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Wulf Hanson, Sarah, Abbafati, Cristiana, Aerts, Joachim, Al-Aly, Ziyad, Ashbaugh, Charlie, Ballouz, Tala, Blyuss, Oleg, Bobkova, Polina, Bonsel, Gouke, Borzakova, Svetlana, Buonsenso, Danilo, Butnaru, Denis, Carter, Austin, Chu, Helen, De Rose, Cristina, Diab, Mohamed Mustafa, Ekbom, Emil, El Tantawi, Maha, Fomin, Victor, Frithiof, Robert, Gamirova, Aysylu, Glybochko, Petr, Haagsma, Juanita, Javanmard, Shaghayegh Haghjooy, Hamilton, Erin, Harris, Gabrielle, Heijenbrok-Kal, Majanka, Helbok, Raimund, Hellemons, Merel, Hillus, David, Huijts, Susanne, Hultström, Michael, Jassat, Waasila, Kurth, Florian, Larsson, Ing-Marie, Lipcsey, Miklós, Liu, Chelsea, Loflin, Callan, Malinovschi, Andrei, Mao, Wenhui, Mazankova, Lyudmila, McCulloch, Denise, Menges, Dominik, Mohammadifard, Noushin, Munblit, Daniel, Nekliudov, Nikita, Ogbuoji, Osondu, Osmanov, Ismail, Peñalvo, José, Petersen, Maria Skaalum, Puhan, Milo, Rahman, Mujibur, Rass, Verena, Reinig, Nickolas, Ribbers, Gerard, Ricchiuto, Antonia, Rubertsson, Sten, Samitova, Elmira, Sarrafzadegan, Nizal, Shikhaleva, Anastasia, Simpson, Kyle, Sinatti, Dario, Soriano, Joan, Spiridonova, Ekaterina, Steinbeis, Fridolin, Svistunov, Andrey, Valentini, Piero, van de Water, Brittney, van den Berg-Emons, Rita, Wallin, Ewa, Witzenrath, Martin, Wu, Yifan, Xu, Hanzhang, Zoller, Thomas, Adolph, Christopher, Albright, James, Amlag, Joanne, Aravkin, Aleksandr, Bang-Jensen, Bree, Bisignano, Catherine, Castellano, Rachel, Castro, Emma, Chakrabarti, Suman, Collins, James, Dai, Xiaochen, Daoud, Farah, Dapper, Carolyn, Deen, Amanda, Duncan, Bruce, Erickson, Megan, Ewald, Samuel, Ferrari, Alize, Flaxman, Abraham, Fullman, Nancy, Gamkrelidze, Amiran, Giles, John, Guo, Gaorui, Hay, Simon, He, Jiawei, Helak, Monika, Hulland, Erin, Kereselidze, Maia, Krohn, Kris, Lazzar-Atwood, Alice, Lindstrom, Akiaja, Lozano, Rafael, Magistro, Beatrice, Malta, Deborah Carvalho, Månsson, Johan, Mantilla Herrera, Ana, Mokdad, Ali, Monasta, Lorenzo, Nomura, Shuhei, Pasovic, Maja, Pigott, David, Reiner, Robert, Reinke, Grace, Ribeiro, Antonio Luiz, Santomauro, Damian Francesco, Sholokhov, Aleksei, Spurlock, Emma Elizabeth, Walcott, Rebecca, Walker, Ally, Wiysonge, Charles Shey, Zheng, Peng, Bettger, Janet Prvu, Murray, Christopher J. L.; Vos, Theo.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-337680

ABSTRACT

Importance While 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. Objective To 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 Design We 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. Results Analyses 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 relevance The 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 Points Question What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021? Findings Globally, 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. Meaning The 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.

2.
Front Med (Lausanne) ; 9: 792881, 2022.
Article in English | MEDLINE | ID: covidwho-1775691

ABSTRACT

Background: Coronavirus Disease-19 (COVID-19) convalescents are at risk of developing a de novo mental health disorder or worsening of a pre-existing one. COVID-19 outpatients have been less well characterized than their hospitalized counterparts. The objectives of our study were to identify indicators for poor mental health following COVID-19 outpatient management and to identify high-risk individuals. Methods: We conducted a binational online survey study with adult non-hospitalized COVID-19 convalescents (Austria/AT: n = 1,157, Italy/IT: n = 893). Primary endpoints were positive screening for depression and anxiety (Patient Health Questionnaire; PHQ-4) and self-perceived overall mental health (OMH) and quality of life (QoL) rated with 4 point Likert scales. Psychosocial stress was surveyed with a modified PHQ stress module. Associations of the mental health and QoL with socio-demographic, COVID-19 course, and recovery variables were assessed by multi-parameter Random Forest and Poisson modeling. Mental health risk subsets were defined by self-organizing maps (SOMs) and hierarchical clustering algorithms. The survey analyses are publicly available (https://im2-ibk.shinyapps.io/mental_health_dashboard/). Results: Depression and/or anxiety before infection was reported by 4.6% (IT)/6% (AT) of participants. At a median of 79 days (AT)/96 days (IT) post-COVID-19 onset, 12.4% (AT)/19.3% (IT) of subjects were screened positive for anxiety and 17.3% (AT)/23.2% (IT) for depression. Over one-fifth of the respondents rated their OMH (AT: 21.8%, IT: 24.1%) or QoL (AT: 20.3%, IT: 25.9%) as fair or poor. Psychosocial stress, physical performance loss, high numbers of acute and sub-acute COVID-19 complaints, and the presence of acute and sub-acute neurocognitive symptoms (impaired concentration, confusion, and forgetfulness) were the strongest correlates of deteriorating mental health and poor QoL. In clustering analysis, these variables defined subsets with a particularly high propensity of post-COVID-19 mental health impairment and decreased QoL. Pre-existing depression or anxiety (DA) was associated with an increased symptom burden during acute COVID-19 and recovery. Conclusion: Our study revealed a bidirectional relationship between COVID-19 symptoms and mental health. We put forward specific acute symptoms of the disease as "red flags" of mental health deterioration, which should prompt general practitioners to identify non-hospitalized COVID-19 patients who may benefit from early psychological and psychiatric intervention. Clinical Trial Registration: [ClinicalTrials.gov], identifier [NCT04661462].

3.
Eur J Neurol ; 29(6): 1685-1696, 2022 06.
Article in English | MEDLINE | ID: covidwho-1759178

ABSTRACT

BACKGROUND AND PURPOSE: Neurological sequelae from coronavirus disease 2019 (COVID-19) may persist after recovery from acute infection. Here, the aim was to describe the natural history of neurological manifestations over 1 year after COVID-19. METHODS: A prospective, multicentre, longitudinal cohort study in COVID-19 survivors was performed. At a 3-month and 1-year follow-up, patients were assessed for neurological impairments by a neurological examination and a standardized test battery including the assessment of hyposmia (16-item Sniffin' Sticks test), cognitive deficits (Montreal Cognitive Assessment < 26) and mental health (Hospital Anxiety and Depression Scale and Post-traumatic Stress Disorder Checklist 5). RESULTS: Eighty-one patients were evaluated 1 year after COVID-19, out of which 76 (94%) patients completed a 3-month and 1-year follow-up. Patients were 54 (47-64) years old and 59% were male. New and persistent neurological disorders were found in 15% (3 months) and 12% (10/81; 1 year). Symptoms at 1-year follow-up were reported by 48/81 (59%) patients, including fatigue (38%), concentration difficulties (25%), forgetfulness (25%), sleep disturbances (22%), myalgia (17%), limb weakness (17%), headache (16%), impaired sensation (16%) and hyposmia (15%). Neurological examination revealed findings in 52/81 (64%) patients without improvement over time (3 months, 61%, p = 0.230) including objective hyposmia (Sniffin' Sticks test <13; 51%). Cognitive deficits were apparent in 18%, whereas signs of depression, anxiety and post-traumatic stress disorders were found in 6%, 29% and 10% respectively 1 year after infection. These mental and cognitive disorders had not improved after the 3-month follow-up (all p > 0.05). CONCLUSION: Our data indicate that a significant patient number still suffer from neurological sequelae including neuropsychiatric symptoms 1 year after COVID-19 calling for interdisciplinary management of these patients.


Subject(s)
COVID-19 , Anosmia/diagnosis , Anosmia/etiology , COVID-19/complications , COVID-19/diagnosis , Cohort Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Prospective Studies , SARS-CoV-2
4.
Eur J Neurol ; 28(10): 3348-3359, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1607398

ABSTRACT

BACKGROUND AND PURPOSE: To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19. METHODS: In this prospective, multicenter, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin Sticks test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist-5) 3 months after disease onset. RESULTS: Of 135 consecutive COVID-19 patients, 31 (23%) required intensive care unit (ICU) care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient care (mild) during acute disease. At the 3-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included polyneuro/myopathy (n = 17, 13%) with one patient presenting with Guillain-Barré syndrome, mild encephalopathy (n = 2, 2%), parkinsonism (n = 1, 1%), orthostatic hypotension (n = 1, 1%), and ischemic stroke (n = 1, 1%). Objective testing revealed hyposmia/anosmia in 57/127 (45%) patients at the 3-month follow-up. Self-reported hyposmia/anosmia was lower (17%) at 3 months, however, improved when compared to the acute disease phase (44%; p < 0.001). At follow-up, cognitive deficits were apparent in 23%, and QoL was impaired in 31%. Assessment of mental health revealed symptoms of depression, anxiety, and posttraumatic stress disorders in 11%, 25%, and 11%, respectively. CONCLUSIONS: Despite recovery from the acute infection, neurological symptoms were prevalent at the 3-month follow-up. Above all, smelling disorders were persistent in a large proportion of patients.


Subject(s)
COVID-19 , Stroke , Cohort Studies , Humans , Prospective Studies , Quality of Life , SARS-CoV-2
5.
Clin Infect Dis ; 2021 Nov 26.
Article in English | MEDLINE | ID: covidwho-1545917

ABSTRACT

BACKGROUND: Long COVID, defined as presence of COVID-19 symptoms 28 days or more after clinical onset, is an emerging challenge to healthcare systems. The objective of this study was to explore recovery phenotypes in non-hospitalized COVID-19 individuals. METHODS: A dual cohort, online survey study was conducted between September 2020 and July 2021 in the neighboring European regions Tyrol (TY, Austria, n = 1157) and South Tyrol (STY, Italy, n = 893). Data on demographics, comorbidities, COVID-19 symptoms and recovery adult outpatients were collected. Phenotypes of acute COVID-19, post-acute sequelae and risk of protracted recovery were explored by semi-supervised clustering and multi-parameter LASSO modeling. RESULTS: Working age subjects (TY: 43 yrs (IQR: 31 - 53), STY: 45 yrs (IQR: 35 - 55)) and females (TY: 65.1%, STY: 68.3%) predominated the study cohorts. Nearly half of the participants (TY: 47.6%, STY: 49.3%) reported symptom persistence beyond 28 days. Two acute COVID-19 phenotypes were discerned: the non-specific infection phenotype and the multi-organ phenotype (MOP). Acute MOP symptoms encompassing multiple neurological, cardiopulmonary, gastrointestinal and dermatological complaints were linked to elevated risk of protracted recovery. The major subset of long COVID individuals (TY: 49.3%, STY: 55.6%) displayed no persistent hyposmia or hypogeusia but high counts of post-acute MOP symptoms and poor self-reported physical recovery. CONCLUSION: The results of our two-cohort analysis delineated phenotypic diversity of acute and post-acute COVID-19 manifestations in home-isolated patients which needs to be considered for predicting protracted convalescence and allocation of medical resources.

6.
Qual Life Res ; 31(5): 1401-1414, 2022 May.
Article in English | MEDLINE | ID: covidwho-1439744

ABSTRACT

PURPOSE: To assess patient characteristics associated with health-related quality of life (HR-QoL) and its mental and physical subcategories 3 months after diagnosis with COVID-19. METHODS: In this prospective multicentre cohort study, HR-QoL was assessed in 90 patients using the SF-36 questionnaire (36-item Short Form Health Survey), which consists of 8 health domains that can be divided into a mental and physical health component. Mental health symptoms including anxiety, depression, and post-traumatic stress disorders were evaluated using the Hospital Anxiety and Depression Scale (HADS) and Post-traumatic Stress Disorder Checklist-5 (PCL-5) 3 months after COVID-19. Using descriptive statistics and multivariable regression analysis, we identified factors associated with impaired HR-QoL 3 months after COVID-19 diagnosis. RESULTS: Patients were 55 years of age (IQR, 49-63; 39% women) and were classified as severe (23%), moderate (57%), or mild (20%) according to acute disease severity. HR-QoL was impaired in 28/90 patients (31%). Younger age [per year, adjOR (95%CI) 0.94 (0.88-1.00), p = 0.049], longer hospitalization [per day, adjOR (95%CI) 1.07 (1.01-1.13), p = 0.015], impaired sleep [adjOR (95%CI) 5.54 (1.2-25.61), p = 0.028], and anxiety [adjOR (95%CI) 15.67 (3.03-80.99), p = 0.001) were independently associated with impaired HR-QoL. Twenty-nine percent (n = 26) scored below the normal range on the mental health component of the SF-36 and independent associations emerged for anxiety, depression, and self-reported numbness. Impairments in the physical health component of the SF-36 were reported by 12 (13%) patients and linked to hypogeusia and fatigue. CONCLUSION: Every third patient reported a reduction in HR-QoL 3 months after COVID-19 diagnosis and impairments were more prominent in mental than physical well-being.


Subject(s)
COVID-19 , Anxiety/epidemiology , COVID-19/epidemiology , COVID-19 Testing , Cohort Studies , Depression/epidemiology , Depression/psychology , Female , Humans , Male , Prospective Studies , Quality of Life/psychology
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