New research adds to data on symptoms after COVID-19, vaccines' effects

Persistent symptoms after SARS-CoV-2 infection were analyzed by multiple recent studies. An analysis of more than 200,000 people treated for COVID-19 found that 14% developed clinical sequelae that required medical care in the four months after acute illness, with higher rates in those who had pre-existing conditions or required hospitalization for COVID-19. The analysis of a U.S. health care database was published by The BMJ on May 19. A survey of 593 patients with COVID-19 in Michigan found that many had ongoing symptoms after infection: 52.5% at 30 days and 35.0% at 60 days. Continued symptoms were significantly more common among patients who reported having very severe illness than among those who had mild infections, according to the study published May 19 by Clinical Infectious Diseases. A third study, published by the Journal of General Internal Medicine on May 13, included 153 patients who were hospitalized for COVID-19 in New York City. At three months, it found full recovery in only 35.5%, with 23.5% having COVID-19-related post-traumatic stress disorder (PTSD), 18.3% having depression, and 12.4% both. The most common persistent symptoms were body aches, fatigue, shortness of breath, and headaches; all were more common in patients with depression or PTSD.

Several recent studies also looked at the COVID-19 vaccines' effects, including a case series analyzing patients with persistent COVID-19 symptoms, published by Annals of Internal Medicine on May 25. It included 36 patients who had been hospitalized with COVID-19, still reported symptoms eight months later, and subsequently received a vaccine. They were surveyed a median of 30 days after vaccination, and of the 159 symptoms patients reported before vaccination, 23.2% had improved, 5.6% had worsened, and 71.1% were unchanged. Two other studies published the same day by Annals reported limitations in the antibody response to the COVID-19 vaccines among patients who have rheumatic and musculoskeletal diseases or solid organ transplants. Some advice on identifying vaccine-induced immune thrombotic thrombocytopenia was offered by a letter published by the New England Journal of Medicine on May 19. Based on analysis of plasma samples from nine patients, the authors advised that rapid immunoassays should be avoided for the detection of anti-platelet factor 4 antibodies and that a sensitive, quantitative, immunologic test should be used instead.

In other COVID-19 research, a new analysis of a trial of tocilizumab in patients hospitalized with COVID-19 found that the drug's effects varied by C-reactive protein (CRP) level. The trial included patients who received oxygen but not high-flow or mechanical ventilation (63 given tocilizumab, 67 usual care). The analysis, published by JAMA Internal Medicine on May 24, found a statistical interaction between CRP level and the outcomes of need for mechanical ventilation and death, with a benefit from tocilizumab in patients with a CRP level greater than 15.0 mg/dL, not those with lower levels. Finally, gender differences in COVID-19 infection were analyzed by a study published by the Journal of Hospital Medicine on May 19. A propensity-score matched cohort of 876 men and 876 women hospitalized with COVID-19 found that men more often reported fever and women more often reported vomiting, diarrhea, and hyposmia/anosmia. Laboratory tests and other markers indicated greater severity of illness in men than women, and their 30-day mortality risk was also higher (23.4% vs. 19.2%).