A new study published in JAMA Open, found that understanding the frequency with which new symptoms and conditions emerge in the months following SARS-CoV-2 infection is important in order to inform patients’ expectations for recovery, and allow healthcare professionals and health systems to address patients’ needs.
Shortness of breath, fatigue or muscle weakness, and mild subjective cognitive dysfunction (ie, “brain fog”) are among the most commonly reported persistent symptoms in the months following SARS-CoV-2 infection. Researchers observed that symptoms and conditions reported as possible sequelae of SARS-CoV-2 infection occurred infrequently (≤11% prevalence) in nonventilated persons with medical encounters at 31 to 150 days after SARS-CoV-2 testing, using EHR data from 168,701 persons aged 20 years or older and 26,665 aged younger than 20 years who tested positive for SARS-CoV-2.
Studies have also documented an increase in diagnoses of new-onset neuropsychiatric conditions and type 2 diabetes among persons after SARS-CoV-2 infection. New symptoms and conditions months after a positive SARS-CoV-2 test have been described among small cohorts of non-hospitalized and hospitalized persons.
However, population-based estimates of the occurrence of new symptoms and conditions following a diagnosis of SARS-CoV-2 infection remain undercharacterized in the US. In addition, whether certain new symptoms and conditions occur more frequently among persons with SARS-CoV-2 infection compared with those without has not been well established.
New diagnoses of shortness of breath were significantly higher among persons with a positive test compared with those with a negative test in both age cohorts. Diagnoses of fatigue, cognitive dysfunction, sleep disorders, heart rate abnormalities, myoneural disorders, and type 2 diabetes among hospitalized persons aged 20 years or older and heart rate abnormalities and type 2 diabetes among hospitalized persons younger than 20 years were more common for those with a positive vs negative test.
Although new symptoms and conditions occurred infrequently, applying the proportions of these rare events to the millions of persons infected with SARS-CoV-2 means that a substantial number might experience new symptoms and conditions after their acute illness. In addition, new symptoms can be long-lasting and involve chronic conditions, such as type 2 diabetes. Increasing awareness of new symptoms and conditions among healthcare professionals and health systems is paramount to meet the needs of patients with prolonged or chronic sequelae of SARS-CoV-2 infection.
The prevalence of new symptoms and condition diagnoses following a positive test was higher among hospitalized persons compared with their non-hospitalized counterparts; new symptoms and conditions also were most prevalent among ventilated persons aged 20 years or older.
This study suggests that long-term symptoms and conditions may be more common with increased SARS-CoV-2 infection severity. Previous reports have highlighted a higher incidence of neuropsychiatric conditions and diabetes among hospitalized and ventilated adults with SARS-CoV-2 infection compared with those without,
The higher prevalence of anxiety and depression, myopathies, peripheral nerve disorders, and weight loss among ventilated persons highlights the role of post–intensive care syndrome in compounding the effects of SARS-CoV-2 infection.
The prevalence of new-onset diabetes in our population may be overestimated, as hyperglycemia or receipt of glucocorticoids during the acute event might have unmasked diabetes that was only coded during a follow-up visit when persistent hyperglycemia was recognized. Nevertheless, there is evidence of direct cytopathic effects of SARS-CoV-2 infection in pancreatic tissue and increases in insulin resistance owing to inflammation. Future studies should evaluate whether evidence for type 2 diabetes persists beyond the time period that could be affected by treatments.