Profiling post-COVID syndrome across different variants of SARS-CoV-2

Abstract

Background: Self-reported symptom studies rapidly increased our understanding of SARS-CoV-2 during the pandemic and enabled the monitoring of long-term effects of COVID-19 outside the hospital setting. It is now evident that post-COVID syndrome presents with heterogeneous profiles, which need characterisation to enable personalised care among the most affected survivors. This study describes post-COVID profiles, and how they relate to different viral variants and vaccination status. Methods: In this prospective longitudinal cohort study, we analysed data from 336,652 subjects, with regular health reports through the Covid Symptom Study (CSS) smartphone application. These subjects had reported feeling physically normal for at least 30 days before testing positive for SARS-CoV-2. 9,323 individuals subsequently developed Long-COVID, defined as symptoms lasting longer than 28 days. 1,459 had post-COVID syndrome, defined as more than 12 weeks of symptoms. Clustering analysis of the time-series data was performed to identify distinct symptom profiles for post-COVID patients, across variants of SARS-CoV-2 and vaccination status at the time of infection. Clusters were then characterised based on symptom prevalence, duration, demography, and prior conditions (comorbidities). Using an independent testing sample with additional data (n=140), we investigated the impact of post-COVID symptom clusters on the lives of affected individuals. Findings: We identified distinct profiles of symptoms for post-COVID syndrome within and across variants: four endotypes were identified for infections due to the wild-type variant; seven for the alpha variant; and five for delta. Across all variants, a cardiorespiratory cluster of symptoms was identified. A second cluster related to central neurological, and a third to cases with the most severe and debilitating multi-organ symptoms. Gastrointestinal symptoms clustered in no more than two specific phenotypes per viral variant. The three main clusters were confirmed in an independent testing sample, and their functional impact was assessed. Interpretation: Unsupervised analysis identified different post-COVID profiles, characterised by differing symptom combinations, durations, and functional outcomes. Phenotypes were at least partially concordant with individuals reported experiences. Our classification may be useful to understand distinct mechanisms of the post-COVID syndrome, as well as subgroups of individuals at risk of prolonged debilitation. Funding: UK Government Department of Health and Social Care, Chronic Disease Research Foundation, The Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value-Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation and Alzheimers Society, and ZOE Limited, UK.

Olfactory and Gustatory Outcomes Including Health-Related Quality of Life 3–6 and 12 Months after Severe-to-Critical COVID-19: A SECURe Prospective Cohort Study

“…COVID-19 may also be neurogenic, capable of the cerebral affection of the olfactory pathways such as the olfactory bulb and the orbitofrontal cortex [ 16 , 17 ]. As the COVID-19 pandemic continues, our knowledge of post-COVID syndromes (COVID-19 symptoms present for more than 12 weeks after the initial infection) has increased [ 18 ]. Recently studies have reported ODG in 1.6–27% up to 5 months after COVID-19.…”

Post COVID-19 condition after Wildtype, Delta, and Omicron variant SARS-CoV-2 infection and vaccination: pooled analysis of two population-based cohorts

“…One study so far has investigated symptom clusters in the context of different SARS-CoV-2 variants. 33 The authors reported three main emerging PCC symptom clusters (i.e., central neurological, cardiorespiratory, and systemic/inflammatory), while total number of identified clusters and cluster profiles varied across Wildtype, Alpha, and Delta variants. In our study, we found no substantial variation in the prevalence of symptom clusters across infections with different variants, but relevant variation in participant characteristics across clusters.…”

“…We retained dimensions that explained 90% of the variance and 9 / 25 performed an agglomerative hierarchal clustering on the selected dimensions using Ward minimumvariance linkage methods. 31,32 We based the selection of the number of clusters on findings from other studies [33][34][35] and by maximizing the relative loss of inertia. We selected four clusters for the main analysis, but present findings from sensitivity analyses assuming five and six clusters for future comparison.…”

Prevalence of Insomnia in the Early Post-COVID-19 Recovery Period

“…It should be considered whether the severity of the course of acute infection is actually a parameter that allows us to predict the occurrence of mental health and sleep symptoms in the selected population, or whether the observation of the course of long-COVID-19 is a more important aspect. A recently published work describes post-COVID profiles and how they relate to different viral variants and vaccination status; researchers identified three clusters of symptoms associated with different SARS-CoV-2 variants (cardiorespiratory, neurological, and multi-organ/gastrointestinal) [ 32 ]. This may also explain the presented differences in the results obtained in the AIS between the hospitalized and non-hospitalized patients in relation to the number of persistent COVID-19 symptoms.…”