A model framework for projecting the prevalence and impact of Long-COVID in the UK

Martin, Chris; Luteijn, Michiel; Letton, William; Robertson, Josephine; McDonald, Stuart

doi:10.1371/journal.pone.0260843

Cited by 16 publications

(11 citation statements)

References 24 publications

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“…The organs and body systems most frequently involved can only be indirectly inferred from the drugs dispensed and the instrumental and biochemical tests performed. Furthermore, we were unable to evaluate the post‐COVID prevalence of such frequently reported subjective symptoms as fatigue, insomnia, confusion, breathlessness, ageusia, and anosmia, even though a questionnaire developed in collaboration with the main Italian daily newspaper and administered to more than 5000 patients and their significant next of kin helped to gather this information [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the post‐COVID‐19 condition on health care after the first disease wave in Lombardy

et al. 2022

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Background Lombardy was affected in the early months of 2020 by the SARS‐CoV‐2 pandemic with very high morbidity and mortality. The post‐COVID‐19 condition and related public health burden are scarcely known. Setting and design Using the regional population administrative database including all the 48,932 individuals who survived COVID‐19 and became polymerase‐chain‐reaction negative for SARS‐CoV‐2 by 31 May 2020, incident mortality, rehospitalizations, attendances to hospital emergency room, and outpatient medical visits were evaluated over a mid‐term period of 6 months in 20,521 individuals managed at home, 26,016 hospitalized in medical wards, and 1611 in intensive care units (ICUs). These data were also evaluated in the corresponding period of 2019, when the region was not yet affected by the pandemic. Other indicators and proxies of the health‐care burden related to the post‐COVID condition were also evaluated. Main results In individuals previously admitted to the ICU and medical wards, rehospitalizations, attendances to hospital emergency rooms, and out‐patient medical visits were much more frequent in the 6‐month period after SARS‐CoV‐2 negativization than in the same prepandemic period. Performances of spirometry increased more than 50‐fold, chest CT scans 32‐fold in ICU‐admitted cases and 5.5‐fold in non‐ICU cases, and electrocardiography 5.6‐fold in ICU cases and twofold in non‐ICU cases. Use of drugs and biochemical tests increased in all cases. Conclusions These results provide a real‐life picture of the post‐COVID condition and of its effects on the increased consumption of health‐care resources, considered proxies of comorbidities.

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Section: Discussionmentioning

confidence: 99%

Impact of the post‐COVID‐19 condition on health care after the first disease wave in Lombardy

et al. 2022

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“…We now add that 3 in 5 people with Long COVID have impairment in at least one organ, and 1 in 4 have impairment in two or more organs, in some cases without symptoms. Impact on quality of life and time off work, particularly in healthcare workers, is a major concern for individuals, health systems and economies 23 . Many healthcare workers had no prior illness (2% diabetes, 2% heart disease and 22% asthma, which may play a pathophysiologic role 24 ), but of 172 participants, 19 were still symptomatic at follow-up and off work at a median of 180 days.…”

Section: Discussionmentioning

confidence: 99%

Multi-organ impairment and Long COVID: a 1-year prospective, longitudinal cohort study

Dennis¹,

Cuthbertson

Wootton

et al. 2022

Preprint

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ImportanceMulti-organ impairment associated with Long COVID is a significant burden to individuals, populations and health systems, presenting challenges for diagnosis and care provision. Standardised assessment across multiple organs over time is lacking, particularly in non-hospitalised individuals.ObjectiveTo determine the prevalence of organ impairment in Long COVID patients at 6 and at 12 months after initial symptoms and to explore links to clinical presentation.DesignThis was a prospective, longitudinal study in individuals following recovery from acute COVID-19. We assessed symptoms, health status, and multi-organ tissue characterisation and function, using consensus definitions for single and multi-organ impairment. Physiological and biochemical investigations were performed at baseline on all individuals and those with organ impairment were reassessed, including multi-organ MRI, 6 months later.SettingTwo non-acute settings (Oxford and London).Participants536 individuals (mean 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post-COVID-19). 331 (62%) with organ impairment or incidental findings had follow up, with reduced symptom burden from baseline (median number of symptoms: 10 and 3, at 6 and 12 months).ExposureSARS-CoV-2 infection 6 months prior to first assessment.Main outcomePrevalence of single and multi-organ impairment at 6 and 12 months post-COVID-19.ResultsExtreme breathlessness (36% and 30%), cognitive dysfunction (50% and 38%) and poor health-related quality of life (EQ-5D-5L<0.7; 55% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single organ impairment. At baseline, there was fibro-inflammation in the heart (9%), pancreas (9%), kidney (15%) and liver (11%); increased volume in liver (7%), spleen (8%) and kidney (9%); decreased capacity in lungs (2%); and excessive fat deposition in the liver (25%) and pancreas (15%). Single and multi-organ impairment were present in 59% and 23% at baseline, persisting in 59% and 27% at follow-up.Conclusion and RelevanceOrgan impairment was present in 59% of individuals at 6 months post-COVID-19, persisting in 59% of those followed up at 1 year, with implications for symptoms, quality of life and longer-term health, signalling need for prevention and integrated care of Long COVID.Trial RegistrationClinicalTrials.govIdentifier:NCT04369807Key pointsQuestion: What is the prevalence of organ impairment in Long COVID at 6- and 12-months post-COVID-19?Findings: In a prospective study of 536 mainly non-hospitalised individuals, symptom burden decreased, but single organ impairment persisted in 59% at 12 months post-COVID-19.Meaning: Organ impairment in Long COVID has implications for symptoms, quality of life and longer-term health, signalling need for prevention and integrated care of Long COVID.

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“…Given the United Kingdom (UK) evidence that some patients still report Long COVID over 12 months after infection [ 18 ], our model assumed that Long COVID could potentially last up to 2 years. Due to the lack of longitudinal data regarding the length of Long COVID, we extrapolated available data on numbers of Long COVID cases over time from the UK Office of National Statistics (ONS) [ 18 ] and a population-based cohort study in New South Wales (NSW) [ 19 ] until it reached 0% using a fitted decay function [ 27 ]. This estimate was only applied to COVID-19 survivors.…”

Section: Methodsmentioning

confidence: 99%

Modelling the potential acute and post-acute burden of COVID-19 under the Australian border re-opening plan

et al. 2022

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Background Concerns have grown that post-acute sequelae of COVID-19 may affect significant numbers of survivors. However, the analyses used to guide policy-making for Australia’s national and state re-opening plans have not incorporated non-acute illness in their modelling. We, therefore, develop a model by which to estimate the potential acute and post-acute COVID-19 burden using disability-adjusted life years (DALYs) associated with the re-opening of Australian borders and the easing of other public health measures, with particular attention to longer-term, post-acute consequences and the potential impact of permanent functional impairment following COVID-19. Methods A model was developed based on the European Burden of Disease Network protocol guideline and consensus model to estimate the burden of COVID-19 using DALYs. Data inputs were based on publicly available sources. COVID-19 infection and different scenarios were drawn from the Doherty Institute’s modelling report to estimate the likely DALY losses under the Australian national re-opening plan. Long COVID prevalence, post-intensive care syndrome (PICS) and potential permanent functional impairment incidences were drawn from the literature. DALYs were calculated for the following health states: the symptomatic phase, Long COVID, PICS and potential permanent functional impairment (e.g., diabetes, Parkinson’s disease, dementia, anxiety disorders, ischemic stroke). Uncertainty and sensitivity analysis were performed to examine the robustness of the results. Results Mortality was responsible for 72-74% of the total base case COVID-19 burden. Long COVID and post-intensive care syndrome accounted for at least 19 and 3% of the total base case DALYs respectively. When included in the analysis, potential permanent impairment could contribute to 51-55% of total DALYs lost. Conclusions The impact of Long COVID and potential long-term post-COVID disabilities could contribute substantially to the COVID-19 burden in Australia’s post-vaccination setting. As vaccination coverage increases, the share of COVID-19 burden driven by longer-term morbidity rises relative to mortality. As Australia re-opens, better estimates of the COVID-19 burden can assist with decision-making on pandemic control measures and planning for the healthcare needs of COVID-19 survivors. Our estimates highlight the importance of valuing the morbidity of post-COVID-19 sequelae, above and beyond simple mortality and case statistics.

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A model framework for projecting the prevalence and impact of Long-COVID in the UK

Cited by 16 publications

References 24 publications

Impact of the post‐COVID‐19 condition on health care after the first disease wave in Lombardy

Impact of the post‐COVID‐19 condition on health care after the first disease wave in Lombardy

Multi-organ impairment and Long COVID: a 1-year prospective, longitudinal cohort study

Modelling the potential acute and post-acute burden of COVID-19 under the Australian border re-opening plan

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