Characterization of long-term patient-reported symptoms of COVID-19: an analysis of social media data (preprint)

As the SARS-CoV-2 virus (COVID-19) continues to affect people across the globe, there is limited understanding of the long term implications for infected patients. While some of these patients have documented follow-ups on clinical records, or participate in longitudinal surveys, these datasets are usually designed by clinicians, and not granular enough to understand the natural history or patient experiences of "long COVID". In order to get a complete picture, there is a need to use patient generated data to track the long-term impact of COVID-19 on recovered patients in real time. There is a growing need to meticulously characterize these patients' experiences, from infection to months post-infection, and with highly granular patient generated data rather than clinician narratives. In this work, we present a longitudinal characterization of post-COVID-19 symptoms using social media data from Twitter. Using a combination of machine learning, natural language processing techniques, and clinician reviews, we mined 296,154 tweets to characterize the post-acute infection course of the disease, creating detailed timelines of symptoms and conditions, and analyzing their symptomatology during a period of over 150 days.

Comparison of the Characteristics, Morbidity, and Mortality of COVID-19 and Other Viral and Bacterial Pneumonia in Individuals with Down Syndrome: A Retrospective Cohort Study in Spain (preprint)

Background: Individuals with Down syndrome (DS) have an increased risk for coronavirus disease 2019 (COVID-19) hospitalization and death. Whether these outcomes are COVID-19-specific, or also occur in hospitalized individuals with DS and non-COVID-19 pneumonias, is unknown.Methods: This retrospective cohort study compared COVID-19 cases in persons with DS hospitalized in Spain reported to the Trisomy 21 Research Society COVID-19 survey, with admissions for viral or bacterial pneumonias from a retrospective clinical database of the Spanish Ministry of Health.Findings: 89 of 150 patients with COVID-19 and 2832 patients with non-COVID-19 pneumonias were hospitalised in Spain during the respective study periods. Patients with DS admitted for COVID-19 were significantly older and had more frequently obesity or dementia than patients with non-COVID-19 pneumonias. The mean length of stay of COVID-19 patients who died during their admission was significantly shorter than those who survived or those with non-COVID-19 pneumonias (p < 0·001). In-hospital mortality rates were significantly higher for COVID-19 patients (26·7% vs. 9·4%), especially among individuals over 40 (59% vs. 15·3%).Interpretation: Acute SARS-CoV-2 infection leads to higher mortality rates than non-COVID-19 pneumonias in individuals with DS. The length of stay of deceased COVID-19 patients was significantly shorter than those who survived the admission or those with non-COVID-19 pneumonias.Funding: Down Syndrome Affiliates in Action, Down Syndrome Medical Interest Group-USA, GiGi’s Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, The Matthew Foundation, National Down Syndrome Society, National Task Group on Intellectual Disabilities and Dementia Practices.Declaration of Interests: None to declare. Ethics Approval Statement: The study was approved by the Hospital del Mar institutional review board (CEIC Parc de Salut Mar, ref. code 2020/9197)

An international survey on the impact of COVID-19 in individuals with Down syndrome (preprint)

Background: Health conditions and immune dysfunction associated with trisomy 21 (Down syndrome, DS) may impact the clinical course of COVID-19 once infected by SARS-CoV-2. Methods: The T21RS COVID-19 Initiative launched an international survey for clinicians or caregivers/family members on patients with COVID-19 and DS (N=1046). De-identified survey data collected between April and October 2020 were analysed and compared with the UK ISARIC4C survey of hospitalized COVID-19 patients with and without DS. COVID-19 patients with DS from the ISARIC4C survey (ISARIC4C DS cases=100) were matched to a random set of patients without DS (ISARIC4C controls=400) and hospitalized DS cases in the T21RS survey (T21RS DS cases=100) based on age, gender, and ethnicity. Findings: The mean age in the T21RS survey was 29 years (SD=18), 73% lived with their family. Similar to the general population, the most frequent signs and symptoms of COVID-19 were fever, cough, and shortness of breath. Pain and nausea were reported less frequently (p<0.01), whereas altered consciousness/confusion were reported more frequently (p<0.01). Risk factors for hospitalization and mortality were similar to the general population (age, male gender, diabetes, obesity, dementia) with the addition of congenital heart defects as a risk factor for hospitalization. Mortality rates showed a rapid increase from age 40 and were higher than for controls (T21RS DS versus controls: risk ratio (RR)=3.5 (95%-CI=2.6;4.4), ISARIC4C DS versus controls: RR=2.9 (95%-CI=2.1;3.8)) even after adjusting for known risk factors for COVID-19 mortality. Interpretation: Leading signs/symptoms of COVID-19 and risk factors for severe disease course are similar to the general population. However, individuals with DS present significantly higher rates of mortality, especially from age 40. Funding: Down Syndrome Affiliates in Action, Down Syndrome Medical Interest Group-USA, GiGi's Playhouse, Jerome Lejeune Foundation, LuMind IDSC Foundation, Matthews Foundation, National Down Syndrome Society, National Task Group on Intellectual Disabilities and Dementia Practices.