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Long COVID Outcomes at 1 Year After Mild SARS-CoV-2 Infection
To determine the clinical sequelae of long covid for a year after infection in patients with mild disease and to evaluate its association with age, sex, SARS-CoV-2 variants, and vaccination status.
Retrospective nationwide cohort study.
Electronic medical records from an Israeli nationwide healthcare organisation.
1 913 234 Maccabi Healthcare Services members of all ages who did a polymerase chain reaction test for SARS-CoV-2 between 1 March 2020 and 1 October 2021.
MAIN OUTCOME MEASURES
Risk of an evidence based list of 70 reported long covid outcomes in unvaccinated patients infected with SARS-CoV-2 matched to uninfected people, adjusted for age and sex and stratified by SARS-CoV-2 variants, and risk in patients with a breakthrough SARS-CoV-2 infection compared with unvaccinated infected controls. Risks were compared using hazard ratios and risk differences per 10 000 patients measured during the early (30-180 days) and late (180-360 days) time periods after infection.
Covid-19 infection was significantly associated with increased risks in early and late periods for anosmia and dysgeusia (hazard ratio 4.59 (95% confidence interval 3.63 to 5.80), risk difference 19.6 (95% confidence interval 16.9 to 22.4) in early period; 2.96 (2.29 to 3.82), 11.0 (8.5 to 13.6) in late period), cognitive impairment (1.85 (1.58 to 2.17), 12.8, (9.6 to 16.1); 1.69 (1.45 to 1.96), 13.3 (9.4 to 17.3)), dyspnoea (1.79 (1.68 to 1.90), 85.7 (76.9 to 94.5); 1.30 (1.22 to 1.38), 35.4 (26.3 to 44.6)), weakness (1.78 (1.69 to 1.88), 108.5, 98.4 to 118.6; 1.30 (1.22 to 1.37), 50.2 (39.4 to 61.1)), and palpitations (1.49 (1.35 to 1.64), 22.1 (16.8 to 27.4); 1.16 (1.05 to 1.27), 8.3 (2.4 to 14.1)) and with significant but lower excess risk for streptococcal tonsillitis and dizziness. Hair loss, chest pain, cough, myalgia, and respiratory disorders were significantly increased only during the early phase. Male and female patients showed minor differences, and children had fewer outcomes than adults during the early phase of covid-19, which mostly resolved in the late period. Findings remained consistent across SARS-CoV-2 variants. Vaccinated patients with a breakthrough SARS-CoV-2 infection had a lower risk for dyspnoea and similar risk for other outcomes compared with unvaccinated infected patients.
This nationwide study suggests that patients with mild covid-19 are at risk for a small number of health outcomes, most of which are resolved within a year from diagnosis.
Disclosure statements are available on the authors' profiles:
Long covid outcomes at one year after mild SARS-CoV-2 infection: nationwide cohort studyBMJ 2023 Jan 11;380(xx)e072529, B Mizrahi, T Sudry, N Flaks-Manov, Y Yehezkelli, N Kalkstein, P Akiva, A Ekka-Zohar, SS Ben David, U Lerner, M Bivas-Benita, S Greenfeld
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
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Long COVID following mild infection
Long COVID is a relative term, given that the first COVID-19 case in the United States occurred only 3 years ago. As our experiences with and understanding of SARS-CoV-2 infection have evolved, so too have our approaches to the persisting constellations of symptoms known as long COVID. The passage of time and the huge numbers of accumulated cases across wide swaths of demographic and severity categories are now allowing more refined evaluations of SARS-CoV-2-related syndromes, such as long COVID.
This extensive study compared unvaccinated SARS-CoV-2–infected individuals, vaccinated infected individuals, and uninfected individuals for the presence of 70 separate long COVID outcomes in “early” (30–180 days after infection) and “late” (181–360 days) time intervals. As hospitalized patients were excluded, the included cases were considered “mild” infections. Key findings — expressed as hazard ratios comparing infected with matched control cases — are presented as short- and long-term outcomes.
Short-term outcomes (found only in the first period through 180 days):
Outcomes lasting at least 1 year with most declining through time:
Other interesting findings included a minimal difference between males and females, reduced symptoms for children; similar outcomes across wild-type, alpha, and delta variants; and reduced likelihood for shortness of breath in breakthrough (vaccinated) cases.
Overall, we are presented with some reassuring results here. First, the overall burden of long COVID outcomes was relatively low for people with mild (nonhospitalized) infections. Second, most of the long COVID symptoms — if present — declined over time. Finally, vaccination (despite breakthrough infection) reduced prolonged shortness of breath. We will continue to learn more regarding the risks, trajectories, and consequences of long COVID in the months and years to come. For now, keep in mind that vaccination can prevent infection, and even when a breakthrough infection occurs, it is milder. Both of these situations are associated with fewer long-term outcomes.