post-covid disability prevalence

 A recent observational study found that a substantial number of patients who had long COVID (also called post COVID condition, PCC) had prolonged disability that was activity-limiting: see covid postcovid disability prevalence  JAMA2024, or doi:10.1001/jamanetworkopen.2024.51151

 

Details:

--Data from the 2023 National Health Interview Survey (NHIS) included 29,522 respondents (NHIS response rate 47%) in this survey which was nationally representative of a civilian noninstitutionalized population residing in the US

    -- this survey included a new question to ascertain the degree to which these long-term symptoms reduced their ability to carry out day-to-day activities, as compared to a time prior to COVID

    -- all estimates below were based on self-report, which was weighted to be nationally representative

-- the researchers included individuals who had symptoms lasting 3 months or longer as the definition of long COVID (PCC), as well as how much these long-term symptoms reduced their ability to carry out their day-to-day activity, with responses of "a little" or "a lot" of disability (either one of these responses were considered activity-limiting) or "not at all"

 

Results:

-- prevalence of PCC:

    -- total respondents ever having had PCC: 2398 individuals, 8.4% (8.0%-8.8%)

    -- currently had PCC: 1063 individuals, 3.6% (3.3-3.9%)

    -- had activity-limiting PCC: 706 individuals, 2.3% (2.1-2.5%), 64.5% of those who currently had PCC

-- for each PCC category about twice as many women had PCC, most were aged 35-64, most having income <200 % of federal poverty level, and more often lived in nonmetropolitan or small/medium metropolitan areas

    -- in addition, there were differences by sexual orientation, and race and Hispanic origin

 

Commentary:

-- PCC, or long covid, remains pretty common, with data from the 2022 NHIS finding that 6.9% of adults in the US had long COVID: See https://gmodestmedblogs.blogspot.com/2024/07/long-covid-prevalence-in-us.html

    -- this study found that 3.4% of them had PCC at the time of this interview

-- longer studies have found that even 2 years after a covid infection, some people continue to have symptoms (ie, long covid can be really long), that this can be independent of how severe their initial covid infection was (this was not borne out in all studies), and can be quite profound: https://gmodestmedblogs.blogspot.com/2022/05/covid-keeps-on-getting-longer.html

    -- and a British study that included MRI and lab findings found long-term liver disease, high pancreatic fat, and increased kidney volume, as well as higher AST/ALT levels and erythrocyte sedimentation rates 6 to 12 months later: https://gmodestmedblogs.blogspot.com/2023/04/long-covid-long-term-pathology.html

-- vaccination can decrease the risk of PCC significantly: https://gmodestmedblogs.blogspot.com/2022/07/covid-long-covid-decreased-with.html

-- it does seem that long covid is less common with the omicron variant: https://gmodestmedblogs.blogspot.com/2022/10/covid-long-covid-less-common-with.html

    -- unclear if that is related to the actual virologic changes in omicron, or the fact that many people had some combination of prior covid episode(s) and vaccination(s), or both

 

Limitations:

-- this is all self-reported information and may not be completely accurate

-- there were significant differences in both PCC and activity-limiting PCC by race/Hispanic origin and sexual orientation, family income and urbanization level

    -- these associations are complex and likely to be at least a large part explainable by the large sociodemographic and psychological differences in these factors, such as the effect of racism, stress, living situations, access to health care, other environmental or occupational differences, etc

        -- eg, even people working in the “same” types of jobs may have very different experiences: people of color working in some communities in similar jobs may well be subjected to huge additional stresses of discrimination, being pushed to work harder, less comfortable or accommodating work environments, etc, leading to differences in their self-categorization as being able to carry out day-to-day activities

        -- ie, it is not appropriate to single out the PCC association based solely on the person’s sex, sexual orientation, income, race/ethnicity, or type of area they live in

 

so, i realize that much of the population and most of us are pretty sick and tired of this covid stuff, and a pretty low percent of the population has continued to be immunized: per the CDC, 10.6% of children, 21.0% of adults  (including 44.5% of those >65 yo); ie, most of us feel somewhat liberated as if being in a "post-covid" situation, BUT the somber reality is:

    -- covid is still here

    -- covid will very likely be endemic and recur in bits and spurts over time in the foreseeable future

    -- covid is perhaps more benign than before (perhaps partly from virus changes, partly from partial immunity from prior vaccinations and infections): 

        -- omicron may not be more transmissible than the delta variant, despite prior studies, and this may well be related to vaccinations: https://gmodestmedblogs.blogspot.com/2022/01/covid-omicron-increased-transmissibility.html

        -- omicron has a much lower hospitalization rate than delta (again, ?related to prior partial immunity) https://gmodestmedblogs.blogspot.com/2022/01/covid-omicron-has-12-hospitalization.html

        -- but there may be a higher rate of omicron reinfections in those with prior omicron infections: https://gmodestmedblogs.blogspot.com/2023/09/covid-reinfections-more-likely-if-prior.html

        -- covid vaccinations are pretty miserable. lots of pain for a few days at injection site, pretty frequently feeling miserable/having fevers/staying in bed for a few days, and generally not something to look forward to

    -- the bottom line:

        -- vaccinations seem to be important for decreasing long covid (PCC), and PCC can still lead to long-term disability

        -- given the huge numbers of people getting covid (though hard to get numbers here, since data collection is not great), and many who get milder or asymptomatic infections and either never see a health care provider or only have outpatient visits that are not reported

        -- BUT the 6.9% who get long covid times the 2.3% who had activity-limiting PCC times the unknown huge numbers getting covid is still a pretty large number of people...

        -- and the repeated vaccinations likely will decrease this number

    -- which means that we health care workers need to be pretty aggressive in promoting vaccination both to decrease the intensity of subsequent covid infections and the likelihood on long-term disability

 

geoff

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