A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021 (preprint)

ImportanceWhile much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID. ObjectiveTo estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery DesignWe jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study. ResultsAnalyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9-92.4), 60.4% (18.9-89.1), and 35.4% (9.4-75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84-4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10-9.78]). At twelve months, 15.1% (10.3-21.1) continued to experience long COVID symptoms. Conclusions and relevanceThe occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane. Key PointsO_ST_ABSQuestionC_ST_ABSWhat are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021? FindingsGlobally, 144.7 million people experienced one or more of three symptom clusters (fatigue; cognitive problems; and ongoing respiratory problems) of long COVID three months after infection, in 2020 and 2021. Most cases arose from milder infections. At 12 months after infection, 15.1% of these cases had not yet recovered. MeaningThe substantial number of people with long COVID are in need of rehabilitative care and support to transition back into the workplace or education when symptoms start to wane.

Dental practice closure during COVID-19 and associated professional, practice and structural determinants: a multi-country survey (preprint)

Background: The outbreak of the novel coronavirus disease (COVID-19) in China has influenced every aspect of life worldwide. Due to the characteristics of dental settings, the risk of cross-infection is high between dental practitioners and patients and dentists may develop severe anxiety about the current pandemic. In addition, the limited provision of services and closure of dental practices raised concerns among dental professionals about the financial consequences of this closure. This study assessed the frequency of dental practice closure in several countries, the factors associated with this closure and whether closure and associated factors differed between private and non-private sectors.Methods: From April to May 2020, an electronic survey was sent to dentists in several countries. The survey assessed professional factors, practice factors and country-level structural factors. Multilevel logistic regression was used to assess the association between practice closure and these factors. Effect modification by type of sector was also assessed. Results: Dentists (n= 3243) participated from 29 countries. The majority (75.9%) reported practice closure with significantly higher percentage in the private sector than the non-private sector. Pandemic- related fears were associated with significantly higher likelihood of practice closure in private (OR= 1.54, 95%CI= 1.24, 1.92) and non-private sectors (OR= 1.38, 95%CI= 1.04, 1.82). Dentists in non-private, governmental sector (OR= 0.54, 95%CI= 0.31, 0.94), those in rural areas (OR= 0.58, 95%CI= 0.42, 0.81) and those in hospitals (overall OR= 0.60, 95%CI= 0.36, 0.99) reported low likelihood of closure. High likelihood of closure was reported by those in academia (OR= 2.13, 95%CI= 1.23, 3.71). More hospital beds at country-level were associated with lower likelihood of closure in the non-private sector (OR= 0.65, 95%CI= 0.46, 0.91). Private sector dentists in high income countries (HICs) reported less closure than in non-HICs (OR= 0.55, 95%= 0.15, 1.93).Conclusions: Most dentists reported practice closure because of COVID-19 with greater impact in the private than non-private sectors. Closure was associated with factors at professional, practice, and country-level.

Knowledge of Dental Academics about the COVID-19 Pandemic: A Multi-Country Online Survey (preprint)

Background: COVID-19 is a global pandemic affecting all aspects of life in all countries. We assessed COVID-19 knowledge and associated factors among dental academics in 26 countries. Methods: : We invited dental academics to participate in a cross-sectional, multi-country, online survey from March to April 2020. The survey collected data on knowledge of COVID-19 regarding the mode of transmission, symptoms, diagnosis, treatment, protection, and dental treatment precautions as well as participants’ background variables. Multilevel linear models were used to assess the association between dental academics’ knowledge of COVID-19 and individual level (personal and professional) and country-level (number of COVID-19 cases/ million population) factors accounting for random variation among countries. Results: : Two thousand forty-five academics participated in the survey (response rate 14.3%, with 54.7% female and 67% younger than 46 years of age). The mean (SD) knowledge percent score was 73.2 (11.2) %, and the score of knowledge of symptoms was significantly lower than the score of knowledge of diagnostic methods (53.1% and 85.4%; P< 0.0001). Knowledge score was significantly higher among those living with a partner/spouse than among those living alone (regression coefficient (B)= 0.48); higher among those with PhD degrees than among those with Bachelor of Dental Science degrees (B= 0.48); higher among those seeing 21 to 30 patients daily than among those seeing no patients (B= 0.65); and higher among those from countries with a higher number of COVID-19 cases/million population (B= 0.0007). Conclusions: : Dental academics had poorer knowledge of COVID-19 symptoms than of COVID-19 diagnostic methods. Living arrangements, academic degrees, patient load, and magnitude of the epidemic in the country were associated with COVD-19 knowledge among dental academics. Training of dental academics on COVID-19 can be designed using these findings to recruit those with the greatest need.

Dental practice closure during COVID-19 and associated professional, practice and structural determinants: a multi-country survey (preprint)

Background: The outbreak of novel coronavirus disease (COVID-19) in China has influenced every aspect of life worldwide. Due to the characteristics of dental settings, the risk of cross infection may be high between dental practitioners and patients. Being on the list of high-risk professions, dentists are very much expected to develop severe anxiety about the current pandemic situation. In addition, the limited provision of services and closure of dental practices raised concerns among dental professionals about the financial consequences of this closure. Therefore, the study assessed the extent of dental practice closure in various countries around the world, factors associated with this closure and whether closure and associated factors differed between private and non-private sectors.Methods: From April to May 2020, a web-based survey was sent to dentists in several countries. The survey assessed professional factors, practice factors and country-level structural factors. Multilevel logistic regression was used to assess the association of practice closure with these factors. Effect modification due to private and non-private sectors was assessed. Results: Dentists (n= 3243) participated from 29 countries. The majority (75.9%) reported practice closure with significantly higher percentage in the private than non-private sector. Fears were associated with significantly higher likelihood of closure in private (OR= 1.54, 95%CI= 1.24, 1.92) and non-private sectors (OR= 1.38, 95%CI= 1.04, 1.82). Non-private, governmental sector dentists (OR= 0.54, 95%CI= 0.31, 0.94) and those in rural areas (OR= 0.58, 95%CI= 0.42, 0.81) and those in hospitals (overall OR= 0.60, 95%CI= 0.36, 0.99) reported low likelihood of closure. High likelihood of closure was reported by those in academia (OR= 2.13, 95%CI= 1.23, 3.71). More hospital beds were associated with lower likelihood of closure in the non-private sector (OR= 0.65, 95%CI= 0.46, 0.91) and private sector dentists in high income countries (HICs) reported less closure than in non-HICs (OR= 0.55, 95%= 0.15, 1.93).Conclusions: Most dentists reported practice closure because of COVID-19 with greater impact in the private than non-private sectors with professional, practice and country-level factors associated.