Many COVID-19 ‘long-haulers’ are initially asymptomatic
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About one-third of patients who reported having COVID-19 symptoms weeks after diagnosis were initially asymptomatic, according to a preprint study in medRxiv.
“Asymptomatic individuals may be less often intensely monitored due to an inherent notion of low risk for severe acute disease; however, this is problematic as asymptomatic individuals account for 32% of the long-haulers observed in this study,” Yong Huang, a PhD student at the Sue & Bill Gross School of Nursing at the University of California Irvine, and colleagues wrote.
Recent data indicate that about 10% of patients hospitalized with COVID-19 become “long-haulers,” the researchers wrote. They added that research in “long-haulers,” especially the 99% of cases that do not require hospitalization, is lacking. Therefore, Huang and colleagues analyzed electronic health records from 1,407 patients of all age groups within the University of California COVID Research Data Set who were not hospitalized for the condition.
Twenty-seven percent (n = 382) of “community dwelling” patients with COVID-19 had persistent symptoms that lasted more than 60 days after diagnosis and were considered “long-haulers,” Huang and colleagues wrote. Of these patients, the most common symptom was chest pain, followed by dyspnea, anxiety, abdominal pain, cough, low back pain and fatigue.
Women and members of underrepresented groups were more likely to become “long-haulers,” according to the researchers. More than 72% of “long-haulers” were aged 50 ± 20 years, and 34 were aged younger than 18 years (mean age = 9.29 years).
The researchers reported that many “long-haulers” — approximately 32% — did not have symptoms at the time of testing for SARS-CoV-2.
“Age distribution of all SARS-CoV-2 infected individuals at day 0-11 very closely mimicked that of the long-haulers, suggesting the latter group are distributed across all age groups,” Huang and colleagues wrote. “Although our study supported a potential association with female sex and higher likelihood of becoming a long-hauler, race appeared to be less predictive for both Caucasian and Hispanic ethnicity.”
The researchers noted that “long-haulers represent a very significant public health concern, and there are no guidelines to address their diagnosis and management.”
They said that more research is needed to better understand the emotional, mental and physical impact of persistent COVID-19 symptoms.
Perspective
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Kathleen Bell, MD
This is a very interesting yet‐to‐be‐peer-reviewed study derived retrospectively from the medical records of a university health system in California. The study found that there was an appreciable number (almost 30%) of persons with persistent COVID-19 symptoms 61 days or more post-diagnosis.
The take-home message from this study includes that even those who are not initially hospitalized with COVID‐19 infection may have persisting symptoms. The researchers also found that persistent symptoms were more common in women, white populations and those, interestingly enough, with “normal” weight (as defined by BMI). This is interesting because risk factors for severe pulmonary disease include obesity and racial/ethnic minority status.
One of the limitations of this study is that the survey focused on acute symptoms associated with viral infections; therefore, there was no survey of neuropsychiatric or autonomic complaints. These complaints have proven to be fairly common in clinical populations, and the persistence of dyspnea or the perception of breathlessness is also quite common. It may be that the grouping of low back pain/joint pain or the grouping of anxiety‐tachycardia patients may also include those with neurological disorders.
After careful peer review, it is likely that this study will contribute to our growing knowledge about post-acute sequelae of COVID-19 and how to target treatments for this population.
Department of physical medicine and rehabilitation
University of Texas Southwestern Medical Center
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