Long Covid prevalence in US

A recent article confirmed that about 7% of US adults who have had Covid infection develop long Covid (see covid long covid frequency in US JAMA2024 in dropbox, or doi:10.1001/jama.2024.11370)

 

Details:

-- new data from the Medical Expenditure Panel Survey (MEPS), a representative household survey of the US civilian non-institutionalized population sponsored by the Agency for Healthcare Research and Quality (AHRQ)

-- 17,418 adults were surveyed, a statistical representation of 259 million adults

-- 8275 adults reported having Covid, 1202 adults reported having long Covid symptoms (defined as symptoms lasting three months), which translates to:

    -- 14.5% of those who reportedly had had Covid subsequently reported symptoms of long Covid

    --  6.9% of the whole group surveyed had long Covid, which would translate to a total of 17.9 million adults in the US

-- females were more likely to have reported Covid than males (8.6% versus 5.1% of the whole group surveyed), and this was true in each of the age groups of 18 to 34, 35 to 49, 50 to 64, and older

 

 

-- in terms of pre-existing chronic conditions:

    -- the highest risk for long Covid was in individuals with emphysema and chronic bronchitis, followed by asthma, heart disease, arthritis, and obesity; and that was followed by high blood pressure, high cholesterol, diabetes

 

 

    -- these findings were at odds with other studies that found that hypertension, lung disease, obesity, diabetes, and depression were the leading factors for long Covid

-- effect of vaccines: there is not much difference in long covid in those who had the primary series of vaccinations (8.7%) versus never being vaccinated (8.4%), but those who had booster vaccinations did have substantial protection (5.8%)

    -- likely, these booster vaccinations decreased the risk of severe Covid infections, since MEPS did not find a reduced risk of having Covid infection overall

-- the overall percentages of patients having long Covid is consistent with prior studies, including a 2022 National Health Interview Survey (NHIS) also reporting a 6.9% incidence, and a 2022 CDC Behavioral Risk Factor Surveillance System reporting 6.4% of adults

-- interestingly, there was no relationship overall between poverty status (defined by income level, which is perhaps not a great poverty indicator: https://gmodestmedblogs.blogspot.com/2024/03/mortality-benefits-from-decreasing.html ), since disabilities do often track with socioeconomic status

 

-- In summary, this study found that long Covid was especially prevalent in females, people aged 35 to 64, individuals with chronic conditions, and those who did not receive Covid boosters

 

Commentary:

Most symptoms of long Covid do get better over time, with a mean time of about nine months in hospitalized patients and four months in non-hospitalized patients. About 15% of those with long Covid continue to have symptoms for at least one year. longer periods of recovery are more frequent in those who had more prolonged hospitalizations or required intensive care unit care, were sicker overall, had pre-existing comorbidities, or had medical complications such as secondary pneumonia or venous thromboembolism

 

I am as ready as anyone to get beyond Covid. It has been a miserable few years associated with serious morbidity and mortality of those afflicted with this miserable virus, profound degrees of social isolation/anomie (school and work changes, not going out of the house much, etc), as well as remarkable politicization of a huge public health threat (to the point where many people now are questioning the value of public health as an entity as well as the utility of pretty much all vaccines). However, the reality is that we clinicians will be continuing to see the remnants of previous Covid infections: the rather large number of people who have long Covid after an infection. And the 6.9% of those with Covid infection subsequently developing long Covid translates to large numbers of people

 

Limitations

-- this study was based on individual's responses to surveys, which may well be inaccurate or biased.

-- there is no information in terms of what “long Covid” means for these individuals:

    -- were the symptoms minor problems of little consequence or problems that created significant functional disability?

    -- were there specific Covid-specific symptoms that were more likely associated with long Covid and perhaps were more disabling in the future? For example, how often did people develop brain fog/cognitive issues, and for how long?

    -- was there a relationship of long covid risk within categories of these comorbidities? Did patients with more severe asthma have a worse prognosis than those with occasional asthma symptoms? Did patients with inflammatory arthritis have different outcomes than those with some minor joint symptoms? Did the level of hypertension matter? The level of diabetes control? The functional disability of COPD? The class of obesity?

    -- were there combinations of disabilities that were particularly predictive of long Covid: for example did people who had high blood pressure, high cholesterol, diabetes, and obesity (a not uncommon combination) have different outcomes than those with fewer of these or other combinations of comorbidities?

 

So, a few comments:

-- large survey studies like this one do give important insight into the magnitude of a condition such as long Covid

-- they provide a perspective of how frequently the issue is likely to be present in society as well as in our clinical offices, with an anticipated 18 million adults in the US having long Covid

-- which means that we need to anticipate this issue of long covid, perhaps focusing on specific questions to ask all patients who had Covid, especially those with more severe cases

-- and, perhaps the overriding issue is prevention:

    -- while it seems that continued Covid vaccinations do not prevent the infection (and patients need to understand that they could still be infected), they do seem to decrease potentially long-term long Covid by about 30% 

    -- but only about 20% of the US adult population has received the current booster....

    -- which brings up the mantra of oh-so-many prior Covid blogs: vaccinate, vaccinate, vaccinate