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Solving the long COVID puzzle: Experts look for answers in the latest data

More Americans have died from COVID-19 than in two decades of car crashes or on the battlefields in the country's wars combined. While many patients fully recover, some may experience lingering symptoms for weeks or months on end. If you or a loved one have experienced shortness of breath, “brain fog,” or trouble sleeping longer than two weeks after diagnosis, you may wonder if you're a long-COVID-19 survivor or a long-hauler. 

There is a significant ongoing discussion about the definition of long COVID, and current research continues to add to our understanding and approach to decisions to help these patients. In a recent conversation with physician experts, Dr. Thomas G. McGinn, System Executive Vice President, CommonSpirit Health, discussed a new meta-analysis that provides a valuable look at what we know today.

McGinn broke down the facts when he sat down with fellow CommonSpirit leaders, Drs. Ankita Sagar, Vice President of Clinical Standards and Variation Reduction, and Renuga Vivekanandan, Chief of Infectious Disease and Associate Professor, Creighton University School of Medicine.

This conversation was edited for clarity and brevity.

 

Dr. McGinn

We now have new research that looks closely at long COVID and gives insight into how we might help patients suffering from the lingering effects. Ankita, tell us more about this meta-analysis and how they defined long-COVID.

 

Dr. Sagar

Think of this meta-analysis as a systematic review, a summary of many small studies that pulls relevant data points to recognize and find statistically significant effects, such as prevalence or risk factors. It’s a meaningful study to highlight because it involved high-quality articles published across the globe. According to the WHO, long COVID occurs in individuals within the first 120 days after diagnosis, and the symptoms last at least 60 days. That’s slightly different from how the CDC defines it, presenting symptoms arising at least 28 days, or four weeks, after diagnosis. The study used those two parameters as bookends–they looked at patients whose symptoms lasted anywhere from 28 days to 120 days after diagnosis.

 

Dr. McGinn

How many articles became part of the study? 

 

Dr. Vivekanandan 

They started with 4,000 studies and narrowed it down to 31 strong studies. They looked at a mix of hospitalized and non-hospitalized patients. The big takeaway was that 43% of the patients had developed long COVID, and hospitalized patients had a higher chance of having long COVID conditions–approximately 53%.

 

Dr. McGinn

What are some of the risk factors that stood out to you that you know predispose people to have long COVID, and what did that look like in the article?

 

Dr. Sagar

The study investigated the risk factors we should be concerned about, including age (older patients), gender (female patients), and those with two or more health conditions, such as hypertension, obesity, and hypothyroidism. Those individuals have a higher risk of developing long COVID.

 

Dr. McGinn

Dr. Vivekanandan, let's talk about the severity and mild COVID in the acute phase and how that relates to getting long COVID. The initial thought was that if you're hospitalized and your condition worsens rapidly, you will have long COVID. What does the article tell us about this?  

 

Dr. Vivekanandan 

The data showed that if you have a mild disease, you still have a chance of having long COVID, but at a much lower rate, approximately around 33%. That’s compared to if you're hospitalized and have a severe disease, which means you’re at a higher rate of having long COVID–approximately 45%.

It’s also interesting to point out that we saw a difference in higher rates of long COVID conditions in each region–Asia (55%), the United Kingdom (40%), and the United States (30%).  And that poses the question: Is it due to therapeutics, such as monoclonals and antivirals?

 

Dr. McGinn

Dr. Sagar, there was an article published in The Lancet about diabetes and COVID-19. Tell us a little bit about that.

 

Dr. Sagar

The study used the US Department of Veterans Affairs national databases and looked at 180,000 patients in the VA system. They found a specific segment of those patients developed new onset of diabetes or were prescribed a hypoglycemic agent after COVID diagnosis for a certain amount of time. That makes us reflect and think about patients we see in our clinics every day and whether we should be screening them for diabetes at their visit after COVID diagnosis.

 

Dr. McGinn

What were the predominant symptoms that were prolonged in this article?

 

Dr. Vivekanandan 

They looked at 23 different symptoms, but dyspnea, memory loss, sleep disturbance, and fatigue were the most common for long COVID conditions.

 

Dr. McGinn

Thank you both for the work that you've done in this space with long COVID in your clinical care, your research, and for speaking about it. I know we have a lot of work to do to help these patients with long COVID. 

Talk to your doctor if you think you have long COVID or a post-COVID condition. Learn more: Tips for Talking to Your Healthcare Provider about Post-COVID Conditions

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