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Risk factors for long COVID

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Dr V Ramasubramanian, Sr. Consultant, Infectious Disease & Tropical Medicine, Apollo Hospitals, Chennai; Adjunct Prof. Infectious Diseases, SRMC, Chennai    27 September 2021

A preprint study from Japan has characterized risk factors that not only contribute to the development of long COVID, but also for the persistence of the symptoms of long COVID.

The researchers utilized a questionnaire-based survey of patients recovering from COVID-19 and visited the outpatient service of the Disease Control and Prevention Center (DCC) at the National Center for Global Health and Medicine in Japan between February 2020 and March 2021 to evaluate risk factors; 457 of 526 responses were analysed for the study.

Seventeen long Covid symptoms were identified and categorised into three:

  • Acute symptoms that persisted for 4 weeks such as fever, headache, loss of appetite, joint pain, sore throat, myalgia, diarrhea and sputum (<10%).
  • On-going/chronic symptoms that persisted for four weeks such as fatigue, dysosmia, cough, dysgeusia, shortness of breath (>10%)
  • Late-onset symptoms that developed >4 weeks after disease onset such as loss of concentration, depression, hair loss and memory disturbance (>5%)

The less frequently occurring symptoms such as chest pain, abdominal pain, runny nose, conjunctivitis and nausea were not considered for the study.

Analysis of the data showed that 378 patients (84.4%) had mild disease in the acute phase; 120 patients had at least one symptom after six months of Covid-19 diagnosis and at 12 months, 40 patients had at least one symptom suggesting that many patients had recovered by this time. Even patients with mild Covid-19 had prolonged symptoms.

Fever (64.1%)  was the most commonly reported symptom with acute Covid-19 followed by fatigue (64.0%), dysosmia (47.9%), cough (46.8%) and dysgeusia (40.6%).

Women were found to be more vulnerable to develop several long Covid symptoms such as fatigue, dysosmia, dysgeusia and hair loss. They were also more at risk of persistent dysgeusia. Patients who had developed pneumonia and moderately severe disease were more likely to have persistent fatigue.  Dysosmia and dysgeusia had an inverse association with age, BMI i.e., younger age and lower BMI were risk factors for dysgeusia and dysosmia. Only persistence of dysosmia had an inverse association with the use of antiviral drugs.

Long-Covid or prolonged symptoms of Covid-19 is becoming a significant public health problem and a challenging condition to manage. But not all patients develop long-Covid; some patients are more vulnerable. Timely recognition of patients with risk factors may prevent long-Covid.

Reference

  1. Miyazato Y, et al. Risk factors associated with development and persistence of long COVID. medRxiv, posted September 23, 2021. doi: https://doi.org/10.1101/2021.09.22.21263998

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