how to predict that yet. The very idea of rehabilitation will be abandoned one way or another, it just sucks that the only realistic way is long after it will make a difference. Just like with peptic ulcers, the scam industry will just die out, but it won't be killed. No such thing as accountability here.

Although it remains that we could, and in some cases have, said all those things for decades. We have still learned nothing since day 1. Hence:

Despite the existence of some guidelines, its management remains complicated

There is no reason why any amount of guidelines should help manage things when they are either not based on reality, or are unrealistic. We can't just "solve this problem" when we don't understand what the problem is, and even less so when there is a strong majority opinion that is basically delusional about it. The idea of pacing is nice in principle, but it basically amounts to suggestions to remain ambulant as much as possible after a broken leg, in a world where walking aids simply don't exist.

It still all looks like medicine is just completely out of its depth dealing with problems like this, and doesn't seem capable of producing useful... anything. Literally all the useful advice out there came from the patient community and pre-dates LC by decades. The medical profession has simply not added a single useful bit of information to it, and way too many mountains of bullshit.

It should be useful to have studies like this, I just mostly expect that it will be ignored in favor of psychosomatic squirrels.

 

[Sean]

It still all looks like medicine is just completely out of its depth dealing with problems like this, and doesn't seem capable of producing useful... anything.

And then some. Thus far.