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

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Most prolonged 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 severe or chronic long-term morbidity in the vast majority of patients,” said study co-author Barak Mizrahi, a senior investigator at the KI Research Institute in Kfar Malal, via email.

The study, published Wednesday in 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. Long Covid was defined as symptoms that continue or appear more than four weeks after an initial Covid-19 infection.

“I find this study reassuring, as most ongoing post-COVID symptoms improve within the first few months after acute infection,” said Dr. Benjamin Abramoff, director of the Post-COVID Assessment and Recovery Clinic at Penn Medicine, via email. He was not involved in the study.

But not for everyone. Abramoff said his clinic continues to see many patients with severe and long-lasting Covid symptoms that last more than a year after infection.

Long Covid is a debilitating condition that can include breathing problems, mental confusion, chronic coughing and overwhelming fatigue.

“This is particularly true in those individuals who experience severe persistent symptoms shortly after their acute infection,” said Abramoff, who leads the American Academy of Physical Medicine and Rehabilitation’s long-running Covid collaboration.

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

“I continue to see many ‘first wave’ COVID patients who had mild to moderate acute COVID (and were never) hospitalized, who have significant persistent and functionally limiting symptoms nearly 3 years later,” Whiteson said via email. He was not involved with 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 to approximately 300,000 people who did not have Covid. The average age of those who tested positive for Covid was 25 years old, and 51% were female.

The researchers looked for 65 conditions associated with long-term Covid and divided them into two time periods: early, or the first 30 to 180 days after Covid infection; and late, or 180 to 360 days after infection.

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

Chest pain, coughing, hair loss, muscle and joint pain, and breathing disturbances significantly increased during the initial phase alone, according to the researchers.

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

“Due to the size of the study, we were able to observe the change in symptom prevalence 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 smell disturbance usually resolves within about 9 months, but when they are present, concentration and memory disturbances tend to be more persistent,” said Openshaw, who was not involved in the study.

Only small differences appeared between men and women in the study, but children had fewer early symptoms than adults, which mostly disappeared by the end of the year. No real difference was found between the original wild type of SARS-CoV-2 (March 2020 to November 2020), the Alpha variant (January 2021 to April 2021) and the Delta variant (July 2021 to 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 SARS-CoV-2 infection, and their risk decreased with time since infection,” Mizrahi said. by email.

However, “we are not claiming that there are not patients who suffer from prolonged symptoms of COVID such as dyspnoea (difficulty breathing), weakness, cognitive impairment, etc.”, he added. “(Our study) does not contradict the evidence that a small number of patients suffer from enduring symptoms, as noted in this analysis.”

The researchers pointed out certain limitations in the study, such as the possibility of misdiagnosis or failure to record some milder symptoms over time. Abramoff agreed.

“This study design is not capable of detecting the severity of these symptoms, and there are potentially other patients missed due to the use of medical coding to detect persistent symptoms of long-term COVID,” 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 clinicians code symptoms. For example, the study did not identify several conditions often found in long-term Covid clinics in the US, 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 this was not on this list. Postexertion malaise, dysautonomia/POTS, or ME/CFS were also missing. These are some of the key presentations I’m seeing in my clinical population, so it’s a big limitation of this study not having these results,” said Verduzco-Gutierrez, who was not involved in the new study.

Post-exertional malaise is overwhelming exhaustion even after minimal exertion. Unlike regular exhaustion, it can take days to weeks for a person to recover, and the malaise can reactivate if activity is resumed too quickly.

Postural orthostatic tachycardia syndrome, or POTS, is an increase in heart rate after sitting or standing that can lead to dizziness or fainting. It is a form of dysautonomia, a 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 overwhelming fatigue that does not improve with 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.

Responding to that concern, Mizrahi told CNN that “post-exertion malaise was not included in this study as it is not a commonly prescribed diagnosis in Israel.” Also, he said, dysautonomia/POTS only received an International Classification of Diseases, or ICD medical code, as of October 2022, so it was also not included in the study.

However, symptoms of POTS and other conditions may have been subsumed into more general categories such as cardiac arrhythmias or palpitations, he said.

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