COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and Denmark Article Swipe
Qing Shen
,
Emily E. Joyce
,
Omid V. Ebrahimi
,
Maria Didriksen
,
Anikó Lovik
,
Karen Sól Sævarsdóttir
,
Ingibjörg Magnúsdóttir
,
Dorte Helenius Mikkelsen
,
Anna Bára Unnarsdóttir
,
Arna Hauksdóttir
,
Asle Hoffart
,
Anna K. Kähler
,
Edda Björk Þórðardóttir
,
Elías Eyþórsson
,
Emma M. Frans
,
Gunnar Tómasson
,
Helga Ask
,
Hrönn Harðardóttir
,
Jóhanna Jakobsdóttir
,
Kelli Lehto
,
Li Lu
,
Ole A. Andreassen
,
Patrick F. Sullivan
,
Runólfur Pálsson
,
Christian Erikstrup
,
Sisse Rye Ostrowski
,
Thomas Werge
,
Thor Aspelund
,
Ole Birger Pedersen
,
Sverre Urnes Johnson
,
Fang Fang
,
Unnur Valdimarsdóttir
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1101/2023.04.18.23288720
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1101/2023.04.18.23288720
Background Persistence of physical symptoms after SARS-CoV-2 infection is a major public health concern, although evidence from large observational studies remain scarce. We aimed to assess the prevalence of physical symptoms in relation to acute illness severity up to more than 2-years after diagnosis of COVID-19. Methods This multinational study included 64 880 adult participants from Iceland, Sweden, Denmark, and Norway with self-reported data on COVID-19 and physical symptoms from April 2020 to August 2022. We compared the prevalence of 15 physical symptoms, measured by the Patient Health Questionnaire (PHQ-15), among individuals with or without a confirmed COVID-19 diagnosis, by acute illness severity, and by time since diagnosis. We additionally assessed the change in symptoms in a subset of Swedish adults with repeated measures, before and after COVID-19 diagnosis. Findings During up to 27 months of follow-up, 22 382 participants (34.5%) were diagnosed with COVID-19. Individuals who were diagnosed with COVID-19, compared to those not diagnosed, had an overall 37% higher prevalence of severe physical symptom burden (PHQ-15 score ≥ 15, adjusted prevalence ratio [PR] 1.37 [95% confidence interval [CI] 1.23-1.52]). The prevalence was associated with acute COVID-19 severity: individuals bedridden for seven days or longer presented with the highest prevalence (PR 2.25[1.85-2.74]), while individuals never bedridden presented with similar prevalence as individuals not diagnosed with COVID-19 (PR 0.92 [0.68-1.24]). The prevalence was statistically significantly elevated among individuals diagnosed with COVID-19 for eight of the fifteen measured symptoms: shortness of breath, chest pain, dizziness, heart racing, headaches, low energy/fatigue, trouble sleeping, and back pain. The analysis of repeated measurements rendered similar results as the main analysis. Interpretation These data suggest an elevated prevalence of some, but not all, physical symptoms during up to more than 2 years after diagnosis of COVID-19, particularly among individuals suffering a severe acute illness. Funding This work was mainly supported by grants from NordForsk (COVIDMENT, grant number 105668 and 138929) and Horizon2020 (CoMorMent, 847776). See Acknowledgements for further details on funding. Research in context Evidence before the study As the majority of the global population has contracted COVID-19, persistence of physical symptoms after SARS-CoV-2 infection ( Long COVID or post COVID-19 condition) has become a major public health concern. We searched PubMed for studies assessing physical symptoms after COVID-19, published by March 22, 2023. The search term was (physical symptoms after covid) AND LitCLONGCOVID [Pubmed filter]. We reviewed 82 studies, after excluding those not on humans or not published in English. High prevalence of multiple physical symptoms, mainly fatigue, shortness of breath, headache, muscle and chest pain, has been reported, mostly based on small samples of hospitalized patients confined to three to six months after diagnosis. A comprehensive assessment of long-term prevalence of physical symptoms beyond six months after diagnosis and among non-hospitalized patients is lacking. Added value of this study We included 64 880 participants from the general population of four Nordic countries, of whom 22 382 had been diagnosed with COVID-19 up to 2 years earlier (<1% hospitalized due to COVID-19). Individuals diagnosed with COVID-19 reported a 37% higher prevalence of overall severe physical symptom burden compared to individuals not diagnosed with COVID-19. We found that shortness of breath, chest pain, dizziness, headaches, and low energy/fatigue were particularly increased among individuals with COVID-19 diagnosis. Individuals bedridden for seven days or more during the acute illness phase (9.6% of the patients) showed the greatest and most persistent elevation in prevalence of severe physical symptoms while individuals not bedridden during the acute COVID-19 illness showed no increase in prevalence of physical symptoms compared to those not diagnosed. Implications of the available evidence Our findings provide timely and valuable evidence to demonstrate the constitution of Long COVID and the long-term health consequences after recovery from COVID-19 in the general population. The long-term risk of severe physical symptom burden is distinctly associated with acute illness severity, highlighting the importance of sustained monitoring of physical symptoms among the group of patients who suffered severe acute illness course.
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- preprint
- Language
- en
- Landing Page
- https://doi.org/10.1101/2023.04.18.23288720
- https://www.medrxiv.org/content/medrxiv/early/2023/04/20/2023.04.18.23288720.full.pdf
- OA Status
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- Cited By
- 12
- References
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- Related Works
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- OpenAlex ID
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https://openalex.org/W4366596602Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1101/2023.04.18.23288720Digital Object Identifier
- Title
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COVID-19 illness severity and 2-year prevalence of physical symptoms: an observational study in Iceland, Sweden, Norway and DenmarkWork title
- Type
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preprintOpenAlex work type
- Language
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enPrimary language
- Publication year
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2023Year of publication
- Publication date
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2023-04-20Full publication date if available
- Authors
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Qing Shen, Emily E. Joyce, Omid V. Ebrahimi, Maria Didriksen, Anikó Lovik, Karen Sól Sævarsdóttir, Ingibjörg Magnúsdóttir, Dorte Helenius Mikkelsen, Anna Bára Unnarsdóttir, Arna Hauksdóttir, Asle Hoffart, Anna K. Kähler, Edda Björk Þórðardóttir, Elías Eyþórsson, Emma M. Frans, Gunnar Tómasson, Helga Ask, Hrönn Harðardóttir, Jóhanna Jakobsdóttir, Kelli Lehto, Li Lu, Ole A. Andreassen, Patrick F. Sullivan, Runólfur Pálsson, Christian Erikstrup, Sisse Rye Ostrowski, Thomas Werge, Thor Aspelund, Ole Birger Pedersen, Sverre Urnes Johnson, Fang Fang, Unnur ValdimarsdóttirList of authors in order
- Landing page
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https://doi.org/10.1101/2023.04.18.23288720Publisher landing page
- PDF URL
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https://www.medrxiv.org/content/medrxiv/early/2023/04/20/2023.04.18.23288720.full.pdfDirect link to full text PDF
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- OA status
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greenOpen access status per OpenAlex
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https://www.medrxiv.org/content/medrxiv/early/2023/04/20/2023.04.18.23288720.full.pdfDirect OA link when available
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Medicine, Observational study, Confidence interval, Coronavirus disease 2019 (COVID-19), Severity of illness, Cross-sectional study, Prevalence, Epidemiology, Demography, Pediatrics, Internal medicine, Disease, Pathology, Infectious disease (medical specialty), SociologyTop concepts (fields/topics) attached by OpenAlex
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12Total citation count in OpenAlex
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2025: 1, 2024: 7, 2023: 3, 2013: 1Per-year citation counts (last 5 years)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.2.25[1.85-2.74]), | 203 |
| cited_by_percentile_year.max | 99 |
| cited_by_percentile_year.min | 89 |
| corresponding_author_ids | https://openalex.org/A5010145550, https://openalex.org/A5101984400 |
| countries_distinct_count | 9 |
| institutions_distinct_count | 32 |
| corresponding_institution_ids | https://openalex.org/I116953780, https://openalex.org/I136199984, https://openalex.org/I165368041, https://openalex.org/I28166907 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/3 |
| sustainable_development_goals[0].score | 0.6200000047683716 |
| sustainable_development_goals[0].display_name | Good health and well-being |
| citation_normalized_percentile.value | 0.90217369 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | True |