United States: Healthcare professionals stricken with COVID-19 exhibited more profound and prolonged symptomatology compared to those with alternate respiratory ailments, with a larger percentage aligning with the World Health Organization (WHO) or UK National Institute for Health and Care Excellence (NICE) criteria for long COVID, as revealed in a recent publication within Viruses and Viral Diseases.
A research collective from the Murdoch Children’s Research Institute, based in Parkville, Australia, identified advanced age, chronic respiratory conditions, and pre-existing symptoms as significant risk factors for the development of long COVID, also referred to as post-acute COVID-19 syndrome (PACS), according to CIDRAP News.
Data Derived from a Phase 3 Clinical Trial
The investigators examined longitudinal data pertaining to long-COVID symptoms, their persistence, and antecedent health conditions. This was sourced from the multinational, randomized controlled BRACE trial, focusing on healthcare workers diagnosed with either COVID-19 or other respiratory infections, with a follow-up duration of one year post-diagnosis.
Participants were subjected to SARS-CoV-2 testing upon symptom manifestation, underwent periodic blood sampling every quarter to assess for antibodies, and filled out comprehensive surveys every three months. A specific subset, comprising 184 individuals with COVID-19 and 184 controls, was selected for detailed case-control analysis of daily symptoms, extending both pre- and post-infection.
The BRACE trial, a phase 3 RCT, aimed to evaluate the potential impact of Bacillus Calmette-Guérin (BCG) vaccination on the incidence of COVID-19 among healthcare professionals across Australia, Brazil, the Netherlands, Spain, and the UK between March 2020 and April 2021, as per CIDRAP News.
Amplified Systemic Impact
The cohort of 593 healthcare workers who contracted COVID-19 exhibited notably more intense illness severity compared to 1,112 participants with alternative respiratory infections (odds ratio [OR], 7.4). A larger percentage of COVID-19 survivors met the definitions of long COVID, as set forth by NICE and WHO, in contrast to those afflicted with other respiratory illnesses (2.5% vs. 0.5%, OR 6.6 for NICE and 8.8% vs. 3.7%, OR 2.5 for WHO).
“Understanding the interplay between pre-existing health conditions and PACS is pivotal in unraveling the underlying mechanisms and in managing individuals plagued by persistent symptoms,” noted the researchers.
Individuals in the COVID-19 cohort reported a broader range and duration of symptoms compared to their non-COVID counterparts, with the most commonly cited complaints being fatigue, myalgia, headaches, and anosmia/ageusia. These observations, according to the research team, corroborate the growing histopathological evidence indicating a hyperactive immune response linked to SARS-CoV-2 infection, as per CIDRAP.
Within the COVID-19 group, ages 40 to 59 (adjusted OR [aOR], 2.8), pre-existing respiratory diseases (aOR, 5.5), and prior symptoms (aOR, 3.0) were identified as key contributors to the risk of long-term COVID. Additionally, a subset of participants reported lingering symptoms such as fatigue and muscle soreness (32%) and intermittent coughing and dyspnea (11%).
“Deciphering the connection between prior symptoms and PACS is critical for shedding light on the pathophysiology and helping to tailor ongoing management for those enduring protracted symptomatology,” the authors concluded.