July 15, 2024

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The largest investigation reveals more than 200 long-term COVID symptoms

The Lancet: The largest investigation reveals more than 200 long-term COVID (Long COVID) symptoms



The largest investigation reveals more than 200 long-term COVID symptoms.  In the largest international “Long COVID” study to date, patients who have experienced long-term sequelae reported more than 200 symptoms in 10 organ systems.

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Under the leadership of UCL scientists, a patient-led collaboration to date is the largest international “Long COVID” study. Patients who have experienced long-term sequelae reported more than 200 symptoms in 10 organ systems.

The research was published in EClinicalMedicine under the journal The Lancet. For patients contacted through the Body Politic online COVID-19 support group, the researchers created a web-based survey to describe patients with confirmed or suspected long-term COVID-19 The characteristics and time course of symptoms, as well as the impact on daily life and work, restore health.

In response to 3762 qualified participants from 56 countries, the researchers identified 10 organ systems* with a total of 203 symptoms; 66 of which were followed for 7 months. The most common symptoms are fatigue, discomfort after exertion (symptoms worsen after physical or mental exertion), and cognitive dysfunction, commonly referred to as brain fog.

Among the various symptoms, others include: visual hallucinations, tremors, itchy skin, menstrual cycle changes, sexual dysfunction, palpitations, bladder control problems, shingles, memory loss, blurred vision, diarrhea, and tinnitus.

The research team called for clinical guidelines for evaluating long-term COVID to be broader than currently recommended cardiovascular and respiratory function tests, including neuropsychiatric, neurological, and activity intolerance symptoms.

In addition, because a large number of patients with long-term sequelae “endure the pain silently,” the author advocates that a nationwide screening program should be launched to allow anyone who thinks they have COVID to participate. Taking into account the heterogeneity (diversity) of the symptoms that affect multiple organ systems, only the root cause can be found before the patient can get the correct treatment.

Senior author Dr. Athena Akrami said in explaining the study: “Although there is a lot of public discussion about long COVID, there are few systematic studies investigating this population; therefore, the range of symptoms, progression over time, and severity Little is known about the expected clinical course (lifespan), the impact on daily functions, and the expected return to baseline health. Our study is by far the most comprehensive characterization of long COVID symptoms.”

The survey is open to those 18 years of age or older whose symptoms are consistent with COVID-19, including those who have tested positive and negative for SARS-CoV-2. There are 257 questions in total.

In order to describe the characteristics of long-term coronavirus symptoms over a longer period of time, the analysis of the survey data is limited to respondents whose illnesses lasted more than 28 days and whose symptoms occurred between December 2019 and May 2020. The symptoms that appeared in the first week to the seventh month were analyzed.

Although this study does not estimate the prevalence of long-term COVID, other studies estimate that one in seven people (from the National Bureau of Statistics) develops some symptoms 12 weeks after a positive test result, or in other words, 12 weeks after a symptomatic disease. Nearly 30% of people have symptoms in Zhou (from the REACT study of Imperial College London).


Survey summary

In this long COVID cohort, the probability of symptoms lasting more than 35 weeks (8 months) is 91.8%. Among the 3762 respondents, 3608 (96%) reported symptoms for more than 90 days, 2454 (65%) had symptoms for at least 180 days (6 months), and only 233 recovered.

Among those who recovered within 90 days, the average number of symptoms (11.4 out of 66 symptoms measured over time) peaked in the second week, and among those who did not recover within 90 days, the average number of symptoms (17.2) It peaked in the second month. Respondents with symptoms more than 6 months had an average of 13.8 symptoms in the 7th month. During the illness, participants experienced an average of 55.9 symptoms (in the long list of 203 symptoms measured in the study), involving an average of 9.1 organ systems.

Recurrence occurred in 89.1% of the subjects, and the main cause was exercise, physical or mental activity, and stress. Compared with before the illness, 45.2% of the people said they needed to shorten their working hours, and 22.3% were unable to work at all during the survey.

Dr. Akrami said: “This study reveals for the first time a wide range of symptoms, especially neurological symptoms, which are common and persistent in patients with long-term COVID-19.

“The memory and cognitive dysfunction experienced by more than 85% of the interviewees is the most common and long-lasting neurological symptom, which is equally common at all ages and has a great impact on work.

Headaches, insomnia, dizziness, neuralgia, neuropsychiatric changes, tremors, sensitivity to noise and light, hallucinations (olfactory and other), tinnitus, and other sensorimotor symptoms are also common and may indicate involvement of the central and peripheral nervous system Greater nerve problems.

“With the adequate documentation of respiratory and cardiovascular symptoms, it is now clear that it is necessary to expand medical guidelines to assess a wider range of symptoms when diagnosing long-term COVID. In addition, there may be tens of thousands of long-term COVID patients who silently endure them without being sure Are my symptoms related to COVID-19. We now believe that a nationwide program can be extended to communities that can be screened to diagnose and treat all patients suspected of having long-term complications.”

The future work of the research team will focus on emerging themes of long-term COVID: mental health outcomes, diagnosis and antibody testing, symptom clustering, and the socio-economic impact of the disease.




Research limitations

This study has several limitations. First, the retrospective nature of the research reveals the possibility of recall bias. Second, because the survey was conducted in the online support group, when the survey was released, there was a sampling bias for the long-term COVID patients who joined the support group and actively participated in the support group. In addition, despite the eight types of translation and inclusive outreach work, the demographic data is still strongly biased towards English-speaking (91.9%) and white (85.3%) respondents.


Prevalence of symptoms-summary

The top three symptoms: fatigue 98.3%, discomfort after exertion 89.0%, brain fog and cognitive dysfunction accounted for 85.1% (3203 cases).

The top three most debilitating symptoms listed by the patient were fatigue (2652 cases), breathing problems (2242 cases), and cognitive dysfunction (1274 cases).

Symptoms still remain after six months. A total of 2454 people (65.2%) had symptoms for at least 6 months. More than 50% of patients have the following symptoms: fatigue (80%), discomfort after exertion (73.3%), cognitive dysfunction (58.4%), sensorimotor symptoms (55.7%), headache (53.6%) and memory problems (51 %).

In addition, 30%-50% of respondents have the following symptoms 6 months after the onset of symptoms: insomnia, heart palpitations, muscle aches, shortness of breath, dizziness and balance problems, sleep and language problems, joint pain, tachycardia and others Sleep problems.


*Note: 10 organ systems

  • whole body: fatigue, body temperature, weakness, discomfort after exertion;
  • neuropsychiatric disease (subcategory): cognitive function, memory, speech and language, neurosensory, sleep, headache, mood and mood, taste Related to smell and hallucinations;
  • cardiovascular disease: heart related; skin disease: skin related; gastrointestinal disease: intestinal/appetite related symptoms;
  • lungs and breathing: breathing related;
  • head, ears, eyes, nose, throat (HEENT): including Physical and sensory symptoms;
  • reproduction, genitourinary and endocrine: symptoms related to menstruation, thirst and urinary function, hypoglycemia and hyperglycemia; immunity and autoimmunity:
  • new and enhanced immune responses;
  • musculoskeletal: chest tightness, body muscles Pain in the skeletal system.




Original search:

Hannah E. Davis, Gina S. Assaf, Lisa McCorkell, Hannah Wei, Ryan J. Low, Yochai Re’em, Signe Redfield, Jared P. Austin, Athena Akrami. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine, 2021; 101019 DOI: 10.1016/j.eclinm.2021.101019



The largest investigation reveals more than 200 long-term COVID symptoms

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