Study IDs Most Common Persistent Symptoms 8 Months After Mild COVID

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Loss of sense of smell, loss of taste, shortness of breath and fatigue are the four most common symptoms reported by healthcare professionals in Sweden 8 months after mild COVID-19 illness, new evidence shows.

According to the study, about one in 10 health professionals experiences one or more moderate to severe symptoms that negatively affect their quality of life.

“We see that a significant proportion of health professionals experience long-lasting symptoms after mild COVID-19,” said senior author Charlotte Thålin, MD, PhD. Medscape Medical NewsShe added that loss of smell and taste “may seem trivial, but in the long run it negatively impacts work, social and private life”.

The study is not only notable for tracking the COVID-19-related experiences of health professionals over time, but also for what has not been found. There was no increased prevalence of cognitive problems – including memory or concentration – that others have associated with what is often referred to as COVID-19.

The research letter was published online April 7, 2021, in JAMA

“Even if you are young and previously healthy, a mild COVID-19 infection can have long-term consequences,” said Thålin, of the Danderyd Hospital’s Department of Clinical Sciences, Karolinska Institute, Stockholm, Sweden.

The researchers did not see an increased risk of long-term symptoms after asymptomatic COVID-19.

Add to existing evidence

This research letter “adds to the growing body of literature showing that people recovering from COVID have reported a diverse set of symptoms that persist for months after the initial infection,” Lekshmi Santhosh, MD, said. Medscape Medical News when asked for comment. She is chief of the physician faculty at the Post-COVID OPTIMAL Clinic at the University of California, San Francisco (UCSF).

Previous research revealed serious long-term symptoms, including palpitations and neurological disturbances, in people hospitalized with COVID-19. “However, there is limited data on the long-term effects after mild COVID-19, and these studies are often hampered by selection bias and without the appropriate control groups,” said Thålin.

The absence of these more severe symptoms after mild COVID-19 is “reassuring,” she added.

The current findings are part of the ongoing COMMUNITY study (COVID-19 Biomarker and Immunity) that looks at long-term immunity. Healthcare professionals participated in the study between April 15 and May 8, 2020 and the first blood tests are repeated every 4 months.

Thålin, lead author Sebastian Havervall, MD, and their colleagues compared symptom reporting between 323 hospital employees who had mild COVID-19 at least 8 months earlier with 1072 employees who did not have COVID-19 during the study.

The results show that 26% of those who had previously had COVID-19 had at least one moderate to severe symptom that lasted for more than 2 months, compared with 9% in the control group.

The group with a history of mild COVID-19 was on average 43 years old and 83% were female. The controls were on average 47 years old and 86% were female.

“These data reflect what we have seen in long-term cohorts of patients with COVID-19 infection. In particular, mild illness in previously healthy individuals may be associated with long-lasting persistent symptoms,” said Sarah Jolley, MD, a pulmonologist specializing in care. at UCHealth University of Colorado Hospital in Aurora and director of the Post-COVID Clinic Medscape Medical News.

“In this cohort, as in others, this appears to be more pronounced in women,” added Jolley.

Main findings about functioning

After 8 months, using a smartphone app, the participants reported the presence, duration and severity of 23 predefined symptoms. Researchers used the Sheehan Disability Scale to measure functional disability.

A total of 11% of the participants reported at least one symptom that negatively impacted work or social or private life at 8 months versus only 2% of the control group.

Seropositive participants reported nearly twice as likely to have long-lasting symptoms moderately to markedly disrupted their working life, 8% versus 4% of seronegative health workers [RR], 1.8; 95%; Confidence Interval [CI]1.2-2.9).

Disruptions to social life due to long-lasting symptoms were 2.5 times more likely in the HIV-positive group. Overall, 15% of this cohort reported moderate to clear effects, compared to 6% of the seronegative group (RR, 2.5; 95% CI, 1.8-3.6).

The researchers also asked about home life disruptions, which were reported by 12% of seropositive health professionals and 5% of seronegative participants (RR, 2.3; 95% CI, 1.6-3.4).

The study’s findings “follow with much of the other work we see,” said David Putrino, PT, PhD, director of rehabilitation innovation at Mount Sinai Health System in New York City. Medscape Medical NewsHe and his colleagues are responsible for managing the rehabilitation of patients with long-term COVID.

Interestingly, the number of people with persistent symptoms may be underestimated in this study, Putrino said. “Antibodies are not a completely reliable biomarker. So what the researchers are using here is the most conservative measure of who has had the virus.”

Possible bias in the recall and subjective assessment of symptoms were potential limitations of the study.

When asked to speculate why researchers did not find higher levels of cognitive impairment, Putrino said self-reports are generally less reliable than measures such as MoCA (Montreal Cognitive Assessment) for detecting cognitive impairment.

In addition, unlike many of the people with COVID-19 he treats clinically – the ones who “really struggle” – the health workers studied in Sweden are functioning well enough to perform their duties in the hospital, so the study population may represent not the population in general.

More research required

“More research needs to be done to investigate the mechanisms underlying these persistent symptoms, and several centers, including UCSF, are investigating why this might be,” Santhosh said.

Thålin and colleagues plan to continue to follow the participants. “The primary goal of the COMMUNITY study is to investigate long-term immunity after COVID-19, but we will also look at possible underlying pathophysiological mechanisms behind COVID-19-related long-term symptoms,” she said.

“I hope the taste and smell will return,” added Thålin.

“We’re actually just beginning to understand the long-term effects of COVID-19,” Putrino said. “This is something that we will see much progress.”

Thålin, Santhosh, Jolley and Putrino have not disclosed any relevant financial relationships. Grants from the Knut and Alice Wallenberg Foundation, Jonas and Christina af Jochnick Foundation, Leif Lundblad Family Foundation, Region Stockholm and Erling-Persson Family Foundation funded the research.

Damian McNamara is a personnel journalist based in Miami. It covers a wide variety of medical specialties, including infectious diseases, gastroenterology and intensive care. Follow Damian on Twitter: @MedReporter.

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