Health and Wellness

The pandemic is now affecting fewer people with long-covid symptoms than it was earlier.

“Long covid is a complicated beast,” one researcher said. (Da’Shaunae Marisa for The Washington Post)

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Americans infected with the coronavirus’s omicron variant are less likely to develop symptoms typical of long covid than those who had covid-19 earlier in the pandemic, according to the largest-ever study of who is most vulnerable to being sickened — or debilitated — by the virus’s lingering effects.

The Washington Post collaborated with research partners to analyze nearly 5 million U.S. covid cases. It found that 1 in 16 patients with omicron had received treatment for covid symptoms within the first few months of becoming infected. Patients exposed to the coronavirus during the first wave of pandemic illness — from early 2020 to late spring 2021 — were most prone to develop long covid, with 1 in 12 suffering persistent symptoms.

This pattern mirrors what leading doctors who treat long covid — and some scientists who study it — have noticed as the coronavirus pandemic evolves. The shifting rates they suggest are more conjecture than proof.

“Long covid is a complicated beast,” said Ziyad Al-Aly, director of the Clinical Epidemiology Center at Washington University School of Medicine in St. Louis and a major researcher into the disease.


After omicron, long-covid symptoms are less common

A study of 4.9 Million Americans with covid-19 in the United States between January 2022 and early 2020 shows that 7.2 Percent sought medical attention for symptoms resembling long covid. As successive waves came, the rate fell. Researchers found that symptoms are not always common, but more prevalent after covid infections.

Note: The baseline is the percentage of patients who reported.

New symptoms within six months of infection. The rate

Covid refers to the percentage of one who has new symptoms after covid.

After the infection, it can take up to six months.

Source: Epic Systems research

EMILY M. EENG/THE WASHINGTON POSTER

After omicron, long-covid symptoms are less common

A study of 4.9 Million Americans with covid-19 in the United States between January 2022 and early 2020 shows that 7.2 Percent sought medical attention for symptoms resembling long covid. As successive waves came, the rate fell. Researchers found that symptoms are not always common, but more prevalent after covid infections.

Note: The baseline is the percentage of patients who have reported new symptoms.

In the six months prior to infection. The share after covid is the rate with new

The symptoms can last for up to six months.

Source: Epic Systems research

EMILY M. EENG/THE WASHINGTON POSTER

After omicron, long-covid symptoms are less common

An analysis of 4.9 million Americans who had covid-19 from January 2020 to January 2022 revealed that 7.2 percent sought treatment for covid symptoms. As successive waves came, the rate fell. Researchers found that symptoms are not always common, but more prevalent after covid infections.

Notice: The baseline is the percentage of patients who have reported new symptoms in the past six months.

Before infection. The share of patients with new symptoms after covid is between one and three months.

Six months after the infected.

EMILY M. EENG/THE WASHINGTON POSTER

Source: Epic Systems research

Also, patients with certain medical conditions have twice the likelihood of seeking care for long-term covid symptoms than people who are otherwise healthy. Only 9 percent of patients suffering from any of the pre-existing conditions received treatment to treat long-covid symptoms during the six month period following their diagnosis. That compares with 4.6 % who did not. The analysis shows that health problems are a major concern.

Long-covid symptoms were three times more common in obese patients than those with no previous medical conditions. People with lung disease or kidney problems were also at risk.


Preexisting conditions and severe cases of covid make long-covid symptoms more common

People with preexisting medical conditions/comorbidities that make covid-19 more dangerous are more likely to report long-covid symptoms than people without such comorbidities.

People with at-least

one comorbidity

People who are unable to speak English can use the Internet.

comorbidity

Patients who have been admitted are more likely than patients who are not to experience long-covid symptoms.

Note: The baseline is the percentage of patients who reported.

New symptoms within six months of infection. The rate

Covid refers to the percentage of one who has new symptoms after covid.

After the infection, it can take up to six months.

Source: Epic Systems research

EMILY M. EENG/THE WASHINGTON POSTER

Preexisting conditions and severe cases of covid make long-covid symptoms more common

People with preexisting medical conditions/comorbidities that make covid-19 more dangerous are more likely to report long-covid symptoms than people without such comorbidities.

At least one of the following qualifications is required:

one comorbidity

People with no

comorbidity

Long-covid symptoms are more common in patients who have been hospitalized than those who aren’t.

Note: The baseline is the percentage of patients who have reported new symptoms.

In the six months prior to infection. The share after covid is the rate with new

The symptoms can last for up to six months.

EMILY M. EENG/THE WASHINGTON POSTER

Source: Epic Systems research

Preexisting conditions and severe cases of covid make long-covid symptoms more common

People with preexisting medical conditions/comorbidities that make covid-19 more dangerous are more likely to report long-covid symptoms than people without such comorbidities.

People with at

Minimum one

comorbidity

People with no

comorbidity

Patients who are admitted to hospital are more likely than those who are not to experience long-covid symptoms.

Notice: The baseline is the percentage of patients who have reported new symptoms in the past six months.

Before infection. The share of patients with new symptoms after covid is between one and three months.

Six months after the infected.

Source: Epic Systems research

EMILY M. EENG/THE WASHINGTON POSTER

These and other findings from The Post’s partnership trace the contours of a troubling ripple effect from the country’s worst public health crisis in a century. Researchers made rapid headway in understanding covid’s patterns of sickness and death and in developing vaccines and treatments. The pandemic is now in its fourth year. However, it remains a mystery as to the exact nature of long covid.

Although theories have advanced about the causes, they are still not well understood. There are many symptoms that can be caused by coronavirus infection. Doctors can borrow from other diseases to treat the symptoms. And although physicians are familiar with post-viral syndrome — lingering symptoms after the flu, pneumonia, Epstein-Barr and other viral ailments — long covid tends to persist far longer.

“It’s scary not to be who I was before,” said Noemi Chiriac of Dallas, who has not regained her senses of taste and smell since a second bout of covid days before Christmas 2021, when the virus’s delta variant overlapped with the early stage of the omicron variant. “It’s losing your identity.”

Chiriac, 45, is now single and can finally go on the miles-long, beautiful walks that she loves, but gets short of breath when she tries to talk with more than one person at a time. She needs to take a nap for hours when she returns home.

In summer 2021, the aerospace and defense company where Chiriac worked chose her to compete for more-senior management jobs as part of a “talent pool.” She flubbed an interview. When she was asked about how she would deal with situations with company leaders, her brain fog from seven months prior got in the way of her remembering their names.

“I could see their faces. I know exactly who they are, but I could not remember,” Chiriac said. She was not selected for the talent pool job.

A growing body of research has attempted to determine who is most at risk for the long-term covid syndrome. But the findings vary substantially because of different research methods, the small cohort of patients on which many studies are based and researchers’ lack of consensus over how the syndrome should be defined.

The study with The Post’s partners, based on anonymous Covid patients in the United States have long-standing medical records. This adds to the picture of long-standing covid. Altogether, the analysis shows that about 1 in 14 — slightly more than 7 percent — of U.S. patients who had covid visited health-care practitioners within six months of their initial infections complaining of at least one symptom typical of long covid they’d not had before. This proportion is in the same range as other studies, but lower than those found by research that uses broader definitions for long covid.

The Post has detected about 14 cases of SARS-CoV-2 infection in a country with at least 200million people, according to federal estimates. Millions of people in the United States have survived the virus, and many are now dealing with long-lasting consequences that can often change their lives.

“It’s a staggering amount of people,” said endocrinologist Zijian Chen, medical director of the Center for Post-COVID Care at Mount Sinai Health System in New York, among The first U.S. medical center to establish an interdisciplinary clinic for patients suffering from the emerging symptoms known as long covid.

“And the implication for long-term care for some of these people, and the implication for health-care dollars we need to use to care for these people, it’s pretty huge,” Chen said.

The Post’s analysis is based on data from a Wisconsin company called Epic Systems, which houses the nation’s largest collection of electronic medical records from hospitals, health systems and medical practices. This research collaboration includes the Kaiser Family Foundation, which is a non-profit health-policy organisation. It helped to determine how to conduct the analysis and interpret the results.

The analysis relies on records, from Epic’s research database, of nearly 4.9 million patients diagnosed with covid from the start of the pandemic in early 2020 through January 2022, forming the largest data set used in any long-covid study in the world. Epic’s Cosmos data was shared in this study for the first time by the company. This analysis examines which patients sought treatment for any of the diffuse symptoms that are common in long covid (also known as long-haul syndrome or post-covid syndrome). These symptoms include fatigue, breathing difficulties, coughs, irregular heart rhythms, trouble thinking or concentrating, as well as difficulty with concentration and other problems.

In The Post analysis looked at who sought care, adding a twist to long-covid research. The same symptoms were present in the six-month period before patients got coronavirus. By including this “before” time, the study shows that those symptoms circulate in the general population but are more common in the months after patients get the coronavirus than during the period before. That before-and-after comparison offers one way of understanding that long covid — sometimes dismissed by doctors, especially early in the pandemic — is real.

Yet, the same symptoms appear before covid is diagnosed. This demonstrates the difficulty of diagnosing covid and determining its prevalence.

“We have work to do to understand what is long covid and what is the [downstream effect] of being chronically unwell or having an acute condition,” CDC Director Rochelle Walensky said in an interview with The Post.

For that reason, The Post’s analysis and other studies might inadvertently overstate how common long covid is, said Al-Aly, of Washington University, who has led major post-covid studies using data from the Department of Veterans Affairs. Al-Aly stated that studies may underestimate the severity of long covid, but the condition is still being better understood. Researchers could also discover other symptoms.

There is a need, Al-Aly said, to “shed light on the complexity of the matter.”


Long-covid symptoms are more common among older adults and women than they are in younger people, but the same applies to all races and ethnicities.

Long covid symptoms are more common in older adults, and the rate of such symptoms decreases with age.

Long-term covid symptoms are more common in women than men.

Non-Hispanic Whites report symptoms at slightly higher rates than other groups.

INCOME – MEDICAID ELIGIBLE

Patients with low incomes are less likely to experience symptoms than other patients.

Note: The baseline is the percentage of patients who reported.

New symptoms within six months of infection. The rate

Covid refers to the percentage of one who has new symptoms after covid.

After the infection, it can take up to six months.

Source: Epic Systems research

EMILY M. EENG/THE WASHINGTON POSTER

Long-covid symptoms are more common among older adults and women than they are in younger people, but the same applies to all races and ethnicities.

Long covid symptoms are more common in older adults, and the rate of such symptoms decreases with age.

Long-term covid symptoms are more common in women than men.

Non-Hispanic Whites report symptoms at slightly higher rates than other groups.

INCOME – MEDICAID ELIGIBLE

The rate of symptoms in patients who have low enough income to be eligible for Medicaid is slightly lower than that of other patients.

Note: The baseline is the percentage of patients who have reported new symptoms.

In the six months prior to infection. After covid, the rate is the share with new

The symptoms can last for up to six months.

EMILY M. EENG/THE WASHINGTON POSTER

Source: Epic Systems research

Long-covid symptoms are more common among older adults and women than they are in younger people, but the same applies to all races and ethnicities.

Long covid symptoms are more common in older adults, and the rate of such symptoms decreases with age.

Long-term covid symptoms are more common in women than men.

While white, non-Hispanic people reported slightly higher levels of symptoms than other groups (although this group has a greater age distribution), it had slightly higher rates.

INCOME – MEDICAID ELIGIBLE

The rate of symptoms in patients who have low incomes enough to be eligible for Medicaid is slightly lower than that in other patients.

Notice: The baseline is the percentage of patients who have reported new symptoms within six months.

Before infection. After covid, the rate at which there are new symptoms within one month.

Six months after the infected.

Source: Epic Systems research

EMILY M. EENG/THE WASHINGTON POSTER

The Post analysis sought out to identify those most likely to seek treatment for symptoms that are typical of long covid. The following are some of the results:

· The lower rate of symptoms from the omicron wave is consistent across age groups, gender, race and people of differing health status before they got covid. This wave has a lower rate of symptoms than earlier waves. It is mainly due to the higher percentage of young cases and the fact that long covid patients are less likely to be treated.

· Women are more likely than men to seek care for long-covid symptoms — nearly 8 percent of women, compared with slightly more than 6 percent of men. Other long-covid research has also identified a similar gap.

· Older survivors of a coronavirus infection are more prone to report a symptom of long covid. Compared to 1 in 24 people under 30, slightly more than 1 in 9 65-year-olds sought treatment for these symptoms.

· Patients with the most severe cases of covid are more likely to develop long-haul symptoms. One in five covid patients has a severe case. Patients who had been admitted to intensive care units experienced post-covid symptoms much later than patients who were treated in the general hospital. About 1 in 15 people who were not admitted to hospital did not have covid symptoms. But because of the simple math of the pandemic — the overwhelming majority of infected people are never hospitalized — patients with relatively mild covid account for the bulk of those reporting post-covid symptoms.

· Even though covid cases and deaths have cut deepest in communities that are Black, Latino or poor, the same does not appear true for long-covid symptoms. Patients on Medicaid, the public insurance program that covers people with low incomes and disabled, have seen a marginal improvement. Private insurance has a higher rate of patients reporting symptoms. Some physicians believe that the lack of differences between racial, ethnic, and income groups may tell more about who has access to health services than what the actual incidence of long-term covid is in these communities.

“Health equity plays a huge role regarding the type of patients able to seek care for long covid,” said Alba Azola, a co-director of the Johns Hopkins Post-Acute COVID-19 Team in Baltimore. “The people who make it to our … clinic are rich, White and able to access medical care.”

The three viral waves that caused the pandemic are all associated with long-covid symptoms. However, they are consistent less common during the omicron period in each patient group. Patients with mild covid cases, or those in ICUs were all less likely to report. Any post-covid symptoms in people who had omicron rather than earlier versions.

‘A different infection’

Pat Hill, a Shaker Heights, Ohio insurance agent, was infected by the coronavirus at the time of delta. This was when long-covid symptoms were more likely than in the earlier wave. She is part of the medical mystery that doctors and researchers are still trying to crack: Why do each of the pandemic’s major variants seem to produce different chances of lingering effects?

Hill has had N95 masks since she was first diagnosed with asthma. She continues to do so for over 20 years. Since the pandemic began, Hill said, “I have masks in my car, and a box by my door, and all my purses have masks. I will wear a mask if I see someone not wearing one. [one], I’ll give away masks.”

But one morning in September 2021 — just days before she was scheduled to get her first booster of the Moderna vaccine — she went to a gathering with representatives of local insurance companies. This small room was meant to hold 10 people but it held twice as many. “It set off an alarm” in her mind, she recalls. She sipped coffee and ate a bagel, but she still removed her mask.

Hill realized that Hill had an allergy to late-summer Ragweed a few days later when she developed a runny, irritable nose, and cough. Hill saw that Shaker Heights was offering coronavirus. To be certain, I took a number of tests. “I was shocked,” she said, when a nurse called. Positive.

Her bout with covid was nothing like her fear of being admitted to the hospital on a ventilator. “It was like a mild case of the flu,” Hill recalled. Although she was tired, she never had a fever and her blood oxygen levels never dropped to dangerously low. “I figured I’d do my quarantine, and I thought I’d get back to normal,” she said. A month later, the real trouble began. Her fatigue deepened. She developed bronchitis. She was short of breath. Her ankles and legs swelled.

It isn’t clear why the covid original form and the delta wave are more likely to cause such symptoms than the omicron or its subvariants. Doctors and biomedical scientists have some insights.

Akiko Iwasaki (an immunologist at Yale School of Medicine) suggested that there is a possibility that variants of the virus target cells in different parts of a person’s respiratory tract. Omicron targets the upper portion of the virus while earlier forms of this virus target lower down. “And the lower respiratory tract creates more damage.” As a result, Iwasaki said, omicron “could produce less severity and less long covid.”

Omicron “appears to be somewhat of a different infection,” said Kathleen Bell, a rehabilitation medicine physician at the University of Texas Southwestern Medical Center in Dallas, which was among the first medical centers to create a clinic for treating patients with lingering symptoms.

Omicron is infected in fewer patients Patients arrive at the long covid clinic with severe symptoms or a loss of smell. The virus has “changed its attack,” said Bell, whose clinic still sees new patients turn up with symptoms that have persisted since they were diagnosed with covid during the delta wave more than a year ago, rather than in the omicron wave.

Hill, an insurance agent who specializes in Medicare health plans is always busiest. Hill was able to keep her energy levels high despite having long-covid symptoms in her first autumn, and she was able to remind clients to renew their insurance. “When people have been with you for years, they are like family,” she said of the rest. “I felt like such a failure.”

She was infected two months later when she learned of a long covid clinic at University Hospitals. Three months later, her first appointment took place. She continues to see an immunologist as well as a hematologist, cardiologist, and a hemologist. Her back pain is treated by an acupuncture therapist. this could be a post-covid sign. She meets with a social worker. Due to her worsening cough, she recently added a physician to her team.

“I know it doesn’t feel like that to her, [but] it’s still early in the long-covid journey,” said Juliane Torer, a nurse-practitioner at the suburban clinic who knows Hill.

In July, close to Hill’s birthday, a friend she considers a niece as part of her large “chosen family” surprised her with tickets to an Elton John concert. It was at Cleveland’s downtown baseball park, and they had to park two blocks away. Hill walked slowly and haltingly to her seats. The audience clapped rapturously, but Hill couldn’t move. Hill made it half the distance back to her car with her cane and walked the rest of the route. Still, Hill said, “I did it, and that was my bigger accomplishment than seeing Elton John.”

The Post review is just one of many that has found a connection between preexisting and long-term covid.

“The more severe covid, the higher risk of long covid. And people with comorbidities are at higher risk for severe covid,” said Albert Ko, an epidemiologist at the Yale School of Public Health and specialist in infectious diseases.

Patty Reales is one such. patient. Her parents didn’t want it known she had lupus as she was growing up in the Queens borough of New York, even though she was called names by other children because she was out sick from grammar school a lot and, when in school, was often too tired for gym class. Her kidney disease was caused by an autoimmune disorder, which in turn led to high blood pressure. She also has asthma.

Reales, who was in her late 40s, shared a three-room house with her parents and younger brother. Reales also worked at Mount Sinai as a grants administrator. Reales knew she was vulnerable to infection because she had been on immune-suppressing drugs for many decades. The first time she got covid symptoms, in March 2020, she was pretty certain she’d been exposed walking through the hospital lobby as New York was emerging as the nation’s hub of the young pandemic.

Reales worked remotely for a few days while suffering from a fever and headache. She also lost her sense of smell and taste. When she started having trouble breathing, she went to Mount Sinai’s emergency room. Even though a coronavirus test — still in its infancy — did not turn up positive, she was admitted to an isolation unit as a “person under investigation.” When she returned home after three days, her cough and breathing were better. Other symptoms didn’t go away.

“I was easily tired,” she recalled. Her hobbies — running, exploring Manhattan’s neighborhoods, traveling every few months — were impossible. A friend suggested to them that they go for a jog on a summer’s day. “After like one block I couldn’t keep up,” Reales said. “I had to … call on her cellphone, and she realized I wasn’t behind her.”

The fatigue and wheezing continued until the following winter. She’d finally begun feeling better and was up to date on her coronavirus vaccine when, in April 2021, another episode of covid descended. That time, Reales said, “I really felt like I was struggling just to breathe. It was terrible. I developed insomnia.” It was fall before her symptoms lifted. Four days before Christmas 2021, when omicron was beginning to sweep the country she tested positive for it again.

As with some — but not all — long-covid patients, doctors say, her health has been improving slowly. One year after her second bout with covid, she entered a 5K run and sent her mother a picture of her smiling in Flushing Meadows Corona Park. In May, she ran another. She ran a 10K in June.

“I was ready to give up after the fourth mile. I said, ‘This is too much.’ I just wanted to stop,” Reales recalled. She kept going despite the cheers along the way. She was successful.

Reales is now a grants portfolio manager at Weill Cornell Medical College. She can work from home full-time. She is a student online for a bachelor’s degree in administrative studies. She sometimes has to stop walking up flights of stairs and take a moment to catch her breath. Brain fog continues. “I’m usually on point, but I’ll forget things. It could be something I already told my mom before,” Reales said. “When I’m doing my schoolwork, I’ll have to read and read and read again.” It is such a struggle that she withdrew from three of four courses one recent semester.

“I already have one animal. That is the lupus,” Reales said. “Once you disturb that animal [with covid and what follows], it’s like unshielding Pandora’s box.”

The Washington Post collaborated with Epic Systems, an electronic health record company, and Kaiser Family Foundation to create a study that examined who was most likely to report long-covid symptoms.

This study examined 4.88 million people, of all ages, who had been diagnosed with covid-19 between March 2020 – January 2022. The coronavirus variant that was circulating at the time the patients became ill was used to classify the patients. The original variant ran from March 2020 to June 2021. The delta variant was available from August 2021 to November 2021. The omicron variation was in January 20,22. Due to transitions between major variants in those periods, July 2021 and December 2021 were not included.

Epic used multiple steps to identify patients reporting to it new symptoms. Epic analyzed each patient’s electronic health record going back to 2017. Epic used this history to identify whether Epic had identified any patient who sought care for the first-time for at least one of the symptoms that the Centers for Disease Control and Prevention (CDC) has listed. The following symptoms may be indicative of long-term COvid: fatigue, difficulty breathing and chest pain. New symptoms were only defined as symptoms that a person has not experienced since 2017.

It was determined whether each patient sought treatment. Any new symptoms within one to six months of the coronavirus inoculation. The second step was to determine if each patient had experienced any new symptoms within the six-month period preceding a covid diagnosis.

The percentage of patients experiencing new symptoms after coronavirus infection established a baseline rate that indicates how often these symptoms can occur, even without covid. After covid, the rate of new symptoms among patients was determined by the percentage who had new symptoms.

The post-infection and baseline rates were calculated separately for each wave and for the overall group. To calculate the change in percentage points, the baseline rate was subtracted form the post-infection rates.

The Post shared data with Epic Research was done at the national level to protect patient privacy.

Because of the severity of their illnesses and the possibility of developing post-ICU syndrome, patients who were admitted to intensive care units were not included in the majority of the long-covid analyses.

It is possible that patients were prevented from seeking treatment for new symptoms, particularly in the early stages of the pandemic. This could have been a problem. may have affected patients’ reported rates of new symptoms before they had coronavirus infections. The duration of symptoms or how many symptoms each patient had — or their severity — were not measured in this study.

https://www.washingtonpost.com/health/2023/03/18/long-covid-less-likely/?utm_source=rss&utm_medium=referral&utm_campaign=wp_health

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