Non-Hospitalized COVID Patients May Be at Less Risk for Long COVID

In terms of severe post-acute complications from COVID-19, there is a low relative risk for those who were not admitted to the hospital.

As the United States emerges from the long siege of COVID-19 and infection, hospitalization, and mortality rates decrease, infection preventionists and other health care professionals will focus on aftereffects such as long COVID, in which symptoms linger for weeks or even months after acute infection. As Kevin Kavanagh, MD, a member of Infection Control Today®’s Editorial Advisory Board recently put it, “survival is a low bar for community health. Ten to thirty percent of mildly affected individuals can develop long-haulers syndrome.”

As with everything else COVID, data on the long-hauler version continues to be collected. A new study focusing on Danish patients sheds some light—and hope—saying that patients who had not been hospitalized for COVID-19 appear to be a low risk for long COVID.

Investigators with the University of Southern Denmark state that “the absolute risk of delayed acute complications such as venous thromboembolism, ischaemic stroke, and psychoses after SARS-CoV-2 infection not requiring hospital admission is low. Furthermore, the measured burden placed on the secondary health-care sector by post-acute effects of primarily non-hospitalised individuals with SARS-CoV-2 infection might be lower than expected, possibly because of persisting symptoms being managed in general practice or not all persisting symptoms leading to health-care encounters.”

The Centers for Disease Control and Prevention (CDC) defines long COVID as “a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms: tiredness or fatigue, difficulty thinking or concentrating (sometimes referred to as “brain fog”), headache, loss of smell or taste, dizziness on standing, etc.”

Anthony Fauci, MD, the director of the CDC’s National Institute of Allergy and Infectious Diseases, cited the dangers presented by long COVID as a reason that young people should get vaccinated against COVID-19. Fauci made his remarks yesterday while appearing with President Biden in a You Tube town hall on COVID-19 vaccination.

Young children and adolescents are much less likely to get severe COVID-19, Fauci said, but that doesn’t mean that they are exempt from long COVID.

Fauci said that people “don’t appreciate is that even with people who get mild disease, or very few symptoms, there’s a syndrome that is referred to as long COVID, which means that you get a syndrome following the clearing of the virus where it could be for months and months that you have symptoms that are profound fatigue, muscle aches, temperature dysregulation, and even an inability to focus or concentrate.”

The Danish study utilizes a population-based cohort harnessing prescription, patient, and health insurance registries, the researchers reviewed patients with a positive or negative PCR test between February 27 to May 31, 2020.

The team reviewed outcomes related complications like persistent symptoms and certain prescription drug utilization. The authors reported that of the 10,498 individuals with SARS-CoV-2, they were able to review 8983 who were alive and not admitted to the hospital within 2 weeks of the positive test. “Compared with SARS-CoV-2-negative individuals, SARS-CoV-2-positive individuals were not at an increased risk of initiating new drugs (RD <0·1%) except bronchodilating agents, specifically short-acting β2-agonists (117 [1·7%] of 6935 positive individuals vs 743 [1·3%] of 57, 206 negative individuals; RD +0·4% [95% CI 0·1–0·7]; RR 1·32 [1·09–1·60]) and triptans (33 [0·4%] of 8292 vs 198 [0·3%] of 72,828; RD +0·1% [0·0–0·3]; RR 1·55 [1·07–2·25]). There was an increased risk of receiving hospital diagnoses of dyspnoea (103 [1·2%] of 8676 vs 499 [0·7%] of 76 728; RD +0·6% [0·4–0·8]; RR 2·00 [1·62–2·48]) and venous thromboembolism (20 [0·2%] of 8785 vs 110 [0·1%] of 78,872; RD +0·1% [0·0–0·2]; RR 1·77 [1·09–2·86]) for SARS-CoV-2-positive individuals compared with negative individuals, but no increased risk of other diagnoses.”

While there is still much to be learned about long COVID, we will need considerable resources and sustained funding to support future research. Moreover, as we learn about the prevalence of long COVID and the needs of those experiencing effects of infection, it will be imperative that resources are provided to those experiencing those symptoms.

This original version of this article first appeared in Contagion®.