Health Status, Persistent Symptoms, and Effort Intolerance One Year After Acute COVID-19 Infection

Abstract

Background The long-term prevalence and risk factors for post-acute COVID-19 sequelae (PASC) are not well described and may have important implications for unvaccinated populations and policy makers. Objective To assess health status, persistent symptoms, and effort tolerance approximately 1 year after COVID-19 infection Design Retrospective observational cohort study using surveys and clinical data Participants Survey respondents who were survivors of acute COVID-19 infection requiring Emergency Department presentation or hospitalization between March 3 and May 15, 2020. Main Measure(s) Self-reported health status, persistent symptoms, and effort tolerance Key Results The 530 respondents (median time between hospital presentation and survey 332 days [IQR 325–344]) had mean age 59.2±16.3 years, 44.5% were female and 70.8% were non-White. Of these, 41.5% reported worse health compared to a year prior, 44.2% reported persistent symptoms, 36.2% reported limitations in lifting/carrying groceries, 35.5% reported limitations climbing one flight of stairs, 38.1% reported limitations bending/kneeling/stooping, and 22.1% reported limitations walking one block. Even those without high-risk comorbid conditions and those seen only in the Emergency Department (but not hospitalized) experienced significant deterioration in health, persistent symptoms, and limitations in effort tolerance. Women (adjusted relative risk ratio [aRRR] 1.26, 95% CI 1.01–1.56), those requiring mechanical ventilation (aRRR 1.48, 1.02–2.14), and people with HIV (aRRR 1.75, 1.14–2.69) were significantly more likely to report persistent symptoms. Age and other risk factors for more severe COVID-19 illness were not associated with increased risk of PASC. Conclusions PASC may be extraordinarily common 1 year after COVID-19, and these symptoms are sufficiently severe to impact the daily exercise tolerance of patients. PASC symptoms are broadly distributed, are not limited to one specific patient group, and appear to be unrelated to age. These data have implications for vaccine hesitant individuals, policy makers, and physicians managing the emerging longer-term yet unknown impact of the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07379-z.

Targeted Down Regulation Of Core Mitochondrial Genes During SARS-CoV-2 Infection

“…Hence, the viral regulation of host mitochondrial transcription occurs after the initial viral protein inhibition of mitochondrial protein function. Surprisingly, however, brain mitochondrial gene expression was affected possibly accounting for the commonly experienced “brain fog” ( 1 ).…”

“…While generally considered an inflammatory disease, recent evidence suggests that SARS-CoV-2 infection also inhibits mitochondrial bioenergetics, and that mitochondrial inhibition can activate of the inflammasome. Thus, in infected individuals, mitochondrial inhibition may not only contribute to excessive cytokine production but may be particularly impactful for the heart and brain, since these organs are highly reliant on mitochondrial energy production ( 1–5 ).…”

Post-Acute Sequelae and Adaptive Immune Responses in People Living With Hiv Recovering From Sars-Cov-2 Infection

“…Another study suggested that HIV was one factor associated with higher risk of PASC among those requiring emergency department or hospital-based care [32], but the analysis was limited to 10 PWH and did not include biological measurements. While our cohort is not representative of all individuals with SARS-CoV-2 infection and cannot estimate the population-level prevalence of PASC, the observation that persistent SARS-CoV-2-attributed symptoms were highly prevalent in PWH and that the adjusted odds of PASC were four-fold as high as in well-matched HIV-negative comparators was striking.…”

“…One single-center study suggested that acute illness severity in PWH was significantly associated with PASC with 44% of participants experiencing at least one symptom 30 days after recovery [40], however it did not find an association between clinical parameters such as CD4+ T cell count, viral load, demographics or comorbidities and the presence of PASC, and did not compare PWH with HIV-negative individuals. Another retrospective study suggested that HIV was one factor that was associated with higher risk of PASC approximately one year after COVID-19 diagnosis among those requiring emergency department or hospital-based care [56], but the analysis was limited to 10 PWH and did not include biological measurements. While our cohort is not representative of all individuals with SARS-CoV-2 infection and cannot be utilized to estimate the population-level prevalence of PASC in the overall population or among PWH, the observation that persistent SARS-CoV-2-attributed symptoms were highly prevalent in PWH and that the adjusted odds of PASC were nearly four-fold as high as in a relatively well-matched HIV-negative comparator group was striking.…”

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

“…Several studies confirm persistence of symptoms in individuals with Long COVID up to 1 year [20][21][22] . 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.…”