Determinants of the onset and prognosis of the post-COVID-19 condition: a 2-year prospective observational cohort study

Trajectories of persisting Covid- 19 symptoms up to 24 months after acute infection: findings from the Predi-Covid cohort study

INTRODUCTION

Long COVID is a multisystemic, fluctuating condition inducing a high burden on affected people. Despite the existence of some guidelines, its management remains complicated. We aimed to demonstrate that symptoms after a COVID-19 infection evolve following different trajectories from the initial infection until 24 months after, to identify the determinants of these trajectories, and the quality of life of people in these trajectories.

METHODS

Study participants from the Predi-COVID cohort were digitally followed from their acute SARS-CoV-2 infection until a maximum of 24 months. Data from 10 common symptoms collected at study inclusion, and months 12, 15, and 24 awere used to create a total symptom score. Impact of symptoms on quality of life was assessed at month 24 using standardized questionnaires and ad-hoc questions. Latent classes mixed models were used to identify total score symptom trajectories and individual symptoms trajectories.

RESULTS

We included 555 participants with at least 2 different time points available during follow-up (Baseline and at least one of the M12, M15 or M24 questionnaires). We identified 2 total symptom score trajectories: T1 "Mild symptoms, fast resolution" (N = 376; 67.7%), and T2 "Elevated and persisting symptoms" (N = 179; 32.3%). The main determinants of being in T2 were: older age (OR = 1.86; p = 0.003), to be a woman (OR = 1.81; p = 0.001)), elevated BMI (OR = 3.97; p < 0.001), and the presence of multi comorbidities (OR = 2.67; p = 0.005). Symptoms impacted the quality of life more in T2 than in T1 at 24 months (high fatigue level: 64.8% vs 19.5%, altered respiratory quality of life: 42.6% vs 4.6%, anxiety: 24.1% vs 4.6%, stress: 57.4% vs 35.6%, and bad sleep: 75.9% vs 51.1%).

CONCLUSION

A third of our study population was in the T2 "Elevated and persisting symptoms" trajectory, presenting high symptom frequencies up to 24 months after initial infection, with a significant impact on quality of life. This work underlined the urgent need to better identify individuals most vulnerable to long-term complications to develop tailored interventions for them.

TRIAL REGISTRATION

Clinicaltrials.gov NCT04380987 (date of registration: 2020-05-07).

Lingering symptoms in non-hospitalized patients with COVID-19 - a prospective survey study of symptom expression and effects on mental health in Germany

BACKGROUND

The infection rates with SARS-CoV 2 virus, known since 2019, are currently significantly weakened in their dynamics. Nevertheless, COVID 19 is still a common disease, which in most cases is overcome quite well and can be treated by the general practitioner. Despite an initially uncomplicated disease progression, the long-term consequences can be considerable. Symptoms persisting over a period of more than 12 weeks after infection are summarized as Post-COVID (PC) syndrome. The aim of this study is to document the symptom expression in PC patients in the outpatient setting, with a major focus on limitations in daily life and consequences for mental health.

METHODS

This survey is part of a prospective European collaborative study with the German cohort having been slightly extended and evaluated separately. Data collection was performed by telephone interviews of adult SARS CoV 2 positive patients using standardized questionnaires (38 open and 6 closed questions). After an inclusion interview, follow-up interviews were conducted every 4 weeks over a period of 6 months. Participants were recruited in collaboration with the local health department (Wuerzburg, Germany).

RESULTS

Sixty participants were recruited in April and May 2021. After 12 weeks (PC cutoff), 48.3% still reported symptoms related to SARS-CoV-2 infection. The most commonly reported symptoms were fatigue/tiredness (33.3%), reduced concentration (26.7%), and shortness of breath (23.3%). One-quarter of respondents reported impaired functioning, with the most common daily limitations being sports (28.3%), work (25.0%), and social life (15.0%). At 6 months, 21.6% of respondents experienced anxiety and 11.6% reported depressive symptoms. Overall, 40.0% of respondents were concerned that their health would deteriorate again or not fully normalize because of COVID-19. Over two-thirds (70.0%) visited a physician during the course of the study because of COVID-19, 73.8% of whom visited their general practitioner.

CONCLUSION

PC in outpatient care appears to be a complex and multifaceted condition that not only presents with physical symptoms, but also has a significant impact on mental health and daily life. Although the complexity of the condition is not yet fully understood, our findings suggest that it presents long-term challenges, particularly in outpatient care. Further research, particularly in larger and more diverse cohorts, is needed to confirm these observations. Routine screening for psychosocial comorbidities could be a valuable approach to identify supportive interventions that may help to reduce the risk of chronification and/or somatization.

Post-COVID recovery is faster after an infection with the SARS-CoV-2 Omicron variant: a population-based cohort study

PURPOSE

Post-COVID-19 condition (PCC) poses a substantial burden to affected individuals, health care systems, and society as a whole. We examined factors associated with recovery from PCC, focusing on the vaccination status prior to infection and the virus variant.

METHODS

Our analyses are based on the population-based cohort study for digital health research in Germany (DigiHero). Respondents who reported a SARS-CoV-2 infection and COVID-related symptoms ≥ 12 weeks post-infection were classified as having PCC. Those with ongoing PCC were followed-up in six-month intervals based on their date of infection. We used a Cox model for interval-censored data to analyze PCC recovery.

RESULTS

Among the 4,529 respondents with PCC included in our analyses, about 26%, 19%, 36%, and 44% of those infected during dominance of the SARS-CoV-2 wildtype, Alpha, Delta, and Omicron variant had recovered one year after infection, respectively. When stratifying by virus variant, vaccination was not associated with a faster recovery. Conversely, those infected with Omicron (HR = 2.20; 95%CI: 1.96-2.48) or Delta (HR = 1.69; 95%CI: 1.43-2.01) recovered faster than those infected with the SARS-CoV-2 wildtype or Alpha strain.

CONCLUSION

Although the recovery from PCC is faster for the newer virus variants, still a substantial fraction of those who developed PCC after an infection with the Omicron variant report prolonged persistence of symptoms.

Long-term outcomes of post-acute sequelae of SARS-CoV-2 infection: a cohort study protocol

Introduction

Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) presents a multifaceted interplay of demographic, clinical, environmental, and socioeconomic factors. Quantification at the individual level of these factors remains underexplored. Our study aims to address this knowledge gap by analyzing the long-term health implications of PASC, utilizing a comprehensive integration of spatiotemporal, clinical, environmental, and socioeconomic data.

Methods and analysis

The study will enroll over 4,000 confirmed COVID-19 patients from Gansu Provincial Hospital, treated from December 2022 to May 2023, as the baseline. These patients are spread across 14 cities in Gansu Province, with geographic coordinates ranging from 92°13'E to 108°46'E and 32°31'N to 42°57'N. Follow-ups will be conducted via structured telephone interviews at 24, 36, and 48 months post-discharge, from 2024 to 2027, to assess PASC and long-term health outcomes. Participants will be categorized into three age groups: children and teenagers (birth to 18 years), adults (18-65 years), and the older adult (over 65 years). Environmental and socioeconomic data corresponding to each case are also integrated. The primary objective is to assess the persistence and long-term health outcomes of PASC symptoms. Secondary objectives focus on evaluating the acute infection phase, its progression, and the efficacy of medical management strategies in influencing PASC trajectories. Mixed-effects models will be utilized to evaluate the impact of various factors on PASC, while spatiotemporal analyses will explore the correlations between environmental and socioeconomic conditions and the diagnosis and recovery trajectories of PASC.

Ethics and dissemination

The Gansu Provincial Hospital's research ethics committee has approved this study protocol. Participation will be voluntary, with informed consent obtained from all participants. Study results will be published in peer-reviewed journals.

Clinical trial registration

ChiCTR2400091805.

Identifying and Validating Prognostic Hyper-Inflammatory and Hypo-Inflammatory COVID-19 Clinical Phenotypes Using Machine Learning Methods

Background

COVID-19 exhibits complex pathophysiological manifestations, characterized by significant clinical and biological heterogeneity. Identifying phenotypes may enhance our understanding of the disease's diverse trajectories, benefiting clinical practice and trials.

Methods

This study included adult patients with COVID-19 from Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine, between December 15, 2022, and February 15, 2023. The k-prototypes clustering method was employed using 50 clinical variables to identify phenotypes. Machine learning algorithms were then applied to select key classifier variables for phenotype recognition.

Results

A total of 1376 patients met the inclusion criteria. K-prototypes clustering revealed two distinct subphenotypes: Hypo-inflammatory subphenotype (824 [59.9%]) and Hyper-inflammatory subphenotype (552 [40.1%]). Patients in Hypo-inflammatory subphenotype were younger, predominantly female, with low mortality and shorter hospital stays. In contrast, Hyper-inflammatory subphenotype patients were older, predominantly male, exhibiting a hyperinflammatory state with higher mortality and rates of organ dysfunction. The AdaBoost model performed best for subphenotype prediction (Accuracy: 0.975, Precision: 0.968, Recall: 0.976, F1: 0.972, AUROC: 0.975). "CRP", "IL-2R", "D-dimer", "ST2", "BUN", "NT-proBNP", "neutrophil percentage", and "lymphocyte count" were identified as the top-ranked variables in the AdaBoost model.

Conclusion

This analysis identified two phenotypes based on COVID-19 symptoms and comorbidities. These phenotypes can be accurately recognized using machine learning models, with the AdaBoost model being optimal for predicting in-hospital mortality. The variables "CRP", "IL-2R", "D-dimer", "ST2", "BUN", "NT-proBNP", "neutrophil percentage", and "lymphocyte count" play a significant role in the prediction of subphenotypes. Use the identified subphenotypes for risk stratification in clinical practice. Hyper-inflammatory subphenotypes can be closely monitored, and preventive measures such as early admission to the intensive care unit or prophylactic anticoagulation can be taken.

Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial

The post-COVID-19 condition (PCC) is a highly debilitating and persistent postinfectious syndrome that affects millions of people worldwide and has no effective treatment. Therapeutic plasma exchange (TPE) has the potential to improve the PCC by clearing the peripheral soluble pro-inflammatory immune milieu derived from acute or persistent SARS-CoV-2 infection. In a phase II, double-blind, placebo-controlled, randomized trial, fifty subjects with PCC were randomly assigned (1:1) to receive six sessions of either TPE or a sham plasma exchange and were followed for 90 days (ClinicalTrials.gov registration: NCT05445674). The primary endpoint was safety; secondary endpoints included functional status, symptomology, quality of life, neurocognitive symptoms, and peripheral biochemistry, hematology, coagulation and inflammation parameters. Both study arms had a similarly favorable safety profile. There were no diferences between groups in any of the efficacy parameters evaluated. Whereas TPE is safe, it did not lead to any discernible improvement of the PCC in this clinical trial.

Cluster analysis of post-COVID-19 physical and mental health outcomes 3-6 months after SARS-CoV-2 infection: results of the French Prospective ALCOVID Cohort Study

OBJECTIVES

This study aims to characterise the diversity of post-COVID-19 physical and mental health outcomes, known as the post-COVID-19 condition (PCC), and the determining factors 3-6 months after acute SARS-CoV-2 infection.

DESIGN

This is a prospective cohort study.

SETTING

This study took place at the European Hospital of Marseille, France.

PARTICIPANTS

Participants include patients with acute COVID-19 treated as inpatients or outpatients.

INTERVENTIONS

Interventions include face-to-face assessment of physical and mental health symptoms.

MAIN OUTCOME MEASURES

Main outcome measures include symptom scores and scales, as well as paraclinical elements (thoracic CT scan, pulmonary functional tests). Multiple component analysis was used to identify clinical phenotypic clusters of PCC patients, as well as their initial comorbidity groups. A multinomial regression model was used to evaluate the association between the initial comorbidities and disease severity with PCC phenotype.

RESULTS

A total of 210 patients agreed to participate, of which 157 (75%) reported at least one symptom at the 3-6 months visit; mostly asthenia, dyspnoea, psychiatric disorders such as anxiety, depression, post-traumatic stress disorder and cognitive disorders. Four PCC clusters were recognised: (1) paucisymptomatic PCC (n=82, 39%); (2) physical sequelae PCC (n=39, 18.6%), (3) pre-existing pulmonary comorbidities PCC (n=29, 13.8%); and (4) functional somatic and/or mental symptoms PCC (n=60, 28.6%). In addition to their PCC symptoms, the patients in these clusters differed in terms of their demographic characteristics (sex), comorbidities and severity of COVID-19.

CONCLUSIONS

The four identified PCC clusters corresponded to distinct and coherent clinical and paraclinical entities, making it possible to consider adapted and personalised prognosis and therapeutic interventions.

Healthcare utilization patterns before and after a long COVID diagnosis: a case-control study

BACKGROUND

Documenting Long COVID cases has been challenging partly due to the lack of population-level data and uncertain diagnostic criteria, hindering the ability to ascertain healthcare utilization patterns over time. The objective of this study is to examine the characteristics and healthcare utilization patterns of Long COVID patients in Colorado pre- and post-diagnosis compared to controls.

METHODS

Retrospective, longitudinal case-control study using a 100% sample of Colorado's All-Payer Claims Database. The sample includes individuals 18 or older diagnosed with Long COVID between October 1, 2021, and August 1, 2022, with patients followed until August 2023. Long COVID was identified using the International Classification of Diseases, 10th Revision, U09.9 code in medical insurance claims. Analysis of healthcare utilization required one year of continuous enrollment before and after diagnosis. Controls were matched 2:1 on age group, sex, payer, and index month to account for contemporaneous trends in utilization.

RESULTS

26,358 individuals were ever diagnosed with Long COVID, resulting in a claims-based prevalence of 674 per 100,000 during the study period (population 3,906,402 individuals). Of these, 12,698 individuals had continuous enrollment and a Long COVID diagnosis: mean (SD) age, 59.0 (17.1); 65.3% female; 60.1% white; 83.0% residing in urban areas. The Long COVID sample was matched with 25,376 controls. Before diagnosis, 17% of Long COVID patients were hospitalized at least once, and 40% visited an emergency department on at least one occasion. Within the year following diagnosis, utilization of acute healthcare services significantly decreased relative to controls: hospitalizations, -6.1percentage points (p.p.), emergency department visits, -7.7 p.p., whereas outpatient services and medications increased: office visits, 3.6 p.p.; specialist office visits, 4.7 p.p.; and 5.2 new medications, (controls: 2.8). Changes in diagnoses of some conditions (e.g., metastatic carcinomas and lung cancer) were similar between groups.

CONCLUSIONS AND RELEVANCE

Long COVID patients increased outpatient healthcare utilization following a diagnosis, switching from acute care settings. The change in service settings among this population suggests that diagnosis could lead to better patient management. Healthcare utilization among these patients is high, underscoring the need to understand the Long COVID burden on healthcare systems with population-level data.

Profiling the persistent and episodic nature of long COVID symptoms and the impact on quality of life and functional status: a cohort observation study

Background

Post-viral issues following acute infection with coronavirus disease 2019 (COVID-19), referred to widely as long COVID, are associated with episodic, persistent, and disabling symptoms affecting quality of life and functional status. Evidence demonstrates a significant impairment and long disease course, but there remains limited empirical data to profile and determine the fluctuating symptom profile of long COVID.

Methods

We devised a 16-week, multicentre prospective cohort observation study to profile changes in patient-reported outcomes, and biological, physiological, psychological, and cognitive parameters following diagnosis and/or referral to an established long COVID clinic. Following baseline assessments, participants completed four face-to-face visits interspersed with telephone consultations. Face-to-face visits included physiological assessment, patient-reported outcome measures (PROMs), functional status, and respiratory function. Telephone consultations involved PROMs and symptom profiling.

Results

Patient-reported outcomes improved from baseline to week sixteen, but demonstrated between visit fluctuations in frequency and severity. Further findings highlight the severity and frequency of long COVID symptom profiles and the extent of quality of life and functional status impairment.

Conclusions

The data presented here highlight the episodic and relapsing nature and should be used to help characterise long COVID disability. They can inform the development of long COVID-specific guidelines and support services that can adequately respond to the reductions in patient well-being.

Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study

Introduction

Social gradients in COVID-19 exposure and severity have been observed internationally. Whether combinations of pre-existing social factors, particularly those that confer cumulative advantage and disadvantage, affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood.

Methods

We analysed data on self-perceived recovery following self-reported COVID-19 illness in two UK community-based cohorts, COVID Symptom Study Biobank (CSSB) (N=2548) and TwinsUK (N=1334). Causal effects of sociodemographic variables reflecting status prior to the COVID-19 pandemic on recovery were estimated with multivariable Poisson regression models, weighted for inverse probability of questionnaire participation and COVID-19 infection and adjusted for potential confounders. Associations between recovery and social strata comprising combinations of sex, education level and local area deprivation were estimated using the intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) approach. Further analyses estimated associations with variables reflecting experiences during the pandemic.

Results

Gradients in recovery from COVID-19 along the lines of social advantage were observed in intersectional MAIHDA models, with predicted probability of recovery lowest in female strata with lowest education and highest deprivation levels (CSSB: 55.1% (95% CI 44.0% to 65.1%); TwinsUK: 73.9% (95% CI 61.1% to 83.0%)) and highest in male strata with highest education and lowest deprivation levels (CSSB: 79.1% (95% CI 71.8% to 85.1%); TwinsUK: 89.7% (95% CI 82.5% to 94.1%)). Associations were not explained by differences in prepandemic health. Adverse employment, financial, healthcare access and personal experiences during the pandemic were also negatively associated with recovery.

Conclusions

Inequalities in likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with greater social disadvantage prior to the pandemic.

A cycle of invisibilisation: a qualitative study of Brazilian health system factors shaping access to long COVID care

INTRODUCTION

Long COVID (LC), an often-debilitating infection-associated chronic condition (IACC), affects millions of people globally. Globally, LC patients struggle to access timely, appropriate care, often experiencing disbelief, misunderstandings or being diverted from healthcare. Few studies have examined health system factors influencing LC healthcare access, especially in the Global South. Drawing on the concept of candidacy, we examine health system factors influencing access to LC care in Brazil's public healthcare system (Sistema Único de Saúde, SUS) and theorise implications for equitable access to public healthcare for IACCs globally.

METHODS

We conducted a patient-engaged, qualitative study in the city of Rio de Janeiro. 29 individual semi-structured interviews were conducted with SUS professionals from administrative leaders to multidisciplinary primary and specialist care staff (November 2022 to July 2023). Verbatim transcripts were analysed using a pragmatic thematic analysis.

RESULTS

LC patients' candidacy for care is invisibilised within SUS through multiple, interacting processes. Interplay of an over-burdened health system, prioritisation of resources in response to (flawed) evidence of demand, misalignment of LC patient capacities and demands of navigating fragmented services, complex referral processes, professionals' lack of LC knowledge and disregard of the severity and morbidity of a chronic condition amid acute demands, led to the under-recognition of LC by healthcare professionals. Professionals' under-recognition perpetuates administrators' de-prioritisiation of resources, policies and training necessary to ensure access to appropriate care, creating a cycle of invisibilisation.

CONCLUSION

Urgent action to disrupt a cycle of invisibilisation is essential to mitigate patients' suffering and intensification of inequalities. Disrupting this pernicious cycle requires more than narrow clinical education efforts. Improved surveillance, education, patient involvement, attention to moral injury and building on existing multidisciplinary strengths may enhance access to LC care. Doing so offers wider benefits beyond patients with LC. We call for a paradigm shift in clinical approaches to IACCs.

Trajectories of functional limitations, health-related quality of life and societal costs in individuals with long COVID: a population-based longitudinal cohort study

OBJECTIVES

To examine trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs of patients referred to long COVID clinics.

DESIGN

A population-based longitudinal cohort study using real-time user data.

SETTING

35 specialised long COVID clinics in the UK.

PARTICIPANTS

4087 adults diagnosed with long COVID in primary or secondary care deemed suitable for rehabilitation and registered in the Living With Covid Recovery (LWCR) programme between 4 August 2020 and 5 August 2022.

MAIN OUTCOME MEASURES

Generalised linear mixed models were fitted to estimate trajectories of functional limitations, using the Work and Social Adjustment Scale (WSAS); scores of ≥20 indicate moderately severe limitations. Other outcomes included fatigue using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) reversed score (scores of ≥22 indicate impairment), HRQL using the EQ-5D-5L, and long COVID-related societal costs, encompassing healthcare costs and productivity losses.

RESULTS

The mean WSAS score at 6 months after registration in the LWCR was 19.1 (95% CI 18.6, 19.6), with 46% of the participants (95% CI 40.3%, 52.4%) reporting a WSAS score above 20 (moderately severe or worse impairment). The mean change in the WSAS score over the 6-month period was -0.86 (95% CI -1.32, -0.41). The mean reversed FACIT-F score at 6 months was 29.1 (95% CI 22.7, 35.5) compared with 32.0 (95% CI 31.7, 32.3) at baseline. The mean EQ-5D-5L score remained relatively constant between baseline (0.63, 95% CI 0.62, 0.64) and 6 months (0.64, 95% CI 0.59, 0.69). The monthly societal cost per patient related to long COVID at 6 months was £931, mostly driven by the costs associated with working days lost.

CONCLUSIONS

Individuals referred to long COVID clinics in the UK reported small improvements in functional limitations, fatigue, HRQL and ability to work within 6 months of registering in the LWCR programme.

Mapping the landscape of mental health and long COVID: a protocol for scoping review

INTRODUCTION

Mental health concerns are prevalent among adult patients with long COVID (LC), but the current state of knowledge regarding mental health in the context of LC is not fully understood. The objective of this scoping review is to map and summarise the existing research on mental health conditions among LC patients and highlight the knowledge gaps. This review aims to provide a comprehensive overview of the evolving landscape of research in the area.

METHODS AND ANALYSIS

The concept of interest is mental health in adult LC patients. This scoping review will be guided by the Joanna Briggs Institute Manual for Evidence Synthesis and reported according to the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. Using predefined search parameters, a comprehensive search of two electronic databases (Medline and APA PsycINFO) and grey literature sources identified 3104 potentially eligible articles published from 1 January 2020 to 4 April 2024. Following the removal of duplicates, 2767 articles were imported for screening in Covidence. The study selection process involves screening titles, abstracts and full text of potentially relevant articles, which will then be analysed using thematic analysis. Data will be extracted using a predefined extraction form.

ETHICS AND DISSEMINATION

Ethical approval is not required because this study does not involve human participants or primary data collection. The findings from this review will be disseminated through a peer-reviewed publication, conference presentations and professional networks. In addition, a summary of the results will be shared with patient partners and other relevant stakeholders.

PUBLIC HEALTH IMPLICATIONS

The findings from this scoping review will contribute to a better understanding of mental health issues arising in LC patients and inform future research directions and public health interventions in this area.

Emerging small-molecule antiviral agents in long COVID prevention

Long COVID, or Post-Acute Sequelae of COVID-19 (PASC), was characterized by persistent symptoms such as fatigue, shortness of breath, and cognitive impairments. These symptoms, emerging one to 2 months post-infection and persisting for several months, cannot be attributed to other diagnoses. The pathophysiology of long COVID remained elusive; however, emerging studies suggested multiple potential mechanisms, including the reactivation of Epstein-Barr virus, persistent SARS-CoV-2 reservoirs, neuroinflammation, and vascular damage, which may contribute to its development. Long COVID affected multiple organ systems, including respiratory, circulatory, and nervous systems, leading to a range of functional impairments. Additionally, it showed a profound impact on mental health, manifesting as anxiety and depression, which significantly degraded the quality of life. The absence of definitive treatments underscored the importance of prevention. Recent evidence indicated that early antiviral intervention-particularly with small-molecule drugs such as Metformin, Ensitrelvir, Molnupiravir, and Nirmatrelvir-may effectively reduce the incidence of long COVID. This underscored the promising role of small-molecule compounds in mitigating long-term COVID-19 consequences, offering a novel preventive strategy against long COVID and its extensive impacts on patients.

Cluster analysis identifies long COVID subtypes in Belgian patients

Severe acute respiratory syndrome coronavirus infection presents complications known as long COVID, a multisystemic organ disease which allows multidimensional analysis. This study aims to uncover clusters of long COVID cases and establish their correlation with the clinical classification developed at the Clinical Research Unit of Brugmann University Hospital, Brussels. Such an endeavour is instrumental in customizing patient management strategies tailored to the unique needs of each distinct group. A two-stage multidimensional exploratory analysis was performed on a retrospective cohort of 205 long COVID patients, involving a factorial analysis of mixed data, and then hierarchical clustering post component analysis. The study's sample comprised 76% women, with an average age of 44.5 years. Three clinical forms were identified: long, persistent, and post-viral syndrome. Multidimensional analysis using demographic, clinical, and biological variables identified three clusters of patients. Biological data did not provide sufficient differentiation between clusters. This emphasizes the importance of identifying or classifying long COVID patients according to their predominant clinical syndrome. Long COVID phenotypes, as well as clinical forms, appear to be associated with distinct pathophysiological mechanisms or genetic predispositions. This underscores the need for further research.

Understanding long COVID: prevalence, characteristics, and risk factors in the Eastern Province of Saudi Arabia

Background

The COVID-19 pandemic has significantly raised public health concerns and efforts to limit its spread, impacting societies and health systems worldwide. As challenges persist, the emergence of Long COVID (LC) marks a turning point in understanding the pandemic's long-term effects.

Aim

This study aimed to determine the prevalence of LC in the Eastern Province of the Kingdom of Saudi Arabia (KSA) and explore factors contributing to its persistence.

Methods

This descriptive, cross-sectional, questionnaire-based study was carried out between December 1, 2023, and March 1, 2024, involving 1,355 patients who recovered from COVID-19. Participants were conveniently chosen and information was gathered through in-person interviews in public settings after obtaining consent.

Results

A majority of the patients (N = 1,355; 47.5% female; 93.8% Saudis; mean Age ± SD 33.13 ± 12.60 years) had received three COVID-19 vaccine doses (89.5%). Women experienced 17.4% more LC symptoms than men (p < 0.001). The risk of having a higher symptom count increased by 42.5% 12 months after acute COVID-19 infection compared with baseline (<3 months, p < 0.001). A higher body mass index (BMI) was associated with more symptoms (1.1% increase per unit, p = 0.004). More acute-phase symptoms correlated with more LC symptoms (p < 0.001). Higher educational attainment reduced LC risk by 33% (p < 0.001). Finally, age and vaccination status had no effect on LC symptoms count (p > 0.05).

Conclusion

Sociodemographic and clinical factors contribute differently to the chances of having LC and the count of symptoms. Awareness of such factors could provide insight into improving management, leading to better health outcomes.

Multimodal neuroimaging in Long-COVID and its correlates with cognition 1.8 years after SARS-CoV-2 infection: a cross-sectional study of the Aliança ProHEpiC-19 Cognitiu

Introduction

There is a growing interest in the effect of Long-COVID (LC) on cognition, and neuroimaging allows us to gain insight into the structural and functional changes underlying cognitive impairment in LC. We used multimodal neuroimaging data in combination with neuropsychological evaluations to study cognitive complaints in a cohort of LC patients with mild to moderate severity symptoms.

Methods

We conducted a 3T brain magnetic resonance imaging (MRI) study with diffusion tensor imaging (DTI) and functional MRI (fMRI) sequences on 53 LC patients 1.8 years after acute COVID-19 onset. We administered neuropsychological tests to evaluate cognitive domains and examined correlations with Tract-Based Spatial Statistics (TBSS) and resting state.

Results

We included 53 participants with LC (mean age, 48.23 years; 88.7% females). According to the Frascati criteria, more than half of the participants had deficits in the executive (59%) and attentional (55%) domains, while 40% had impairments in the memory domain. Only one participant (1.89%) showed problems in the visuospatial and visuoconstructive domain. We observed that increased radial diffusivity in different white matter tracts was negatively correlated with the memory domain. Our results showed that higher resting state activity in the fronto-parietal network was associated with lower memory performance. Moreover, we detected increased functional connectivity among the bilateral hippocampus, the right hippocampus and the left amygdala, and the right hippocampus and the left middle temporal gyrus. These connectivity patterns were inversely related to memory and did not survive false discovery rate (FDR) correction.

Discussion

People with LC exhibit cognitive impairments linked to long-lasting changes in brain structure and function, which justify the cognitive alterations detected.

Two-year epidemiology of post-COVID-19 conditions in Bangladesh: a cohort study of post-COVID-19 from 12,925 SARS-CoV-2 cases between July and December 2021-2023 in Bangladesh

BACKGROUND

Post-COVID-19 conditions (PCCs), also known as long COVID, is persistently debilitating disorders that need investigation on their incidence, morbidity, and case-fatality rate.

PURPOSE

The objectives of this cohort study were to determine the incidence, characteristics, case-fatality, morbidity, and recovery of post-COVID-19 symptoms throughout a two-year period of observation.

METHODS

This was a population-based cohort study of post-COVID-19 cases among 12,925 SARS-CoV-2 positive individuals in eight administrative districts of Bangladesh between July and December 2021-2023. PCC was diagnosed according to WHO clinical diagnostic criteria, and the screening procedure was completed through a household screening process.

RESULTS

The incidence of PCC was 3.6%, the case-fatality rate was 1.92%, and the recovery rate was 9.0%. The significant predictors of PCC morbidity were geographical distribution, vaccination, comorbidities, and a longer duration of symptoms or multiple symptoms (p < 0.05).

CONCLUSION

Nearly 465 out of 522 people suffering from PCC are persistent and have a significant disability. However, the rate of recovery was 9.0%. It is necessary to investigate approaches to improve the recovery of PCC in Bangladesh.

Persistent disabilities 28 months after COVID-19 hospitalisation, a prospective cohort study

Background

Limited data are available on long-term respiratory disabilities in patients following acute COVID-19.

Patients and methods

This prospective, monocentric, observational cohort study included patients admitted to our hospital with acute COVID-19 between 12 March and 24 April 2020. Clinical, functional and radiological data were collected up to 28 months after hospital discharge.

Results

Among 715 patients hospitalised for COVID-19, 493 (69.0%) were discharged alive. We could access complete medical records for 268 out of 493 patients (54.4%); 138 out of 268 (51.5%) exhibited persistent respiratory symptoms and agreed with the data collection and follow-up. Patients were predominantly male (64.5%), with a mean±sd age of 58.9±15.3 years. At the last follow-up, the leading symptoms were asthenia (31.5%), dyspnoea (29.8%) and neuropsychological symptoms (17.7%). Lung function improved up to the last visit. Mean diffusing capacity of the lung for carbon monoxide (D LCO) was 77.8% of predicted value, total lung capacity (TLC) was 83.5% and O2 desaturation during exercise (O2 desaturation) was 2.3%. While D LCO improved over the entire period, TLC improved in the early phase and O2 desaturation in the late phase. Except for those with lung comorbidities, only one patient presented with minor functional and chest radiological alterations at 28 months.

Conclusion

Patients with acute COVID-19 discharged alive showed improved clinical symptoms, lung function parameters and radiological signs up to 28 months post-infection. Persistent symptoms consisted mainly of asthenia and dyspnoea, with lung function returning to normal. One patient without prior respiratory issues exhibited moderate pulmonary fibrosis.

Beyond the acute: pain in long COVID survivors at 1.5 years

OBJECTIVE

Long COVID, characterized by persistent symptoms post-acute COVID-19, remains a subject of intense investigation. This study focuses on pain, a common and notable symptom reported by long COVID patients.

METHOD

A cohort of 191 individuals, initially diagnosed with mild-to-moderate COVID-19, was followed up 1.5 years later to assess the frequency, clinical characteristics, and factors associated with pain persistence.

RESULTS

Our study revealed that 31.9% of participants experienced at least one persistent pain symptom after 1.5 years. Headache emerged as the most prevalent symptom (29.8%), followed by myalgia (5.8%) and neuropathic pain (4.2%). Factors such as female gender and the presence of neuropathic pain symptom were identified as predictors of long-term headaches. Myalgia, showed associations with headache, arthralgia, and low ferritin levels. Persistent neuropathic pain symptom (4.2%) was linked to older age, female gender, sore throat, and headache.

CONCLUSION

This study provides insights into the evolution of pain symptoms over time after COVID-19 infection, emphasizing the interconnection between different pain syndromes. This research contributes to understanding the diverse and evolving nature of pain in long COVID survivors, offering valuable insights for targeted interventions and further investigations into the underlying mechanisms of persistent pain.

Altered brain perfusion and oxygen levels relate to sleepiness and attention in post-COVID syndrome

OBJECTIVE

Persisting neurological symptoms after COVID-19 affect up to 10% of patients and can manifest in fatigue and cognitive complaints. Based on recent evidence, we evaluated whether cerebral hemodynamic changes contribute to post-COVID syndrome (PCS).

METHODS

Using resting-state functional magnetic resonance imaging, we investigated brain perfusion and oxygen level estimates in 47 patients (44.4 ± 11.6 years; F:M = 38:9) and 47 individually matched healthy control participants. Group differences were calculated using two-sample t-tests. Multivariable linear regression was used for associations of each regional perfusion and oxygen level measure with cognition and sleepiness measures. Exploratory hazard ratios were calculated for each brain metric with clinical measures.

RESULTS

Patients presented with high levels of fatigue (79%) and daytime sleepiness (45%). We found widespread decreased brain oxygen levels, most evident in the white matter (false discovery rate adjusted-p-value (p-FDR) = 0.038) and cortical grey matter (p-FDR = 0.015). Brain perfusion did not differ between patients and healthy participants. However, delayed patient caudate nucleus perfusion was associated with better executive function (p-FDR = 0.008). Delayed perfusion in the cortical grey matter and hippocampus were associated with a reduced risk of daytime sleepiness (hazard ratio (HR) = 0.07, p = 0.037 and HR = 0.06, p = 0.034). Decreased putamen oxygen levels were associated with a reduced risk of poor cognitive outcome (HR = 0.22, p = 0.019). Meanwhile, lower thalamic oxygen levels were associated with a higher risk of cognitive fatigue (HR = 6.29, p = 0.017).

INTERPRETATION

Our findings of lower regional brain blood oxygen levels suggest increased cerebral metabolism in PCS, which potentially holds a compensatory function. These hemodynamic changes were related to symptom severity, possibly representing metabolic adaptations.

Long COVID science, research and policy

Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system and can be severely disabling. The cumulative global incidence of long COVID is around 400 million individuals, which is estimated to have an annual economic impact of approximately $1 trillion-equivalent to about 1% of the global economy. Several mechanistic pathways are implicated in long COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, endothelial inflammation and microbiome dysbiosis. Long COVID can have devastating impacts on individual lives and, due to its complexity and prevalence, it also has major ramifications for health systems and economies, even threatening progress toward achieving the Sustainable Development Goals. Addressing the challenge of long COVID requires an ambitious and coordinated-but so far absent-global research and policy response strategy. In this interdisciplinary review, we provide a synthesis of the state of scientific evidence on long COVID, assess the impacts of long COVID on human health, health systems, the economy and global health metrics, and provide a forward-looking research and policy roadmap.

Long COVID: cognitive, balance, and retina manifestations

Background

The neurological symptoms of Long COVID (LC) and the impact of neuropsychological manifestations on people's daily lives have been extensively described. Although a large body of literature describes symptoms, validating this with objective measures is important. This study aims to identify and describe the effects of Long COVID on cognition, balance, and the retinal fundus, and determine whether the duration of symptoms influences cognitive impairment.

Methods

This cross-sectional study involved LC volunteers with cognitive complaint from public health centers in northern Barcelona who participated between January 2022 and March 2023. This study collected sociodemographic characteristics, information on substance use, comorbidities, and clinical data related to COVID-19. We measured five cognitive domains using a battery of neuropsychological tests. Balance was assessed through posturography and retinal vascular involvement by retinography.

Results

A total of 166 people with LC and cognitive complaints participated, 80.72% were women and mean age was 49.28 ± 8.39 years. The most common self-reported symptoms were concentration and memory deficit (98.80%), brain fog (82.53%) and insomnia (71.17%). The 68.67% presented cognitive deficit in at least one domain, with executive functions being the most frequent (43.98%). The 51.52% of the participants exhibited a dysfunctional pattern in balance, and 9.2% showed some alteration in the retina. There were no statistically significant differences between cognitive impairment and symptom duration.

Conclusion

Our findings contribute to a more comprehensive understanding of the pathology associated with Long COVID. They highlight the diversity of self-reported symptoms, the presence of abnormal balance patterns, and some cognitive impairment. These findings underscore the necessity of addressing the clinical management of this condition in primary care through follow-up and the pursuit of multidisciplinary and comprehensive treatment.

Prognosis of patients with post-Covid-19 condition: Prospective cohort cluster analysis at one year

OBJECTIVE

We aimed to identify clinically relevant clusters among patients with post-Covid-19 condition (PCC) and assess prognosis overall and within clusters.

METHODS

Prospective cohort study of patients with PCC attending a rehabilitation clinic. We monitored patient reported outcome measures (PROMs): EuroHIS quality of life and symptoms. Unsupervised hierarchical cluster analyses were performed to identify clusters of patients with different quantity of symptoms, and symptoms presenting together. Preliminary findings on symptom prevalence and quality of life at 12 months are reported.

RESULTS

Among 409 patients, 70.4% were women, with an average baseline of 20.3 (SD 6.8) symptoms. Three clusters emerged based on symptom quantity, labelled by the average number of symptoms at baseline: Cluster-11 (17% of all patients), Cluster-17 (35%), and Cluster-25 (48%). Multinomial logistic regression showed female sex, multiple comorbidities predicting more symptoms. Four symptom-based clusters were defined: fatigue and cognitive complaints; pain, trouble sleeping, palpitations and other symptoms; gastrointestinal symptoms; and emotion-related symptoms. Linear regression models showed that female sex, multiple comorbidities, anxiety, use of antidepressants, BMI and smoking were among the determinants of symptom clusters. In 12-month follow-up, symptom count decreased, and quality of life improved across all clusters, with 9% having good quality of life at baseline and 33% at 12 months.

CONCLUSION

Four patient clusters based on symptoms were identified in the PCC cohort. Prognosis was favorable across all clusters, with symptom reduction and improved quality of life observed. Female sex, comorbidities, BMI, and mental-health related variables predicted higher symptom burden, suggesting multifactorial origins of PCC.

LC risk score - development and evaluation of a scale for assessing the risk of developing long COVID

INTRODUCTION

The aim of the study was to create a valuable practical tool for evaluating the risk of developing long COVID.

MATERIAL AND METHODS

1150 patients from the Polish STOP-COVID registry (PoLoCOV study) were used to develop the risk score. The patients were ill between 03/2020 and 04/2022. To develop a clinically useful scoring model, the LC risk score was generated using the machine learning-based framework AutoScore. Patient data were first randomised into a training (70% of output) and a test (30% of output) cohort. Due to the relatively small study group, cross-validation was used. Model predictive ability was evaluated based on the ROC curve and the AUC value. The result of the risk score for a given patient was the total value of points assigned to selected variables.

RESULTS

To create the LC risk score, eight variables were ultimately selected due to their significance and clinical value. Female gender significantly contributed to higher final outcome values, with age range 40-49, body mass index < 18.5 kg/m2, hospitalisation during active disease, arthralgia, myalgia as well as loss of taste and smell during infection, COVID-19 symptoms lasting at least 14 days, and unvaccinated status. The final predictive value of the developed LC risk score for a cut-off of 58 points was AUC = 0.630 (95% CI: 0.571-0.688) with sensitivity 39.80%, specificity 85.1%, positive predictive value 80.8%, and negative predictive value 47.3%.

CONCLUSIONS

The LC risk score may be a practical and undemanding utility that employs basic sociodemographic data, vaccination status, and symptoms during COVID-19 to assess the risk of long COVID.

Gender differences in symptomatology, socio-demographic information and quality of life in Spanish population with long COVID condition: a cross-sectional study

Introduction

Long COVID patients experience a decrease in their quality of life due to the symptomatology produced by the disease. It is also important to understand how long COVID affects both men and women. The objective of this study is to examine the impact of long COVID symptomatology on the quality of life of Spanish adults from a gender perspective.

Methods

An observational and cross-sectional study was carried out. Participants were able to complete an online questionnaire using an online platform. A sample of 206 people participated in the study.

Results

The 80.6% of the sample were women with a mean age of 46.51 (±8.28) and the 19.4% were men with a mean age of 48.03 (±9.50). The medium score in the PAC19-QoL test was 141.47 (±24.96) and segmented by gender, 141.65 (±23.95) for women and 140.82 (±28.66) for men. The most common symptoms in women were muscle and joint pain (94.6%), fatigue (94.0%), discomfort (92.2%), difficulty concentrating (91.0%), and memory loss (88.6%). For men the symptoms included muscle and joint pain (97.5%) and fatigue (97.5%) both occupying first position, discomfort (92.0%), difficulty concentrating (90.0%), mood disturbances (90.0%), and memory loss (87.5%). The chi-square test showed statistical significance (p < 0.005) for socio-demographic information, quality of life scores, and long COVID symptoms by intensities.

Conclusion

This study shows that there are gender differences in the way that long COVID is experienced.

Symptom trajectories of post-COVID sequelae in patients with acute Delta or Omicron infection in Bergen, Norway

Introduction

A substantial proportion of the over 700 million COVID-19 cases world-wide experience long-term symptoms. The objectives of this study were to compare symptom trajectories and risk factors for post-COVID-19 condition after Delta and Omicron infection.

Methods

This study consecutively recruited patients with SARS-CoV-2 infection from November 2021 to March 2022. We recorded demographics, comorbidities, vaccination status, sick leave, and 18 symptoms during acute infection and after 4 months. The primary outcome measures were symptoms during acute infection and after 4 months. Secondary outcome measures were work and school absenteeism.

Results

We followed a cohort of 1,374 non-hospitalized COVID-19 patients in Bergen, Norway, at three time points. The median age was 39.8 years and 11% were children <16 years. Common acute upper respiratory symptoms waned during follow-up. Fatigue remained common from acute infection (40%) until after 4 months (37%). Four months post-infection, patients reported increased frequencies of dyspnea (from 15% during acute illness to 25% at 4 months, p < 0.001), cognitive symptoms (from 9 to 32%, p < 0.001) and depression (from 1 to 17%, p < 0.001). Patients infected with Omicron reported less dyspnea (22% versus 27%, p = 0.046) and smell/taste problems (5% versus 19%, p < 0.001) at 4 months follow-up than those with Delta infection. Comorbidities and female sex were risk factors for persistent dyspnea and cognitive symptoms. Ten percent reported sick leave after acute illness, and vaccination reduced the risk of absenteeism (adjusted risk ratio: 0.36, 95% confidence interval: 0.15, 0.72, p = 0.008).

Conclusion

At 4 months, home-isolated patients infected with Omicron reported overall comparable symptom burden, but less dyspnea and smell/taste problems than Delta infected patients. Several acute symptoms waned during follow-up. It is worrying that dyspnea, neurocognitive symptoms, and particularly depression, increased significantly during the first 4 months after acute infection. Previous vaccination was protective against prolonged sick leave.

Improved Functioning and Activity According to the International Classification of Functioning and Disability after Multidisciplinary Telerehabilitation for Post-COVID-19 Condition-A Randomized Control Study

This study investigates the outcomes and feasibility concerning the functioning and activity of multidisciplinary group telerehabilitation for a post-COVID-19 condition. Recruitment for the group rehabilitation was announced three times during 2021 and 2022 through the COVID-19 patient organization in Sweden. The key inclusion criteria were remaining symptoms and functional impairments beyond 12 weeks after SARS-CoV-2 infection; medical assessment and treatment regarding comorbidities or new postinfection symptoms; the ability to use the Internet. Participants were randomized into a rehabilitation group or onto a waiting list using an Internet program. Multiple outcomes included self-scored questionnaires and physical tests before and after eight weeks, and at six months follow-up. Here, we present the self-scored outcomes on the International Classification of Functioning and Disability questionnaire (ICF, 22 body functions and 16 activity/participation categories) and breathing scales. Of the 164 participants who registered for the study, 67 (mean age 43, 78% women) participated in an eight-week group rehabilitation compared to 42 who served as waiting list controls (mean age 47, 88% women). At six months follow-up, 60 participants from the rehabilitation group and 21 from the waiting list completed the data. The results indicate that a larger number of ICF body functions and activity/participation categories had improved in the rehabilitation group after eight weeks and six months. Overall credibility, as assessed by the Credibility Expectancy Questionnaire, was high, and the attrition rate in rehabilitation was low. The results indicate beneficial outcomes for multidisciplinary telerehabilitation in people suffering from a post-COVID-19 condition. Therefore, rehabilitation interventions should be further developed and implemented in clinical practice.

SARS-CoV-2 vaccination may mitigate dysregulation of IL-1/IL-18 and gastrointestinal symptoms of the post-COVID-19 condition

The rapid development of safe and effective vaccines helped to prevent severe disease courses after SARS-CoV-2 infection and to mitigate the progression of the COVID-19 pandemic. While there is evidence that vaccination may reduce the risk of developing post-COVID-19 conditions (PCC), this effect may depend on the viral variant. Therapeutic effects of post-infection vaccination have been discussed but the data for individuals with PCC remains inconclusive. In addition, extremely rare side effects after SARS-CoV-2 vaccination may resemble the heterogeneous PCC phenotype. Here, we analyze the plasma levels of 25 cytokines and SARS-CoV-2 directed antibodies in 540 individuals with or without PCC relative to one or two mRNA-based COVID-19 vaccinations as well as in 20 uninfected individuals one month after their initial mRNA-based COVID-19 vaccination. While none of the SARS-CoV-2 naïve individuals reported any persisting sequelae or exhibited PCC-like dysregulation of plasma cytokines, we detected lower levels of IL-1β and IL-18 in patients with ongoing PCC who received one or two vaccinations at a median of six months after infection as compared to unvaccinated PCC patients. This reduction correlated with less frequent reporting of persisting gastrointestinal symptoms. These data suggest that post-infection vaccination in patients with PCC might be beneficial in a subgroup of individuals displaying gastrointestinal symptoms.

Characterisation, symptom pattern and symptom clusters from a retrospective cohort of Long COVID patients in primary care in Catalonia

BACKGROUND

Around 10% of people infected by SARS-COV-2 report symptoms that persist longer than 3 months. Little has been reported about sex differences in symptoms and clustering over time of non-hospitalised patients in primary care settings.

METHODS

This is a descriptive study of a cohort of mainly non-hospitalized patients with a persistence of symptoms longer than 3 months from the clinical onset in co-creation with the Long Covid Catalan affected group using an online survey. Recruitment was from March 2020 to June 2021. Exclusion criteria were being admitted to an ICU, < 18 years of age and not living in Catalonia. We focused on 117 symptoms gathered in 18 groups and performed cluster analysis over the first 21 days of infection, at 22-60 days, and ≥ 3 months.

RESULTS

We analysed responses of 905 participants (80.3% women). Median time between symptom onset and the questionnaire response date was 8.7 months. General symptoms (as fatigue) were the most prevalent with no differences by sex, age, or wave although its frequency decreased over time (from 91.8 to 78.3%). Dermatological (52.1% in women, 28.5% in men), olfactory (34.9% women, 20.9% men) and neurocognitive symptoms (70.1% women, 55.8% men) showed the greatest differences by sex. Cluster analysis showed five clusters with a predominance of Taste & smell (24.9%) and Multisystemic clusters (26.5%) at baseline and _Multisystemic (34.59%) and Heterogeneous (24.0%) at ≥3 months. The Multisystemic cluster was more prevalent in men. The Menstrual cluster was the most stable over time, while most transitions occurred from the Heterogeneous cluster to the Multisystemic cluster and from Taste & smell to Heterogeneous.

CONCLUSIONS

General symptoms were the most prevalent in both sexes at three-time cut-off points. Major sex differences were observed in dermatological, olfactory and neurocognitive symptoms. The increase of the Heterogeneous cluster might suggest an adaptation to symptoms or a non-specific evolution of the condition which can hinder its detection at medical appointments. A carefully symptom collection and patients' participation in research may generate useful knowledge about Long Covid presentation in primary care settings.

Longitudinal Progression of Patients with Long COVID Treated in a Post-COVID Clinic: A Cross-Sectional Survey

BACKGROUND

In addition to the morbidity and mortality associated with acute infection, COVID-19 has been associated with persistent symptoms (>30 days), often referred to as Long COVID (LC). LC symptoms often cluster into phenotypes, resembling conditions such as fibromyalgia, postural orthostatic tachycardiac syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). LC clinics have been established to best address the needs of LC patients and continuity of care. We developed a cross-sectional survey to assess treatment response through our LC Clinic (LCC).

METHODS

A 25-question survey (1-10 Likert scale) was expert- and content-validated by LCC clinicians, patients, and patient advocates. The survey assessed LC symptoms and the helpfulness of different interventions, including medications and supplements. A total of 852 LCC patients were asked to complete the survey, with 536 (62.9%) responding.

RESULTS

The mean time from associated COVID-19 infection to survey completion was 23.2 ± 6.4 months. The mean age of responders was 52.3 ± 14.1 (63% females). Self-reported symptoms were all significantly improved (P < .001) from the initial visit to the LCC (baseline) to the time of the follow-up survey. However, only 4.5% (24/536) of patients rated all symptoms low (1-2) at the time of the survey, indicating low levels of full recovery in our cohort. The patients rated numerous interventions as being helpful, including low-dose naltrexone (45/77; 58%), vagal nerve stimulation (18/34; 53%), and fisetin (28/44; 64%).

CONCLUSIONS

Patients report general improvements in symptoms following the initial LCC visit, but complete recovery rates remain low at 23.2 ± 6.4 months.