Post-COVID syndrome or Long COVID will be the next major health challenge facing the world.
When most people's eyes are focused on the current confirmed cases and deaths, using these indicators to measure the impact of COVID-19 on human health, focusing on preventing infections and deaths (which is indeed a matter of 100,000 urgent matters), and arguing over the economic losses caused by lockdown policies, are we ignoring the long-term impact of COVID-19 on our entire group?
According to the WHO definition of sequelae of COVID-19: a series of symptoms that appear 3 months or more after the possible or confirmed COVID-19 infection, lasting at least 2 months, cannot be explained by other diagnoses, have an impact on daily functioning, and may fluctuate or recur over time.
Healthy people may be asymptomatic after COVID-19 infection or recover within months of developing symptoms, but may also develop into long-term COVID-19; others have an increased risk of stroke and diabetes after infection; and people who receive weeks of treatment in intensive care units may have difficulty returning to their previous healthy state with damage to their brain, heart, or lungs.
The impact of COVID-19 infection on people of different ages, in young people, it reduces the quality of life, infected people may return to health after a few months, may also live in weakness for a long time, severe COVID-19 can even lead to shortened life expectancy, and the elderly die early.
Recently, a study by Imperial College London surveyed more than 600,000 UK community populations by random sampling to calculate the prevalence of COVID-19 sequelae in the population and the mainstream sequelae symptoms, and to assess the risk factors that lead to sequelae, hoping to provide clinicians and the public with more information. The study was published April 12 in Nature Communications.
The study's sample data came from react-2, a national COVID-19 antibody serologic prevalence survey in the UK, with rounds 3-5 (covering 508707 people, time span September 2020 to February 2021) as the main analysis cohort, and round 6 samples (covering 97,727 people, May 2021) as the repeating cohort.
The Real-time Assessment of Community Transmission Programme-2 (REACT-2) aims to assess the cumulative community seropositivity of SARS-CoV-2 IgG antibodies in the UK, the purpose of the seroepidemiological survey is to detect the level of antibodies to the new crown virus in the serum and understand the previous infection status of the new crown virus in the population, while the purpose of the large-scale nucleic acid screening in the population (REACT-1) is to use the PCR method to detect the nucleic acid fragment of the new crown virus and search for existing infected people.
Of the 92,116 COVID-19 antibody-positive patients in the main assay cohort, 37.7% still had more than 1 symptom after the 12th week of the first symptom onset, while 17.5% still had more than 3 symptoms. In the entire UK population, it is equivalent to 5.8% (more than 2 million people) of adults in the UK experiencing more than 1 COVID-19 sequelae and 2.2% (around 1 million) of adults experiencing more than 3 COVID-19 sequelae from September to February 2020.
Note: Changes in THE SEQUELA OF COVID-19 over time: Symptoms decrease rapidly in week 4, a small inflection point at week 12, after which the rate of reduction slows down, and some people have symptoms that last for half a year or more
In the repeat cohort, 21.6% of COVID-19 antibody-positive people reported that they still had more than 1 symptom 12 weeks after the first symptoms appeared, and 11.9% had more than 3 symptoms, that is, 3.1% and 1.6% of adults in the UK in May 2021 were experiencing 1 or 3 more sequelae of COVID-19.
The explanation given by the researchers for the reasons for the discrepancies between the main analysis cohort and the repeating cohort is that the variety of these symptoms, some of which are more common in everyday life, coupled with the participants' recollection biases and the impact of the lockdown policy on participants' self-perception, contributed to differences in the reporting of COVID-19 sequelae between the two cohorts.
Nonetheless, only about 3% of people who are not infected with COVID-19 report that they have had symptoms that last more than 11 days, which means that at week 12, some symptoms of COVID-19 sequelae will appear up to 3% of uninfected COVID-19 populations, while among those infected with COVID-19, this proportion can reach 37.7%, which is about 10 times that of the former, indicating that these sequelae are real and significant in people infected with COVID-19. (Data from people who are not infected with COVID-1 come from nucleic acid test-negative samples in REACT-1.)
Next, the researchers tried to use cluster analysis methods to find the mainstream COVID-19 sequelae present in the population, and the results showed:
There were two broad groups of COVID-19 sequelae in the main analysis cohort, with cluster 1 (Cluster L1, n=15799) having the main symptoms being exhaustion, accompanied by muscle soreness, difficulty sleeping, and shortness of breath. Population 2 (Cluster L2, n=4441) is dominated by respiratory symptoms, manifested by shortness of breath, chest tightness, and chest pain.
Notably, compared with Cluster 1, participants in Group 2 had a higher rate of severe symptoms in the acute phase of COVID-1 (Cluster L2 43.5% vs. Cluster L1 27.4%), and the hospitalization rate was even about 3 times that of the former (Cluster L2 2.9% vs. Cluster L1 1.1%).
Finally, the researchers also analyzed the impact of various factors on the risk of covid-19 sequelae, including age, sex, BMI, smoking, hospitalization, income, whether or not to work in the medical industry, race, etc.
The results showed that women, increasing age, overweight and obesity, smoking or e-cigarettes, hospitalization due to COVID-19, and medical work were all associated with an increased risk of COVID-19 sequelae.
The risk of more than 1 sequelae in women is 1.38 times that of men, and age is also the main risk factor for covid-19 sequelae, with age, the probability of sequelae of covid-19 increases linearly, and the risk of post-sequelae of COVID-19 in women of all ages is 8 percentage points higher than that of men.
People hospitalized for COVID-19 have a 3.45-fold higher risk of COVID-19 sequelae than non-hospitalized patients, although surprisingly, Asian-Americans have a 16% lower risk of COVID-19 sequelae than Caucasians (OR: 0.84 [0.74, 0.96]).
Overall, through this nationwide large-scale community study of COVID-18 sequelae in the UK, the proportion of COVID-19 sequelae among UK adults over a certain period of time is known, and according to this ratio, it can be seen that the number of people with COVID-19 sequelae in the UK is very large.
Older people, women, and economically disadvantaged people face a greater risk of COVID-19 sequelae, and the access and treatment of these populations will be a major challenge for the health service system, and if there are many people in this society who have been in a sub-healthy state of COVID-19 sequelae for a long time, how can we maintain normal production and life.
We must also take into account the lasting health impact when measuring the damage caused by COVID-19, otherwise we can only see, understand and respond to the problems of the present, ignoring the difficulties we face in the future.
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[2] Ward, H., Flower, B., Garcia, P. J., Ong, S., Altmann, D. M., Delaney, B., Smith, N., Elliott, P., & Cooke, G. (2021). Global surveillance, research, and collaboration needed to improve understanding and management of long COVID. Lancet (London, England), 398(10316), 2057–2059. https://doi.org/10.1016/S0140-6736(21)02444-2
[4] Riley, S., Atchison, C., Ashby, D., Donnelly, C. A., Barclay, W., Cooke, G. S., Ward, H., Darzi, A., Elliott, P., & REACT study group (2021). REal-time Assessment of Community Transmission (REACT) of SARS-CoV-2 virus: Study protocol. Wellcome Open Research, 5, 200. https://doi.org/10.12688/wellcomeopenres.16228.2
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