Long-term symptoms of mild Covid disappear within a year, study says

Long-term symptoms of mild Covid disappear within a year, study says

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The majority of long-term Covid symptoms disappear within the first year after infection in people with mild cases of Covid-19, according to a large study conducted in Israel.

“Mild disease does not lead to serious or chronic long-term morbidity in the majority of patients,” study co-author Barak Mizrahi, a senior researcher at the KI Research Institute in Kfar Malal, said by email.

learning, published Wednesday in the journal The BMJ, compared thousands of vaccinated and unvaccinated people with mild Covid symptoms who were not hospitalized with people who tested negative for the virus. Prolonged Covid is defined as symptoms that persist or occur more than four weeks after initial infection with Covid-19.

“I think this study is reassuring because most ongoing symptoms after COVID really do improve in the first few months after the acute infection,” said Dr. Benjamin Abramoff, director of Penn Medicine’s Post-COVID Assessment and Recovery Clinic, per email. He did not participate in the research.

But not for everyone. Abramoff said his clinic continues to see many patients with severe, lingering Covid symptoms lasting more than a year after their infection.

“This is particularly true in those individuals who had severe persistent symptoms early after their acute infection,” said Abramoff, who led The American Academy of Physical Medicine and Rehabilitation’s long-standing covid collaboration.

Dr. Jonathan Whiteson, an associate professor of rehabilitation medicine at NYU’s Grossman School, sees the same in his clinic.

“I continue to see many patients from the ‘first wave’ of COVID who had mild to moderate acute COVID (and were never hospitalized) who have significant persistent and functionally limiting symptoms almost 3 years later,” Whiteson said on email. He did not participate in the study.

Israeli researchers analyzed the medical records of nearly 300,000 people diagnosed with mild cases of Covid-19 and compared their health over the next year with roughly 300,000 people who did not have Covid. The average age of a Covid positive is 25, with 51% being women.

The researchers looked for 65 conditions that are associated with prolonged Covid and divided them into two time frames: early, or the first 30 to 180 days after contracting Covid; and late or 180 to 360 days after infection.

After controlling for age, sex, alcohol and tobacco use, pre-existing conditions and different variants of Covid-19, the researchers found a significant risk of brain fog, loss of smell and taste, breathing problems, dizziness and weakness, palpitations and strep throat both in the early and late time periods.

According to the researchers, chest pain, cough, hair loss, muscle and joint pain, and respiratory disorders increased significantly only during the early phase.

Difficulty breathing was the most common complaint, the study found. Vaccination reduced the risk of respiratory problems, but the researchers found that vaccinated individuals had “similar risk for other outcomes compared to unvaccinated infected patients,” according to the study.

“Because of the size of the study, it was possible to look at the change in the prevalence of symptoms over time and the effects of other factors on persistent symptoms,” said Dr. Peter Openshaw, professor of experimental medicine at Imperial College London, in a statement.

“The olfactory disorder usually resolves by about 9 months, but when the changes in concentration and memory are present they are more persistent,” said Openshaw, who was not involved in the study.

Only slight differences were seen between men and women in the study, but children had fewer early symptoms than adults, which disappeared by the end of the year. No real differences were found between the original wild-type SARS-CoV-2 (March 2020 by November 2020), the alpha version (January 2021 until April 2021) and the Delta option (July 2021 until October 2021).

“Patients with mild Covid-19 had an increased risk for a small number of health outcomes, with only a few symptoms persisting one year after infection with SARS-CoV-2 and their risk decreasing with time post-infection,” Mizrahi said by email.

“However, we do not claim that there are no patients who suffer from prolonged symptoms of COVID such as dyspnea (difficulty breathing), frailty, cognitive impairment etc,” he added. “(Our study) does not contradict the evidence that a small number of patients do suffer from long-lasting symptoms as seen in this analysis.”

The researchers pointed out some limitations of the study, such as the possibility of diagnostic errors or the inability to record some milder symptoms over time. Abramov agreed.

“This study design is not able to detect the severity of these symptoms, and there are potentially other missed patients due to the use of medical coding to detect persistent Long COVID symptoms,” Abramoff said.

It may also be difficult to apply the study’s findings to other countries, such as the United States, because of differences in how doctors code symptoms. For example, the study did not identify several conditions commonly seen in long Covid clinics in the U.S., said Dr. Monica Verduzco-Gutierrez, professor and chair of the department of rehabilitation medicine at the Long School of Medicine at UT Health, San Antonio.

“The most common symptom of Long COVID is fatigue and that was not on that list. Post-exertional malaise, dysautonomia/POTS or ME/CFS were also absent. Those are some of the main presentations that I see in my clinical population, so that’s the main limitation of this study not having those results,” said Verdusco-Gutierrez, who was not involved in the new study.

Nausea after exertion is massively exhausting even after minimal effort. Unlike ordinary exhaustion, it can take days to weeks for a person to recover, and the condition can reactivate if activity is resumed too quickly.

Postural orthostatic tachycardia syndrome, or POTS, is an increased heart rate after sitting or standing up that can lead to dizziness or fainting. It is a form of dysautonomia, disorder of the autonomic nervous system. “There is usually no cure for dysautonomia,” according to the National Institute of Neurological Disorders and Stroke.

Myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS, is a serious long-term illness in which people experience extreme fatigue that is not improved by rest. The condition can affect sleep and thought processes, cause pain in many parts of the body and prevent people from carrying out most daily activities.

In response to this concern, Mizrahi told CNN that “postexercise malaise was not included in this study because it is not a commonly prescribed diagnosis in Israel.” In addition, he said, dysautonomia/POTS has been assigned International Classification of Diseases or ICD medical code only from October 2022, so it is also not included in the study.

However, the symptoms of POTS and other conditions may be subsumed under more general categories such as cardiac arrhythmias or palpitations, he said.

Additionally, Mizrahi said fatigue was coded as a “weakness” in the survey. In fact, the researchers found that weakness was the second most common symptom reported in the study, and it continued to plague the 19- to 60-year-olds for months.

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