Atlanta—At least one-fifth of U.S. COVID-19 survivors—one-fourth of those aged 65 years and older—have conditions that appear to be attributable to their novel coronavirus infection, according to a new report.

Across all age groups, the most common "long COVID" conditions were acute pulmonary embolism and respiratory symptoms, the researchers from the CDC wrote.

The article in the Morbidity & Mortality Weekly Report pointed out that those estimates are in line with those from several large studies that indicated that post-COVID incident conditions occur in 20% to 30% of patients.

"COVID-19 severity and illness duration can affect patients' healthcare needs and economic well-being," the authors wrote. "The occurrence of incident conditions following infection might also affect a patient's ability to contribute to the workforce and might have economic consequences for survivors and their dependents, particularly among adults aged 18Ð64 years. In addition, care requirements might place a strain on health services after acute illness in communities that experience heavy COVID-19 case surges."

Among the findings of concern was that older COVID-19 survivors (those aged 65 years and older) were at an increased risk for neurologic conditions, as well as mood disorders, other mental conditions, anxiety, and substance-related disorders. "Neurocognitive symptoms have been reported to persist for up to 1 year after acute infection and might persist longer," the authors warned.

Nearly one-half (45.5%) of survivors aged 65 years and older in the study had incident conditions. "Among adults aged >65 years, who are already at higher risk for stroke and neurocognitive impairment, post-COVID conditions affecting the nervous system are of particular concern because these conditions can lead to early entry into supportive services or investment of additional resources into care," the researchers pointed out.

Researchers used electronic health record data from March 2020 to November 2021 for U.S. adults to assess the incidence of 26 conditions often attributable to post-COVID among recovered case patients and compared with matched patients without evidence of COVID-19.

Patients were followed for 30 to 365 days after the index encounter until one or more incident conditions were observed or through October 31, 2021 (whichever occurred first).

The study found that, among all patients, 8% of case-patients experienced an incident condition compared with 16% of controls. Those conditions affected multiple systems, including cardiovascular, pulmonary, hematologic, renal, endocrine, gastrointestinal, musculoskeletal, neurologic, and psychiatric signs and symptoms.

By age group, the highest risk ratios (RRs) were for acute pulmonary embolism (RR= 2.1 and 2.2 among patients aged 18-64 and >65 years, respectively) and respiratory signs and symptoms (RR= 2.1 in both age groups).

In the younger age group (aged 18 to 64 years), 35.4% of case-patients experienced an incident condition compared with 14.6% of controls. The most common complaints were respiratory symptoms and musculoskeletal pain.

Among patients aged 18 to 64 years, the risks were higher among case-patients than among controls for 22 incident conditions, with RRs ranging from 1.1 (anxiety) to 2.1 (acute pulmonary embolism). The authors pointed out that no significant difference was observed for cerebrovascular disease or mental health conditions, such as mood disorders, other mental conditions, and substance-related disorders.

The study noted other differences by age group, including that the RR for cardiac dysrhythmia was significantly higher among patients aged 18 to 64 years (RR= 1.7) compared with those aged >65 years, as was musculoskeletal pain. On the other hand, among case-patients, the RRs for 10 incident conditions were significantly higher in the 65 years and older age group, including renal failure, thromboembolic events, cerebrovascular disease, type 2 diabetes, muscle disorders, neurologic conditions, and mental health conditions.

"As the cumulative number of persons ever having been infected with SARS-CoV-2 increases, the number of survivors suffering post-COVID conditions is also likely to increase," the authors explained. "Therefore, implementation of COVID-19 prevention strategies, as well as routine assessment for post-COVID conditions among persons who survive COVID-19, is critical to reducing the incidence and impact of post-COVID conditions, particularly among adults aged >65 years."

The authors suggested that the study's findings "can increase awareness for post-COVID conditions and improve post-acute care and management of patients after illness. Further investigation is warranted to understand the pathophysiologic mechanisms associated with increased risk for post-COVID conditions, including by age and type of condition."

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