Long COVID risk extends two years after infection


Getting sick from COVID-19 is bad enough. What if you were one of the unlucky people going through what is called the long COVID? It’s a mix of symptoms that can occur months — even years — after recovery from COVID, according to a new study of more than one million people from eight countries.

Adults’ risk of developing seizure disorders, brain fog, dementia and other mental health conditions remains elevated two years after recovering from COVID-19, the study found.

“These are important findings, but they should not lead to panic,” said co-author Paul Harrison, professor of psychiatry at the University of Oxford in the UK. “We’re not talking about things that are 10 or 100 times more common. I think the worst odds ratio is sort of two or three.”

The children had an increased risk of being diagnosed with epilepsy or seizures, encephalitis and nerve root disorders, which can cause pain, weakness or loss of sensation in an arm or leg. There was also a small but concerning risk of being diagnosed with a psychotic disorder such as schizophrenia or delusional thinking.

“This is an extremely robust and well-conducted study, using data from a large sample and spanning multiple countries,” said Rachel Sumner, senior researcher at Cardiff Metropolitan University in the UK, who did not participate in the study.

“The results are alarming and are critically important in our current context of unmitigated COVID spread,” she added via email.

The study findings align with the clinical experience of Dr. Aaron Friedberg, a clinical assistant professor of internal medicine who works in the post-COVID recovery program at Wexner Medical Center at Ohio State University in Columbus.

“I just spoke to someone who was originally diagnosed with COVID over two years ago, but he only sees a post-COVID specialist today,” said Friedberg, who did not. participated in the study. “It doesn’t necessarily mean they have these symptoms two years later. It means they are just diagnosed with them.”

Friedberg also said he sees people with severe symptoms two years after diagnosis.

“They can’t think, they can’t breathe. I have a person whose illness is so bad that they can hardly get out of bed,” he said. “I recently saw a person who is still not working due to COVID symptoms two years later.”

GOOD AND BAD NEWS

Two years of hospital data for adults and children extracted from the TriNetX electronic health record network were analyzed for the study, published Wednesday in the journal Lancet Psychiatry. TriNetX is an international network of data without any identifying factors from hospitals, primary care providers and specialists. About 89 million patients are in the data pool.

The study looked at 1.25 million patients two years after they were diagnosed with COVID-19 and compared them to a closely matched group of 1.25 million people who had a different respiratory infection.

“We compared these two groups of patients in terms of 14 major neurological and psychiatric disorders over the two years following COVID-19 or a respiratory infection,” said co-author Maxime Taquet, an academic clinician researcher in psychiatry at the National Institute of Health and Care. UK Biomedical Research Center

The research team looked at the following conditions: anxiety disorders; mood disorders; psychotic disorder; insomnia; cognitive deficit (composite of codes to capture so-called brain fog); dementia; epilepsy or seizures; encephalitis; intracranial hemorrhage; stroke; parkinsonism; Guillain Barre syndrome; disorders of the nerves, nerve roots and plexus; and neuromuscular and muscular diseases. The researchers also looked at deaths from any cause.

Most of the patients were from the United States, but the study also included people from Australia, the United Kingdom, Spain, Bulgaria, India, Malaysia and Taiwan.

The study could not say whether people had experienced continuous symptoms for the full two years since a diagnosis of COVID-19: “It might be the case, it might not be,” said the study. Taquet said. “These data relate only to the number of new diagnoses made, not the persistence or duration of symptoms.”

The news was both good and bad.

For adults, the risk of developing “brain fog, dementia, psychotic disorders, epilepsy and seizures remains elevated throughout the two years” compared to people with other respiratory conditions, Taquet said.

Adults over the age of 65 had a 1.2% increased risk of being diagnosed with dementia, according to the study. While it is “very clear that this is not a tsunami of new cases of dementia, it is also (I think) difficult to ignore, given the seriousness of the consequences of the diagnosis of dementia” , did he declare.

There was good news for adults, Taquet added: “The risk of some disorders – particularly mood and anxiety disorders – disappeared within two to three months, with no overall excess of cases over the two years. “

EFFECT ON CHILDREN

There was also good news for children: “The risk of brain fog in children was transient – there was no overall risk,” Taquet said. The children were also not at risk of being diagnosed with anxiety and depression after COVID-19, “even in the first six months,” he said.

But there were troubling results when it came to other conditions. For example, the children had a “twice as high risk of epilepsy and seizures,” Taquet said, and a “three times as high risk of being diagnosed with a psychotic disorder within two years of having COVID-19 compared to to those diagnosed with another airway”. infection.”

In the study of 10,000 children with a diagnosis of Covid-19, 260 had developed epilepsy and seizures within two years, compared to 130 out of 10,000 children diagnosed with another respiratory tract infection, which was a “doubling risk”. increased,” said Taquet,

There was a threefold increased risk of being diagnosed with a psychotic disorder in children two years after COVID-19 infection, Taquet said. Yet “the absolute risk remains quite low,” he said, with 18 diagnosed cases of psychosis in every 10,000 children.

“I think we have to be careful in interpreting the reported small increases in dementia and psychosis,” said Paul Garner, Emeritus Professor of Evidence Synthesis in Global Health at the Liverpool School of Tropical Medicine in the UK. . Garner was not involved in the study.

“These are, in my view, more likely to be related to the societal upheaval and dystopia we have experienced rather than being a direct effect of the virus.”

A LONG-TERM IMPACT

Overall, the study’s evidence is “particularly worrying”, said Sumner from Cardiff, because even COVID-19 variants thought to be milder appear to have the same long-term consequences.

Further, “some of these disorders will continue to have diagnostic and treatment delays with health systems struggling to cope with both COVID infections and patient waiting list backlogs,” added Sumner.

This reality matches the clinical experience of physicians such as Friedberg, who has a long history of treating patients with COVID-19 shortly after the pandemic began.

“I have severe post-COVID (patients) of the March 2020 ancestral strain, and I have the same in people who developed it a few months ago. So I think it may be just as serious with any of these variants,” he said.

Still, Friedberg told CNN there has been “no public policy decision” about what happens after COVID-19.

“The idea that maybe this terrible thing is happening that we won’t appreciate until months or years later isn’t adequately addressed,” Friedberg said.

“Let’s say kids just can’t run around as much as they used to, or have seizure disorders now, or adults just can’t handle as many work tasks or have a hard time looking after their kids at home because they just have brain fog, they suffer from chronic shortness of breath.

“If it starts happening to, say, 5% of the population every time there’s a surge of COVID, it starts to accumulate.”


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