European studies shed light on long COVID risk and recovery

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Center for Infectious Disease Research and Policy

Mary Van Beusekom | News Writer | CIDRAP News. (April 27, 2022)

A trio of new observational studies from Europe describes long COVID prevalence in Luxembourg, the effect of initial infection severity on risk in Sweden, and an occupational therapy program to ease symptoms in Ireland. The research was presented at the annual congress of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) in Portugal, which ended yesterday.

Symptoms lasting 15 weeks likely to persist

Researchers from the Luxembourg Institute of Health surveyed 289 people about whether they had any of 64 common long COVID symptoms 1 year after they tested positive. Patients were also asked about their sleep quality and the effect of respiratory symptoms such as shortness of breath on quality of life. Average patient age was 40.2 years, and 50.2% were women.

The researchers found that 6 in 10 patients (59.5%) had at least one COVID-19 symptom, and that symptoms that don’t resolve by 15 weeks are likely to persist for at least a year. One in seven participants (14.2%) indicated that they couldn’t fathom coping with their symptoms long term. The most common symptoms were fatigue, shortness of breath, and irritability.

One-third (34.3%) still had fatigue, while 12.9% said respiratory symptoms were affecting their quality of life, and 54.2% still had sleep issues. Patients who had moderate or severe infections were twice as likely as those with asymptomatic cases to report symptoms, with 63.8% versus 38.6% still having poor sleep quality.

“Participants with a mild form of the acute illness were more likely than those who’d been asymptomatic to have at least one symptom at one year, and to have sleep problems, but to a lesser extent than those with a moderate or severe acute illness,” lead author Aurelie Fischer, a PhD student, said in an ESCMID news release.

The results also showed that some symptoms tend to cluster together, suggesting that there are different subtypes of long COVID. “Long Covid can still have a large impact on quality of life, even a year after the acute infection,” Fischer said. “This work will help raise awareness of the needs of people with long Covid and contribute to the development of health strategies to help them.”

ICU patients most likely to have long COVID

In Sweden, Karolinska Institutet modeled associations between severity of COVID-19 infection, underlying medical conditions, previous healthcare usage, sociodemographic factors, and long COVID in 205,241 adults in Stockholm. Participants had tested positive for COVID-19 90 to 360 days before, from Mar 1, 2020, to Jul 31, 2021.

Of the 205,241 COVID-19 patients, 32% of those who had been admitted to an intensive care unit (ICU) developed long COVID, as did 6% of hospitalized participants and 1% of outpatients.

The most common symptom among outpatients was fatigue (26%), while shortness of breath was most common in both hospitalized and ICU patients (23% and 39%, respectively). Among patients with mild infections, women were more than twice as likely as men to develop long COVID. A similar link with female sex was identified in hospitalized patients but not those treated in an ICU.

Also among participants with mild illness, a history of mental illness or asthma was tied to twice the risk of developing long COVID. This link was weaker among hospitalized patients and wasn’t observed in ICU patients. A history of outpatient primary care visits was strongly associated with long COVID in those with mild illness but not in hospitalized or ICU patients.

Outpatient visits in the previous 10 to 12 months were much more common after, rather than before, infection, which the study authors said indicated persistence of symptoms well beyond the initial diagnosis.

“Our findings reveal different associations between age, sex, comorbidities, symptoms, and healthcare use in people with more severe and milder forms of disease, which indicates different clinical trajectories and characteristics of long COVID,” lead author Pontus Hedberg, MD, said in an ESCMID press release. “Future research should focus on better understanding the persistence of this debilitating condition across different groups of individuals.”

The authors acknowledged not being able to evaluate the impact of vaccination or the Omicron variant on long COVID.

Occupational therapy program helped patients cope

Researchers at St. James’s Hospital and Trinity College in Dublin conducted a pilot occupational therapy program involving 53 COVID-19 patients who reported fatigue that interfered with their ability to participate in daily activities such as personal care, climbing stairs, work, and leisure pursuits. Of the patients, 73% were women. The median age was 51 years.

“We became concerned after seeing increasing numbers of patients who were having difficulty carrying out everyday activities because of fatigue,” lead author Louise Norris, a senior occupational therapist at the hospital, said in an ESCMID news release. “We’ve previously helped those with other conditions, such as multiple sclerosis and rheumatoid arthritis, learn techniques to manage their fatigue and felt we could use that experience to address the needs of those with long-term fatigue post COVID.”

Sixty-eight percent of the 53 participants reported COVID-19 symptoms 12 weeks to 1 year after diagnosis, and 25% said they still had symptoms after 1 year. Ninety-eight percent of long COVID patients reported moderate to severe fatigue, while 72% reported moderate to severe shortness of breath, and half had problems with concentration and memory (brain fog).

Among all participants, 74% reported moderate to severe problems trying to return to work, 64% said they had difficulty engaging in leisure activities, and 58% reported that they struggled with everyday activities such as making meals, driving, or going for a walk.

In the ongoing pilot program, patients participated in three 1.5-hour online group interventions with an occupational therapist for 4 weeks. The sessions focused on self-management techniques to ameliorate fatigue and brain fog, with education on energy planning, stress reduction, and good sleep practices.

The therapist taught participants how to determine their body’s and brain’s limits so they could rest before reaching the point of exhaustion. Patients completed questionnaires before the study and 2 weeks after the last session about fatigue, energy levels, quality of life, and concerns about well-being.

A preliminary analysis of the questionnaire results revealed significant improvements in fatigue, quality of life, and concerns about wellbeing. “Initial results from our pilot programme are highly promising,” Norris said. “They show equipping patients with a range of practical techniques can result in meaningful improvements in fatigue and quality of life. Patients also have fewer concerns about their wellbeing.”

She said that the need is urgent for new and better ways of managing long COVID fatigue and its “wide-ranging, and in some cases, devastating, effects on people’s lives.”