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Odor loss, loss of taste, shortness of breath and fatigue are the four most common symptoms reported by health workers in Sweden 8 months after mild COVID-19 disease, new evidence shows.
About one in ten health professionals experience one or more moderate to severe symptoms that negatively affect their quality of life, according to the study.
Dr Charlotte Thålin
“We see that a large proportion of health workers suffer from long-term symptoms due to mild COVID-19,” said senior author Charlotte Thålin, MD, PhD. Medscape Medical News. She added that loss of smell and taste “may seem trivial, but in the long run can have a negative effect on work, social and domestic life.”
The study is notable not only for tracing the COVID-19-related experiences of health workers over time, but also for what it did not find. There was no increased incidence of cognitive problems – including memory or concentration – that others linked to what is often called COVID-19.
The research letter was published online on April 7, 2021 JAMA.
“Even if you are young and previously healthy, a mild COVID-19 infection can have long-term consequences,” said Thålin, of the Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
The researchers did not observe an increased risk for long-term symptoms after asymptomatic COVID-19.
Add to existing evidence
This research letter “contributes to the growing body of literature showing that people who recovered from COVID reported a diverse range of symptoms that lasted months after the initial infection,” said Lekshmi Santhosh, MD. Medscape Medical News when asked to comment. She is a doctoral student at the University of California, San Francisco (UCSF) Post-COVID OPTIMAL Clinic.
Dr Lekshmi Santhosh
Previous research has revealed severe long-term symptoms, including palpitations and neurological disorders, among people hospitalized with COVID-19. However, there is limited data on the long-term effects after mild COVID-19, and these studies are often hampered by selection bias and without proper control groups, “Thålin said.
The absence of these worse symptoms after mild COVID-19 is ‘reassuring’, she added.
The current findings are part of the ongoing COMMUNITY (COVID-19 Biomarker and Immunity) study looking at long-term immunity. Healthcare staff enrolled in the research between 15 April and 8 May 2020 and the first blood tests are repeated every 4 months.
Thålin, lead author Sebastian Havervall, MD, and their colleagues compared symptom reporting between 323 hospital employees who had mild COVID-19 at least 8 months earlier with 1,072 employees who did not have COVID-19 during the entire study.
The results show that 26% of those who had COVID-19 previously had at least one moderate to severe symptom that lasted longer than 2 months, compared to 9% in the control group.
The group with a history of mild COVID-19 was a median of 43 years old and 83% were women. The controls were on average 47 years old and 86% were women.
Dr Sarah Jolley
“These data reflect what we have seen about long-term groups of patients with COVID-19 infection. Remarkably, mild illnesses among previously healthy individuals may be associated with prolonged persistent symptoms,” said Sarah Jolley, MD, a pulmonologist specializing in critical issues. . care at UCHealth University of Colorado Hospital in Aurora and director of the Post-COVID Clinic, told Medscape Medical News.
“In this group, similar to others, it seems to be more pronounced in women,” Jolley added.
Key findings on functioning
At 8 months, using a smartphone app, participants reported the presence, duration, and severity of 23 predetermined symptoms. Researchers used the Sheehan Disability Scale to measure functional impairment.
A total of 11% of participants reported at least one symptom that negatively affected work or social or domestic life at 8 months compared to only 2% of the control group.
Seropositive participants were almost twice as likely to report that their long-term symptoms moderately to markedly disrupted their working lives, 8% versus 4% of seronegative health workers (relative risk [RR], 1.8; 95%; confidence interval [CI], 1.2 – 2.9).
Disruptions in social life due to long-term symptoms were 2.5 times more likely in the seropositive group. A total of 15% of this group reported moderate to marked effects, compared with 6% of the seronegative group (RR, 2.5; 95% BI, 1.8 – 3.6).
The researchers also inquired about interruptions in the home, which were reported by 12% of the seropositive health workers and 5% of the seronegative participants (RR, 2.3; 95% BI, 1.6 – 3.4).
The findings of the study “follow many other work we see”, said David Putrino, PT, PhD, director of rehabilitation innovation at Mount Sinai Health System in New York City. Medscape Medical News. He and his colleagues are responsible for the rehabilitation of patients with a long COVID.
Dr David Putrino
Interestingly, the proportion of people with persistent symptoms in this study could be underestimated, Putrino said. “Antibodies are not a reliable biomarker. What the researchers are using here is therefore the most conservative measure the virus has had.”
Potential memory bias and the subjective assessment of symptoms were possible limitations of the study.
When asked why researchers did not find higher levels of cognitive dysfunction, Putrino said that self-reports are generally less reliable than measures such as MoCA (Montreal Cognitive Assessment) for detecting cognitive impairment.
Furthermore, unlike many people with COVID-19 whom he treats clinically – people who are “really struggling”, the health workers studying in Sweden function well enough to perform their duties in the hospital. does not represent the general population.
More research needed
“More research needs to be done to investigate the mechanisms underlying these persistent symptoms, and several centers, including UCSF, are doing research into why this may be,” Santhosh said.
Thålin and colleagues plan to continue to follow participants. “The main objective of the COMMUNITY study is to investigate long-term immunity to COVID-19, but we will also look at possible underlying pathophysiological mechanisms behind COVID-19-related long-term symptoms,” she said.
“I hope to see the taste and smell return,” Thålin added.
“We’re actually starting to understand the long-term effects of COVID-19,” Putrino said. “This is something we are going to see a lot going forward.”
Thålin, Santhosh, Jolley and Putrino did not disclose any relevant financial relationships. Grants from the Knut and Alice Wallenberg Foundation, Jonas and Christina af Jochnick Foundation, Leif Lundblad Family Foundation, Region Stockholm and Erling-Persson Family Foundation funded the research.
Damian McNamara is a staff journalist in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter.
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