Persistent COVID-19 Symptoms at 6 Months After Onset and the Role of Vaccination Before or After SARS-CoV-2 Infection

Abstract

ImportanceUnderstanding the factors associated with post-COVID conditions is important for prevention.ObjectiveTo identify characteristics associated with persistent post–COVID-19 symptoms and to describe post–COVID-19 medical encounters.Design, Setting, and ParticipantsThis cohort study used data from the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases With Pandemic Potential (EPICC) study implemented in the US military health system (MHS); MHS beneficiaries aged 18 years or older who tested positive for SARS-CoV-2 from February 28, 2020, through December 31, 2021, were analyzed, with 1-year follow-up.ExposuresSARS-CoV-2 infection.Main Outcomes and MeasuresThe outcomes analyzed included survey-reported symptoms through 6 months after SARS-CoV-2 infection and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis categories reported in medical records 6 months following SARS-CoV-2 infection vs 3 months before infection.ResultsMore than half of the 1832 participants in these analyses were aged 18 to 44 years (1226 [66.9%]; mean [SD] age, 40.5 [13.7] years), were male (1118 [61.0%]), were unvaccinated at the time of their infection (1413 [77.1%]), and had no comorbidities (1290 [70.4%]). A total of 728 participants (39.7%) had illness that lasted 28 days or longer (28-89 days: 364 [19.9%]; ≥90 days: 364 [19.9%]). Participants who were unvaccinated prior to infection (risk ratio [RR], 1.39; 95% CI, 1.04-1.85), reported moderate (RR, 1.80; 95% CI, 1.47-2.22) or severe (RR, 2.25; 95% CI, 1.80-2.81) initial illnesses, had more hospitalized days (RR per each day of hospitalization, 1.02; 95% CI, 1.00-1.03), and had a Charlson Comorbidity Index score of 5 or greater (RR, 1.55; 95% CI, 1.01-2.37) were more likely to report 28 or more days of symptoms. Among unvaccinated participants, postinfection vaccination was associated with a 41% lower risk of reporting symptoms at 6 months (RR, 0.59; 95% CI, 0.40-0.89). Participants had higher risk of pulmonary (RR, 2.00; 95% CI, 1.40-2.84), diabetes (RR, 1.46; 95% CI, 1.00-2.13), neurological (RR, 1.29; 95% CI, 1.02-1.64), and mental health–related medical encounters (RR, 1.28; 95% CI, 1.01-1.62) at 6 months after symptom onset than at baseline (before SARS-CoV-2 infection).Conclusions and RelevanceIn this cohort study, more severe acute illness, a higher Charlson Comorbidity Index score, and being unvaccinated were associated with a higher risk of reporting COVID-19 symptoms lasting 28 days or more. Participants with COVID-19 were more likely to seek medical care for diabetes, pulmonary, neurological, and mental health–related illness for at least 6 months after onset compared with their pre-COVID baseline health care use patterns. These findings may inform the risk-benefit ratio of COVID-19 vaccination policy.

Treadmill Exercise Stress Echocardiography Exposes Impaired Left Ventricular Function in Patients Recovering from Hospitalization with COVID-19 Without Overt Myocarditis Versus Historical Controls

“… Prior hospitalization with COVID-19 even in the absence of overt myocarditis was often associated with a modest but consistent decrement in left ventricular systolic contraction and diastolic relaxation; these functional abnormalities were evident after peak treadmill exercise stress despite lack of distinctive difference in contractile parameters at rest. Routine testing of blood troponin, brain natriuretic peptide, and C-reactive protein shows no abnormalities during recovery in nearly all patients hospitalized with COVID-19 without overt myocarditis during or after their hospital stay (4)(5). The same lack of abnormality is also observed when these patients have electrocardiograms, echocardiograms, or magnetic resonance images (6)(7)(8).…”

Clinical Characteristics and Short-term Outcomes of Acute Pancreatitis with COVID-19

“…Additionally, studies have reported that even post-infection vaccination can alleviate long COVID syndrome (21). Therefore, it is recommended that patients who have not received the vaccine after infection should consider getting vaccinated to mitigate the symptoms of long COVID syndrome.…”

Long COVID-19 and diabetes mellitus: a short review

“…Vaccination against Covid-19 has been highly effective in combating the SARS-CoV-2 pandemic [107] , reducing acute symptoms, hospitalization, and death; however, patients with diabetes (especially those with uncontrolled glycemia) appear to be less responsive to the protective effects of the vaccination [39,108] . Moreover, vaccines are sometimes seen as potentially harmful.…”