An interesting article by Goff and others published in the Journal of the American Medical Association October 2021 reviewed this issue.
Short term and long term persistent post acute sequelae of COVID-19 have not been systematically evaluated. The incidence and evolution of post acute sequelae are dependent on time from infection, organ systems and tissues affected, vaccination status, variant of the virus and geographic region. This study tried to estimate the organ system specific frequency and the evolution of post acute sequelae of COVID-19 infection. From a total of 2,100 studies identified, 57 studies with 250,351 survivors of COVID-19 met the inclusion criteria. The mean age of the survivors was 54.4 years, 140196 were male that is 56% and 19777 that is 79% of hospitalised during acute COVID-19.
High income countries contributed 45 studies, that was 79%. The median proportion of COVID-19 survivors experiencing at least one post acute sequelae of COVID-19 was 54% at one month, 55% at two to five months intermediate term and 54% at six or more months.
Most prevalent: pulmonary sequelae, neurological disorders, mental health disorders, functional mobility impairments and general and constitutional symptoms were chest imaging abnormality 62.2%, difficulty concentrating 23.8% generalised anxiety disorder 26.9%, general functional impairments 44% and fatigue or muscle weakness 37.5% respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive and ear, nose and throat disorders.
This systematic review showed that more than half of COVID-19 survivors experienced post acute sequelae some six months after recovery. The most common involved functional mobility impairments, pulmonary abnormalities and mental health disorders. The study suggests that the long term post acute sequelae effects could occur on a scale that would overwhelm existing health care capacity, particularly in low and middle income countries.
The London General Practice, the leading London doctors’ clinic in Harley Street offers a long COVID service and has put together a multidisciplinary team to help rehabilitate and review all symptoms.
Dr Paul Ettlinger
BM, DRCOG, MRCGP, FRIPH, DOccMed