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Long COVID is ‘exaggerated’ and ‘overblown’

Despite a number of studies pointing to the persistence of COVID symptoms in large numbers of those who have recovered from the infection, another of medical scientists believe that the problem of long-COVID is “exaggerated” and “overblown”.

Last week an Oxford University study suggested that more a third of people infected with coronavirus will suffer at least one persisting symptom for three months or longer, such as fatigue, pain, depression, and problems with breathing and digestion. The researchers, in the journal PLoS One, also compared COVID-19ʼs power to cause lasting post-viral symptoms with another lethal virus foe: influenza. They estimate that post-viral symptoms are around 50% more common after COVID-19 than after flu.

Earlier this month, investigators at University College London and Public Health England reported in a yet-to-be published study (called the CLoCk study) that one in seven children with COVID is still suffering three months later. The most common symptoms include unusual tiredness and headaches.

The latest long COVID estimates from the Office for National Statistics suggest that about 31,000 youngsters in the 11-17 age group already have the condition.

Such statistics augur widespread ill for countless thousands whose debilitating problems may persist for months or years, or perhaps never resolve.

But, says The Telegraph, not everyone agrees. Sir John Bell, the regius professor of medicine at Oxford University who helped to drive the AstraZeneca vaccineʼs development, has declared that the impact of long COVID is actually “overblown”.

“The incidence [of long COVID] is much, much lower than people had anticipated,” he said last month. He argues that many people who think they have long COVID are actually suffering from other conditions that share “the long list” of symptoms.

How can expert beliefs differ so wildly? Blame the nature of science. Much about COVID-19 still remains a mystery. Scientists may have developed vaccines in record-shattering time, but research on long COVID is proceeding at medicineʼs more usual cautious pace.

Dr Janet Scott, a clinical lecturer in infectious diseases at the Medical Research Council-Glasgow University Centre for Virus Research, suggests that we may be seeing exaggerated numbers on long COVID sufferers because proper full-strength, large-scale research is yet to be completed.

“I would not be at all surprised if we see the numbers go down once the
large studies finally report in six to 12 months. At the moment we only have small-scale studies that, because of data quirks, can produce higher numbers than they should,” says Scott, who is involved in Glasgow Universityʼs COVID in Scotland study, which is tracking tens of thousands of patients.

“Furthermore, studies that use social media reports from individuals are not the best place to get data,” she says. The danger here is that numbers get inflated because social media surveys rely on data from a self-electing group of people who are probably keener than average to report symptoms.

Also, she adds, months of lockdown may have left many feeling severely fatigued and depressed regardless of infection: “It would not be surprising if some people who never actually contracted the infection report long COVID type symptoms because living through 2020 was a very rough experience.”

Nevertheless, Scott says significant numbers of people may still be facing mysterious new COVID-related post-viral sicknesses that might dog them for years.

Scott was studying post-Ebola syndrome before COVID emerged. “Most viral illnesses have some sequelae. They all have their similarities but they all have their differences,” she explains.

“Often this involves pain and fatigue. In Ebola, for example, the post-viral symptoms seem far more about pain than fatigue. The dominant feature of post-COVID is fatigue. That is coming out in all the studies as the top symptom. Does this mean that long COVID is caused in a specific new way? The jury is still out.”

One possibility, she says, is that in some long COVID cases the virus persists in the body. However, long COVID might instead be an autoimmune condition caused by the bodyʼs defences continuously reacting to the now-banished infection, she adds.

The Telegraph reports that this leaves medics in a quandary. If long COVID is caused by the virus persisting in the body, it might be treated with a vaccine jab. But if itʼs an autoimmune condition, then giving a vaccine could worsen symptoms by further stimulating the immune system. Instead, treatment might involve immune-dampening drugs, as are given for arthritis.

“Autoimmune problems might be more likely because we are seeing young women being affected most by long COVID, and they are statistically significantly more likely to suffer autoimmune diseases,” says Scott.

Both theories (and more) might be true, she admits. “The causes of long COVID may be different for different patients. So many people have been infected and long COVID sufferers report so many differing symptoms.. With every new phenomenon the first scientific step is to characterise it. Only after you understand it can you treat it. Iʼm afraid the big answers are still a way down the road.”

One certainty that has already been established, she adds, is that long COVID hits younger people rather than the elderly. Among them long COVID is showing baffling new signs.

Esther Crawley, professor of child health at the University of Bristol, set up a rapid-access long COVID clinic for children suffering from fatigue two months ago. She says significant numbers are showing unprecedented problems.

“Many have similar symptoms to those whoʼve suffered post-viral fatigue after other infections such as flu. But at least 10% have variations we have not seen before,” she says, “like persistently raised temperature. Breathlessness is another new symptom. Colleagues say they are seeing more gastro- intestinal problems as well, and more neurological symptoms.

“What we are looking at may, in fact, be three to five different illnesses. They all feature fatigue but are accompanied by different clusters of symptoms that indicate different underlying biologies.”

Dr Michael Absoud, a reader in the Department of Women & Childrenʼs Health at Kingʼs College London, says a striking finding from the CLoCk study is that children who had contracted COVID had the same levels of fatigue scores as children who had tested negative for the virus.

As well as fatigue, both groups shared another thing in common, high levels of emotional symptoms, with 40% saying they felt worried, sad or unhappy, regardless of whether they had been infected or not.

“Last year had a serious impact on all children,” says Absoud. “That could explain the fatigue and emotional problems.” He argues that health services should now prioritise treating this wave of tiredness and anxiety with medical and psychological support, “regardless of whether itʼs long COVID or not”.

Crawley does not believe, in children at least, that long COVID symptoms are the psychosomatic results of lockdown disruption and anxiety.

“The figures show that 30%-40% of young people with long COVID have anxiety or depression or another psychological problem. But 60% of them have nothing like that whatsoever,” she says. “Most of those with anxiety or depression develop it after they get sick. Itʼs understandable that children who get sick may become depressed and anxious. We have not found any evidence that anxiety or depression predict post-infectious fatigue (such as ME or chronic-fatigue syndrome) in children or young people.”

Stopping long-COVID in the first place with double-vaccination may be the best preventive tactic, a new study of children in England who had COVID-19 led by Queen Mary, University of London said last week.

The report in the Journal of the Royal Society of Medicine estimates that giving children both jabs would avert up to 56,000 long-COVID cases in 12- to 17-year-olds.

Children as young as 12 in the UK are now eligible for their first dose of the Pfizer/BioNTech COVID-19 vaccine. However, vaccination experts are yet to advise if and when children should get the full course of two jabs.

Beyond vaccination, Absoud says that new persistent-symptom support services need to be set up in local areas, particularly for youngsters, adds The Telegraph.

“We need to provide help for post-COVID problems regardless of their underlying cause. We especially need intervention in schools. We want to still be coming to school, not having to go long distances to regional hubs for support.”

Even if fatigue, pain and depression arenʼt the result of long COVID, he says: “Clinics need to identify the primary problem stopping people from living normally, and address it.”

Indeed, whether itʼs long COVID or non-COVID, current data suggest a post-pandemic wave of long-term debilitating symptoms may now threaten to swamp us.

 

Study details

Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19

Maxime Taquet, Quentin Dercon, Sierra Luciano, John R. Geddes, Masud Husain, Paul J. Harrison

Published in PLOS Medicine on 28 September 2021

Abstract

Background
Long-COVID refers to a variety of symptoms affecting different organs reported by people following Coronavirus Disease 2019 (COVID-19) infection. To date, there have been no robust estimates of the incidence and co-occurrence of long-COVID features, their relationship to age, sex, or severity of infection, and the extent to which they are specific to COVID-19. The aim of this study is to address these issues.

Methods and findings
We conducted a retrospective cohort study based on linked electronic health records (EHRs) data from 81 million patients including 273,618 COVID-19 survivors. The incidence and co-occurrence within 6 months and in the 3 to 6 months after COVID-19 diagnosis were calculated for 9 core features of long-COVID (breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression). Their co-occurrence network was also analyzed. Comparison with a propensity score–matched cohort of patients diagnosed with influenza during the same time period was achieved using Kaplan–Meier analysis and the Cox proportional hazard model. The incidence of atopic dermatitis was used as a negative control.

Among COVID-19 survivors (mean [SD] age: 46.3 [19.8], 55.6% female), 57.00% had one or more long-COVID feature recorded during the whole 6-month period (i.e., including the acute phase), and 36.55% between 3 and 6 months. The incidence of each feature was: abnormal breathing (18.71% in the 1- to 180-day period; 7.94% in the 90- to180-day period), fatigue/malaise (12.82%; 5.87%), chest/throat pain (12.60%; 5.71%), headache (8.67%; 4.63%), other pain (11.60%; 7.19%), abdominal symptoms (15.58%; 8.29%), myalgia (3.24%; 1.54%), cognitive symptoms (7.88%; 3.95%), and anxiety/depression (22.82%; 15.49%). All 9 features were more frequently reported after COVID-19 than after influenza (with an overall excess incidence of 16.60% and hazard ratios between 1.44 and 2.04, all p < 0.001), co-occurred more commonly, and formed a more interconnected network. Significant differences in incidence and co-occurrence were associated with sex, age, and illness severity.

Besides the limitations inherent to EHR data, limitations of this study include that (i) the findings do not generalise to patients who have had COVID-19 but were not diagnosed, nor to patients who do not seek or receive medical attention when experiencing symptoms of long-COVID; (ii) the findings say nothing about the persistence of the clinical features; and (iii) the difference between cohorts might be affected by one cohort seeking or receiving more medical attention for their symptoms.

Conclusions
Long-COVID clinical features occurred and co-occurred frequently and showed some specificity to COVID-19, though they were also observed after influenza. Different long-COVID clinical profiles were observed based on demographics and illness severity.

Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis

Deepti Gurdasani, Samir Bhatt, Anthony Costello, Spiros Denaxas, Seth Flaxman, Trisha Greenhalgh, Stephen Griffin, Zoë Hyde, Aris Katzourakis, Martin McKee, Susan Michie , Oliver Ratmann, Stephen Reicher, Gabriel Scally, Christopher Tomlinson, Christian Yates, Hisham Ziauddeen, Christina Pagel

Currently in publication in Royal Society of Medicine Journal

Abstract

Objective
To offer a quantitative risk-benefit analysis of 2 doses of SARS-CoV-2 vaccination among adolescents in England.

Design
Following the risk-benefit analysis methodology carried out by the US Centres for Disease Control (CDC), we calculated historical rates of hospital admission, ICU admission and death for ascertained SARS-CoV-2 cases in children aged 12-17 in England. We then used these rates alongside a range of estimates for incidence of Long COVID, vaccine efficacy and vaccine-induce myocarditis, to estimate hospital and ICU admissions, deaths and cases of Long Covid over a period of 16 weeks under assumptions of high and low case incidence.

Participants
All 12-17 year olds with a record of confirmed SARS-CoV-2 infection in England between 1st July 2020 and 31st March 2021 using national linked electronic health records, accessed through the British Heart Foundation Data Science Centre.

Main outcome measures
Hospitalisations, ICU admissions, deaths and cases of Long COVID averted by vaccinating all 12-17 year olds in England over a 16 week period under different estimates of future case incidence.

Results
At high future case incidence of 1000/100,000 population/week over 16 weeks, vaccination could avert 4,430 hospital admissions and 36 deaths over 16 weeks. At the low incidence of 50/100,000/week, vaccination could avert 70 hospital admissions and 2 deaths over 16 weeks. The benefit of vaccination in terms of hospitalisations in adolescents outweighs risks unless case rates are sustainably very low (below 30/100,000 teenagers/week). Benefit of vaccination exists at any case rate for the outcomes of death and long COVID, since neither have been associated with vaccination to date.

Conclusions
Conclusions Given the current (as at 15 September 2021) high case rates (680/100,000 population/week in 10-19 year olds) in England, our findings support vaccination of adolescents against SARS-CoV2.

 

The Telegraph article – Is long Covid being overblown? (Restricted access)

 

PLOS Journal article – Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19 (Open access)

 

Royal Society of Medicine Journal final unedited document – Vaccinating adolescents against SARS-CoV-2 in England: a risk-benefit analysis (Open access)

 

See more from MedicalBrief archives:

 

Long COVID less common than previously estimated — UK National Statistics

 

Doctors are ambivalent about the looming catastrophe of ‘long COVID’

 

Long COVID-19 may have affected 2m in England – REACT-2

 

Long COVID: More than a quarter of patients still symptomatic after six months — Swiss study

 

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