Long COVID manifestations vary based on severity of acute illness

Key takeaways:

• Neurology was the specialty that patients with long COVID visited most.
• Nonhospitalized patients with a positive COVID-19 test had similar persistent symptoms as those with a negative test or no test.

Long COVID symptoms widely ranged based on the severity of the acute illness phase, demonstrating the need for individualized and multidisciplinary care, according to researchers.

The findings are from Northwestern Medicine’s Comprehensive COVID-19 Center, where nearly 4,000 patients from 44 states have received care since the center was established in May 2020, according to a press release.

The center comprises 12 specialty clinics, including pulmonology, cardiology, neurology and rheumatology, Igor J. Koralnik, MD, chief of neuro-infectious disease and global neurology and codirector of the Comprehensive COVID-19 Center at Northwestern Medicine, said during a press conference. Patients do not require a referral or a COVID-19 diagnosis in order to receive treatment at the center, he added.

CDC data have shown that new weekly COVID-19 hospitalizations decreased from 44,410 the week of Jan. 7, 2023, to 6,220 the week of July 1. However, long COVID continues to affect millions of patients, becoming the third-leading neurological disorder in the United States, according to the release.

Koralnik said the research team conducted a “first of its kind” retrospective study, published in the American Journal of Medicine, after discovering long COVID’s ability to affect multiple organ systems.

Koralnik, Marc Sala, MD, an assistant professor at Northwestern Medicine, and colleagues examined 1,802 patients with long COVID symptoms who were evaluated at the Comprehensive COVID-19 Center from May 2020 to February 2022.

Among the patients, the mean age was 47 years, 65% were women and 350 were previously hospitalized. The patients were seen during 2,361 initial visits across 12 specialty clinics, most often neurology (48.8%), pulmonology (25%) and cardiology (12%).

The researchers found that, “perhaps unexpectedly, 17% of patients saw more than one subspecialty,” Sala said during the press conference.

The frequency of cognitive impairment and pulmonary dysfunction were associated with the severity of acute COVID-19 infection, according to the researchers. There was a wide range of neurologic, pulmonary and cardiologic abnormalities. Among patients tested:

• 85% reported a decreased quality of life;
• 51% had cognitive impairment;
• 44.9% had alteration of lung function;
• 83.3% had abnormal CT scans; and
• 12.1% had an elevated heart rate during rhythm monitoring.

Sala noted that the results underline “the fact there are very different constellations of phenotypes or symptoms based on your severity of illness.”

“There is not a ‘one size fits all’ long COVID,” he said.

The study also revealed, however, that nonhospitalized patients with positive COVID-19 tests had similar abnormalities as those who had a negative test or no test at all, “which is really emphasizing that screening patients away from long COVID care based on a positive test is may not be the right idea for managing patients,” Sala said.

He added that for many patients who developed lung damage to the point of not being able to work “there is still a lack of social and support for their chronic illness of lung disease.”

Ultimately, the study “supports the utility of using multiple subspecialists to investigate the myriad organ symptoms of patients with long COVID,” Sala said.

*Editor’s note: This story was updated to clarify that the percentages of patients with abnormalities are based on those who were tested for the conditions.

References:

• Bailey J, et al. Am J Med. 2023;doi:10.1016/j.amjmed.2023.05.002.
• Northwestern Medicine shares new findings from the Comprehensive COVID-19 Center as significant demand remains for patient appointments. https://news.nm.org/northwestern-medicine-shares-new-findings-from-the-comprehensive-covid-19-center-as-significant-demand-remains-for-patient-appointments/. Published July 13, 2023. Accessed July 13, 2023.
• Trends in United States COVID-19 hospitalizations, deaths, emergency visits, and test positivity by geographic Area. https://covid.cdc.gov/covid-data-tracker/#trends_weeklyhospitaladmissions_select_00. Accessed July 13, 2023.