Patients experiencing post-acute COVID syndrome (PACS, also known as “long COVID”) may have symptoms for at least 12 months after initial COVID-19 infection, significantly and negatively impacting their cognition, ability to work, participation in physical activity, interaction with others, and overall quality of life, according to a new Mount Sinai study.
The study, published in the October 25 issue of the American Journal of Physical and Rehabilitation Medicine, is one of the first to measure the actual impairment and impact of PACS on patients, and detail factors that may exacerbate their symptoms. This work will help guide lawmakers and national and international health agencies to develop strategies and policies to support these patients during their lengthy recovery.
“With millions of Americans at risk of developing PACS by the end of the pandemic, a second, longer-term public health emergency has emerged. It is imperative to understand the burden of this novel condition and develop targeted interventions to help patients participate in daily activities, as well as policies that will assist them with their disability and employment status,” says senior author David Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System. “This study is a concerning reminder of how severely debilitating PACS symptoms are, the toll they take on health and wellness, and the fact that, without active treatment, these symptoms appear to persist indefinitely.”
A team of researchers did a retrospective, observational study of 156 patients treated at Mount Sinai’s Center for Post-COVID Care between March 2020 and March 2021. The patients had previously had COVID-19 and had not yet been vaccinated at the time of the study. Patients filled out surveys on persistent symptoms and triggers of symptom exacerbation a median of 351 days from their first day of infection – patients received surveys after scheduling their first appointment and timestamped once submitted. They were asked detailed questions about fatigue, breathlessness, ability to complete moderate and vigorous intensity physical activity, cognitive function, health-related quality of life, anxiety, depression, disability, and their pre- and post-COVID-19 employment status
The most common reported symptoms were fatigue (82 percent of patients), followed by brain fog (67 percent), headache (60 percent), sleep disturbance (59 percent), and dizziness (54 percent). Researchers performed a more detailed evaluation of the severity of self-reported cognitive impairment and discovered that more than 60 percent of PACS patients had some level of cognitive impairment (either mild, moderate or severe), with symptoms including diminished short-term memory, difficulty remembering names, and issues with decision-making and daily planning.
In total, 135 patients answered questions about their employment pre- and post-COVID-19, and the number of patients in full-time work (102) went down to 55.
Going further, the study noted factors that the patients said made their PACS symptoms worse. The biggest trigger was physical exertion (reported by 86 percent of patients), followed by stress (69 percent), dehydration (49 percent), and weather changes (37 percent).
“Many of the symptoms reported in this study have been measured, but for many this is the first time they have been objectively documented using well-validated patient-reported outcomes, and linked to changes in activities of daily living and quality of life,” explains Dr. Putrino. “The long duration of these symptoms remind us that this is a problem that is not going away, and that we need to aggressively pursue policies that will better support and protect these patients in the long-term. Future research should focus on more detailed monitoring of PACS symptoms—better understanding how and why they are happening will be crucial in developing targeted treatments.”
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