Americans infected with the omicron variant of the coronavirus are less likely to develop the typical symptoms of prolonged COVID than those who had COVID-19 before in the pandemic, according to the largest study ever conducted on other people. poor health, or weakened, due to the lingering effects of the virus.
Studies of nearly five million COVID patients in the U. S. In the U. S. , a study based on a collaboration between The Washington Post and study partners, shows that one in 16 people with omicron received medical care for long-term COVID-related symptoms in the months following their infection. Patients exposed to the coronavirus in the first wave of pandemic disease, from early 2020 to late spring 2021, were most likely to spread COVID in the long term, with 1 in 12 suffering persistent symptoms.
This trend reflects what leading physicians treating prolonged COVID, and some scientists, have detected as the coronavirus pandemic evolves. But the reasons they propose for converting rates are more of a guess than a test.
“Long COVID is a beast,” said Ziyad Al-Aly, director of the Center for Clinical Epidemiology at the University of Washington School of Medicine in St. Petersburg. Louis and principal investigator of the disease.
The effects also show that patients with certain underlying medical conditions are twice as likely as before for other people to seek treatment for long-term COVID-related symptoms: about 9% of patients with any of those pre-existing conditions gained Long-Term COVID Symptom Remedy within six months of hiring COVID. compared with 4. 6% who had no such fitness problems in the past, according to the analysis.
Obese patients were about three times more likely to report lasting COVID symptoms than those with no previous medical problems, while others with lung disease or kidney disorders followed closely.
These findings and others from The Post’s partnership define a troubling domino effect of the nation’s worst public fitness crisis in a century. year, the exact nature of the long COVID and the cures to deal with it are in a black box.
His reasons have not gone beyond theories. Their symptoms differ between patients and, as the study shows, some are not unusual even before other people contract the virus, making it difficult to perceive what is caused by a coronavirus infection and what is incidental. Doctors treat symptoms by borrowing from what they know. about other diseases. And while doctors are familiar with postviral syndrome (persistent symptoms after the flu, pneumonia, Epstein-Barr, and other viral situations), prolonged COVID tends to persist for much longer.
“It’s scary not to be who I was before,” said Noemi Chiriac of Dallas, who hasn’t regained her senses of taste and smell since an episode of COVID-19 days before Christmas 2021, when the delta variant of the virus superimposed the initial level of the omicron variant. “It’s wasting your identity. “
Forty-five-year-old single Chiriac can still take the one-mile rides she loves, but she is out of breath if she tries to communicate with someone at the same time and wants to nap hours once she gets home.
In the summer of 2021, the aerospace and defense corporation where Chiriac worked chose her to compete for senior leadership positions as part of a “talent pool. “Missed an interview. He was asked how he would deal with conditions with business leaders, but the lingering brain fog of his first COVID circular seven months ago prevented him from remembering their names.
“You may only see their faces. I know exactly who they are, but I don’t remember them,” Chiriac said. He said goodbye to the race for jobs in the skill group.
An emerging set of studies in the U. S. The U. S. and elsewhere has tried to determine who is most vulnerable to the large constellation of symptoms, such as Chiriac’s experiences, that characterize prolonged COVID. But the effects vary widely due to other study methods, the small cohort of patients on which many studies are based, and the lack of consensus among scholars on how to profile the syndrome.
The study with The Post’s partners, found in anonymized medical records of COVID patients across the country, adds to the merged picture of prolonged COVID. consulted medical professionals within six months of their initial infections, complaining of at least one typical symptom of a long COVID they wouldn’t have had before. This proportion is within the diversity known through some smaller studies, but is lower than that discovered through other studies defining broader definitions of prolonged COVID.
In a country where at least two hundred million people have been infected with SARS-CoV-2, according to federal estimates, the rate detected through The Post translates into about 14 million US citizens who have survived the virus and suffer from long-term illnesses. long-lasting and life-altering effects.
“That’s a staggering number of people,” said endocrinologist Zijian Chen, medical director of the Post-COVID Care Center at Mount Sinai Health System in New York City, one of the first U. S. medical centers. The U. S. Department of Health and Prevention is to create an interdisciplinary clinic to treat patients with incipient symptoms that would become known as prolonged COVID.
“And the implication for long-term care for some of those people, and the implication for the physical care dollars that we have to use to care for those people, is pretty big,” Chen said.
The Post’s studies are based on knowledge from a Wisconsin company called Epic Systems, which houses the nation’s largest collection of electronic hospital medical records, fitness systems and doctors’ offices. This collaboration of studies, helping how the studies would be carried out and interpreting the results.
The studies are based on recordings, from Epic’s knowledge base of studies, of nearly 4. 9 million patients diagnosed with COVID from the start of the pandemic in early 2020 to January 2022, forming the largest dataset used in any long-term COVID study in the world. The study marks the first time Epic has shared what the company calls its Cosmos know-how as part of a collaboration with a news agency. The study examines which patients sought care for one of a list of diffuse symptoms that the Centers for Disease Control and Prevention identifies as not unusual with long-term COVID, also known as post-COVID or long-haul syndrome. They come with fatigue, breathing problems, coughing, rapid or abnormal heartbeat, difficulty thinking or concentrating, and many others.
In a twist on the prolonged COVID investigation, The Post’s investigation also looked at who sought care for the same symptoms over a six-month period before having COVID. Including this “before” time, the examination shows that those symptoms circulating in the general population are still less unusual in the months after patients have contracted the coronavirus than in the previous period. This before-and-after comparison gives a way to perceive that the long COVID, rarely rejected by doctors, especially at the beginning of the pandemic, is real. .
And yet, the onset of the same symptoms before others spread COVID attests to the complexity of diagnosing COVID long-term and measuring its prevalence.
“We have pictures to look at what is prolonged COVID and what is the [after-effect] of chronic illness or acute illness,” CDC Director Rochelle Walensky said in an interview with The Post.
For this reason, The Post’s research and other studies may also inadvertently exaggerate the existing duration of COVID, said Al-Aly of the University of Washington, who has conducted giant post-COVID studies using knowledge from the Department of Veterans Affairs. At the same time, Al-Aly said, studies could underestimate the actual duration of COVID because, as the syndrome is better understood, researchers may also notice symptoms that are on the CDC’s list.
It is necessary, Al-Aly said, “to be kind to the complexity of the issue. “
The Post’s investigation sought to identify who is most likely to see a doctor for the typical symptoms of prolonged COVID. Among the discoveries:
The rate of decline in omicron wave symptoms is consistent across all age groups, gender, race, and other people in other fitness situations prior to contracting COVID. The reduced rate of symptoms in this wave is largely due to the fact that other young people account for a higher percentage of omicron cases than in previous waves and the fact that they are unlikely to seek care for symptoms of prolonged COVID.
Women are more likely than men to seek care for COVID-19 symptoms — only about 8% of women, compared to just over 6% of men. Other long-term COVID studies have found a gap.
Older survivors of coronavirus infection are more likely to report a long-term COVID symptom. Just over 1 in nine people over the age of 65 sought care for such symptoms, with 1 in 24 people under 30.
Patients with the most severe cases of COVID are more likely to develop long-term symptoms. About 1 in five COVID patients who were in intensive care sets reported post-COVID symptoms later, compared with about 1 in five who were not hospitalized. But because of the pandemic’s undeniable estimates (the vast majority of inflamed people are never hospitalized), mild COVID patients make up the bulk of those reporting post-COVID symptoms.
While COVID cases and deaths have profoundly affected Black, Latino, or underserved communities, the same is not true for long-lasting COVID symptoms. They are slightly more likely to report symptoms than those with personal insurance. Because the study is based on medical records, the lack of differences between racial, ethnic, and income source groups may reveal more about who has sufficient access to fitness facilities. than the real influence of long COVID on those communities, according to some doctors.
“Health equity plays an important role in terms of the type of patients who can seek care during a long era of COVID,” said Alba Azola, co-leader of the post-acute COVID-19 team at Johns Hopkins in Baltimore. other people who come to ourArray clinics. . . They are rich, white and can access health care. “
Among the 3 viral waves of the pandemic, symptoms of prolonged COVID are becoming less common in the omicron era for each patient organization in the analysis. For example, regardless of whether patients had mild cases of COVID or were in intensive care units, they were less likely to report post-COVID symptoms if they had omicron than if they had older versions of the virus.
——
‘Another infection’
Pat Hill, a 76-year-old insurance agent in Shaker Heights, Ohio, outside Cleveland, fell ill with coronavirus during the delta era, when the chances of developing lasting symptoms were lower than in the first wave. Higher than in the next wave of Omicron. It’s part of the medical mystery that doctors and researchers are still trying to get to the bottom of: Why do all the major variants of the pandemic seem to generate other possibilities of lingering effects?
Hill has been in the habit of buying N95 masks for two decades, ever since being diagnosed with asthma, to protect herself and others whenever the flu or no blood circulates. Since the beginning of the pandemic, Hill said, “I have a mask in my car, and a box next to my door, and all my bags have a mask. If I see someone who isn’t dressed in a mask and I think they’re dressed in [one], I’m going to give them a mask. “
But one morning in September 2021, just days before receiving his first booster shot from Moderna, he went to a meeting with representatives of local insurance companies. The small room, intended for 10 people, was filled twice more. It set off an alarm” in his mind, he recalls. Still, he took off his mask long enough to chew a bagel and take a sip of coffee.
A few days later, with a runny nose, postnasal discharge and cough, Hill thought it was his same allergy to late-summer ragweed. But she saw a notice that Shaker Heights submitted coronavirus tests and was given one, just to be safe. “I was surprised,” she said, when a nurse called. Positive.
Her COVID episode had nothing to do with her worry about being hospitalized on a ventilator. “It was like a mild case of the flu,” Hill recalls. She was tired but never had a fever, never saw her blood oxygen levels drop dangerously. I think I would quarantine and get back to normal,” he said. The real annoyance began a month later. His fatigue increased. Bronchitis evolved. He is short of breath. His legs and ankles are swollen.
It is fully understood why the delta wave and the original form of COVID seem to produce such symptoms more likely than the newer omicron and its subvariants. But doctors and biomedical researchers have some ideas.
One option is for variants to target cells elsewhere in the airways, said Akiko Iwasaki, an immunologist at Yale School of Medicine, and the omicron affects the upper component and the virus’ previous bureaucracy decreases. And the shrinking respiratory tract creates more damage. “As a result, Iwasaki said, the omicron “could produce less severity and less COVID. “
Omicron “appears to be another infection,” said Kathleen Bell, a rehabilitation physician at the University of Texas Southwestern Medical Center at Dallas, which was one of the first medical centers to create a clinic to treat patients with persistent symptoms.
Fewer patients infected with omicron arrive at the COVID-19 clinic with significant loss of smell or severe pulmonary symptoms. The virus has “changed their attack,” said Bell, whose clinic continues to receive new patients with symptoms that persist since they were diagnosed. with COVID the delta wave more than a year ago, instead of the omicron wave.
For insurance agents like Hill, who specialize in Medicare fitness plans, the fall enrollment season is the busiest. He had enough power in his first fall with lasting COVID symptoms to send renewal reminders to only a few customers. I’ve been with you for years, they’re like family,” he said of the rest. “I felt like a failure. “
In November 2021, two months after becoming infected, he learned of a prolonged COVID clinic at a branch of training hospitals. The first appointment was made 3 months later. See an immunologist, hematologist, and cardiologist. An acupuncture therapist treats back pain, which can be a post-COVID symptom. Meets with a social worker. He recently brought in a pulmonologist because his cough was worse.
“I know it’s not like that for her, [but] it’s still early in the long COVID journey,” said Juliane Torer, a nurse practitioner at the suburban clinic who knows Hill.
In July, as Hill’s birthday approached, a friend she considers a niece of her gigantic “chosen family” surprised her with tickets to an Elton John concert. It was at the baseball park in downtown Cleveland, and they had to park two blocks away. Hill walked hesitantly to his seats. While the audience applauded with delight, she couldn’t. On the way back to the car, he walked halfway with his cane to a bus stop, where he rested before walking the rest of the way. Hill said, “I did, and my biggest accomplishment was seeing Elton John. “
——
The Unions
The Post is one of many that have discovered an obvious link between long COVID and pre-existing medical conditions.
“The more severe COVID is, the greater the risk of long-term COVID. And other people with comorbidities have a higher threat of severe COVID,” said Albert Ko, an epidemiologist at the Yale School of Public Health and an infectious disease specialist.
Patty Reales is a patient. Her parents didn’t need anyone to know she had lupus developing in Queens, New York, though other young men insulted her because she had left high school in poor health and, when she was in school, she was too sick. Tired for gym classes. An autoimmune disease was the cause of his kidney disease and, in turn, his high blood pressure. She is also asthmatic.
When she was in her early forties, sharing a three-apartment space with her parents and younger brother, and applying as a grant administrator at Mount Sinai, Reales had been taking immunosuppressive drugs for decades and knew she was vulnerable to infections. The first time she had COVID symptoms, in March 2020, she was pretty sure she had been exposed while walking through the hospital lobby, as New York City had become the national center of the young pandemic.
Reales worked from home for a few days, due to fever, cough, headache and deep fatigue, and lost his sense of taste and smell. When he began having trouble breathing, he went to the Mount Sinai emergency room. A coronavirus control, still in diapers, did not test positive, he entered an isolation unit as a “person under investigation”. When he returned home after 3 days, his coughing and breathing were better. The other symptoms did not pass away.
“I was slightly tired,” she recalls. His hobbies — running, exploring Manhattan neighborhoods, traveling every few months — were impossible. One summer day, a friend advised them to do a simple jog. “After a block, I couldn’t stay awake,” Reales said. “I had to. . . Call her mobile phone and she found out I wasn’t her. “
Wheezing and tiredness persisted until the following winter. Through it all, he was starting to feel better and was up to date on his coronavirus vaccine when, in April 2021, another COVID episode subsided. This time, Reales said, “I felt like I was suffering just to breathe. The tiredness was horrible. I developed insomnia. ” It was in the fall before her symptoms disappeared. Then, 4 days before Christmas 2021, when Omicron started sweeping the country, he tested positive again.
As with some long-time COVID patients, though not all, according to doctors, their fitness is slowly improving. In April, a year into her COVID battle, she competed in a 5K race and sent her mother a photo of herself, beaming, in Flushing Meadows-Corona Park as she crossed the finish line. He ran one in May. At the end of June, he did 10K.
“I am in a position to retire after the fourth mile. I said, ‘It’s too much. I just wanted to stop,” Reales recalls. But cheers along the way kept him going. It’s over.
Reales has a new assignment as a grant portfolio manager for Weill Cornell Medical College. This allows you to paint full-time from home. She is an online student to pursue a bachelor’s degree in administrative studies. However, when you climb the stairs, you infrequently want to prevent and catch your breath. The brain fog continued. it may be anything I’ve said to my mom before,” Reales said. “When I do my home paintings, I’ll have to read and read and read again. “semester.
“I already have an animal. It’s lupus,” Reales said. Once you’ve bothered that animal [with COVID and the following], it’s like opening Pandora’s box. “
——
Methodology
The Washington Post worked with electronic fitness records company Epic Systems and input from the Kaiser Family Foundation to design a study of others most likely to report long-term COVID symptoms.
The study analyzed 4. 88 million anonymized people of all ages in Epic Research Cosmos’ national database of patient registries who were first diagnosed with COVID-19 between March 2020 and January 2022. The patients studied were separated into categories corresponding to the main variant of the coronavirus. circulating at the time they became ill. The original variant was from March 2020 to June 2021. The delta variant was from August 2021 to November 2021. The omicron variant was from January 2022. The months of July and December 2021 were overlooked due to transitions between the major variants in those periods.
Epic used a multi-step procedure to identify patients who reported new symptoms. Epic analyzed the patient’s electronic fitness record dating back to 2017. Using this history, Epic knew if the patient sought care for the first time for at least one symptom that the Centers for Disease Control and Prevention indexed as a prospective indication of long-term COVID, adding fatigue, shortness of breath, cough, chest pain, mental confusion, headaches, sleep problems, dizziness, depression, muscle pain, rashes and abdominal pain. Only symptoms that a user had not consulted for since 2017 were classified as new symptoms.
The review established whether the patient sought care for any new symptoms one month to six months after coronavirus infection. A momentary step established whether the patient had reported new symptoms in the six months prior to receiving a COVID diagnosis.
The percentage of patients with new symptoms before experiencing coronavirus infections established a baseline rate of what those symptoms look like even without COVID. The percentage of patients with new symptoms in the post-infection era was the post-COVID rate.
Baseline and post-infection rates were calculated separately for total organization and for each wave, as well as for demographic teams by sex, age, and race, and for teams of patients with pre-existing situations (comorbidities) and with other severity of covid infection. The base rate was subtracted from the post-infection rate to identify the change, expressed in percentage points.
The knowledge shared with The Post has been aggregated nationally according to Epic Research’s criteria for patient privacy.
Patients who had been hospitalized in extended care sets were excluded from maximal long-term COVID testing because the severity of their illness, as well as post-ICU syndrome, can cause symptoms that are indistinguishable from those of long-term COVID.
Patients may have been forced to seek treatment for new symptoms of the pandemic, especially in its early stages. This could have affected the rates of new symptoms reported by patients before contracting coronavirus infections. The duration of symptoms or the number of symptoms each. What the patient had, or its severity, was not measured in this study.