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Loss of smell, loss of taste, dyspnea and fatigue are the four most common symptoms reported by healthcare professionals in Sweden 8 months after mild COVID-19 illness, new evidence reveals.
According to the study, about one in ten healthcare workers have one or more moderate to severe symptoms that negatively affect their quality of life.
"We see that a substantial portion of healthcare workers suffer from long-term symptoms after mild COVID-19," said lead author Charlotte Thålin, MD, PhD. Medscape Medical News. She added that the loss of smell and taste "may seem trivial, but have a negative impact on work, social life and family life in the long run."
The study is notable not only for tracking healthcare workers' COVID-19 experiences over time, but also for what it did not find. There has been no increase in the prevalence of cognitive problems - including memory or concentration - that others have linked to what is often referred to as long-distance COVID-19.
The research letter was published online on April 7, 2021 at JAMA.
"Even if you are young and previously healthy, a mild infection with COVID-19 can have long-term consequences," said Thålin, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Researchers have not observed an increased risk of long-term symptoms after asymptomatic COVID-19.
Addition to existing evidence
This research letter "adds to the growing body of publications showing that people recovering from COVID have reported a wide range of symptoms for months after the initial infection," said Lekshmi Santhosh, MD. Medscape Medical News when asked to comment. She is the Chief Faculty Physician at the Post-COVID OPTIMAL Clinic at the University of California, San Francisco (UCSF).
Previous research has revealed serious long-term symptoms, including heart palpitations and neurological disorders, in 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 appropriate control groups," Thålin said.
The absence of these more severe symptoms after mild COVID-19 is "reassuring," she added.
The current findings are part of the ongoing COMMUNITY (COVID-19 Biomarker and Immunity) study on long-term immunity. Healthcare professionals signed up for the research between April 15 and May 8, 2020 and have initial blood tests repeated every 4 months.
Thålin, lead author Sebastian Havervall, MD, and their colleagues compared the reporting of symptoms between 323 hospital workers who had mild COVID-19 at least 8 months earlier with 1,072 employees who did not have COVID -19 throughout the study.
The results show that 26% of those who had COVID-19 previously had at least one moderate to severe symptom that lasted more than 2 months, compared to 9% in the control group.
The group with a history of mild COVID-19 had a median of 43 years and 83% were female. Controls had a median of 47 years and 86% were female.
"These data reflect what we have seen in long-term cohorts of patients with COVID-19 infection. Notably, mild illness in previously healthy people may be associated with long-term persistent symptoms." , Sarah Jolley, MD, a pulmonologist specializing in care at UCHealth University of Colorado Hospital in Aurora and director of the post-COVID clinic, said Medscape Medical News.
"In this cohort, similar to others, it seems to be more pronounced in women," Jolley added.
Main conclusions on the functioning
At 8 months, using a smartphone app, participants reported the presence, duration and severity of 23 predefined symptoms. The researchers used the Sheehan Handicap Scale to assess functional impairment.
A total of 11% of participants reported at least one symptom that had a negative effect on work or social or family life at 8 months compared to only 2% of the control group.
HIV-positive participants were almost twice as likely to report that their long-term symptoms moderately to markedly disrupted their working lives, 8% vs. 4% of HIV-negative healthcare workers (relative risk [RR], 1.8; 95%; Confidence interval [CI], 1.2 - 2.9).
Social disturbances due to long-term symptoms were 2.5 times more likely in the HIV-positive group. A total of 15% of this cohort reported moderate to marked effects, compared to 6% of the HIV negative group (RR, 2.5; 95% CI, 1.8 - 3.6).
Researchers also asked about disruptions in life at home, which was reported by 12% of HIV-positive healthcare workers and 5% of HIV-negative participants (RR, 2.3; 95% CI, 1, 6 - 3,4).
The study results "match up with a lot of other work that we're seeing," 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 managing the rehabilitation of patients with long COVID.
Interestingly, the proportion of people with persistent symptoms might be underestimated in this research, Putrino said. "Antibodies are not a fully reliable biomarker. So what the researchers are using here is the most conservative measure of who may have had the virus."
Potential recall bias and subjective assessment of symptoms were possible limitations of the study.
When asked to speculate on why researchers did not find higher levels of cognitive dysfunction, Putrino said self-reports are generally less reliable than measures like the Montreal Cognitive Assessment (MoCA) for detect cognitive impairment.
Additionally, unlike many people with long-haul COVID-19 that he clinically treats - those who are "really struggling" - the health workers studied in Sweden are functioning well enough to perform their duties in the hospital, so the population studied may not represent the population as a whole.
More research required
"More research needs to be done to investigate the mechanisms underlying these persistent symptoms, and several centers, including UCSF, are researching why this might be," Santhosh said.
Thålin and his colleagues plan to continue monitoring participants. "The main purpose of the COMMUNITY study is to study long-term immunity after COVID-19, but we will also examine the possible underlying pathophysiological mechanisms behind the long-term symptoms related to COVID-19," said she declared.
"I hope to see that taste and smell come back," Thålin added.
"We are just starting to understand the long-term effects of COVID-19," Putrino said. "This is something that we are going to see a lot move forward."
Thålin, Santhosh, Jolley and Putrino did not disclose any relevant financial relationship. Grants from the Knut and Alice Wallenberg Foundation, the Jonas and Christina af Jochnick Foundation, the Leif Lundblad Family Foundation, the Stockholm region, and the Erling-Persson Family Foundation funded the research.
Damian McNamara is a journalist working in Miami. It covers a wide range of medical specialties, including infectious diseases, gastroenterology and intensive care. Follow Damian on Twitter: @MedReporter.
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