High proportions of post-exertional malaise and orthostatic intolerance in people living with post-COVID-19 condition: the PRIME post-COVID study (preprint)

Background Exercise-based treatments can be harmful in people who were SARS-CoV-2 positive and living with post-COVID-19 condition (PL-PCC) and who have post-exertional malaise (PEM) or orthostatic intolerance (OI). Nevertheless, PEM and OI are not routinely assessed by clinicians. We estimated PEM and OI proportions in PL-PCC, as well in people not living with PCC (PnL-PCC) and negatives (i.e., never reported a SARS-CoV-2 positive test), and identified associated factors. Methods Participants from the PRIME post-COVID study were included. PEM and OI were assessed using validated questionnaires. PCC was defined as feeling unrecovered after SARS-CoV-2 infection. Multivariable regression analyses to study PEM and OI were stratified for sex. Results Data from 3,783 participants was analyzed. In PL-PCC, proportion of PEM was 48.1% and 41.2%, and proportion of OI was 29.3% and 27.9% in women and in men, respectively. Proportions were higher in PL-PCC compared to negatives, for PEM in women OR=4.38 [95%CI:3.01-6.38]; in men OR=4.78 [95%CI:3.13-7.29]; for OI in women 3.06 [95%CI:1.97-4.76]; in men 2.71 [95%CI:1.75-4.21]. Associated factors were age [≤]60 years, [≥]1 comorbidities and living alone. Conclusions High proportions of PEM and OI are observed in PL-PCC. Standard screening for PEM and OI is recommended in PL-PCC, to promote appropriate therapies. Trial registration ClinicalTrials.gov identifier:NCT05128695

Prevalence of long-term symptoms varies by using different post-COVID-19 definitions in positively and negatively tested adults: the PRIME post-COVID study (preprint)

BackgroundLong-term symptoms after a SARS-CoV-2 infection (i.e., post-COVID-19 condition or long COVID), constitute a substantial public health problem. Yet, the prevalence remains currently unclear as different case definitions are used, and negatively tested controls are lacking. We aimed to estimate post-COVID-19 condition prevalence using six definitions. MethodsThe Prevalence, Risk factors, and Impact Evaluation (PRIME) post-COVID-19 condition study is a population-based sample of COVID-19 tested adults. End 2021, 61,655 adults were invited to complete an online questionnaire, including 44 symptoms plus a severity score (0-10) per symptom. The prevalence was calculated in both positively and negatively tested adults, stratified by time since their COVID-19 test (3-5, 6-11 or [≥]12 months ago). ResultsIn positives (n=7,405; 75.6%), the prevalence of long-term symptoms was between 26.9% and 64.1% using the six definitions, while in negatives (n=2,392; 24.4%) the prevalence varied between 11.4% and 32.5%. The prevalence of long-term symptoms potentially accountable to COVID-19 ranged from 17.9% to 26.3%. ConclusionThere is a (substantial) variation in prevalence estimates by using different definitions as is current practice, showing limited overlap between definitions, indicating that the essential post-COVID-19 condition criteria are still unclear. Including negatives is important to determine long-term symptoms accountable to COVID-19. Trial registration ClinicalTrials.gov Identifier: NCT05128695.