Background

It is reported that as many as 80% of COVID-19 patients continue to have at least one lingering symptom greater than 60 days post-symptom onset (PSO). Different authors have referred to post-COVID syndrome as long COVID or chronic COVID syndrome (CCS) and patients suffering from post-COVID-19 syndrome as COVID-19 long-haulers.

Objective

The object of this study is to define the population suffering from post-COVID-19 syndrome and describe the myriad of symptoms demonstrated by the syndrome’s patients. The symptoms are presented according to the organ system in which they affect. Findings on mental health deterioration, and the syndrome’s disproportionate effect on racial/ethnic minorities and other vulnerable populations are also addressed.

Methods

This study is a systematic literature review of data and information published on chronic symptoms resulting from SARS-CoV-2 (COVID-19) infections between March 1, 2020 and March 1, 2021. Over seventy articles have been reviewed to document the syndrome.

Results

More than 50 different symptoms have been recorded, with chronic fatigue affecting most long-haulers. This fatigue can be so debilitating that it leaves some patients completely bedridden. Symptoms can be cyclic with the patient feeling ill for a few days, followed by few days of feeling better before feeling ill again. The more severely patients suffer from the acute symptoms of COVID-19, the greater their chances of becoming a long-hauler.

Conclusion

Patients can manifest numerous complications for weeks and months post-Covid-19 symptom onset. These complications can lead to a decreased quality of life, and increased morbidity and mortality.

Background: The COVID-19 pandemic has led to significant morbidity and mortality in the Washington D.C. metro area.

Objective: To understand risk factors for mortality among hospitalized COVID-19 patients.

Method: A case-cohort study was conducted amongst hospitalized patients at a tertiary care hospital in Washington,DC who tested positive for COVID-19. Cases were patients who experienced in-hospital death and were matched by sex in a 1:4 ratio to control patients who were surviving on the day of death event for a case. A Breslow modified conditional multivariate logistic regression was performed to determine coefficients and odds ratios.

Results: There were 105 cases and 424 controls. Of the deceased, the mean age was 74, N=51(62.2%) were male, and N=65 (70.7%) were Black/African American. 53.7% of those admitted to the ICU (N=44) experienced mortality. Of those who experienced mortality, N=35 or 42.7% were intubated. Factors associated with worsened mortality included age (OR=9.50, p<0.001) and intubation (OR=6.35, p<0.001). Mortality was also associated with higher CRP (OR=3.44, p=0.001), d-dimer (OR=2.89, p<0.01), and lactate dehydrogenase (LDH) (OR=2.77, p< 0.01). Those on statins (OR=0.42, p<0.01) and valsartan (OR=0.36, p<0.001) were less likely to experience mortality.

Conclusion: Mortality from COVID-19 amongst our hospitalized patients was found to be worse amongst intubated, older patients, and those with higher inflammatory markers, whereas statin and valsartan use was protective.

Background: Adverse Childhood Experiences (ACEs) have long been associated with negative adult health outcomes. Although early studies have shown more proximal effects of ACEs on childhood health, assessment of confounding is limited and may result in overestimated effects.

Objective: To compare associations between ACE exposure and child health while controlling for confounding parent and child attributes.

Methods: The 2018 Southeastern Pennsylvania Household Health Survey (n=1,164) comprised a representative sample of households with children (<18 years). A parent/guardian reported ACE and health data for one randomly-identified child. Eight ACEs were tallied and categorized as 0, 1-3, >4. Health was categorized as low (poor/fair/good) vs. high (very good/excellent). Using multiple logistic regression (α=0.05) and sensitivity analyses with e-value estimates, we modeled the association between ACEs and low child health adjusting for child’s race, sex, age, county of residence, <150% federal poverty limit (FPL); parent’s employment, marital status, chronic illness status, and witnessing family violence during childhood.

Results: Participants were 64% White, 18% Black, and 12% Biracial/Multiracial; half (49%) were female, 61% had a college-educated parent, and 20% were <150% FPL. Compared to those with no ACEs, children with >4 ACEs had significantly higher odds of poor health (OR_4+ACEs= 3.79, 95%CI: 1.17, 12.33; p<0.03). E-value_{pointestimate}=7.04; e-value_CI=1.16

Conclusions: Controlling for parent/child confounders, we found that high ACE exposure is associated with poor child health, and a strong unmeasured confounder is needed to negate this association. Future work should explore whether protective factors may buffer children from the negative impacts of high ACE exposure.

Background. Most pediatric COVID-19 cases are asymptomatic; however, a small number of children develop Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but severe condition that is associated with SARS-CoV-2 infection. The long-term complications of MIS-C in the pediatric population are unknown thus, the objective of this analysis was to describe the presence of long-term complications in children previously diagnosed with MIS-C.

Methods. A retrospective electronic health record review identified patients with previously diagnosed MIS-C from one pediatric healthcare system that serves predominantly Medicaid-dependent families. Patients or caregivers completed a telephone survey from March-June 2021 to assess the presence of long-term complications (existing for ≥ 14 days). Stepwise logistic regression models explored predictors of long-term complications of MIS-C.

Results. From 64 patients with MIS-C (31 [48.4%] female, mean age at diagnosis 9.8 years [SD 4.4]), 11 (17.2%) non-Hispanic white (NHW), 27 (42.2%) non-Hispanic black, 21 (32.8%) Hispanic, 5 (7.8%) other ethnicity), 32 (50%) were admitted to the Intensive Care Unit. Twenty-seven (42.2%) of the patients/caregivers completed the survey. 13 (48.2%) patients reported long-term complications including tiredness (10 [76.9%]), headache (5 [38.5%]), difficulty with thinking/concentration (4 [30.8%]), and shortness of breath (3 [23.1%]). The odds of reporting long-term complications increased with age (OR 1.22, 95% CI 1.0-1.51, p = 0.05). One third reported fewer social connections even though the majority (23 [85.2%]) were enrolled in school.

Conclusion. A substantial proportion of MIS-C children are impacted by long-term complications. Findings can inform pediatric professionals about this vulnerable population in post-COVID-19 recovery efforts.