Persistent COVID-19 Symptoms in a Community Study of 606,434 People in England

Overview

Journal Nat Commun

Specialty Biology

Date 2022 Apr 13

PMID 35413949

Authors

Matthew Whitaker

Joshua Elliott

Marc Chadeau-Hyam

Steven Riley

Ara Darzi

Graham Cooke

Helen Ward

Paul Elliott

Affiliations

Soon will be listed here.

Abstract

Long COVID remains a broadly defined syndrome, with estimates of prevalence and duration varying widely. We use data from rounds 3-5 of the REACT-2 study (n = 508,707; September 2020 - February 2021), a representative community survey of adults in England, and replication data from round 6 (n = 97,717; May 2021) to estimate the prevalence and identify predictors of persistent symptoms lasting 12 weeks or more; and unsupervised learning to cluster individuals by reported symptoms. At 12 weeks in rounds 3-5, 37.7% experienced at least one symptom, falling to 21.6% in round 6. Female sex, increasing age, obesity, smoking, vaping, hospitalisation with COVID-19, deprivation, and being a healthcare worker are associated with higher probability of persistent symptoms in rounds 3-5, and Asian ethnicity with lower probability. Clustering analysis identifies a subset of participants with predominantly respiratory symptoms. Managing the long-term sequelae of COVID-19 will remain a major challenge for affected individuals and their families and for health services.

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References

Riley S, Atchison C, Ashby D, Donnelly C, Barclay W, Cooke G . REal-time Assessment of Community Transmission (REACT) of SARS-CoV-2 virus: Study protocol. Wellcome Open Res. 2021; 5:200. PMC: 8095190. DOI: 10.12688/wellcomeopenres.16228.2. View

Sykes D, Holdsworth L, Jawad N, Gunasekera P, Morice A, Crooks M . Post-COVID-19 Symptom Burden: What is Long-COVID and How Should We Manage It?. Lung. 2021; 199(2):113-119. PMC: 7875681. DOI: 10.1007/s00408-021-00423-z. View

Blomberg B, Mohn K, Brokstad K, Zhou F, Linchausen D, Hansen B . Long COVID in a prospective cohort of home-isolated patients. Nat Med. 2021; 27(9):1607-1613. PMC: 8440190. DOI: 10.1038/s41591-021-01433-3. View

Davies B, Parkes B, Bennett J, Fecht D, Blangiardo M, Ezzati M . Community factors and excess mortality in first wave of the COVID-19 pandemic in England. Nat Commun. 2021; 12(1):3755. PMC: 8213785. DOI: 10.1038/s41467-021-23935-x. View

Ward H, Flower B, Garcia P, Ong S, Altmann D, Delaney B . Global surveillance, research, and collaboration needed to improve understanding and management of long COVID. Lancet. 2021; 398(10316):2057-2059. PMC: 8580495. DOI: 10.1016/S0140-6736(21)02444-2. View

Ward H, Atchison C, Whitaker M, Ainslie K, Elliott J, Okell L . SARS-CoV-2 antibody prevalence in England following the first peak of the pandemic. Nat Commun. 2021; 12(1):905. PMC: 7876103. DOI: 10.1038/s41467-021-21237-w. View

Tomasoni D, Bai F, Castoldi R, Barbanotti D, Falcinella C, Mule G . Anxiety and depression symptoms after virological clearance of COVID-19: A cross-sectional study in Milan, Italy. J Med Virol. 2020; 93(2):1175-1179. PMC: 7461061. DOI: 10.1002/jmv.26459. View

Venturelli S, Benatti S, Casati M, Binda F, Zuglian G, Imeri G . Surviving COVID-19 in Bergamo province: a post-acute outpatient re-evaluation. Epidemiol Infect. 2021; 149:e32. PMC: 7873454. DOI: 10.1017/S0950268821000145. View

Augustin M, Schommers P, Stecher M, Dewald F, Gieselmann L, Gruell H . Post-COVID syndrome in non-hospitalised patients with COVID-19: a longitudinal prospective cohort study. Lancet Reg Health Eur. 2021; 6:100122. PMC: 8129613. DOI: 10.1016/j.lanepe.2021.100122. View

10.

Ali A, Siddiqui A, Arshad M, Iqbal F, Arif T . Effects of COVID-19 pandemic and lockdown on lifestyle and mental health of students: A retrospective study from Karachi, Pakistan. Ann Med Psychol (Paris). 2021; 180(6):S29-S37. PMC: 7883721. DOI: 10.1016/j.amp.2021.02.004. View

11.

Yomogida K, Zhu S, Rubino F, Figueroa W, Balanji N, Holman E . Post-Acute Sequelae of SARS-CoV-2 Infection Among Adults Aged ≥18 Years - Long Beach, California, April 1-December 10, 2020. MMWR Morb Mortal Wkly Rep. 2021; 70(37):1274-1277. PMC: 8445372. DOI: 10.15585/mmwr.mm7037a2. View

12.

Klein H, Asseo K, Karni N, Benjamini Y, Nir-Paz R, Muszkat M . Onset, duration and unresolved symptoms, including smell and taste changes, in mild COVID-19 infection: a cohort study in Israeli patients. Clin Microbiol Infect. 2021; . PMC: 7884919. DOI: 10.1016/j.cmi.2021.02.008. View

13.

Arnold D, Hamilton F, Milne A, Morley A, Viner J, Attwood M . Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. Thorax. 2020; 76(4):399-401. PMC: 7716340. DOI: 10.1136/thoraxjnl-2020-216086. View

14.

Fernandez-de-Las-Penas C, Palacios-Cena D, Gomez-Mayordomo V, Rodriuez-Jimenez J, Palacios-Cena M, Velasco-Arribas M . Long-term post-COVID symptoms and associated risk factors in previously hospitalized patients: A multicenter study. J Infect. 2021; 83(2):237-279. PMC: 8110627. DOI: 10.1016/j.jinf.2021.04.036. View

15.

Del Rio C, Collins L, Malani P . Long-term Health Consequences of COVID-19. JAMA. 2020; 324(17):1723-1724. PMC: 8019677. DOI: 10.1001/jama.2020.19719. View

16.

Sudre C, Murray B, Varsavsky T, Graham M, Penfold R, Bowyer R . Attributes and predictors of long COVID. Nat Med. 2021; 27(4):626-631. PMC: 7611399. DOI: 10.1038/s41591-021-01292-y. View

17.

Callard F, Perego E . How and why patients made Long Covid. Soc Sci Med. 2020; 268:113426. PMC: 7539940. DOI: 10.1016/j.socscimed.2020.113426. View

18.

Odriozola-Gonzalez P, Planchuelo-Gomez A, Irurtia M, de Luis-Garcia R . Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res. 2020; 290:113108. PMC: 7236679. DOI: 10.1016/j.psychres.2020.113108. View

19.

Moreno-Perez O, Merino E, Leon-Ramirez J, Andres M, Ramos J, Arenas-Jimenez J . Post-acute COVID-19 syndrome. Incidence and risk factors: A Mediterranean cohort study. J Infect. 2021; 82(3):378-383. PMC: 7802523. DOI: 10.1016/j.jinf.2021.01.004. View

20.

Ward H, Cooke G, Atchison C, Whitaker M, Elliott J, Moshe M . Prevalence of antibody positivity to SARS-CoV-2 following the first peak of infection in England: Serial cross-sectional studies of 365,000 adults. Lancet Reg Health Eur. 2021; 4:100098. PMC: 8088780. DOI: 10.1016/j.lanepe.2021.100098. View