Even mild COVID-19 cases can cause persistent symptoms, especially in women and younger adults, while severe cases show a strong link to long-term fatigue, brain mist and joint pain, which set COVID-19, apart from other respiratory tract infections.
Study: Risk of postacute symptoms in adults: a comparison study of severe COVID-19, pneumonia and flu. Image Credit: Lightspring / sHutterstock
Published in a recent study in the magazine Plos OneResearchers from the University of Texas Southwestern Medical Center, US, assessed the associations between the severity of Coronavirus’s disease 2019 (COVID-19) and the risk of postacute symptoms.
Under symptomatic COVID-19 patients, almost two-thirds regain their usual health status within one or two months, while others experience long-term recovery. According to the United States Centers for Disease Control and Prevention, Long Covid is defined as consequences that last for at least three months after the initial infection. Other studies, however, suggest post-acute COVID-19 as symptoms that last up to 120 days after recovery.
Furthermore, although Long Covid is more likely in people who had the most serious initial disease, people with a mild initial disease also develop symptoms. Some studies have observed differences in long-term consequences between COVID-19 and Influenza. In addition, while postacute COVID-19 has been studied repeatedly, few studies have focused on the nuanced definitions of the severity of acute diseases or compared to other infectious respiratory diseases.
About the study
In the current study, researchers investigated the risk of post-acute COVID-19 on serious levels of initial disease in American adults. They have extracted data from the Database of CLOFFTATICS Data Mart. Eligible test subjects were ≥ 18 years old and had been clinically diagnosed or confirmed by Laboratory in 2020 COVID-19, with continuous inclusion in the database from January to December 2020 and reported symptoms in diagnosis.
Characteristics of diseases.
Similar criteria were used for people with influenza during the 2018–19 flu season. In addition, another cohort was set up for test subjects with the diagnosis of pneumonia in 2018. The primary outcome was the presence or absence of symptoms four weeks, three months and six months after COVID-19 diagnosis. The following symptoms were considered: fatigue, cough, dyspneu, anosmia, ageusia, arrhythmias, brain fog, insomnia, joint pain, general pain, muscle weakness and headache.
Potential predictors of symptoms were gender, ethnicity/race, age, American region and comorbidities (hypertension, diabetes, obesity, dementia, asthma, rheumatoid arthritis, chronic obstructive lung disease [COPD]Chronic kidney disease and ischemic heart disease). The disease index of the disease was adapted from the World Health Organization. The 10-point seriousness index was changed and only six levels were considered.
These were Ernst level 3 (symptomatic but outpatient), 4 (symptomatic when visiting the emergency department), 5 (hospitalization), 6 (in the hospital and required additional oxygen), 7 (hospitalization and required mechanical ventilation) and 8 (hospitalization and required mechanical ventilation plus kidlysisisan or extracorale or extracorale or extracorale or extracorale or extracoral -Oxygenation). Logist regression models investigated the relationship between postacute symptoms and the infectious agent.
Presence of symptoms through cohort over time.
Findings
The cohorts of Covid-19, flu and pneumonia include 121.205, 20,844 and 29,052 topics respectively. About cohorts was the most common sex female, the race was non-Spanish white and the American region was the south. In accordance with other studies, women were more likely to develop after acute symptoms. The most common comorbidity between Cohorten was hypertension. In particular, the flu cohort had the lowest frequencies of all comorbidities, except asthma, and the pneumonia -cohort showed higher frequencies, except for obesity. It is interesting that, although racial and ethnic minorities are often confronted with higher risks for acute COVID-19, this study mild reductions in adapted post-acute risks under non-Spanish black and Spanish individuals within this insured population observed. An unexpected finding was a regional difference, in which patients in the northeast showed the greatest risk of postacute symptoms.
In the COVID-19 cohort, fatigue, dyspnea and joint pain were the most common symptoms after four weeks. In the flu cohort, joint pain, fatigue and cough were the most common after four weeks, while dyspnea, fatigue and coughs for pneumonia. In the COVID-19 cohort, the chance of any symptom after four weeks was 1.12 for Ernst-Level 5, 1.16 for level 6, 1.46 for level 7 and 2.64 for level 8 compared to severity level 3.
Although the symptoms tend to decrease over time over time, they continued to exist at all severity levels for three and six months, although the increased chances of symptoms remained the highest for the most serious initial cases (levels 7 and 8) compared to the least serious (level 3). The specific symptoms also experience per age, in which younger adults have increased risks to anxiety and headaches, while older adults had increased risks for brain fog and fatigue. The presence of comorbidity increased the chance of post-acute symptoms at all times. The comorbidities with the highest increase in opportunities were rheumatoid arthritis, asthma and ischemic heart disease.
Furthermore, the chance of any symptom in the flu cohort compared to COVID-19 were 0.77 after four weeks and three months and 0.68 after six months. Conversely, the corresponding ODDS ratios for pneumonia were 2.24, 2.41 and 2.46, four weeks, three months and six months respectively. The most common symptoms after four weeks were fatigue in the COVID-19 cohort, dyspneu in the pneumonia cohort and joint pain in the flu cohort. After six months, the most common symptoms were the same for pneumonia and flu cohorts, but joint pain was the most common symptom in the COVID-19 cohort.
The chance of any symptom, apart from cough, was lower for the flu cohort than for COVID-19 test persons at all times. Similarly, the chance of any symptom, except headache and brain fog, were higher for the pneumonia cohort than the COVID-19 cohort at all times. The risk of headache was lower in the pneumonia cohort than in the COVID-19 cohort. There were no differences in the chance of brain fog between the cohorts of COVID-19 and Pneumonia.
Conclusions
The findings confirm earlier observations that fatigue, dyspneu and joint pain are the most common persistent symptoms after acute COVID-19. The highest risk of postacute symptoms was found in people with rheumatoid arthritis, asthma or ischemic heart disease. Symptoms observed four weeks after the initial COVID-19 would probably improve later. The considerable levels of symptoms, however, persisted that correlated with the severity of the initial COVID-19 episode. Although people with less serious initial diseases had a lower risk of persistent symptoms, the paper notes that, because their number is considerably larger than that of hospitalization, they contribute considerably to the overall population burden of post-acute COVID-13.
The post-acute symptoms differed between the three diseases, which probably reflect the differences in their pathophysiology, comorbidity levels and age distributions. In general, COVID-19 symptomatology cannot be perfectly described due to pneumonia or flu symptomatology, and there are differences in symptom revalence and the time as a solution that better characterize COVID COVID, indicating that this persistence is unique to COVID-19. The study recognizes restrictions, including the dependence on administrative health claims data from an insured population during the early phase of the pandemic, which can influence generalization and requires careful interpretation.