Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years — United States, March 2020–November 2021

Bull-Otterson, Lara; Baca, Sarah; Saydah, Sharon; Boehmer, Tegan K.; Adjei, Stacey; Gray, Seymour J.; Harris, Aaron M.

doi:10.15585/mmwr.mm7121e1

Cited by 271 publications

(230 citation statements)

References 8 publications

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“…In contrast to these phenomena, occurring within 31 days of acute COVID-19, AMI and stroke are infrequent in PASC. A large, self-controlled case series documented that while AMI and stroke have been observed in PASC ( 12 ), the greatest risk is in the first 2 to 4 weeks following acute SARS-CoV-2 infection ( 96 ). A similar national registry reported increased incidence rate ratios for DVT and pulmonary embolism extending to 70 days and 110 days, respectively, after acute COVID-19 ( 97 ).…”

Section: Ec Pathology: Pasc Versus Other Severe Respiratory Infectionsmentioning

confidence: 99%

“…There is no internationally recognized case definition for PASC, and this complicates pathophysiologic investigations. The CDC requires only an interval of more than 4 weeks after acute COVID-19 ( 11 ), on the basis of which one in five COVID-19 survivors aged 18–64 years, and one in four older than 65 years, experienced an incident PASC condition ( 11 , 12 ). Using a prospective Delphi consensus-seeking exercise and a mixed iterative survey of experts and patients, the WHO developed a definition requiring a longer interval: “Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis....…”

Section: Introductionmentioning

confidence: 99%

“…Divergent PASC phenotypes also complicate investigation of PASC epidemiology and pathophysiology ( 11 , 12 , 14 ). Recent surveys of large population groups post–acute COVID-19 that include pre-pandemic comparator groups and involvement of more than one organ system suggest a PASC incidence of approximately 14% in adults ( 15 ) and approximately 21% in children and adolescents ( 16 ).…”

Section: Introductionmentioning

confidence: 99%

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Long COVID endotheliopathy: hypothesized mechanisms and potential therapeutic approaches

Ahamed¹,

Laurence²

2022

Journal of Clinical Investigation

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SARS-CoV-2–infected individuals may suffer a multi–organ system disorder known as “long COVID” or post-acute sequelae of SARS-CoV-2 infection (PASC). There are no standard treatments, the pathophysiology is unknown, and incidence varies by clinical phenotype. Acute COVID-19 correlates with biomarkers of systemic inflammation, hypercoagulability, and comorbidities that are less prominent in PASC. Macrovessel thrombosis, a hallmark of acute COVID-19, is less frequent in PASC. Female sex at birth is associated with reduced risk for acute COVID-19 progression, but with increased risk of PASC. Persistent microvascular endotheliopathy associated with cryptic SARS-CoV-2 tissue reservoirs has been implicated in PASC pathology. Autoantibodies, localized inflammation, and reactivation of latent pathogens may also be involved, potentially leading to microvascular thrombosis, as documented in multiple PASC tissues. Diagnostic assays illuminating possible therapeutic targets are discussed.

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Section: Ec Pathology: Pasc Versus Other Severe Respiratory Infectionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Long COVID endotheliopathy: hypothesized mechanisms and potential therapeutic approaches

Ahamed¹,

Laurence²

2022

Journal of Clinical Investigation

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“…To date, few studies have reported outcomes related to post COVID-19 condition beyond six months after infection (3,(12)(13)(14)(15)(16). Common study limitations include specific participant populations (e.g., hospitalized) or the lack of a prospective follow-up.…”

Section: Introductionmentioning

confidence: 99%

Natural course of post COVID-19 condition and implications for trial design and outcome selection: A population-based longitudinal cohort study

Menges

Anagnostopoulos

Domenghino

et al. 2022

Preprint

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Background: Evidence from population-based studies on the longer-term natural course of post COVID-19 condition is limited, but crucial for informing patients and healthcare providers and for effectively designing clinical trials. Objectives: To evaluate longer-term symptoms and health outcomes within a cohort of SARS-CoV-2 infected individuals. Design: Population-based, longitudinal cohort. Setting: General population, Canton of Zurich, Switzerland. Patients: 1543 adults with confirmed SARS-CoV-2 infection and 628 adults without infection. Measurements: Changes in self-reported health status over time, factors associated with persistence of non-recovery, and prevalence and excess risk of symptoms at 6 and 12 months post-infection compared to non-infected individuals. Results: 25% of SARS-CoV-2 infected individuals did not recover by 6 months. Of those, 67% and 58% also did not recover at 12 and 18 months after infection, respectively. Hospitalization for acute COVID-19, pre-existing fatigue and pain or discomfort, and presence of specific systemic, cardiovascular, or musculoskeletal symptoms at 6 months were associated with persistent non-recovery. Symptom prevalence was higher among infected individuals compared to non-infected individuals at 6 months (adjusted risk difference (aRD)=17%) and 12 months (aRD=20%). aRDs for individual symptoms ranged from 2% to 12%, with the highest excess risks observed for altered taste or smell, post-exertional malaise, fatigue, and reduced concentration and memory. Limitations: We relied on self-reported assessments and did not assess the effects of vaccination or infection with emerging variants of concern. Conclusion: These findings emphasize the need for effective interventions to reduce the burden of post COVID-19 condition. They further demonstrate the importance of using multiple outcome measures and of considering the expected rates of natural recovery and heterogenous patient trajectories in the design and interpretation of clinical trials.

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“…Long COVID-19 refers to a wide range of sustained symptoms, ranging from fatigue, dyspnea, joint pain, chest pain, and anosmia, to cognitive impairment, that “occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis” [ 92 ]. In a study of approximately 2 million people in the U.S., for instance, researchers found that among participants who had contracted COVID-19, approximately 1 in 5 of those aged 18–64 years and 1 in 4, aged 65 years and over, experience at least one long COVID-19 symptom [ 93 ]. This means that, while some mitigation countries, such as Sweden, might have a relatively less daunting toll of COVID-19, especially when compared to nations such as the U.S. (see Table 3 ), they may still have to face long-term issues, such as long COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The Advantages of the Zero-COVID-19 Strategy

Cheshmehzangi

McDonnell

et al. 2022

IJERPH

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Introduction: To curb the COVID-19 pandemic, countries across the globe have adopted either a mitigation or anelimination policy, such as the zero-COVID-19 strategy. However, further research is needed to systematically investigate the advantages of the zero-COVID-19 strategy in the literature. To bridge the research gap, this study examines the zero-COVID-19 strategy in terms of its advantages as a global anti-pandemic framework. Methods: A literature review was conducted in PubMed, PsycINFO, and Scopus to locate academic articles that discussed the advantages of the zero-COVID-19 strategy. Braun and Clarke’s thematic analysis approach was adopted to guide the data analysis process. Results: The findings of our study show that the advantages of the zero-COVID-19 strategy range from short-term (e.g., limited virus infections, hospitalizations, and deaths), to medium-term (e.g., reduced presence of other infectious diseases), and long-term (e.g., low incidence of long COVID-19). While local residents mainly leverage these advantages, they also impact the global community (e.g., stable global supply of essentials, such as COVID-19 vaccines). Conclusions: COVID-19 is catastrophic, yet controllable. Our study examined the advantages of the zero-COVID-19 strategy from a nuanced perspective and discussed how these advantages benefit both the local and the global community in pandemic control and management. Future studies could investigate the shortcomings of the zero-COVID-19 strategy, especially its unintended consequences, such as adverse impacts on vulnerable populations’ mental health, so that society could more efficiently, economically, and empathetically capitalize on the potential of the zero-COVID-19 strategy for the betterment of personal and public health.

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Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years — United States, March 2020–November 2021

Cited by 271 publications

References 8 publications

Long COVID endotheliopathy: hypothesized mechanisms and potential therapeutic approaches

Long COVID endotheliopathy: hypothesized mechanisms and potential therapeutic approaches

Natural course of post COVID-19 condition and implications for trial design and outcome selection: A population-based longitudinal cohort study

The Advantages of the Zero-COVID-19 Strategy

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