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1.
Lancet Digit Health ; 3(9): e577-e586, 2021 09.
Article in English | MEDLINE | ID: covidwho-2184865

ABSTRACT

BACKGROUND: Multiple voluntary surveillance platforms were developed across the world in response to the COVID-19 pandemic, providing a real-time understanding of population-based COVID-19 epidemiology. During this time, testing criteria broadened and health-care policies matured. We aimed to test whether there were consistent associations of symptoms with SARS-CoV-2 test status across three surveillance platforms in three countries (two platforms per country), during periods of testing and policy changes. METHODS: For this observational study, we used data of observations from three volunteer COVID-19 digital surveillance platforms (Carnegie Mellon University and University of Maryland Facebook COVID-19 Symptom Survey, ZOE COVID Symptom Study app, and the Corona Israel study) targeting communities in three countries (Israel, the UK, and the USA; two platforms per country). The study population included adult respondents (age 18-100 years at baseline) who were not health-care workers. We did logistic regression of self-reported symptoms on self-reported SARS-CoV-2 test status (positive or negative), adjusted for age and sex, in each of the study cohorts. We compared odds ratios (ORs) across platforms and countries, and we did meta-analyses assuming a random effects model. We also evaluated testing policy changes, COVID-19 incidence, and time scales of duration of symptoms and symptom-to-test time. FINDINGS: Between April 1 and July 31, 2020, 514 459 tests from over 10 million respondents were recorded in the six surveillance platform datasets. Anosmia-ageusia was the strongest, most consistent symptom associated with a positive COVID-19 test (robust aggregated rank one, meta-analysed random effects OR 16·96, 95% CI 13·13-21·92). Fever (rank two, 6·45, 4·25-9·81), shortness of breath (rank three, 4·69, 3·14-7·01), and cough (rank four, 4·29, 3·13-5·88) were also highly associated with test positivity. The association of symptoms with test status varied by duration of illness, timing of the test, and broader test criteria, as well as over time, by country, and by platform. INTERPRETATION: The strong association of anosmia-ageusia with self-reported positive SARS-CoV-2 test was consistently observed, supporting its validity as a reliable COVID-19 signal, regardless of the participatory surveillance platform, country, phase of illness, or testing policy. These findings show that associations between COVID-19 symptoms and test positivity ranked similarly in a wide range of scenarios. Anosmia, fever, and respiratory symptoms consistently had the strongest effect estimates and were the most appropriate empirical signals for symptom-based public health surveillance in areas with insufficient testing or benchmarking capacity. Collaborative syndromic surveillance could enhance real-time epidemiological investigations and public health utility globally. FUNDING: National Institutes of Health, National Institute for Health Research, Alzheimer's Society, Wellcome Trust, and Massachusetts Consortium on Pathogen Readiness.


Subject(s)
Ageusia , Anosmia , COVID-19 , Cough , Dyspnea , Fever , Population Surveillance/methods , Adolescent , Adult , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/etiology , Anosmia/epidemiology , Anosmia/etiology , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Cough/epidemiology , Cough/etiology , Digital Technology , Dyspnea/epidemiology , Dyspnea/etiology , Female , Fever/epidemiology , Fever/etiology , Humans , Israel/epidemiology , Male , Middle Aged , Odds Ratio , Pandemics , SARS-CoV-2 , United Kingdom/epidemiology , United States/epidemiology , Young Adult
2.
JAMA Netw Open ; 5(11): e2242106, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2118421

ABSTRACT

Importance: Identification of long-term post-COVID-19 symptoms among hospitalized and nonhospitalized patients is needed. Objective: To compare the presence of post-COVID-19 symptoms 2 years after acute SARS-CoV-2 infection between hospitalized and nonhospitalized patients. Design, Setting, and Participants: A cross-sectional cohort study was conducted at 2 urban hospitals and general practitioner centers from March 20 to April 30, 2020, among 360 hospitalized patients and 308 nonhospitalized patients with acute SARS-CoV-2 infection during the first wave of the pandemic. Follow-up was conducted 2 years later. Main Outcomes and Measures: Participants were scheduled for a telephone interview 2 years after acute infection. The presence of post-COVID-19 symptoms was systematically assessed, with particular attention to symptoms starting after infection. Hospitalization and clinical data were collected from medical records. Between-group comparisons and multivariate logistic regressions were conducted. Results: A total of 360 hospitalized patients (162 women [45.0%]; mean [SD] age, 60.7 [16.1] years) and 308 nonhospitalized patients (183 women [59.4%]; mean [SD] age, 56.7 [14.7] years) were included. Dyspnea was more prevalent at the onset of illness among hospitalized than among nonhospitalized patients (112 [31.1%] vs 36 [11.7%]; P < .001), whereas anosmia was more prevalent among nonhospitalized than among hospitalized patients (66 [21.4%] vs 36 [10.0%]; P = .003). Hospitalized patients were assessed at a mean (SD) of 23.8 (0.6) months after hospital discharge, and nonhospitalized patients were assessed at a mean (SD) of 23.4 (0.7) months after the onset of symptoms. The number of patients who exhibited at least 1 post-COVID-19 symptom 2 years after infection was 215 (59.7%) among hospitalized patients and 208 (67.5%) among nonhospitalized patients (P = .01). Among hospitalized and nonhospitalized patients, fatigue (161 [44.7%] vs 147 [47.7%]), pain (129 [35.8%] vs 92 [29.9%]), and memory loss (72 [20.0%] vs 49 [15.9%]) were the most prevalent post-COVID-19 symptoms 2 years after SARS-CoV-2 infection. No significant differences in post-COVID-19 symptoms were observed between hospitalized and nonhospitalized patients. The number of preexisting medical comorbidities was associated with post-COVID-19 fatigue (odds ratio [OR], 1.93; 95% CI, 1.09-3.42; P = .02) and dyspnea (OR, 1.91; 95% CI, 1.04-3.48; P = .03) among hospitalized patients. The number of preexisting medical comorbidities (OR, 3.75; 95% CI, 1.67-8.42; P = .001) and the number of symptoms at the onset of illness (OR, 3.84; 95% CI, 1.33-11.05; P = .01) were associated with post-COVID-19 fatigue among nonhospitalized patients. Conclusions and Relevance: This cross-sectional study suggested the presence of at least 1 post-COVID-19 symptom in 59.7% of hospitalized patients and 67.5% of nonhospitalized patients 2 years after infection. Small differences in symptoms at onset of COVID-19 were identified between hospitalized and nonhospitalized patients. Post-COVID-19 symptoms were similar between hospitalized and nonhospitalized patients; however, lack of inclusion of uninfected controls limits the ability to assess the association of SARS-CoV-2 infection with overall and specific post-COVID-19 symptoms 2 years after acute infection. Future studies should include uninfected control populations.


Subject(s)
COVID-19 , Humans , Female , Middle Aged , COVID-19/complications , COVID-19/epidemiology , Cross-Sectional Studies , SARS-CoV-2 , Hospitalization , Fatigue/epidemiology , Fatigue/etiology , Dyspnea/epidemiology , Dyspnea/etiology
3.
Eur Respir Rev ; 31(166)2022 Dec 31.
Article in English | MEDLINE | ID: covidwho-2098297

ABSTRACT

Persistent breathlessness >28 days after acute COVID-19 infection has been identified as a highly debilitating post-COVID symptom. However, the prevalence, risk factors, mechanisms and treatments for post-COVID breathlessness remain poorly understood. We systematically searched PubMed and Embase for relevant studies published from 1 January 2020 to 1 November 2021 (PROSPERO registration number: CRD42021285733) and included 119 eligible papers. Random-effects meta-analysis of 42 872 patients with COVID-19 reported in 102 papers found an overall prevalence of post-COVID breathlessness of 26% (95% CI 23-29) when measuring the presence/absence of the symptom, and 41% (95% CI 34-48) when using Medical Research Council (MRC)/modified MRC dyspnoea scale. The pooled prevalence decreased significantly from 1-6 months to 7-12 months post-infection. Post-COVID breathlessness was more common in those with severe/critical acute infection, those who were hospitalised and females, and was less likely to be reported by patients in Asia than those in Europe or North America. Multiple pathophysiological mechanisms have been proposed (including deconditioning, restrictive/obstructive airflow limitation, systemic inflammation, impaired mental health), but the body of evidence remains inconclusive. Seven cohort studies and one randomised controlled trial suggested rehabilitation exercises may reduce post-COVID breathlessness. There is an urgent need for mechanistic research and development of interventions for the prevention and treatment of post-COVID breathlessness.


Subject(s)
COVID-19 , Female , Humans , Prevalence , Dyspnea/diagnosis , Dyspnea/epidemiology , Dyspnea/therapy , Risk Factors , Exercise Therapy
4.
BMJ Open ; 12(7): e062439, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-2078988

ABSTRACT

INTRODUCTION: A substantial proportion of individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), report persisting symptoms weeks and months following acute infection. Estimates on prevalence vary due to differences in study designs, populations, heterogeneity of symptoms and the way symptoms are measured. Common symptoms include fatigue, cognitive impairment and dyspnoea. However, knowledge regarding the nature and risk factors for developing persisting symptoms is still limited. Hence, in this study, we aim to determine the prevalence, severity, risk factors and impact on quality of life of persisting symptoms in the first year following acute SARS-CoV-2 infection. METHODS AND ANALYSIS: The LongCOVID-study is both a prospective and retrospective cohort study being conducted in the Netherlands, with a one year follow-up. Participants aged 5 years and above, with self-reported positive or negative tests for SARS-CoV-2 will be included in the study. The primary outcome is the prevalence and severity of persistent symptoms in participants that tested positive for SARS-CoV-2 compared with controls. Symptom severity will be assessed for fatigue (Checklist Individual Strength (CIS subscale fatigue severity)), pain (Rand-36/SF-36 subscale bodily pain), dyspnoea (Medical Research Council (mMRC)) and cognitive impairment (Cognitive Failure Questionnaire (CFQ)). Secondary outcomes include effect of vaccination prior to infection on persistent symptoms, loss of health-related quality of life (HRQoL) and risk factors for persisting symptoms following infection with SARS-CoV-2. ETHICS AND DISSEMINATION: The Utrecht Medical Ethics Committee (METC) declared in February 2021 that the Medical Research Involving Human Subjects Act (WMO) does not apply to this study (METC protocol number 21-124/C). Informed consent is required prior to participation in the study. Results of this study will be submitted for publication in a peer-reviewed journal.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/complications , COVID-19/epidemiology , Cohort Studies , Dyspnea/epidemiology , Dyspnea/etiology , Fatigue/epidemiology , Fatigue/etiology , Humans , Observational Studies as Topic , Prevalence , Prospective Studies , Quality of Life , Retrospective Studies
5.
PLoS One ; 17(10): e0275615, 2022.
Article in English | MEDLINE | ID: covidwho-2065140

ABSTRACT

OBJECTIVE: To determine the health status and exercise capacity of COVID-19 survivors one year after hospital discharge. METHODS: This multicenter prospective study included COVID-19 survivors 12 months after hospital discharge. Participants were randomly selected from a large cohort of COVID-19 patients who had been hospitalized until 15th April 2020. They were interviewed about persistent symptoms, underwent a physical examination, chest X-ray, and a 6-minute walk test (6MWT). A multivariate analysis was performed to determine the risk factors for persistent dyspnea. RESULTS: Of the 150 patients included, 58% were male and the median age was 63 (IQR 54-72) years. About 82% reported ≥1 symptoms and 45% had not recovered their physical health. The multivariate regression analysis revealed that the female sex, chronic obstructive pulmonary disease, and smoking were independent risk factors for persistent dyspnea. Approximately 50% completed less than 80% of the theoretical distance on the 6MWT. Only 14% had an abnormal X-ray, showing mainly interstitial infiltrates. A third of them had been followed up in outpatient clinics and 6% had undergone physical rehabilitation. CONCLUSION: Despite the high rate of survivors of the first wave of the COVID-19 pandemic with persistent symptomatology at 12 months, the follow-up and rehabilitation of these patients has been really poor. Studies focusing on the role of smoking in the persistence of COVID-19 symptoms are lacking.


Subject(s)
COVID-19 , COVID-19/epidemiology , Dyspnea/epidemiology , Dyspnea/etiology , Female , Hospitals , Humans , Male , Middle Aged , Pandemics , Patient Discharge , Prospective Studies
6.
Int J Environ Res Public Health ; 19(19)2022 Sep 26.
Article in English | MEDLINE | ID: covidwho-2043757

ABSTRACT

OBJECTIVES: The study aimed to assess the level of dyspnoea during the COVID-19 pandemic in Poland. METHODS: The online questionnaire was conducted among 204 Polish adult respondents with a positive SARS-CoV-2 test result. The level of dyspnoea was assessed by the modified Medical Research Council (MRC) Dyspnoea Scale in Polish. RESULTS: Dyspnoea is most common in patients with severe COVID-19, and the prevalence of dyspnoea in the study population of patients with COVID-19 was low (34% respondents presented with dyspnoea with a score of 1 or higher). CONCLUSIONS: There is a need for further investigation and close monitoring of the extent of dyspnoea in different social groups, especially in the event of a prolonged pandemic and the emergence of further waves of COVID-19.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Dyspnea/epidemiology , Dyspnea/etiology , Humans , Pandemics , Poland/epidemiology , SARS-CoV-2
7.
BMJ Open ; 12(9): e064979, 2022 09 22.
Article in English | MEDLINE | ID: covidwho-2038321

ABSTRACT

OBJECTIVES: To estimate the treatment incidence of post-COVID syndrome (postinfectious sequelae present at least 12 weeks following infection) in the context of ambulatory care in Bavaria, Germany, and to establish whether related diagnoses occur more frequently than in patients with no known history of COVID-19. DESIGN: Retrospective cohort analysis of routinely collected claims data. SETTING: Ambulatory care in Bavaria, Germany, observed from January 2020 to March 2022 (data accessed May 2022). PARTICIPANTS: 391 990 patients with confirmed COVID-19 diagnosis, 62 659 patients with other respiratory infection and a control group of 659 579 patients with no confirmed or suspected diagnosis of COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome is diagnosis of post-COVID syndrome documented in ambulatory care. Secondary outcomes are: chronic fatigue syndrome, psychological disorder, fatigue, mild cognitive impairment, disturbances of taste and smell, dyspnoea, pulmonary embolism and myalgia. RESULTS: Among all patients with confirmed COVID-19, 14.2% (95% CI 14.0% to 14.5%) received a diagnosis of a post-COVID syndrome, and 6.7% (95% CI 6.5% to 6.9%) received the diagnosis in at least two quarterly periods during a 2-year follow-up. Compared with patients with other respiratory infections and with controls, patients with COVID-19 more frequently received a variety of diagnoses including chronic fatigue syndrome (1.6% vs 0.6% and 0.3%, respectively), fatigue (13.3% vs 9.2% and 6.0%), dyspnoea (9.9% vs 5.1% and 3.2%) and disturbances of taste and smell (3.2% vs 1.2% and 0.5%). The treatment incidence of post-COVID syndrome was highest among adults aged 40-59 (19.0%) and lowest among children aged below 12 years (2.6%). CONCLUSIONS: Our results demonstrate a moderately high incidence of post-COVID syndrome 2 years after COVID-19 diagnosis. There is an urgent need to find efficient and effective solutions to help patients with dyspnoea, fatigue, cognitive impairment and loss of smell. Guidelines and treatment algorithms, including referral criteria, and occupational and physical therapy, require prompt and coherent implementation.


Subject(s)
COVID-19 , Fatigue Syndrome, Chronic , Adult , Ambulatory Care , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Child , Cohort Studies , Dyspnea/epidemiology , Dyspnea/etiology , Germany/epidemiology , Humans , Incidence , Retrospective Studies , SARS-CoV-2
8.
JAMA Netw Open ; 5(9): e2231790, 2022 09 01.
Article in English | MEDLINE | ID: covidwho-2027281

ABSTRACT

Importance: Relatively little is known about the persistence of symptoms in patients with COVID-19 for more than 1 year after their acute illness. Objective: To assess the health outcomes among hospitalized COVID-19 survivors over 2 years and to identify factors associated with increased risk of persistent symptoms. Design, Setting, and Participants: This was a longitudinal cohort study of patients who survived COVID-19 at 2 COVID-19-designated hospitals in Wuhan, China, from February 12 to April 10, 2020. All patients were interviewed via telephone at 1 year and 2 years after discharge. The 2-year follow-up study was conducted from March 1 to April 6, 2022. Statistical analysis was conducted from April 20 to May 5, 2022. The severity of disease was defined by World Health Organization guideline for COVID-19. Exposures: COVID-19. Main Outcomes and Measures: The main outcome was symptom changes over 2 years after hospital discharge. All patients completed a symptom questionnaire for evaluation of symptoms, along with a chronic obstructive pulmonary disease assessment test (CAT) at 1-year and 2-year follow-up visits. Results: Of 3988 COVID-19 survivors, a total of 1864 patients (median [IQR] age, 58.5 [49.0-68.0] years; 926 male patients [49.7%]) were available for both 1-year and 2-year follow-up visits. The median (IQR) time from discharge to follow-up at 2 years was 730 (719-743) days. At 2 years after hospital discharge, 370 patients (19.8%) still had symptoms, including 224 (12.0%) with persisting symptoms and 146 (7.8%) with new-onset or worsening of symptoms. The most common symptoms were fatigue, chest tightness, anxiety, dyspnea, and myalgia. Most symptoms resolved over time, but the incidence of dyspnea showed no significant change (1-year vs 2-year, 2.6% [49 patients] vs 2.0% [37 patients]). A total of 116 patients (6.2%) had CAT total scores of at least 10 at 2 years after discharge. Patients who had been admitted to the intensive care unit had higher risks of persistent symptoms (odds ratio, 2.69; 95% CI, 1.02-7.06; P = .04) and CAT scores of 10 or higher (odds ratio, 2.83; 95% CI, 1.21-6.66; P = .02). Conclusions and Relevance: In this cohort study, 2 years after hospital discharge, COVID-19 survivors had a progressive decrease in their symptom burden, but those with severe disease during hospitalization, especially those who required intensive care unit admission, had higher risks of persistent symptoms. These results are related to the original strain of the virus, and their relevance to infections with the Omicron variant is not known.


Subject(s)
COVID-19 , COVID-19/epidemiology , COVID-19/therapy , China/epidemiology , Cohort Studies , Dyspnea/epidemiology , Follow-Up Studies , Hospitalization , Humans , Longitudinal Studies , Male , Outcome Assessment, Health Care , SARS-CoV-2 , Survivors
9.
Indian J Med Res ; 155(5&6): 570-574, 2022.
Article in English | MEDLINE | ID: covidwho-1994296

ABSTRACT

This retrospective study was aimed to understand the clinical, laboratory, radiological parameters and the outcome of COVID-19 patients with underlying haematological disease. All patients with known haematological disease admitted with COVID-19-positive status from April to August 2020 in the COVID-19 facility of a tertiary care centre in north India, were included. Their medical records were analyzed for outcome and mortality risk factors. Fifty four patients, 37 males, were included in the study. Of these, 36 patients had haematological malignancy and 18 had benign disorder. Fever (95.5%), cough (59.2%) and dyspnoea (31.4%) were the most common symptoms. Nine patients had severe disease at diagnosis, mostly malignant disorders. Overall mortality rate was 37.0 per cent, with high mortality seen in patients with aplastic anaemia (50.0%), acute myeloid (46.7%) and lymphoblastic leukaemia (40.0%). On univariate analysis, Eastern Cooperative Oncology Group performance status >2 [odd ratio (OR) 11.6], COVID-19 severity (OR 8.2), dyspnoea (OR 5.7) and blood product transfusion (OR 6.4) were the predictors of mortality. However, the presence of moderate or severe COVID-19 (OR 16.6, confidence interval 3.8-72.8) was found significant on multivariate analysis. The results showed that patients with haematological malignancies and aplastic anaemia might be at increased risk of getting severe COVID-19 infection and mortality as compared to the general population.


Subject(s)
Anemia, Aplastic , COVID-19 , Hematologic Neoplasms , Male , Humans , COVID-19/complications , Retrospective Studies , Anemia, Aplastic/complications , Anemia, Aplastic/epidemiology , Hematologic Neoplasms/complications , Hematologic Neoplasms/epidemiology , Dyspnea/epidemiology , India/epidemiology
10.
Ann Ig ; 34(5): 478-489, 2022.
Article in English | MEDLINE | ID: covidwho-1954748

ABSTRACT

Objectives: The severe acute respiratory syndrome (COVID-19) due to SARS-CoV-2 was first reported in China in December 2019 and has generated a worldwide pandemic. The objective of the research is to examine and describe (a) the symptoms that persist after the end of the acute stage and (b) their relationship with the severity of the disease. Study Design: This study is a cross-sectional study conducted in the Kingdom of Bahrain on COVID-19 infected patients using an online survey questionnaire with a total number of 52 patient responses (29 females and 23 males). Method: A scale (0 no symptoms to 10 very high symptoms intensity) was assessed in patients after 3 months to detect the relevance of specific symptoms post-COVID-19 such as emotional and physical health, headache, dyspnoea, pain (muscles/joints/chest), anosmia, vertigo, neurologic symptoms, sarcopenia, delirium. Results: The most common COVID-19 symptoms were reported to be fever (69.2%), headache (59.6%), and cough (50.0%). Data analysis showed that BMI was not correlated with any post-acute COVID-19 symptoms. Regarding the post-acute COVID-19 symptoms, this study showed that an increase of intensity of headache was associated with an increase of delirium; an increase of intensity of dyspnoea was associated with an increase of pulmonary dysfunction. The increase of anosmia and dysgeusia was associated with an increase in delirium. In addition, the increase of neurological symptoms and delirium were associated with the increase of sarcopenia. The most common persistent post-COVID-19 symptoms observed in this study were emotional stress, followed by loss of smell and taste, and neurological symptoms. Conclusions: Therefore, follow-up and rehabilitation care for COVID-19 patients must be focused on addressing the needs of these people in the longer term.


Subject(s)
COVID-19 , Delirium , Sarcopenia , Anosmia , COVID-19/epidemiology , Cross-Sectional Studies , Dyspnea/epidemiology , Dyspnea/etiology , Female , Headache/epidemiology , Headache/etiology , Humans , Male , SARS-CoV-2
11.
BMJ Open ; 12(5): e055308, 2022 05 18.
Article in English | MEDLINE | ID: covidwho-1950141

ABSTRACT

OBJECTIVES: COVID-19 can result in persistent symptoms leaving potential rehabilitation needs unmet. This study aims to describe persistent symptoms and health status of individuals hospitalised for COVID-19 according to the International Classification of Functioning, Disability and Health domains of impairments, limitations in activity, and participation restrictions. DESIGN: Cross-sectional study consisting in a telephone interview 3 months after hospital discharge. SETTING: This study was conducted during the first peak of the COVID-19 pandemic by the Local Health Authority of Reggio Emilia (Italy). PARTICIPANTS: Adult individuals discharged from hospital between April and June 2020 after COVID-19. EXCLUSION CRITERIA: hospitalisation for reasons other than COVID-19, inability to participate in the study, concomitant acute or chronic conditions causing disability. PRIMARY AND SECONDARY OUTCOME MEASURES: We assessed: dyspnoea (Medical Research Council), fatigue (Fatigue Severity Scale), mood disturbances (Hospital Anxiety and Depression Scale), limitations in activity (Barthel Index) and participation restrictions (Reintegration to Normal Living Index). We also collected data on sociodemographic characteristics, health status prior to COVID-19, COVID-related clinical manifestations and hospital care pathway up to discharge, rehabilitation interventions, accidental falls and emergency room access. RESULTS: 149 participants (men, 62%; average age 62 (±11) years) were enrolled, 35 of which (23%) were admitted to the intensive care unit (ICU) while hospitalised. Three months after hospital discharge, nearly half of the participants still suffered from dyspnoea (44%) or fatigue (39%). Almost all individuals (91.2%) recovered a good level of independence in activity of daily living, but 76% still suffered participation restrictions. Female sex was significantly associated with worse outcomes for all symptoms. CONCLUSIONS: Individuals who had moderate or severe COVID-19 may perceive persistent symptoms which may result in reduced social participation. Sex differences should be monitored, as women may recover more slowly than men. TRIAL REGISTRATION NUMBER: NCT04438239.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , Cross-Sectional Studies , Dyspnea/epidemiology , Fatigue/epidemiology , Female , Hospitals , Humans , Male , Middle Aged , Pandemics , Patient Discharge , Sex Characteristics , Treatment Outcome
12.
Int J Environ Res Public Health ; 19(11)2022 06 03.
Article in English | MEDLINE | ID: covidwho-1884136

ABSTRACT

We aimed to review the data available to evaluate the long-term consequences of coronavirus disease 2019 (COVID-19) at 6 months and above. We searched relevant observational cohort studies up to 9 February 2022 in Pubmed, Embase, and Web of Science. Random-effects inverse-variance models were used to evaluate the Pooled Prevalence (PP) and its 95% confidence interval (CI) of long-term consequences. The Newcastle-Ottawa quality assessment scale was used to assess the quality of the included cohort studies. A total of 40 studies involving 10,945 cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection were included. Of the patients, 63.87% had at least one consequence at the 6 month follow-up, which decreased to 58.89% at 12 months. The most common symptoms were fatigue or muscle weakness (PP 6-12 m = 54.21%, PP ≥ 12 m = 34.22%) and mild dyspnea (Modified Medical Research Council Dyspnea Scale, mMRC = 0, PP 6-12 m = 74.60%, PP ≥ 12 m = 80.64%). Abnormal computerized tomography (CT; PP 6-12 m = 55.68%, PP ≥ 12 m = 43.76%) and lung diffuse function impairment, i.e., a carbon monoxide diffusing capacity (DLCO) of < 80% were common (PP 6-12 m = 49.10%, PP ≥ 12 m = 31.80%). Anxiety and depression (PP 6-12 m = 33.49%, PP ≥ 12 m = 35.40%) and pain or discomfort (PP 6-12 m = 33.26%, PP ≥ 12 m = 35.31%) were the most common problems that affected patients' quality of life. Our findings suggest a significant long-term impact on health and quality of life due to COVID-19, and as waves of ASRS-CoV-2 infections emerge, the long-term effects of COVID-19 will not only increase the difficulty of care for COVID-19 survivors and the setting of public health policy but also might lead to another public health crisis following the current pandemic, which would also increase the global long-term burden of disease.


Subject(s)
COVID-19 , COVID-19/epidemiology , Dyspnea/epidemiology , Dyspnea/etiology , Humans , Pandemics , Quality of Life , SARS-CoV-2
13.
Eur Rev Med Pharmacol Sci ; 26(10): 3751-3759, 2022 May.
Article in English | MEDLINE | ID: covidwho-1876424

ABSTRACT

OBJECTIVE: Pulmonary embolism as a potential complication that may occur late in the course of COVID-19 cases. The aim of our study is to evaluate the frequency of pulmonary embolism in patients with new or ongoing dyspnea after a COVID-19 infection. PATIENTS AND METHODS: This is a single-center, prospective observational study to evaluate the clinical and radiological outcomes of consecutive patients presenting outpatient clinic diseases to the chest and a new or ongoing dyspnea after a COVID-19 infection. Demographic, clinical and laboratory data were collected. Dyspnea was evaluated according to the New York Heart Association (NYHA) classification. RESULTS: Pulmonary embolism was detected in 23.8% (25/105) of patients with new or ongoing dyspnea after a COVID-19 infection. Proportion of pulmonary embolism in patients with NYHA classes I, II, III and IV were respectively 8.7%, 20.0%, 30.0% and 35.3% (p for trend=0.02). Compared to NYHA class I and II patients with dyspnea, those in NYHA classes III and IV showed a higher rate of pulmonary embolism [31.6% vs. 14.6%, OR: 2.7 (1.0 to 7.1), p=0.04, respectively]. In Logistic Procedures, NYHA classes of dyspnea (OR: 4.3, 95% CI: 1.2 to 16.6, p=0.03) (NYHA class III and IV vs. NYHA class I and II) determine the likelihood of pulmonary embolism after COVID-19 infection. CONCLUSIONS: Pulmonary embolism is common in patients with new or ongoing shortness of breath after a COVID-19 infection. Pulmonary embolism is more likely to develop in patients with higher NYHA classes.


Subject(s)
COVID-19 , Pulmonary Embolism , COVID-19/complications , Dyspnea/epidemiology , Dyspnea/etiology , Humans , Prospective Studies , Pulmonary Embolism/complications , Pulmonary Embolism/etiology
14.
Ecotoxicol Environ Saf ; 239: 113651, 2022 Jul 01.
Article in English | MEDLINE | ID: covidwho-1850969

ABSTRACT

Air pollution, to which children are more susceptible than adults, can promote airway inflammation, potentially exaggerating the effects of respiratory viral infection. This study examined the association between the clinical manifestation of COVID-19 in unvaccinated pediatric patients hospitalized in Poland (n = 766) and levels of particulate matter 2.5 (PM2.5) and benzo(a)pyrene (B(a)P) within a week before hospitalization. Children aged ≤ 12 years exposed to mean and max 24 h B(a)P levels > 1 ng/m3 revealed higher odds of cough, dyspnea, fever, and increased concentrations of inflammatory markers (C-reactive protein, interleukin-6, procalcitonin, white blood cell count). In older patients (13-17 years), elevated mean 24 h B(a)P levels increased odds of dyspnea, fever, and diarrhea, and higher concentrations of C-reactive protein and procalcitonin. Exposure to max 24 h PM2.5 levels > 20 µg/m3 was associated with higher odds of cough, increased concentrations of C-reactive protein (group ≤12 years), and increased procalcitonin concentration (groups ≤12 years and 13-17 years). In both age groups, length of stay was extended in patients exposed to elevated levels of max 24 h PM2.5, mean and max 24 h B(a)P. This study suggests that worse air quality, particularly reflected in increased B(a)P levels, might affect the clinical course of COVID-19 in pediatric patients and adds to the disease burden during a pandemic.


Subject(s)
Air Pollution , COVID-19 , Particulate Matter , Adolescent , Air Pollution/adverse effects , Air Pollution/analysis , C-Reactive Protein , COVID-19/diagnosis , Child , Cough/epidemiology , Cough/etiology , Dyspnea/epidemiology , Dyspnea/etiology , Environmental Exposure/analysis , Humans , Particulate Matter/adverse effects , Particulate Matter/analysis , Procalcitonin
15.
Pan Afr Med J ; 41: 122, 2022.
Article in English | MEDLINE | ID: covidwho-1818699

ABSTRACT

Introduction: despite its relatively low case-fatality rate, COVID-19 is a concern with high mortality and morbidity of hospitalized cases. This study was conducted to assess the relationship between time to consultation, presence of respiratory complications at hospital admission and fatal outcome of COVID-19 cases. Methods: this was a case control study with data collected from records of all patients admitted in the Bafoussam Regional Hospital (BRH) from March 2020 to April 2021. Cases were patients with a fatal outcome and controls were patients that were discharged. The association between the delay in seeking care, dyspnea and blood oxygen level at admission, and fatal outcome was assessed by estimating crude and adjusted odd ratio. Results: of 400 included patients, 239 (59.75%) were male, 84 (23.73%) health professionals and 144 (36.0%) aged 64 years and above. On admission, 236 patients presented at least one sign of respiratory complication. The mean duration of hospitalization was 11.4 days and 120 (30.0%) admitted patients died. Seeking care before the end of the first day of symptom onset (adjusted (A) OR=0.44 [0.21-0.97]) or within the first three days (AOR=0.48 [0.26-0.89]) significantly reduced the risk of fatal outcome, whereas waiting seven days (AOR=0.74 [0.42-1.33]) did not change this risk. Presenting dyspnea (AOR=2.39 [1.32-4.31]) or blood oxygen level <95% (AOR=3.67 [1.37-9.83]) significantly increased the risk of fatal outcome. Conclusion: mortality was one in three patients. Early arrival at the hospital helped to reduce the risk of mortality unlike presenting respiratory complication that increased the risk. Health interventions contributing for early detection and link of COVID-19 cases to care before respiratory complications occur are expected to reduce mortality in COVID-19 patients.


Subject(s)
COVID-19 , Cameroon/epidemiology , Case-Control Studies , Dyspnea/epidemiology , Dyspnea/etiology , Female , Hospitals , Humans , Male
16.
J Infect Public Health ; 15(5): 526-532, 2022 May.
Article in English | MEDLINE | ID: covidwho-1814758

ABSTRACT

BACKGROUND: Many survivors of COVID-19 have developed symptoms and diseases similar to those observed after severe acute respiratory syndrome (SARS). Therefore, this study aimed to characterize the symptoms that appear after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been eradicated and to determine their relationship with COVID-19 severity. METHODS: This multicenter, retrospective cross-sectional study was conducted in all eligible confirmed cases of SARS-CoV-2 infection from Saudi Arabia. Study participants were randomly selected using computerized random sampling from a population of 314,821 patients. Descriptive statistics were used to describe baseline demographic data and clinical characteristics. Categorical variables were presented as counts and percentages, while continuous variables were presented as means and standard deviations. RESULTS: Approximately 70% of patients were found to have five or fewer symptoms simultaneously. Late symptoms (in the ongoing symptomatic COVID-19) occurred in 225 (22·5%) patients with the most common late symptoms being loss of smell, loss of taste, fatigue, shortness of breath, and cough (52·4%, 31·1%, 11·5%, 10·2%, and 8·9% of patients with late symptoms, respectively). We also found that the presence of acute symptoms of COVID-19 and admission to the hospital were significant independent predictors of the post-COVID-19 condition. CONCLUSION: Saudi patients with COVID-19 develop a wide range of symptoms, similar to those observed and reported in other countries. The loss of smell, the loss of taste, shortness of breath, and fatigue were the main persistent symptoms. Regular follow-up of COVID-19 survivors is highly recommended to minimize the burden of the post-acute COVID-19 condition and improve the quality of life of patients.


Subject(s)
Ageusia , COVID-19 , Anosmia , COVID-19/epidemiology , Cross-Sectional Studies , Dyspnea/epidemiology , Fatigue/epidemiology , Humans , Quality of Life , Retrospective Studies , SARS-CoV-2 , Saudi Arabia/epidemiology
17.
BMJ Open Respir Res ; 9(1)2022 04.
Article in English | MEDLINE | ID: covidwho-1807446

ABSTRACT

BACKGROUND: The Clinical Frailty Scale (CFS) is increasingly used for clinical decision making in acute care but little is known about frailty after COVID-19. OBJECTIVES: To investigate frailty and the CFS for post-COVID-19 follow-up. METHODS: This prospective multicentre cohort study included COVID-19 survivors aged ≥50 years presenting for a follow-up visit ≥3 months after the acute illness. Nine centres retrospectively collected pre-COVID-19 CFS and prospectively CFS at follow-up. Three centres completed the Frailty Index (FI), the short physical performance battery (SPPB), 30 s sit-to-stand test and handgrip strength measurements. Mixed effect logistic regression models accounting for repeated measurements and potential confounders were used to investigate factors associated with post-COVID-19 CFS. Criterion and construct validity were determined by correlating the CFS to other concurrently assessed frailty measurements and measures of respiratory impairment, respectively. RESULTS: Of the 288 participants 65% were men, mean (SD) age was 65.1 (9) years. Median (IQR) CFS at follow-up was 3 (2-3), 21% were vulnerable or frail (CFS ≥4). The CFS was responsive to change, correlated with the FI (r=0.69, p<0.001), the SPPB score (r=-0.48, p<0.001) (criterion validity) and with the St George's Respiratory Questionnaire score (r=0.59, p<0.001), forced vital capacity %-predicted (r=-0.25, p<0.001), 6 min walk distance (r=-0.39, p<0.001) and modified Medical Research Council (mMRC) (r=0.59, p<0.001). Dyspnoea was significantly associated with a higher odds for vulnerability/frailty (per one mMRC adjusted OR 2.01 (95% CI 1.13 to 3.58), p=0.02). CONCLUSIONS: The CFS significantly increases with COVID-19, and dyspnoea is an important risk factor for post-COVID-19 frailty and should be addressed thoroughly.


Subject(s)
COVID-19 , Fatigue Syndrome, Chronic , Frailty , Cohort Studies , Dyspnea/epidemiology , Dyspnea/etiology , Female , Frailty/diagnosis , Frailty/epidemiology , Hand Strength , Humans , Male , Prospective Studies , Retrospective Studies
18.
PLoS One ; 16(11): e0260416, 2021.
Article in English | MEDLINE | ID: covidwho-1793553

ABSTRACT

This study determined the association between respiratory symptoms and death from respiratory causes over a period of 45 years. In four cohorts of random samples of Norwegian populations with 103,881 participants, 43,731 persons had died per 31 December 2016. In total, 5,949 (14%) had died from respiratory diseases; 2,442 (41%) from lung cancer, 1,717 (29%) chronic obstructive pulmonary disease (COPD), 1,348 (23%) pneumonia, 119 (2%) asthma, 147 (2%) interstitial lung disease and 176 (3%) other pulmonary diseases. Compared with persons without respiratory symptoms the multivariable adjusted hazard ratio (HR) for lung cancer deaths increased with score of breathlessness on effort and cough and phlegm, being 2.6 (95% CI 2.1-3.2) for breathlessness score 3 and 2.1 (95% CI 1.7-2.5) for cough and phlegm score 5. The HR of COPD death was 6.4 (95% CI 5.4-7.7) for breathlessness score 3 and 3.0 (2.4-3.6) for cough and phlegm score 5. Attacks of breathlessness and wheeze score 2 had a HR of 1.6 (1.4-1.9) for COPD death. The risk of pneumonia deaths increased also with higher breathlessness on effort score, but not with higher cough and phlegm score, except for score 2 with HR 1.5 (1.2-1.8). In this study with >2.4 million person-years at risk, a positive association was observed between scores of respiratory symptoms and deaths due to COPD and lung cancer. Respiratory symptoms are thus important risk factors, which should be followed thoroughly by health care practitioners for the benefit of public health.


Subject(s)
Lung Diseases/diagnosis , Respiration Disorders/diagnosis , Adolescent , Adult , Asthma/diagnosis , Asthma/epidemiology , Cohort Studies , Cough/diagnosis , Cough/epidemiology , Dyspnea/epidemiology , Female , Forced Expiratory Volume , Humans , Lung Diseases/epidemiology , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Male , Middle Aged , Norway/epidemiology , Pulmonary Disease, Chronic Obstructive/diagnosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Respiration Disorders/epidemiology , Respiratory Sounds , Risk Factors , Young Adult
19.
Clin Microbiol Infect ; 28(5): 657-666, 2022 May.
Article in English | MEDLINE | ID: covidwho-1729652

ABSTRACT

BACKGROUND: Post-acute coronavirus 2019 (COVID-19) syndrome is now recognized as a complex systemic disease that is associated with substantial morbidity. OBJECTIVES: To estimate the prevalence of persistent symptoms and signs at least 12 weeks after acute COVID-19 at different follow-up periods. DATA SOURCES: Searches were conducted up to October 2021 in Ovid Embase, Ovid Medline, and PubMed. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Articles in English that reported the prevalence of persistent symptoms among individuals with confirmed severe acute respiratory syndrome coronavirus 2 infection and included at least 50 patients with a follow-up of at least 12 weeks after acute illness. METHODS: Random-effect meta-analysis was performed to produce a pooled prevalence for each symptom at four different follow-up time intervals. Between-study heterogeneity was evaluated using the I2 statistic and was explored via meta-regression, considering several a priori study-level variables. Risk of bias was assessed using the Joanna Briggs Institute tool and the Newcastle-Ottawa Scale for prevalence studies and comparative studies, respectively. RESULTS: After screening 3209 studies, a total of 63 studies were eligible, with a total COVID-19 population of 257 348. The most commonly reported symptoms were fatigue, dyspnea, sleep disorder, and difficulty concentrating (32%, 25%, 24%, and 22%, respectively, at 3- to <6-month follow-up); effort intolerance, fatigue, sleep disorder, and dyspnea (45%, 36%, 29%, and 25%, respectively, at 6- to <9-month follow-up); fatigue (37%) and dyspnea (21%) at 9 to <12 months; and fatigue, dyspnea, sleep disorder, and myalgia (41%, 31%, 30%, and 22%, respectively, at >12-month follow-up). There was substantial between-study heterogeneity for all reported symptom prevalences. Meta-regressions identified statistically significant effect modifiers: world region, male sex, diabetes mellitus, disease severity, and overall study quality score. Five of six studies including a comparator group consisting of COVID-19-negative cases observed significant adjusted associations between COVID-19 and several long-term symptoms. CONCLUSIONS: This systematic review found that a large proportion of patients experience post-acute COVID-19 syndrome 3 to 12 months after recovery from the acute phase of COVID-19. However, available studies of post-acute COVID-19 syndrome are highly heterogeneous. Future studies need to have appropriate comparator groups, standardized symptom definitions and measurements, and longer follow-up.


Subject(s)
COVID-19 , Sleep Wake Disorders , COVID-19/complications , COVID-19/epidemiology , Dyspnea/epidemiology , Dyspnea/etiology , Fatigue/epidemiology , Fatigue/etiology , Follow-Up Studies , Humans , Male , Prevalence , SARS-CoV-2
20.
Med Pr ; 72(6): 711-720, 2021 Dec 22.
Article in Polish | MEDLINE | ID: covidwho-1609128

ABSTRACT

"Long-COVID" is described as long-term effects of SARS­ CoV­2 infection that last >4 weeks after the acutephase of infection. The aim of this narrative reviews to evaluate the frequency of occurrence of 3 symptoms often observed in Long-COVID, i.e., chronic fatigue, shortness of breath and cough, and whether comorbidities such as diabetes and arterial hypertension increase the risk of complications after a history of SARS­ CoV­2 infection. The method of narrative review was used in this paper. PubMed (May 31, 2021) search was performed to retrieve articles concerning the occurrence of long COVID-19 chronic fatigue, dyspnoea and chronic cough. Studies in which the observation period was <30 days and the average age of subjects exceeded 60 years, as well as studies with no information on the methodology used, in particular without the method of recruiting people for the study, were excluded. Populations with a high frequency of diabetes were defined as the prevalence >10%, and in the case of arterial hypertension >40%. The average frequency of diabetes <10%, hypertension 40%. It can be concluded that in the period of >30 days after discharge from the hospital, in populations with a high incidence of diabetes and hypertension, the incidence of chronic fatigue and cough was higher than in the other analyzed groups. Symptoms of dyspnea were most frequently reported in populations with high rates of diabetes, but at the same time in the average percentage of people with arterial hypertension. Persistent symptoms specific to "Long-COVID" can significantly reduce the ability to perform work. In this situation, check-ups performed before returning to work after long-term leave tape on a new dimension. Med Pr. 2021;72(6):711-20.


Subject(s)
COVID-19 , COVID-19/complications , Cough/epidemiology , Cough/etiology , Dyspnea/epidemiology , Epidemiologic Studies , Humans , Middle Aged , SARS-CoV-2
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