More than 2 million adults in England probably experienced persistent symptoms of so-called Long Covid, according to the large REACT-2 study, reports MedicalBrief.
Researchers from Imperial College London released findings stemming from more than half a million people in England who participated in several rounds of the Real-Time Assessment of Community Transmission-2 (REACT-2) study, which invited random samples of adults to take surveys from September to February.
“Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly defined syndrome. There is uncertainty about its predisposing factors and the extent of the resultant public health burden, with estimates of prevalence and duration varying widely,” write the authors .
The survey, funded by the Department of Health and Social Care in England, compiled data on demographics, suspected COVID-19, viral tests, underlying health conditions, COVID-19 symptoms and severity, and duration of some 29 listed symptoms.
Nearly 20% of respondents self-reported COVID-19, according to a weighted prevalence, and 37.7% of some 76,100 people reported experiencing one or more persistent symptoms, with about 15% reporting three or more symptoms lasting for over 12 weeks.
“Estimates [of weighted population prevalence] ranged from 5.8% of the population experiencing one or more persistent symptoms post-COVID-19 (corresponding to more than 2 million adults in England), to 2.2% for three or more persistent symptoms (just under a million adults in England), and 1.7% with one or more symptoms lasting at least 12 weeks in people who reported severe COVID-19 symptoms affecting their daily life at the time of their illness,” the authors wrote.
The study found the risk of persistent symptoms was higher among women and increased with age. Additional risk factors included obesity, smoking, vaping and hospitalisation for COVID-19. Low income was also tied to a higher proportion of long COVID cases, or 51% versus 28.7% for respondents with high income.
Some of the most common persistent symptoms included tiredness (co-occurring with muscle aches and sleep issues) and respiratory-related symptoms, like shortness of breath and chest pain. “Clinicians need to be aware of the differing manifestations of long COVID which may require tailored therapeutic approaches.”
Researchers attributed a “comparatively high estimate"”of people affected with long COVID to the many symptoms under study, some of which are non-specific to COVID and occur frequently. The survey asked “only about symptoms that related to a confirmed or suspected episode of COVID-19, and not to symptoms more generally”, and a further sensitivity analysis limited symptoms to 15 associated with a positive COVID-19 test, like loss of smell or taste, tiredness and shortness of breath.
“We have identified significant ongoing morbidity among people post COVID-19, with a substantial proportion experiencing persistent symptoms lasting 12 weeks or more. Managing the long term sequelae of SARS-CoV-2 infection in the population will remain a major challenge for health services in the next stage of the pandemic,” the authors concluded.
Study details
Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people
Authors: M Whitaker, J Elliott, M Chadeau-Hyam, S Riley, A Darzi, G Cooke, H Ward, P Elliott
Published on Imperial College London site
Abstract
Introduction
Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly defined syndrome. There is uncertainty about its predisposing factors and the extent of the resultant public health burden, with estimates of prevalence and duration varying widely.
Methods
Within rounds 3–5 of the REACT-2 study, 508,707 people in the community in England were asked about a prior history of COVID-19 and the presence and duration of 29 different symptoms. We used uni- and multivariable models to identify predictors of persistence of symptoms (12 weeks or more). We estimated the prevalence of symptom persistence at 12 weeks, and used unsupervised learning to cluster individuals by symptoms experienced.
Results
Among the 508,707 participants, the weighted prevalence of self-reported COVID-19 was 19.2% (95% CI: 19.1,19.3). 37.7% of 76,155 symptomatic people post COVID-19 experienced at least one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more. This gives a weighted population prevalence of persistent symptoms of 5.75% (5.68, 5.81) for one and 2.22% (2.1, 2.26) for three or more symptoms. Almost a third of people 8,771/28,713 (30.5%) with at least one symptom lasting 12 weeks or more reported having had severe COVID-19 symptoms (“significant effect on my daily life”) at the time of their illness, giving a weighted prevalence overall for this group of 1.72% (1.69,1.76). The prevalence of persistent symptoms was higher in women than men (OR: 1.51 [1.46,1.55]) and, conditional on reporting symptoms, risk of persistent symptoms increased linearly with age by 3.5 percentage points per decade of
life. Obesity, smoking or vaping, hospitalisation , and deprivation were also associated with a higher probability of persistent symptoms, while Asian ethnicity was associated with a lower probability. Two stable clusters were identified based on symptoms that persisted for 12 weeks or more: in the largest cluster tiredness predominated, while in the second there was a high prevalence of respiratory and related symptoms.
Interpretation
A substantial proportion of people with symptomatic COVID-19 go on to have persistent symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the differing manifestations of Long COVID which may require tailored therapeutic approaches. Managing the long-term sequelae of SARS-CoV-2 infection in the population will remain a major challenge for health services in the next stage of the pandemic.
Full REACT-2 study (Open access)
See also from the MedicalBrief archives:
Vaccination may ease Long COVID patients — Small Bristol study
Long COVID may cause multiple-organ damage even in low risk patients — Coverscan Study
Long-haul COVID-19 associated with white, female, middle age — UK hospital study