Long COVID symptoms last for more than 1 year, Mount Sinai study shows

Patients with COVID-19 reported sleep, neurological and other symptoms that often lasted for more than a year, according a retrospective, observational analysis at one health care system.

“With millions of Americans at risk of developing [post-acute COVID syndrome] by the end of the pandemic, a second, longer term public health emergency has emerged,” David Putrino, PhD, director of rehabilitation innovation for the Mount Sinai Health System, said in a press release. “It is imperative to understand the burden of this novel condition and develop targeted interventions.”

The researchers reviewed survey responses from a convenience sample of 156 adults who had tested positive for COVID-19 and presented to Mount Sinai’s Center for Post-COVID Care. The results were published in the American Journal of Physical & Rehabilitation Medicine.

According to the researchers, the median time that had elapsed since a patient’s initial COVID-19 diagnosis and survey completion was 351 days. None of the patients had been vaccinated before completing the survey. Among all patients, fatigue was the most common persistent symptom (82%), followed by brain fog (67%), headache (60%), sleep disturbance (59%) and dizziness (54%). The most common triggers of symptom exacerbation included physical exertion, which was reported by 86% of patients, followed by stress (69%), dehydration (49%), weather changes (37%), large meal consumption (28%), premenstrual period (22%) and alcohol consumption (22%).

Putrino and colleagues also reported that among all patients, the median Fatigue Severity Scale score was 5.6 points out of 7, with 78% having scored an average of 4 points or higher, “indicating problematic fatigue.” In addition, 40% of patients scored 3 or higher out of 5 on the Medical Research Council Breathlessness Scale, “suggesting moderate to severe disability due to dyspnea.” The patients also said they were unable to complete 150 minutes of physical activity weekly as frequently as they did prior to being diagnosed with COVID-19.

In addition, Neuro-Quality of Life scores suggested 63% of patients were at least mildly cognitively impaired, whereas EuroQol scores showed that the domains that were impacted most were self-care, usual activities and anxiety/depression. The median EuroQol score was 64 points out of 100, indicating greater reduction in quality of life compared with those who had lower scores.

Also, 19% of patients’ Generalized Anxiety Disorder-7 scores were 10 points or higher, “indicating possible anxiety disorder”; 28% patients had Patient Health Questionnaire scores of 3 points or higher, indicating “possible major depressive disorder”; and the median WHO Disability Assessment Schedule score was 14 points out of 100, indicating some disability. Of the 134 patients who provided details regarding their employment status, 76% said they worked full time prior to COVID-19 and 55% said they did so at the time of the survey.

“Given the known longer term health risks of physical inactivity .... the potential for the worsening of symptoms following physical exertion is the most important consideration when prescribing rehabilitation therapies for people with post-acute COVID-19 syndrome,” the researchers wrote.

Putrino added that the “study is a concerning reminder of how severely debilitating” long COVID can be, and that the study results will help to establish diagnostic criteria for the syndrome and track responses to potential therapies.

References:

American Psychological Association. Patient Health Questionnaire (PHQ-9 & PHQ-2). https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health. Accessed Nov. 17, 2021.

Long COVID can negatively impact physical and cognitive function, employment, and quality of life for at least one year. https://www.mountsinai.org/about/newsroom/2021/long-covid-can-negatively-impact-physical-and-cognitive-function-employment-and-quality-of-life-for-at-least-one-year. Published Oct. 25, 2021. Accessed Nov. 17, 2021.

Spitzer RL, et al. Arch Intern Med. 2006;doi:10.1001/archinte.166.10.1092.

Tabacof L, et al. Am J Phys Med Rehabil. 2021;doi:10.1097/PHM.0000000000001910.

WHO. WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health/who-disability-assessment-schedule. Accessed Nov. 17, 2021.