Boston—Long COVID symptoms often include fatigue, brain fog and dizziness and can last for months and years after the initial infection with SARS-CoV-2, according to an initial study of nearly 10,000 people in the United States.

Of special interest to pharmacists is information that participants who were unvaccinated or who had COVID-19 before the Omicron strain emerged in 2021 were more likely to have long COVID and to experience more severe effects. Reinfection also was associated with higher long COVID frequency and severity, compared with those who had COVID-19 only once.

“Americans living with long COVID want to understand what is happening with their bodies,” stated Admiral Rachel L. Levine, MD, assistant secretary for health for the Department of Health and Human Services, adding, “RECOVER, as part of a broader government response, in collaboration with academia, industry, public health institutions, advocacy organizations and patients, is making great strides toward improving our understanding of long COVID and its associated conditions.”

The study, published in the Journal of the American Medical Association, sought to determine which symptoms are differentially present in SARS-CoV-2–infected individuals 6 months or more after infection compared with uninfected individuals and what symptom-based criteria can be used to identify PASC cases.

Boston University–led researchers identified 37 symptoms across multiple pathophysiological domains as present more often in SARS-CoV-2–infected participants at 6 months or more after infection compared with uninfected participants. They then derived a preliminary rule for identifying based on a composite symptom score.

The prospective observational cohort study of adults with and without SARS-CoV-2 infection had 85 enrolling sites (hospitals, health centers, and community organizations) located in 33 states plus Washington, D.C., and Puerto Rico. The participants who were enrolled in the Researching COVID to Enhance Recovery (RECOVER) adult cohort prior to April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date.

Of the 9,764 participants (median age of 47 years), 89% had been SARS-CoV-2 infected; 71% were female; 16% were Hispanic/Latino; and 15% were non-Hispanic black. The researchers determined that adjusted odds ratios were 1.5 or greater (infected vs. uninfected participants) for 37 symptoms that contributed to the PASC score, including:

• Postexertional malaise
• Fatigue
• Brain fog
• Dizziness
• Gastrointestinal symptoms
• Palpitations
• Changes in sexual desire or capacity
• Loss of or change in smell or taste
• Thirst
• Chronic cough
• Chest pain
• Abnormal movements.

“Among 2,231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months,” the researchers wrote, adding, “A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.”

More than 100 million Americans had been infected with SARS-CoV-2 as of April. The federal government’s Household Pulse survey estimates that approximately 6% of those infected with the virus continue to experience and suffer from the many symptoms termed together as long COVID.

The ongoing RECOVER research serves as the foundation for future clinical trials, which are expected to begin enrolling participants this year.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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