Infectious Disease

International study identifies more than 200 long-term COVID symptoms

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Aiyegbusi reports that he has been funded by Gilead Sciences, Innovate UK, Janssen Pharmaceuticals, the NIHR Applied Research Center, the NIHR Birmingham Biomedical Research Center, and the West Midlands at the University of Birmingham and the University Hospitals Birmingham NHS Foundation. He also reports personal fees from Gilead Sciences Ltd, GlaxoSmithKline, and Merck outside of the study. Healio Primary Care was unable to confirm any relevant financial information at the time of publication. Please refer to the studies for all relevant financial information from the other authors.


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Four articles offer new insights into the symptoms, duration, onset, and prevalence of COVID lengths, with one article documenting more than 200 symptoms of long-term COVID.

The results were published shortly before the President Joe Biden announced efforts to protect patients with long-standing COVID from discrimination.

“We are bringing agencies together to ensure that Americans with long-term COVID who have a disability have access to rights and resources under the Disability Act, including housing and services in the workplace, school and our health care system they lead their lives with dignity and receive the support they need to continue to master these challenges, ”said Biden. said on the 31st anniversary of the Americans with Disabilities Act.

The average patient has nearly 56 symptoms

In the first publication, the researchers analyzed the responses of 3,762 patients from 56 countries with either confirmed or suspected COVID-19 who completed an online survey conducted from September 6, 2020 to November 25, 2020.

The researchers wrote in EclinicalMedicine that their analysis found an estimated 203 symptoms that lasted more than 28 days in 10 organ systems, 66 of which were followed up for 7 months. It took more than 91% of patients at least 35 weeks to recover. On average, they reported 55.9 symptoms in 9.1 organ systems.

The most common symptoms after the 6th month were fatigue (98.3%), malaise after exercise (89%) and cognitive dysfunction (85.1%). These symptoms varied in prevalence over time. Other symptoms included visual hallucinations, tremors, itchy skin, menstrual cycle changes, sexual dysfunction, palpitations, problems with bladder control, shingles, memory loss, blurred vision, diarrhea, and tinnitus, according to the researchers.

Additionally, the researchers said that 96% of respondents said their symptoms lasted more than 90 days, and 65% said their symptoms lasted 180 days or more. About half of respondents (45.2%) needed a restricted work schedule compared to their pre-COVID-19 schedule, and another 22.3% were inactive due to illness at the time of the survey. The prevalence and course of all symptoms were similar in those with confirmed and suspected COVID-19, with the exception of loss of smell and taste.

“There is now a clear need to expand medical guidelines to assess a far wider range of symptoms when diagnosing long-term COVID,” co-authored Athena Akrami, PhD, a neuroscientist at University College London’s Sainsbury Wellcome Center said in a press release.

Studies show trends in long-term COVID symptoms

The second study, published in the Journal of the Royal Society of Medicine, was an analysis of 27 articles on long-term COVID. Olalekan Lee Aiyegbusi MBChB, PhD, a research fellow at the University of Birmingham’s Institute of Applied Health Research and colleagues identified two main symptom clusters associated with long-term COVID: fatigue, headache and upper respiratory discomfort; and multi-system conditions such as persistent fever and gastroenterological symptoms.

As in the first study, Aiyegbusi and colleagues also reported that fatigue – which was experienced by 47% of patients at work – was the most common long-term COVID symptom. Other common symptoms were dyspnoea (32%), muscle pain (25%), joint pain (20%), headache (18%), cough (18%), chest pain (15%), altered sense of smell (14%), altered sense of taste ( 7%) and diarrhea (6%).

In addition, Aiygebusi and colleagues said cognitive impairment (also known as brain fog), amnesia, insomnia, palpitations, and sore throats were also common symptoms of long-term COVID. Less commonly reported symptoms were runny nose, sneezing, hoarseness, and ear pain.

Patients with long-term COVID also commonly reported that the disease affected their quality of life, mental health, and employment.

“Having more than five symptoms in the first week of acute infection was significantly linked to the development of long-term COVID regardless of age or gender,” Aiyegbusi said and colleagues wrote.

In a press release, they said that the course of long-term COVID coincides with that of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). A previous analysis performed 6 months after hospital discharge of patients with SARS and MERS showed that 25% had reduced lung function and exercise capacity.

A third paper published by the Epic Health Research Network showed similar trends in long-term COVID symptoms. Of 693,375 patients with COVID-19 who were included in the analysis, 9.4% had at least one long-term COVID symptom between 4 weeks and 6 months after their initial diagnosis.

The most common long COVID symptom in the Epic cohort was shortness of breath, which occurred in 3.3% of patients, followed by tiredness or exhaustion (3%), chest pain (2.7%), palpitations (1%), brain fog ( 0.8.). %), Myalgia (0.7%) and loss of smell or taste (0.3%). These symptoms were more common in patients previously hospitalized for COVID-19; According to the researchers, about two-thirds of the long COVID diagnoses were in women.

Loss of corneal nerve fibers

A fourth article, this one in the British Journal of Ophthalmology, included 40 patients who had recovered from confirmed COVID-19 infection and took a survey to see if they had long had COVID-19.

The authors of the British Journal of Ophthalmology article said that 55% of patients had no clinical signs of pneumonia; 28% had clinical signs of pneumonia that did not require oxygen therapy; 10% had been hospitalized with pneumonia and were receiving oxygen therapy; and 8% with pneumonia were admitted to the intensive care unit.

According to a press release, neurological symptoms were present in 22 of the 40 patients after 4 weeks and in 13 of 29 patients after 12 weeks. All 40 patients also underwent corneal confocal microscopy; These scans showed that patients with neurological symptoms 4 weeks after recovery from acute COVID-19 had greater damage and loss of corneal nerve fibers, as well as higher numbers of dendritic cells, compared to corneal confocal microscopy scans of 30 people who never Had COVID-19.

“Corneal confocal microscopy can be of clinical use as a quick, objective eye test to assess patients with long-term COVID,” the authors write.


Aiyegbusi OL et al. JR Soc Med. 2021; doi: 10.1177 / 01410768211032850.

BitigrenG, et al. Br J Ophthalmol. 2021; doi: 10.1136 / bjophthalmol-2021-319450. Davis HE, et al. eClinicalMed. 2021; doi: 10.1101 / 2020.12.24.20248802.

Davis HE, et al. eClinicalMed. 2021; doi: 10.1101 / 2020.12.24.20248802.

Epic health research network. Almost 1 in 10 COVID patients seek treatment for long-term symptoms. Accessed July 28, 2021.

The BMJ. The loss of nerve fibers and the rise of important immune cells on the surface of the eye can signal a “long COVID”. Accessed July 28, 2021. Data sheet. The Biden-Harris Administration celebrates the anniversary of the Americans with Disabilities Act and announces resources to assist those with long-term COVID. announces-resources-to-support-people-with-a-long-covid /. Accessed July 28, 2021. Remarks from President Biden in celebration of the 31st Anniversary of the Americans with Disabilities Act. Law/. Accessed July 28, 2021.


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