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Long Covid After One Year: The Good News & the Bad News

“Mild Covid-19 disease does not lead to serious or chronic long term morbidity in the vast majority of patients” was the headline in most media coverage of an important study published last week in The BMJ.

But the reality is not as simple — there is good news and bad news.

The study, which takes advantage of the integrated healthcare system in Israel, is the first to compare mild COVID patients who were not hospitalized directly with people who tested negative for the virus at a large scale. Each study group had nearly 300,000 people. Long Covid was defined as symptoms that continue or appear more than four weeks after an initial COVID-19 infection. Using electronic medical records, the study looked at 65 conditions that have been associated with Long Covid, in the early (first 30 to 180 days) and late (180 to 360 days) periods after catching COVID-19. The large number of participants that was available for this analysis made it possible to look at the change in symptom prevalence over time, and the link to factors like age, sex, preexisting conditions, vaccination and the different variants of COVID-19.

The study found that difficulty with breathing was the most common symptom, as well as a significant risk of weakness (fatigue), poor concentration and memory (“brain fog”), loss of smell and taste, dizziness, heart palpitations, and strep throat in both the early and late time periods. The good news is that respiratory symptoms, chest pain, cough, hair loss, muscle and joint pain were significantly noticeable only during the early phase. The bad news is that neurological symptoms like weakness and cognitive impairment do persist beyond one year — and can be disabling for some people. The study did not provide an estimate for how many people still had symptoms, but given that the majority of the population had mild COVID-19 infections, even a small percentage of people still struggling after one year leads to many millions of people who continue to suffer.

The study goes a long way to clarify the longer-term trajectory of Long Covid after mild infection, in people who were not hospitalized. It is reassuring that many ongoing symptoms following COVID-19 do improve over the first several months following the acute infection. These include the loss of smell and taste and breathing issues. However, those persistent health outcomes appear a lot more similar to known diseases such as ME/CFS and POTS (although they were not included specifically in the analysis because of how electronic diagnoses are captured in the Israeli system). Unfortunately, past experience tells us that recovery from these conditions is much slower and less frequent. Therefore, a public-private effort is urgently needed to find solutions to address this emerging healthcare crisis that affects so many individuals and their families.

This blog post was authored by Solve M.E. President and CEO, Oved Amitay.

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