Study of long-term symptoms in COVID-19 cases offers new insights.

New research has examined long-term symptoms in COVID cases, looking at the physical and mental health of Te Whanganui-a-Tara Wellington study participants, almost two years after their COVID illness.

The Medical Research Institute of New Zealand (MRINZ), in partnership with Te Whatu Ora, explored the prevalence of ongoing symptoms in a cohort of 2020 alpha/beta variant community COVID-19 cases in the Greater Wellington region, with the aim of improving understanding of the long-term effects after COVID infection.

The long-term impacts of COVID-19 on confirmed cases at least 12 months post-infection in Wellington, New Zealand: an observational, crosssectional study’ has been published today in The New Zealand Medical Journal (NZMJ).

Dr Nethmi Kearns, MRINZ Clinical Research Fellow and COVID study lead, and her team of researchers, examined symptoms and laboratory abnormalities in just under half of the confirmed cases of the 2020 alpha/beta variant of community COVID-19 cases in Greater Wellington. Through eight comprehensive surveys and blood sample analysis the team led an observational, cross-sectional study looking at symptoms that continue after initial COVID-19 illness.

52.4% of the study participants felt that their current overall health was worse than it was prior to getting COVID-19, and 90% of participants reported at least two ongoing symptoms since their first illness with COVID-19.

Most people who have COVID-19 recover soon after the acute phase of the illness but others experience persistent health problems for months or longer, and these problems can impact quality of life and the ability to work. The most common ongoing symptoms found in the study were depression, anxiety, fatigue, shortness of breath, light-headedness, forgetfulness, post-exercise malaise, and trouble concentrating.

The Greater Wellington Region had 96 confirmed COVID-19 cases during the first wave of the pandemic from January-August 2020. Of these, 42 of 88 eligible cases took part in the study. The outcomes show a high prevalence of ongoing traits following the first wave of COVID-19 infection, with a wide spectrum of symptoms and symptom severity.

“Between 45–72% of our study participants reported anxiety, depression, laboured breathing, pain or discomfort, and sleep difficulties,” says Dr Kearns. “Ongoing symptoms can have a significant impact on a person’s health, life and work, as our study has identified.”

With 47% of New Zealand’s population now having had COVID, the longer-term consequences of infection with COVID-19 raises an important issue for both the health of New Zealanders and the impact on our health system.

There is no internationally agreed definition of ‘long COVID’ with various institutions such as the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) having different definitions, albeit with fundamental similarities. In Aotearoa New Zealand, the clinical definition of long COVID is ongoing symptoms that continue 12 weeks or more after infection with SARS-CoV-2.

“While the rate of COVID-19 cases and deaths have decreased globally, there has been increasing attention on longer term symptoms following COVID-19 infection,” says Dr Thornley, Clinical Head of Department & Medical Officer of Health at Te Whatu Ora, National Public Health Service, Wellington region. “This study contributes to the local understanding of illness among those who have had COVID-19 infection previously.”

This research builds on an earlier study where Dr Kearns, Dr Thornley, and their research team investigated data showing that that there was no set of overarching symptoms that could accurately predict COVID infection, while also showing how COVID does not provoke severe asthma attacks, an important piece of knowledge given New Zealand’s significant asthma rates.

The study, which will now be added to the canon of global data, will help inform public health interventions both here in Aotearoa New Zealand, and internationally, during this and future pandemics.

“COVID-19 and its sequalae remains a global public health issue,” says Dr Kearns. “Studies focusing on more recent phases of the pandemic, and accounting for complexities such as virus variants, reinfection and vaccination status will be particularly valuable moving forward.”