Long Covid afflicts 1 in 20 people more than six months after infection

A new long-term Covid study, based on the experiences of nearly 100,000 participants, provides strong evidence that many people do not fully recover months after being infected with the coronavirus.

The Scottish study found that between six and 18 months after infection, 1 in 20 people had not recovered and 42 per cent reported a partial recovery. The results had some reassuring aspects: people with asymptomatic infections are unlikely to experience any long-term effects, and vaccination seems to offer some protection against a long Covid.

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“This is another well-conducted population-level study that shows we should be extremely concerned given the current numbers of acute infections,” said David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York. “We have a problem.”

Jill Pell, Professor of Public Health at the University of Glasgow, who led the research, stressed that the study shows the far-reaching impact of a long Covid on people’s lives. “There are many different impacts beyond health, on quality of life, employment, schooling and the ability to take care of themselves,” she said.

These three long-distance drivers have been keeping debilitating symptoms and fatigue from returning to work — and in turn, struggling to adjust to their new normal. (Video: Drea Cornejo, Joy Yi, Colin Archdeacon/The Washington Post, Photo: Carolyn Van Houten/The Washington Post)

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The paper, published in Nature Communications on Wednesday, presents the first results of an ongoing study on long Covid – the Long-CISS (Covid in Scotland Study).

The breadth of reported symptoms and inability to provide patients with a prognosis has baffled veteran researchers, even as the breadth of the challenge has become clearer. The government estimates that between 7 and 23 million Americans – including 1 million who are unable to work – suffer from the long-term effects of contracting the virus. These numbers are expected to increase as Covid becomes an endemic disease.

Previous studies have been challenged by the non-specific nature of long-lasting symptoms, including shortness of breath and fatigue, which are also common in the general population. The Covid-in-Scotland study, which included a control group, was able to identify what symptoms were associated with Covid, Pell said.

“Those who had Covid were significantly more likely to get 24 of the 26 symptoms examined than the general population who had never been infected,” she said. For example, those who were infected were 3½ times more likely to be out of breath.

She went to one doctor, then another, and then another

Putrino pointed out that between 16 percent and 31 percent of the control group also suffered from the same symptoms — a number similar to the false-negative rate of a PCR test, suggesting some of the control group might have been infected. Pell agreed that it’s possible some people who tested negative became infected, confirming the study’s broader findings.

Long-distance symptoms vary greatly from person to person. In the Scottish study, the most commonly reported symptoms were shortness of breath, palpitations, chest pain and “brain fog,” or decreased mental acuity.

Symptoms were worst in people sick enough to be hospitalized during the acute infection – a fact that adds little to the experts’ concerns.

“It’s always been the case that those who are sick are more likely to have long-term consequences,” Putrino said. “What is startling is that mild cases far outnumber severe cases, so that even a small percentage of mild cases that develop long-term sequelae pose a massive public health problem.”

Putrino also warned against assuming that asymptomatic infection is not accompanied by persistent symptoms.

“We have seen many patients who had a confirmed asymptomatic case,” he said. “It happens. It’s statistically less common than symptomatic infections.”

The study found that the risk of long covid was greater in women, the elderly and people living in economically disadvantaged communities. People already suffering from physical and mental health problems, such as respiratory disease and depression, were also more vulnerable to long Covid.

“Crucially, this study also identified a subgroup of 11 percent who got worse over time. This is something that’s commonly seen in patient groups but hasn’t been discussed enough in the public discussion,” said Hannah Davis, a member of the Patient-Led Research Collaborative, a group of patients who have been involved in Covid research for a long time.

While the study revealed no particular surprises, its nationwide design offers new levels of accuracy, Pell said. More than 33,000 people with laboratory-confirmed infections participated, along with 62,957 people without an infection.

Throughout the pandemic, US experts, including the President’s chief medical adviser Anthony S. Fauci, regularly turned to British data because that was the case comes from the nationalized healthcare system and reflects trends across the population.

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Using records from the National Health Service, the researchers sent a text message to each Scottish adult who had a positive PCR test, as well as a group of people who tested negative for Covid, inviting them to take part. Those who chose to register answered questions from the online survey about their pre- and post-infection health.

“Accessing survey data from this single large cohort is very powerful,” said James Harker, an immunologist at Imperial College London who studies the long-term effects of the coronavirus on the lungs. U.S. studies have largely had to rely on smaller numbers or use multiple studies to create meta-analyses, which have inherent flaws, Harker said.

According to Putrino, one of the issues that needs further investigation is the level of protection that vaccinations offer. Recent studies show that vaccination reduces the chance of a long covid, but not as much as previously thought.

“That’s one of the most important things we need to understand next,” Putrino said.

The University of Glasgow team, led by Pell, worked with Public Health Scotland, the National Health Service in Scotland and the Universities of Aberdeen and Edinburgh, and was funded by the Scottish Government’s Chief Scientist Office and Public Health Scotland.

The explorers planning further studies, says Pell. The current study was followed up at six, twelve and 18 months after infection with individuals. Among those who had confirmed Covid, 13 per cent reported some improvement.

“We’re trying to look more closely at these changes in symptoms over time and what factors are involved,” Pell said.

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