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COVID-19 Symptoms Persist Beyond 1
Month in 25% of US Military Group
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IDWeek, September 29-October 3, 2021
Mark Mascolini
One quarter of military members with symptomatic COVID-19 had symptoms like difficulty breathing and fatigue more than 1 month after symptom onset, according to results of a 1333-person Military Health System analysis [1]. Four diagnoses proved independently more likely in the month after COVID symptom onset than 61 to 90 days before symptoms: pulmonary, kidney, cardiovascular, and neurologic disease.
COVID-19 symptoms persist in a substantial proportion of people with this coronavirus infection. But estimates of persistent "long COVID" vary from one population to another and remain poorly understood. Because persistent COVID-19 symptoms can affect readiness in military personnel, researchers from the Uniformed Services University of the Health Sciences conducted this study.
In Wuhan, China, a longitudinal study of 1276 COVID-19 survivors discharged from the hospital found that 49% of these people had at least 1 post-COVID symptom 12 months after hospital discharge [2]. Prevalence of dyspnea (shortness of breath) rose from 26% at the 6-month visit to 30% at the 12-month visit. Twelve months after hospital discharge 12% of people employed before their COVID-19 diagnosis had not returned to work. Compared with non-COVID study participants, 12 months after diagnosis COVID-19 survivors had more mobility problems, pain or discomfort, and anxiety or depression.
The US Military Health System serves about 9.6 million beneficiaries, including 1.4 million active-duty service members. The military study involved people enrolled in the Epidemiology, Immunology, and Clinical Characteristics of Emerging Infectious Diseases with Pandemic Potential (EPICC) cohort from March to April 2021. The overall aim of this prospective, longitudinal, observational cohort study is to fill gaps in the understanding of SARS-CoV-2 infection in active-duty personnel and Military Health System beneficiaries.
During 12 months of follow-up in EPICC, enrollees completed self-administered questionnaires at 0, 1, 3, 6, 9, and 12 months and gave specimens for virologic and host response analyses. Researchers examined electronic medical records to analyze healthcare encounter history and clinical diagnoses before and after COVID-19 symptom onset.
The current analysis focused on people who tested positive for SARS-CoV-2 from March 2020 through April 2021 and had questionnaire data at least 28 days after COVID-19 symptom onset. The investigators used generalized linear models adjusted for prior healthcare use, age, sex, and race to compare odds of organ system clinical diagnoses before and after COVID-19 symptom onset.
Of the 1333 study participants, about 20% were inpatients during their acute COVID-19 illness, two thirds (65.2%) were 18 to 44 years old, 58% were men, 55.8% white, 22.4% Hispanic, and 10.8% black. Most participants (58.3%) were on active duty, 22.7% were dependents, and 19% retired.
Clinicians judged that 69.4% of participants had resolved COVID-19 illness when they first completed a survey. Illness lasted a median of 15 days and in 45.1% lasted fewer than 28 days. But 18.5% were ill for 28 to 84 days and 36.3% for 85 or more days. Among 1209 participants with data on chronic symptoms, 25.4% reported any chronic symptoms beyond 1 month of symptom onset; among people with chronic symptoms, 27.4% rated symptom severity mild, 46.3% called their symptoms moderate and 26.3% severe.
The most frequent symptoms lasting longer than 28 days were dyspnea, loss of smell or taste, fatigue, and exercise intolerance. Compared with 61 to 90 days before symptom onset, odds of four diagnosis were independently greater in the first month after symptom onset: pulmonary conditions (adjusted odds ratio [aOR] 57, 95% confidence interval [CI] 28 to 112), kidney conditions (aOR 29, 95% CI 10 to 84), cardiovascular disease (aOR 7, 95% CI 5 to 11), and neurological diagnoses (aOR 3, 95% CI 2 to 4). Odds of cardiovascular diagnoses remained independently higher through 90 days after symptom onset. Cardiovascular disease included hypertension, ischemic heart disease, atrial fibrillation, and heart failure.
The Uniformed Services University team stressed that one quarter of this relatively young, healthy, and racially diverse US group with COVID-19 had symptoms persist more than 1 month after their onset, and that at least 1 symptom was moderate or severe in three quarters of people with symptoms. The researchers emphasized that the pulmonary, cardiac, and neurologic symptoms or diagnoses seen in this group "are potentially highly relevant to military job duties and medical readiness." And of course such diagnoses would have a similarly profound impact on many nonmilitary occupations.
The findings add to the growing mound of evidence that SARS-CoV-2 infection may cause long-term morbidity in more than a few people who recover from COVID-19 on a virologic basis.
References
1. Richard SA, Pollett S, Epsi NJ, et al. Long-term clinical outcomes following SARS-CoV-2 infection include persistent symptoms and cardiovascular disease beyond 3 months post-infection. IDWeek, September 29-October 3, 2021. Abstract 34.
2. Huang L, Yao Q, Gu X, et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021;398:747-758. doi: 10.1016/S0140-6736(21)01755-4. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01755-4/fulltext
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