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People with five or more symptoms more likely to develop long COVID

People who experience five or more symptoms of COVID-19 in the first week of infection are more likely to develop long-term health problems, irrespective of age or gender, according to a new review of research on long COVID.

The review by the Therapies for Long COVID (TLC) Study Group also identifies the 10 most common symptoms of long COVID. These are fatigue, shortness of breath, muscle pain, cough, headache, joint pain, chest pain, altered smell, diarrhoea and altered taste.

The researchers determined two main symptom clusters of long COVID: those comprising exclusively of fatigue, headache and upper respiratory complaints; and those with multi-system complaints including ongoing fever and gastroenterological symptoms.

The review, published in the Journal of the Royal Society of Medicine, summarises current research on symptom prevalence, complications and management of long COVID. It’s the first output from the University of Birmingham-led TLC Study Group, funded by the NIHR and UK Research and Innovation, which aims to identify which treatments are most likely to benefit people with particular symptoms of long COVID and test supportive treatments to improve their quality of life.

Lead author Dr Olalekan Lee Aiyegbusi, Deputy Director at the University of Birmingham’s Centre for Patient Reported Outcomes Research (CPROR), said: “There is evidence that the impact of acute COVID-19 on patients, regardless of severity, extends beyond hospitalisation in the most severe cases, to ongoing impaired quality of life, mental health and employment issues.

“People living with long COVID generally feel abandoned and dismissed by healthcare providers and receive limited or conflicting advice. More than one-third of the patients in one of the studies included in the review reported they still felt ill or in a worse clinical condition at eight weeks than at the onset of COVID-19.”

Dr Shamil Haroon, Clinical Lecturer in Primary Care and co-Principal Investigator of the University of Birmingham NIHR/UKRI funded TLC Study, further commented: “Neither the biological or immunological mechanisms of long COVID, nor the rationale for why certain people are more susceptible to these effects, are yet clear, limiting development of therapies. It is essential we act quickly to address these issues.”

In a comparison with other coronaviruses, the researchers suggest that in the longer term, patients with long COVID may also experience a similar disease trajectory to that of patients who had SARS or MERS, pointing to analysis showing that six months after hospital discharge, approximately 25% of patients hospitalised with SARS and MERS had reduced lung function and exercise capacity.

TLC Study’s Co-Principal Investigator Melanie Calvert, Professor of Outcomes Methodology at the University of Birmingham and NIHR Senior Investigator, said: “The wide range of potential symptoms and complications patients with long COVID may experience highlights the need for a deeper understanding of the clinical course of the condition. There is an urgent need for better, more integrated care models to support and manage patients with long COVID to improve clinical outcomes.”