Long covid outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort study

Abstract

Objectives To determine the clinical sequelae of long covid for a year after infection in patients with mild disease and to evaluate its association with age, sex, SARS-CoV-2 variants, and vaccination status. Design Retrospective nationwide cohort study. Setting Electronic medical records from an Israeli nationwide healthcare organisation. Population 1 913 234 Maccabi Healthcare Services members of all ages who did a polymerase chain reaction test for SARS-CoV-2 between 1 March 2020 and 1 October 2021. Main outcome measures Risk of an evidence based list of 70 reported long covid outcomes in unvaccinated patients infected with SARS-CoV-2 matched to uninfected people, adjusted for age and sex and stratified by SARS-CoV-2 variants, and risk in patients with a breakthrough SARS-CoV-2 infection compared with unvaccinated infected controls. Risks were compared using hazard ratios and risk differences per 10 000 patients measured during the early (30-180 days) and late (180-360 days) time periods after infection. Results Covid-19 infection was significantly associated with increased risks in early and late periods for anosmia and dysgeusia (hazard ratio 4.59 (95% confidence interval 3.63 to 5.80), risk difference 19.6 (95% confidence interval 16.9 to 22.4) in early period; 2.96 (2.29 to 3.82), 11.0 (8.5 to 13.6) in late period), cognitive impairment (1.85 (1.58 to 2.17), 12.8, (9.6 to 16.1); 1.69 (1.45 to 1.96), 13.3 (9.4 to 17.3)), dyspnoea (1.79 (1.68 to 1.90), 85.7 (76.9 to 94.5); 1.30 (1.22 to 1.38), 35.4 (26.3 to 44.6)), weakness (1.78 (1.69 to 1.88), 108.5, 98.4 to 118.6; 1.30 (1.22 to 1.37), 50.2 (39.4 to 61.1)), and palpitations (1.49 (1.35 to 1.64), 22.1 (16.8 to 27.4); 1.16 (1.05 to 1.27), 8.3 (2.4 to 14.1)) and with significant but lower excess risk for streptococcal tonsillitis and dizziness. Hair loss, chest pain, cough, myalgia, and respiratory disorders were significantly increased only during the early phase. Male and female patients showed minor differences, and children had fewer outcomes than adults during the early phase of covid-19, which mostly resolved in the late period. Findings remained consistent across SARS-CoV-2 variants. Vaccinated patients with a breakthrough SARS-CoV-2 infection had a lower risk for dyspnoea and similar risk for other outcomes compared with unvaccinated infected patients. Conclusions This nationwide study suggests that patients with mild covid-19 are at risk for a small number of health outcomes, most of which are resolved within a year from diagnosis.

Incident autoimmune diseases in association with a SARS-CoV-2 infection: A matched cohort study

“…To date, different respiratory, cardiovascular, neurological and mental diseases as well as various symptoms in the context of long/post-COVID have been studied with routine health care data [11][12][13][14][15][16][17][18]. The group of autoimmune diseases is less discussed in the literature, although autoantibodies could be found in patients after SARS-CoV-2 infection, e.g., anti-type I IFNs, anti-IFN-α and anti-nuclear antibodies (ANAs) [19].…”

Autonomic dysfunction and postural orthostatic tachycardia syndrome in post-acute COVID-19 syndrome

“…Interestingly, POTS and related conditions, such as mast cell disorders, chronic fatigue and general dysautonomia, are diagnosed more often in the 3 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but can also develop after COVID-19 vaccination. The medium-term to long-term prognosis is not well understood 8 , but one report suggests that many patients can spontaneously recover over the next 12 months 9 .…”

Aging and long COVID-19 syndrome: what’s new in 2023?

“…They are also vague, and non measureable as a rule, hence may be overlooked. Inaccuracies in data collection procedures and results of the various retrospective studies based on electronic records in specific high profile health and well funded and organized venues may not represent the big picture at all successfully, 47 given the manifestations of COVID syndrome are inconsistent and diffuse at best and may not have yet emerged in controls when studied. 48 Moreover, the role of rehabilitation in long COVID remains unclear even though as a general principle rehabilitation in its widest sense appears most strongly indicated to safely offset long COVID symptoms.…”