The majority of long-lasting Covid symptoms disappear within the first year after infection for people with mild cases of Covid-19, according to a large study conducted in Israel.
“Mild disease does not lead to serious or chronic long-term morbidity in the vast majority of patients,” study co-author Barak Mizrahi, a senior researcher at the Research Institute, said in an email. KI in Kfar Malal.
The study, published in the journal The BMJ on Wednesday, compared thousands of vaccinated and unvaccinated people with mild Covid symptoms who were not hospitalized with people who tested negative for the virus. Long Covid was defined as symptoms that persist or appear more than four weeks after an initial infection with Covid-19.
“I think this study is reassuring in that most ongoing symptoms after COVID improve within the first few months after acute infection,” said Dr. Benjamin Abramoff, director of the Penn Medicine Post-COVID Assessment. and Recovery Clinic, via email. He did not participate in the study.
But not for everyone. Abramoff said his clinic continues to see many patients with long, severe Covid symptoms that last more than a year after they were infected.
“This is especially true in people who had severe persistent symptoms soon after their acute infection,” said Abramoff, who leads the long-running Covid Collaboration at the American Academy of Physical Medicine and Rehabilitation.
Dr. Jonathan Whiteson, associate professor of rehabilitation medicine at NYU Grossman School of Medicine, sees the same thing in his clinic.
“I continue to see many COVID ‘first wave’ patients who had mild to moderate acute COVID (and were never hospitalized) who have persistent and significant functional symptoms almost 3 years later,” said Whiteson said via email. He did not participate in the study.
Israeli researchers analyzed the medical records of nearly 300,000 people diagnosed with mild cases of Covid-19 and compared their health status over the following year with around 300,000 people who did not have Covid. The average age of those who tested positive for Covid was 25 and 51% were female.
The researchers looked for 65 conditions that have been associated with long Covid and divided them into two time periods: early, or the first 30 to 180 days after catching Covid; and late, 180 to 360 days after infection.
After controlling for age, gender, alcohol and tobacco use, pre-existing conditions and different variants of Covid-19, researchers found a significant risk of brain fog, loss of smell and taste , breathing problems, dizziness and weakness, heart palpitations and strep throat at the beginning and end of periods.
According to the researchers, chest pain, cough, hair loss, muscle and joint pain, and breathing problems only increased significantly during the early phase.
Difficulty breathing was the most common complaint, according to the study. According to the study, being vaccinated reduced the risk of respiratory problems, but the researchers found that vaccinated people had a “similar risk for other outcomes compared to unvaccinated infected patients”.
“Due to the size of the study, it was possible to examine changes in symptom prevalence over time and the effects of other factors on persistent symptoms,” said Dr Peter Openshaw, professor of experimental medicine at Imperial College London, in a statement. .
“The smell disturbances generally resolved by 9 months, but when present, changes in concentration and memory tended to be more persistent,” said Openshaw, who did not participate in the trial. study.
Only slight differences emerged between men and women in the study, but children had fewer early symptoms than adults, which had mostly disappeared by the end of the year. No real difference was found between the original wild type of SARS-CoV-2 (March 2020 to November 2020), the Alpha variant (January 2021 to April 2021) and the Delta variant (July 2021 to October 2021).
“Patients with mild Covid-19 had an increased risk for a small number of health conditions, with only a few symptoms persisting a year from SARS-CoV-2 infection and their risk decreasing over time afterward. infection,” Mizrahi said via email.
However, “we are not claiming that there are not patients who suffer from long COVID symptoms like dyspnea (difficulty breathing), weakness, cognitive impairment, etc. “, he added. “(Our study) does not contradict the evidence that a small number of patients experience long-lasting symptoms, as shown in this analysis.”
The researchers pointed out some limitations of the study, such as the possibility of misdiagnosis or the inability to register some milder symptoms over time. Abramoff agreed.
“This study design is unable to detect the severity of these symptoms, and there are potentially additional missed patients due to the use of medical coding to detect persistent symptoms of Long COVID” , Abramoff said.
It might also be difficult to apply the study results to other countries, such as the United States, due to differences in how doctors code symptoms. For example, the study did not identify several conditions commonly found in long Covid clinics in the United States, said Dr. Monica Verduzco-Gutierrez, professor and chair of the department of rehabilitation medicine at the Long School of Medicine of UT Health, San Antonio.
“The most common symptom of Long COVID is fatigue, and that wasn’t on that list. It also lacked post-exertional malaise, dysautonomia/POTS, or ME/CFS. These are some of the major presentations I see in my clinic’s population, so it’s a major limitation of this study not to have these results,” said Verduzco-Gutierrez, who was not involved in the study. new study.
Post-exercise malaise is overwhelming exhaustion even after minimal exertion. Unlike regular exhaustion, it can take days to weeks for a person to recover, and the discomfort can be reactivated if activity resumes too quickly.
Postural orthostatic tachycardia syndrome, or POTS, is an increase in heart rate after sitting or standing that can cause dizziness or fainting. It is a form of dysautonomia, a disorder of the autonomic nervous system. “There is usually no cure for dysautonomia,” according to the National Institute of Neurological Disorders and Stroke.
Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, or ME/CFS, is a serious, long-term illness characterized by overwhelming fatigue that is not improved by rest. The disease can impact sleep and thinking processes, cause pain in many parts of the body, and prevent people from doing most daily activities.
In response to this concern, Mizrahi told CNN that “post-exertional malaise was not included in this study because it is not a commonly prescribed diagnosis in Israel.” Also, he said, dysautonomia/POTS only received an International Classification of Diseases, or ICD medical code, in October 2022, so it was also not included in the study.
However, symptoms of POTS and other conditions may have been included in more general categories such as heart arrhythmias or palpitations, he said.
Additionally, Mizrahi said fatigue was coded under “weakness” in the study. In fact, the researchers found that weakness was the second most common symptom reported in the study and continued to plague people between the ages of 19 and 60 for months.
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