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> How is everyone so sure 12 month+ symptoms are due to COVID-19? Our lab at Mount Sinai has linked gene expression patterns observed during acute SARS-CoV-2 i

> How is everyone so sure 12 month+ symptoms are due to COVID-19? Our lab at Mount Sinai has linked gene expression patterns observed during acute SARS-CoV-2 infection with the subsequent emergence of long COVID symptoms that were still present a year or more after hospital discharge. The final paper is still under review, but you can read the preprint [1]. Multiple published papers have also reported similar associations between acute COVID and long COVID [2],[3] (these were published after the preprint was posted, but they are cited in the latest draft currently under review). More generally, long COVID is not "one in a million" (and it's not 500k individual "one in a million" events). Very very roughly, somewhere around 50% of people with symptomatic COVID report some kind of long COVID symptom, though not all of those last for 12 months [4]. [1]: https://www.medrxiv.org/content/10.1101/2021.10.04.21264434v1 https://www.medrxiv.org/content/10.1101/2021.10.04.21264434v... [2]: https://www.nature.com/articles/s41467-021-27797-1 https://www.nature.com/articles/s41467-021-27797-1 [3]: https://www.sciencedirect.com/science/article/pii/S0092867422000721 https://www.sciencedirect.com/science/article/pii/S009286742... [4]: https://www.science.org/doi/10.1126/science.abm8108 https://www.science.org/doi/10.1126/science.abm8108

fny 4y ago
Your cohort targets hospitalized patients. It is no surprise to me they have symptoms which continue a year out. If you read my opening I admit that. Also this population is bound to be riddled with other confounders given the population of individuals who were hospitalized looks quite different than those who were symptomatic in the general population. The 50% rate you talk of for PACS I’ve seen published with a very wide confidence band (10%-60%) with varying symptom definitions. The PACS definition also generally starts at 4 weeks, which again, such a high incidence in that time frame makes sense to me given that the flu and other severe respiratory illnesses similarly linger even out to four months. All of the studies you cite show that PACS is also more coincident with age and preexisting conditions. None specifically discuss symptoms beyond twelve months in patients that were entirely healthy prior to COVID. That is my population of interest. The rest makes sense. Is it really surprisinf that hospitalized patients have PACS a year out? Not to me. Is it surprising a lot of people still have symptoms out 4-6 weeks? I remember swine flu, so no. But a thirty to fifty year old with no preexisting conditions who now has persistent brain fog a year after? That’s very curious, and yet the research does not come anywhere near addressing that cohort.
- rcthompson 4y ago
  It's true that our cohort is all patients that were hospitalized for COVID-19, but notably, our long COVID questionnaire specifically asked which new symptoms they had after COVID-19 that they didn't already have beforehand. That, plus the direct link to acute patterns of gene expression and antibodies specific to SARS-CoV-2, makes a strong case for a causal link between acute SARS-CoV-2 infection and long COVID a year later. While we don't look at mild non-hospitalized cases in this study, there's no reason to think a causal link wouldn't exist there as well.

fny 4y ago

Your cohort targets hospitalized patients. It is no surprise to me they have symptoms which continue a year out. If you read my opening I admit that. Also this population is bound to be riddled with other confounders given the population of individuals who were hospitalized looks quite different than those who were symptomatic in the general population. The 50% rate you talk of for PACS I’ve seen published with a very wide confidence band (10%-60%) with varying symptom definitions. The PACS definition also generally starts at 4 weeks, which again, such a high incidence in that time frame makes sense to me given that the flu and other severe respiratory illnesses similarly linger even out to four months. All of the studies you cite show that PACS is also more coincident with age and preexisting conditions. None specifically discuss symptoms beyond twelve months in patients that were entirely healthy prior to COVID. That is my population of interest. The rest makes sense. Is it really surprisinf that hospitalized patients have PACS a year out? Not to me. Is it surprising a lot of people still have symptoms out 4-6 weeks? I remember swine flu, so no. But a thirty to fifty year old with no preexisting conditions who now has persistent brain fog a year after? That’s very curious, and yet the research does not come anywhere near addressing that cohort.

rcthompson 4y ago
It's true that our cohort is all patients that were hospitalized for COVID-19, but notably, our long COVID questionnaire specifically asked which new symptoms they had after COVID-19 that they didn't already have beforehand. That, plus the direct link to acute patterns of gene expression and antibodies specific to SARS-CoV-2, makes a strong case for a causal link between acute SARS-CoV-2 infection and long COVID a year later. While we don't look at mild non-hospitalized cases in this study, there's no reason to think a causal link wouldn't exist there as well.