The most terrible sequelae of COVID-19 often show up after the initial "acute" infection has passed. A team of researchers at the U.S. Department of Veterans Affairs (VA) has been analyzing the various dangerous and lasting consequences that can occur after an initial COVID-19 infection. These COVID-19 complications include mental health disorders, among others.
In one of their two studies on the chronic effects of COVID-19 published in February 2022, researchers at va's St. Louis Health Care System focused on mental health disorders after COVID-19 infection. The team's findings appeared in the British Medical Journal (BMJ) on 16 February 2022.
The researchers found that even in people who did not need to be hospitalized while contracting COVID-19, serious health problems related to mental health could persist in the weeks and months following acute infection, or appear suddenly. They say the reasons for the increased mental health risk after contracting COVID-19 are not entirely clear. Biological changes that can occur in the body that affect the brain, as can non-biological changes such as social isolation and trauma.
Led by lead investigator Dr. Ziyad Al-Aly, who found an increased risk of diseases such as depression, anxiety, sleep disorders, and drug use disorders, the head of the Clinical Epidemiology Center and Research and Development Services at va's St. Louis Health Care System.
For many people, COVID-19 infection is accompanied only by mild or moderate symptoms, such as annoying coughing and shortness of breath that lasts for several days. But Al-Aly says this first phase could be "the tip of the iceberg." "Those who continue to experience severe chronic consequences will usually last a lifetime and they will bear the scars of this pandemic," he said. ”
Al-Aly is a nephrologist and a clinical epidemiologist with expertise in big data. His team analyzes huge data sets that are too complex for traditional computer software. As a researcher, Al-Aly specializes in the chronic effects of COVID, technically known as "acute sequelae of SARS-CoV-2" and informally referred to as "long-course COVID."
Studies by Al-Aly and others have shown that long-term COVID can affect almost every organ system. "When people come back to their doctors, they have fatigue, brain fog, amnesia, stroke, new diabetes, kidney disease, heart disease and so on," the researcher said. ”
From the widespread chronic consequences of COVID, Al-Aly and his team decided to lock a field into mental health. They chose this field because of its serious impact on personal and public health, explains study co-author Dr. Yan Xie, a clinical epidemiologist at the Veterans St. Louis Epidemiology Center.
The team compared the mental health risks of those who contracted COVID-19 and survived the first 30 days after infection with the same health outcomes for those who did not. During the study period of about a year, the researchers found an increased risk of problems such as anxiety, depression, stress disorders, opioid use, substance use disorders, and sleep conditions.
"We've all suffered from some sort of haunting of this pandemic — perhaps a measure of anxiety or difficulty sleeping," said lead investigator Al-Aly. "But these challenges are magnified, especially in those who are admitted to the hospital during the acute phase of the COVID fight, but there are also many who experience only mild or moderate symptoms."
People in the COVID-19 group were at 60 percent higher risk of having any mental health disorders or mental health-related prescriptions compared to those who did not have COVID-19.
The results by type of mental health problem are:
- Anxiety: The risk was 35% higher in the COVID-19 group.
- Depression: 39% higher risk.
- Sleep disorders: 41% higher risk
- Opioid use: 76% higher risk.
- Opioid use disorder: 34% higher risk
- Non-opioid use disorder: 20% higher risk.
The authors note that given the large number of patients with COVID-19, these findings could translate into huge implications in the United States and around the world.
In the study, published in BMJ, the researchers analyzed medical records from a database in the Department of Veterans Affairs, the largest integrated health care system in the United States. The analysis included nearly 154,000 patients who tested positive for COVID-19 within a defined time frame from March 2020 to January 2021. (This time frame predates delta and omicron variants, as well as the widespread availability of vaccines.)
Using sophisticated statistical methods, the researchers compared the health information of these patients with data from more than 11 million people who had not had COVID-19 — about half of which came from the same time period and the other half from the pre-pandemic period.
Al-Aly emphasizes: "One advantage of our research is the large number of patients and the ability to leverage the breadth and depth of veterans' electronic health record systems. As a pioneer in the use of electronic health records, vas can provide answers to questions in a number of areas, including pandemics, that are difficult for others to solve. ”
Al-Aly also owes a debt of gratitude to his multidisciplinary research team, which makes rigorous analysis possible. Al-Aly said: "We have brought together public health experts from various disciplines and successfully combined medical and research perspectives. Evan Xu of the St. Louis Veterans Association co-authored the BMJ article with Al-Aly and Xie Yan.
The team hopes their study and other group's research will encourage individuals, health care systems, and policymakers to remain vigilant about the virus.
The researchers say the best defense against long-term COVID is to avoid getting COVID-19 in the first place. This means taking steps such as vaccinating and boosting immunity, wearing high-quality masks, and washing hands regularly. For those who are infected and develop mental health disorders, Xie Yan said: "We hope that our results will make it easier for them and their healthcare providers to identify these conditions and start treatment." ”
From a broader public policy perspective, Al-Aly urges a swift and forceful response to support the millions of people who may face the serious mental health challenges caused by COVID-19. "There is no doubt that the Department of Veterans Affairs will care for our patients, and the health care system and governments around the world must also be prepared." It is very important to address these issues now, lest they become a bigger crisis in the future. ”
Al-Aly said he and his colleagues will continue to study long-course COVID. "As a physician and fellow himself, working with a group of full-time fellows, we will continue to use our expertise to answer questions of concern to the public, including veterans and veterans' organizations."
Al-Aly's ongoing research includes a study of the link between long-term COVID and diabetes. "By raising awareness of the range of health complications faced by 'long-distance travellers', we can work to nip this long-course COVID crisis in the bud and prevent it from swelling into a larger public health dilemma," he said. ”