The new crown epidemic is about to end its third year. Data shows that the number of infections worldwide currently exceeds 600 million, and the cumulative death toll exceeds 6.56 million. The sequelae of the new crown are being discussed and paid attention to.
On October 10, the Journal of the American Medical Association published an online large-scale global study led by WHO , which is regarded as the most comprehensive analysis of the sequelae of the new crown since the epidemic. The study collected data from 1.2 million symptomatic new crown infections in 22 countries. According to the model, 6.2% of new crown infections were reported to have at least one sequelae of new crown in 2020 and 2021. Three months after the first infection, it said that there was at least one sequelae of new crown.
"The new crown is not just a respiratory disease, but it will also affect multiple tissues and organs of the human body, affecting central nervous system , peripheral nervous system , gastrointestinal tract, heart, musculoskeleton, etc., and more than 200 sequelae of new crown have been reported." Akiko Iwasaki, professor of immunology at Yale University School of Medicine, said in a video interview in August this year, "Even if the new crown pandemic stops today, tens of millions of people still suffer from the sequelae of new crown. This is a parallel epidemic that is happening, and Compared with acute and severe COVID-19 infection, it receives much less attention. "
" A hybrid of multiple symptoms"
The aforementioned study published online in the Journal of the American Medical Association includes data on 1.2 million COVID-19 infections with symptoms from 2020 to 2021, before the Omickron epidemic. The data comes from 44 published studies and 10 multi-country cooperative studies, as well as two electronic medical record databases in the United States. The researchers began collecting data from March 2020 and continued until January this year.
This study mainly involves three long-term COVID-19 symptoms: continuous fatigue and physical pain, respiratory problems, and cognitive problems. The results show that in 2020 and 2021, three months after infection with the new crown, the proportion of these three symptoms was 3.2%, 3.7% and 2.2% respectively. The proportion of infected people who need hospitalization and intensive care are 27.5% and 43.1% of the sequelae of COVID-19, respectively, which is far higher than the proportion of non-hospitalized patients. Among the patients with sequelae of COVID-19, 15.1% still have symptoms one year after infection.
The sequelae of the new crown, namely a series of medium- and long-term effects that may occur after infection with the new crown, including fatigue, dyspnea and cognitive dysfunction, and direct or indirect psychological health effects. Up to now, many countries around the world have followed up on the sequelae of COVID-19.
A study published in The Lancet in July last year showed that through feedback from 3,762 confirmed or suspected COVID-19 infections in 56 countries, researchers collected more than 200 "long-term COVID-19" symptoms from 10 organ systems. Of all the symptoms, these patients developed an average of 55.9 symptoms involving 9.1 organ system.
On September 13, the WHO issued a statement saying that model data from the Institute of Health Indexes and Evaluation (IHME) of the University of Washington School of Medicine shows that in the first two years of the new crown pandemic, about 10%-20% of infected people in the entire European region will continue to experience the sequelae of the new crown after the infection recovers. IHME research shows that nearly 145 million people around the world have at least one long-term COVID-19 symptoms.
"While most people can fully recover after infection, the findings show that more analysis is still needed to monitor the long-term effects of the disease," said Hans Kruger, WHO Regional Director of Europe.
On October 5, the U.S. Centers for Disease Control and Prevention (CDC) updated the latest tracking data on the sequelae of the new crown. According to ABC on October 6, as of September 26, among adults who have been infected with the new coronavirus for a long time, 81% of people reported that their long-term symptoms have reduced their ability to do daily activities. The highest daily activity restriction rate comes from the age group of 18-29, while the lowest proportion comes from the age group of 40-49.
On October 6, a report released by the UK's National Office for Statistics showed that as of September 3, more than 2.3 million infected people in the UK had sequelae of COVID-19, accounting for about 3.5% of the UK's total population. Among those who self-reported to have sequelae of COVID-19, about 1.8 million had contracted COVID-19 at least 12 weeks ago, and 1.1 million had contracted them at least a year ago.There are many people infected many times among these people, and the sequelae have adversely affected the daily activities of 1.6 million people.
There are also large-scale research on the sequelae of the new crown in China. On May 11, 2022, Cao Bin's team from the National Respiratory Medicine Center of the China-Japan Friendship Hospital published a two-year follow-up study on hospitalized patients with COVID-19 in the Lancet. Respiratory Medicine. The study followed up on 1,192 patients hospitalized in Wuhan between January 7 and May 29, 2020. The survey content includes a 6-minute walk test, laboratory test and questionnaire, which involves symptoms, mental health, and health-related quality of life.
results show that regardless of the severity of the initial disease, their physical and mental health status improved over time. 438 of the 494 patients returned to their original jobs two years later. However, among the more than a thousand follow-up subjects, 55% still had sequelae. Compared with patients who do not have long-term symptoms of COVID-19, these patients have poor quality of life and exercise ability, more mental health problems, and more medical care needs after discharge.
A common feature of these studies is that most of the information on the sequelae of COVID-19 that people can obtain comes from the self-report of infected people. "This makes the results lack objective measurement standards. This leads to the sequelae of COVID-19 like a 'basket' without boundaries," said Kim Dongyan, professor and virus expert at the School of Biomedicine of the University of Hong Kong.
On April 11 this year, Akiko Iwasaki, professor of immunology at Yale University School of Medicine, said on a video link that there are many reports trying to define the prevalence of sequelae among new coronavirus patients, but this needs to be considered in different situations. Among the severely ill patients with COVID-19, the proportion of sequelae of COVID-19 is as high as 50%, while this proportion is 5% to 30% in who are asymptomatic infected with mild symptoms and even . The reason for the difference is that the sequelae of COVID-19 lack a unified definition. At present, the difference between the definition of the sequelae of the new crown given by the US CDC and the WHO is mainly in terms of time definition. The former refers to the occurrence of new and recurring health problems at least four weeks or longer after the first infection, while the latter refers to the symptoms lasting for at least 2 months within 3 months of infection with the new crown.
"At present, the scientific community has no unified theory about the sequelae of new crown." In Jin Dongyan's view, the sequelae of new crown is not a simple disease, but should be regarded as a mixture of multiple symptoms.
pathogenic mechanism is unknown, and the risk of sequelae after vaccination is lower
KAIT TV, affiliated to the Arkansas Department of Health, reported on October 11 that data from the Arkansas Department of Health in the state has shown that in the past three months, the number of new infections in the state has steadily decreased. In contrast, hospitalizations have increased slightly, which the state's health officials attribute to the effects of the aftermath of the coronavirus.
There are still many problems with the sequelae of COVID-19. For example, how many infected people may eventually develop long-term symptoms, and which group of people are most susceptible to being affected? How to treat and can it be cured in the end?
Jin Dongyan analyzed to " China News Weekly ", "Compared with the Delta variant strain and the original strain, the proportion of the sequelae of the new crown during the pandemic stage of Omickron has been reduced."
On June 18, a study published in "The Lancet" by King's College London, UK compared the sequelae of the new crown during the period of delta and the Omickron. Nearly 60,000 Omickron infected and more than 40,000 delta infected were included in the analysis at different times. The research results show that the possibility of infection with the Omickron virus strain is 24% to 50% of that of the Delta virus strain.
Long-term symptoms are not unique to the new crown. "After the 1918 Influenza A (H1N1) pandemic, the SARS outbreak in 2003, and the 2014 Ebola outbreak in West Africa, patients had sequelae after infection," said Jin Dongyan.
Akiko Iwasaki said on the aforementioned video link that the symptoms of the sequelae of the new crown are very wide at present, but not every patient has obvious symptoms and requires a correct diagnosis from a doctor. However, the reasons for the occurrence of the sequelae of COVID-19 are still in the hypothetical stage.
In Akiko Iwasaki's view, chronic inflammation that may be caused by the persistent novel coronavirus or virus residues in the tissues is one of the most important hypotheses at present. In addition, there are hypotheses such as infections that may cause autoimmune diseases in some patients, such as and intestinal microbial disorders.
"At present, scientists from all over the world are very concerned about and worried about the sequelae of infection with the new coronavirus." On October 13, Liang Wannian, head of the expert group of the National Health Commission's epidemic response and treatment leadership group, said at a press conference that there is no scientific understanding of the pathogenic mechanism and final duration of the sequelae of COVID-19. Unlike general influenza and known diseases, scientists still have many unknowns about the new coronavirus.
The UK National Institute of Health and Nursing (NICE) updated in November 2021 includes discussing issues with patients, measuring body temperature, checking the heart and lungs and undergoing an electrocardiogram. If necessary, patients will be referred for pulmonary rehabilitation. The treatment plan also involves optimized control of long-term symptoms, limited to the use of antibiotics for adjuvant treatment in the case of confirmed or secondary bacterial infections, etc.
In July 2021, the WHO released the rehabilitation guideline for patients with new coronavirus, pointing out that patients with mild and moderate clinical manifestations are recommended to start rehabilitation treatment from the beginning of the onset. After the mildly infected patients recover, it is recommended to walk easily and do breathing exercises. If necessary, they can use mechanical equipment.
Chinese Center for Disease Control and Prevention chief epidemiology expert Wu Zunyou analyzed at the Joint Prevention and Control Mechanism of the State Council on October 13 that in general, people who have been vaccinated have a risk of sequelae after infection with the new crown, which is much lower than those who have not been vaccinated.
"If the domestic sequelae of new crown is to be conducted, it is recommended to monitor and count the epidemic data in Shanghai, Jilin and other places caused by the Omickron strain." Jin Dongyan said that the sequelae of new crown involves the psychological and mental health levels, and in the future, multiple disciplines such as psychiatry and psychology need to work together to deal with it.
A study published in the Journal of the American Medical Association on September 7 showed that factors such as depression, anxiety, worry, perceived stress and loneliness before the new crown infection increased the risk of sequelae of the new crown. At the same time, after infection with the new crown, these types of psychological distress may also increase the risk of daily life disorders by 15% to 51%.
"Quantitizing the number of patients with COVID-19 sequelae may help decision makers better guide people to recover, return to workplaces or schools, and restore their mental health and social life." The aforementioned study published in the Journal of the American Medical Association wrote.
Reporter: Niu He
