An Italian study of long COVID patients suggests that those infected with the Alpha variant experienced different neurological and emotional symptoms compared to those who contracted the original form of SARS-CoV-2
New research to be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Lisbon, Portugal (April 23-26), suggests that symptoms related to long COVID could be different in people infected with different variants. The study is conducted by Dr. Michele Spinicci and colleagues at the University of Florence and Careggi University Hospital in Italy.
Estimates suggest that more than half of survivors of SARS-CoV-2 infection experience post-acute COVID-19 sequelae (PASC), more commonly known as "long COVID" . The condition can affect anyone: old and young, otherwise healthy and those with underlying conditions. It has been seen in people who were hospitalized with COVID-19 and in those with mild symptoms. But despite a growing body of literature, long COVID remains poorly understood.
In this study, the researchers conducted a retrospective observational study of 428 patients, 254 (59%) men and 174 (41%) women, treated in the post-COVID outpatient service of Careggi University Hospital between June 2020 and June 2021, when the original form of SARS-CoV-2 and the Alpha variant were circulating in the population.
Patients had been hospitalized with COVID-19 and discharged 4-12 weeks before attending a clinical visit in the outpatient department and completing a questionnaire on persistent symptoms (a mean [median] 53 days after hospital discharge ). Additionally, data on medical history, microbiological and clinical course of COVID-19, and patient demographics were obtained from electronic medical records.
At least three quarters 325/428 (76%) of patients reported at least one persistent symptom. The most common reported symptoms were shortness of breath (157/428; 37%) and chronic fatigue (156/428; 36%), followed by problems sleeping (68/428; 16%), visual problems (55/428; 13%) and brain fog (54/428; 13%).
Analyzes suggest that people with more severe forms , which required immunosuppressive drugs such as tocilizumab, were six times more likely to report long COVID symptoms, while those who received high-flow oxygen support were 40% more likely to experience continuous problems.
Women were almost twice as likely to report long COVID symptoms compared to men. However, patients with type 2 diabetes appeared to have a lower risk of developing long COVID symptoms. The authors say more studies are needed to better understand this unexpected finding.
The researchers conducted a more detailed evaluation by comparing symptoms reported by patients infected between March and December 2020 (when the original SARS-COV-2 was dominant) with those reported by patients infected between January and April 2021 (when Alpha was the variant dominant) and found a substantial change in the pattern of neurological and cognitive/emotional problems.
They found that when the Alpha variant was the dominant strain, the prevalence of myalgia (muscle aches and pains), insomnia, mental confusion, and anxiety/depression increased significantly, while anosmia (loss of smell), dysgeusia (difficulty swallowing), and hearing problems were less common.
“Many of the symptoms reported in this study have been measured, but this is the first time they have been linked to different variants of COVID-19,” says Dr. Spinicci. “The long duration and wide range of symptoms remind us that the problem is not going away and that we must do more to support and protect these patients in the long term. "Future research should focus on the potential impacts of variants of concern and vaccination status on ongoing symptoms."
The authors acknowledge that the study was observational and does not prove cause and effect, and they were unable to confirm which variant of the virus caused infection in different patients, which may limit the conclusions that can be drawn.
