Category: Covid-19

More than a month after federal officials recommended a new version of the COVID-19 vaccines, 7% of U.S. adults and 2% of children have gotten a shot. File photo via Getty Images

NEW YORK (AP) A month after federal officials recommended new versions of COVID-19 vaccines, 7% of U.S. adults and 2% of children have gotten a shot.

One expert called the rates "abysmal."

The numbers, presented Thursday at a meeting held by the Centers for Disease Control and Prevention, come from a national survey of thousands of Americans, conducted two weeks ago.

WATCH: What's behind the messy rollout of this fall's new COVID vaccines

The data also indicated that nearly 40% of adults said they probably or definitely will not get the shot. A similar percentage of parents said they did not plan to vaccinate their children.

In the late summer, government health officials made the nation's COVID-19 vaccination campaign more like the annual flu campaign.

"The recommendations are not being heard."

Officials approved updated shots that have a single target, an omicron descendant named XBB.1.5. They replaced vaccines that targeted the original coronavirus strain and a much earlier omicron version. Last month, the CDC recommended the new shots for everyone 6 months and older.

The government also transitioned to a commercialized system that relied on the health-care industry not the government to handle the distribution of the shots. Many people who immediately went for shots said pharmacies or doctors didn't have them.

Americans have been urged to get different iterations of the vaccines for more than 2 and 1/2 years. This year, COVID-19 deaths and hospitalizations fell to lower levels than seen in the previous three years.

Cases remain low compared with the pandemic's early months. Even so, health officials say about 18,000 hospitalization and 1,200 deaths are still being reported each week.

One expert at the meeting, Dr. Camille Kotton of Harvard Medical School, called the numbers "abysmal" and said part of the problem may be patient confusion. She urged stepped-up public education efforts.

Dr. David Kimberlin, of the University of Alabama at Birmingham, also expressed dismay.

"The recommendations are not being heard," he said.

Left: More than a month after federal officials recommended a new version of the COVID-19 vaccines, 7% of U.S. adults and 2% of children have gotten a shot. File photo via Getty Images

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Vaccine data shows rates for latest COVID-19 booster is abysmal, only 7 percent of U.S. adults with shot - PBS NewsHour

State of Illinois is urging Illinoisans to get protection from the full range of seasonal respiratory viruses

CHICAGO - The Illinois Department of Public Health (IDPH) has launched a new awareness campaign called 'Tis The Sneezin' to remind residents to vaccinate against the fall and winter triple threat: the flu, COVID and RSV. The announcement comes as data indicates six counties in the state are at an elevated level for COVID-19 hospitalizations, according to the CDC's national COVID Data Tracker as of the week ending October 14. However, the total number of COVID-19 hospitalizations in the state has been trending downward in recent weeks, with 503 hospitalizations for the week, down 8% from the previous week.

Also this week the CDC issued an alert to healthcare providers advising of a shortage of a medication called nirsevimab which is used to protect infants from RSV. The CDC is recommending that doses should be prioritized for infants under 6 months and those with certain risk factors. The CDC also recommended that expectant parents talk to their healthcare provider about receiving an RSV vaccine approved for use during the 32nd to 36th week of pregnancy that protects newborns from RSV.

"IDPH is continuing to work closely with local, state, and federal partners to monitor the three respiratory viruses that caused last fall and winter's tripledemic," said IDPH Director Dr. Sameer Vohra. "We encourage all Illinois residents to do the same to prevent illness and protect yourself and your loved ones. The tools include washing your hands, improving ventilation inside your homes, staying home if sick, and getting immunized with the vaccines available to you. Why? Because . . . Tis the Sneezin'."

Highlighting a common way respiratory viruses spread, the 'Tis The Sneezin' campaign showcases everyday moments interrupted by a common symptom of the flu, COVID and RSV, along with a punny call to action to encourage vaccinations. Following are some examples (click on links to see videos):

The campaign will reach Illinoisans in every corner of the state in both English and Spanish through a variety of traditional and online media channels, including cable, broadcast and connected TV; streaming audio and radio; billboards and bus shelters; digital display and video; print and social media.

In September, the CDC's Advisory Committee on Immunization Practices (ACIP) recommended newly reformulated COVID-19 shots for everyone over the age of 6 months. The federal agencies have given the green light for updated mRNA vaccines developed by Moderna and Pfizer that target the currently circulating strains of the COVID-19 virus. They also have recently approved an updated Novavax COVID-19 vaccine.

These newly approved shots are considered safe when given at the same time as other vaccines for the flu and RSV.

Studies have consistently shown that COVID-19 vaccines lower the risk of getting symptomatic COVID-19 and improve protection against serious illness, hospitalization and death. New evidence is also emerging that it can protect you from long Covid and flu vaccines are also protective against heart disease. Most Americans can still get a COVID-19 vaccine for free. For people with health insurance, most plans will cover the COVID-19 vaccine at no cost. People who don't have health insurance or with health plans that do not cover the cost can get a free vaccine from their local health centers and pharmacies.

For those who are uninsured or under-insured, the CDC this summer launched the Bridge Access Program that will cover the cost of COVID-19 vaccines this fall. The Vaccines for Children Program will cover vaccines for eligible children.

In June, the CDC's ACIP recommended use of a single dose of RSV vaccine for persons 60 years of age and older. In August, ACIP also recommended a new preventive measure against RSV for infants under 8 months and toddlers at high risk, a new monoclonal antibody shot called nirsevimab. This medication was the subject of the CDC's advisory that warned of shortages and urger healthcare provides to prioritize the use of nirsevimab.

On September 22, ACIP recommended seasonal administration of one dose of RSV vaccine during weeks 32 through 36 of pregnancy, to maximize protection for babies after birth.

For treatment of COVID-19, Illinoisans who experience symptoms can access no cost-share telehealth services through the SIU School of Medicine Covid Test to Treat services or call (217) 545-5100.

Illinois has more than 170,000 courses of effective therapeutic medications, including Paxlovid and Lagevrio, supplied through the US government that are available through providers and pharmacies that will continue to be provided free of charge to those with Medicare, Medicaid and the uninsured until supplies run out. Paxlovid and Lagevrio will also be commercially available in November 2023.

The CDC recently launched a new national respiratory virus dashboard that allows the public to view the levels of COVID-19, flu and RSV in each state.

Additional resources and COVID-19 data can be found at https://dph.illinois.gov/covid19.html.

The federal government has established a website that provides an all-purpose toolkit with information on how to obtain masks, treatment, vaccines and testing resources for all areas of the country at: https://www.covid.gov/.

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'Tis the Sneezin' to Get Protected: IDPH Launches Campaign to ... - Illinois.gov

Suffolk County reported the following information related to COVID-19 on October 25, 2023

According to CDC, hospital admission rates and the percentage of COVID-19 deaths among all deaths are now the primary surveillance metrics.

COVID-19 Hospitalizations for the week ending October 14, 2023

Daily Hospitalization Summary for Suffolk County From October 25, 2023

NOTE: HOSPITALS ARE NO LONGER REPORTING DATA TO NYSDOH ON WEEKENDS OR HOLIDAYS.

Fatalities 10/25/23

COVID-19 Case Tracker October 23, 2023

Note: As of May 11, 2023, COVID-19 Community Levels (CCLs) and COVID-19 Community Transmission Levels are no longer calculatable, according to the Centers for Disease Control and Prevention.

* As of 4/4/22, HHS no longer requires entities conducting COVID testing to report negative or indeterminate antigen test results. This may impact the number and interpretation of total test results reported to the state and also impacts calculation of test percent positivity. Because of this, as of 4/5/22, test percent positivity is calculated using PCR tests only. Reporting of total new daily cases (positive results) and cases per 100k will continue to include PCR and antigen tests.

COVID-19 Vaccination Information

Last updated 5/12/23

Vaccination Clinics

As of September 12, 2023, the Suffolk County Department of Health Services is not authorized to offer COVID-19 vaccines to ALL Suffolk County residents.

The department will offer the updated vaccine to only uninsured and underinsured patients through New York State's Vaccines for Children program and Vaccines for Adults program, also known as the Bridge Access Program.

Those with insurance that covers the COVID-19 vaccine are encouraged to receive their vaccines at their local pharmacies, health care providers offices, or local federally qualified health centers.

The department has ordered the updated COVID-19 vaccine and will announce when the vaccine becomes available.

FOR HEALTHCARE PROVIDERS

New York State Links

CDC COVID Data Tracker Rates of laboratory-confirmed COVID-19 hospitalizations by vaccination status

For additional information or explanation of data, click on the links provided in throughout this page.

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COVID-19 update 10-26-23 - Suffolk County Government (.gov)

Researchers found that severe COVID-19 could cause lasting changes in stem cell gene expression that made the immune system produce more white blood cells. Researchers found that severe COVID-19 could cause lasting changes in stem cell gene expression that made the immune system produce more white blood cells. What you need to know

In a small study supported by the National Institute of Allergy and Infectious Diseases (NIAID), severe cases of COVID-19 were shown to cause long-lasting changes to the immune system.

Researchers found that severe cases of COVID-19 can change which genes are turned on or off in certain stem cells. The study focused on stem cells that produce white blood cells, a part of the immune system. The stem cells of people who recovered from severe COVID-19 produced more white blood cells which then produced more inflammatory signals than the cells of healthy counterparts.

The researchers received blood samples from 38 people recovering from severe COVID-19 and 19 healthy people. They identified differences in gene expression between the recovering and healthy participants stem cells. The gene expression in the recovering participants stem cells was associated with higher production of white blood cells. The white blood cells created by recovering participants also seemed to produce more chemicals that trigger inflammation, compared with the white blood cells of healthy participants. These changes lasted for up to 1 year after the participants recovered from severe COVID-19.

The researchers aimed to find out whether one inflammatory chemical messenger, called IL-6, can cause the changes to gene expression. When the researchers tested blocking IL-6 in the cells of people with COVID-19, there were fewer changes to their stem cells gene expression than in the cells of people who had recovered from COVID-19 without blocking IL-6. When IL-6 was blocked in mouse models with a disease similar to COVID-19, murine hepatitis virus 1 (MHV-1), the mice had fewer changes to gene expression and less organ damage from the disease than mice that had not had IL-6 blocked.

Many people are at increased risk of severe COVID-19, including older adults, pregnant people, and people with weakened immune systems.

Because this was a small study, researchers did not establish a direct association between changes to gene expression and poor health outcomes. But the study shows one way that severe COVID-19 can have a long-term impact on the immune system, and its results can inform future research on possible treatments.

Severe COVID-19 may lead to long-term innate immune system changes

NIH Launches Clinical Trials for Long COVID Treatments

Factors That Affect Your Risk of Getting Very Sick from COVID-19

Cheong, J., Ravishankar, A., Sharma, S., Parkhurst, C. N., Grassmann, S. A., Wingert, C. K., Laurent, P., Ma, S., Paddock, L., Miranda, I. C., Karakaslar, E. O., Nehar-Belaid, D., Thibodeau, A., Bale, M. J., Kartha, V. K., Yee, J. K., Mays, M. Y., Jiang, C., Daman, A. W., Josefowicz, S. Z. (2023). Epigenetic memory of coronavirus infection in innate immune cells and their progenitors. Cell, 186(18), 3882-3902.e24. https://doi.org/10.1016/j.cell.2023.07.019

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Severe COVID-19 May Cause Long-Term Immune System Changes - National Institutes of Health (NIH)

The yeast Candida albicans can play a part in regulating the immune system.Credit: Eye Of Science/SPL

An imbalance of fungi in the gut could contribute to excessive inflammation in people with severe COVID-19 or long COVID. A study found that individuals with severe disease had elevated levels of a fungus that can activate the immune system and induce long-lasting changes.

The work, published on 23 October in Nature Immunology1, raises the possibility that antifungal treatment could provide some relief to people who are critically ill with COVID-19.

We know inflammation is driving severe disease, says Martin Hnigl, a clinical mycology researcher at the Medical University of Graz in Austria, who was not involved in the study. This work, he says, provides a potential mechanism of disease-causing inflammation that might have been overlooked.

Trillions of microorganisms live in and on our bodies, helping us to digest food, protecting us from harmful pathogens and more. Although much of the microbiome consists of bacteria, past research has shown that the fungal portion the mycobiota interacts with the immune system, too2.

Previous studies have shown that many people with COVID-19 have guts with altered microbial make-ups and disrupted protective barriers, which could allow pathogens to enter the blood3,4. And some individuals critically ill with COVID-19 have contracted dangerous fungal infections in their lungs5.

What triggers severe COVID? Infected immune cells hold clues

Immunologist Iliyan Iliev at Weill Cornell Medicine in New York City and his colleagues wanted to further investigate the link between the mycobiota and COVID-19. The researchers examined blood from 91 people hospitalized with the disease in 2020. Almost three-quarters of these people had severe COVID-19, who received more than six litres of supplementary oxygen a minute or invasive mechanical ventilation, whereas the rest had moderate or mild disease.

Compared with 36 individuals who had never tested positive for SARS-CoV-2, people with severe COVID-19 produced about four times as many antibodies against three fungal species commonly found in the gut, including the yeast Candida albicans. A high prevalence of antibodies suggests that these people had elevated amounts of those fungi. Faecal samples collected in early 2021 from 10 people with COVID-19 also showed that they had higher overall levels of gut fungi, especially of Candida species, relative to 10 healthy individuals. For these people, the abundance of Candida was positively correlated with disease severity. The presence of some fungal species, C. albicans in particular, has been shown to activate the immune system6.

In a subset of people with severe COVID-19, the number of antibodies against C. albicans in their blood was linked to the number of immune cells called neutrophils, which can trigger inflammation.

When the researchers infected mice with C. albicans extracted from people with severe COVID-19, and then infected them with SARS-CoV-2, they observed that more neutrophils invaded the animals lungs and activated an inflammatory response than in mice with SARS-CoV-2 alone. If they gave these mice an antifungal drug, it lowered the number and activity of neutrophils.

The study also found that people with severe COVID-19 continued to have raised levels of antibodies against C. albicans and neutrophil precursors primed to counter fungi long after they had recovered from the disease up to one year later in some people. These factors hint that mycobiota changes during a SARS-CoV-2 infection could contribute to inflammation associated with long COVID.

COVID lockdowns altered babies microbiomes

Theres a number of theories of what might trigger persistent symptoms after COVID, says Aran Singanayagam, a respiratory immunologist at Imperial College London. Microbial dysbiosis, either of the gut or the lungs, is one major theory that people are proposing, so I think this adds weight to that theory.

Researchers agree that more work is needed to probe the link between gut fungi and COVID-19. It remains unclear whether the observed changes to the mycobiota in people with COVID-19 resulted from the disease or preceded it and made people more susceptible, says Singanayagam.

If future studies reveal more about the mechanisms involved, existing antifungal treatments could be repurposed to help people with COVID-19. Iliev hopes that this work will make people start thinking about those common types of biology that we see in very different diseases and how we can leverage that.

See the article here:

Inflammation in severe COVID linked to bad fungal microbiome - Nature.com

We want to be done with Covid. But the virus isnt done with us.

While cases are not as high as they were at the end of this summer, newer variants are spreading, and experts predict that the patterns often seen over the last three years of the pandemic the temperature drops, people cluster indoors, cases rise will play out again this fall. That means it might be time to take stock (yes, again) of how you can minimize your risk.

It continues to be a moving target, and I think that continues to be hard for people, said Dr. Peter Chin-Hong, an infectious disease expert at the University of California, San Francisco.

As the holiday season approaches, here is a quick refresher on how to navigate the pandemic.

Youve heard it before, youll hear it again: Masks can help you protect yourself and others from becoming sick. So can washing your hands thoroughly and not touching your face with unwashed hands, said Dr. Joseph Khabbaza, a pulmonary and critical care doctor at Cleveland Clinic.

The updated Covid vaccines can also reduce your chances of being infected, and especially cut down on your risk of serious illness, said Dr. Ziyad Al-Aly, the chief of research and development at the V.A. St. Louis Healthcare System.

Rapid tests are also a vital tool. (You can order four free tests per household from the federal government.) Testing when you have symptoms, or after a confirmed exposure, can help determine if you have the virus. Keep in mind that you should take two tests, 48 hours apart, for a more complete picture. If you do have Covid, you may qualify for Paxlovid, which significantly reduces the risk of severe disease and death but you need to take the medication within five days of symptoms starting.

Risk largely boils down to how crowded a place is and how long you spend there. If youre popping into a convenience store, for example, your risk is probably minimal; if youre lingering unmasked for hours in a full concert hall, its higher.

Any time youre indoors with a lot of people, the risk is still there, said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago. Its a good idea to wear a mask on the subway or bus. Planes are likely less risky because of their ventilation, but you still may want to mask, especially when boarding and deplaning.

For any indoor activity, like going to a bar, there are degrees of risk, said Dr. Chin-Hong. How busy is the place? Can you sit by an open window? Newer buildings tend to have better ventilation, and the bigger a place, the more spaced out you can be from other people, which lowers your chance of infection. And anything becomes riskier when cases are rising. Its tricky to find clear data on Covid-19 cases, but you can check local hospitalization rates and wastewater data to get a better sense of your risk.

As the coronavirus has evolved, the amount of time between being exposed and developing symptoms has shortened, Dr. Chin-Hong said. Most people now tend to test positive three days after they have been exposed to the virus, he said. But for many people, it takes a full week to test positive on a rapid test. (Molecular tests are more sensitive but harder to find outside of a doctors office.) Once youre past the one-week mark, though, youre likely in the clear.

It depends on how risk-averse you and the people around you are. It also depends on who you are spending time with if youre visiting an older relative, for example, you may want to reschedule.

And you may want to tell those youre spending time with that you are not feeling well.

Just like you inform people when youre coming late, you inform them with the symptoms you have, and you negotiate with them, Dr. Chin-Hong said. You might move a dinner party outside, for example, or shift plans to another night. Testing is often the only way to determine whether sniffles are due to a cold, the flu or Covid.

If you have a fever, stay home, Dr. Chin-Hong said. Thats a sign youre likely infectious.

If you caught the coronavirus in the past three months, youre fairly well protected against it. You can still become reinfected within that window, but its far less likely, because the variants circulating are similar.

Consider taking extra precautions, like limiting the time you spend around others unmasked in the five days before a big gathering. Be vigilant about your symptoms, Dr. Khabbaza said. You may also want to test beforehand.

Its hard to eliminate risk completely, Dr. Al-Aly said. But you can reduce ones risk.

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Its Covid Season: What to Know About Risks, Testing and Treatment - The New York Times

Oklahoma Governor, Kevin Stitt has decided to allocate the remainder of the 'GREER II' funds to education purposes.

Monday, October 23rd 2023, 7:28 pm

Governor Kevin Stitt has allocated the remaining GEER II funds, or COVID-19 relief funds to be spent on education purposes. Stitt has allocated almost $18 million to be spent on six different projects, helping students recover from the pandemic.

The GEER funds were allocated to governors across the nation, to spend on education proposals of their choosing.

After hundreds of thousands of GEER funds were flagged in a federal audit, the Oklahoma Office of Management and Enterprise Services has been tasked with overseeing the allocation of these most recent funds. They have also hired an outside contractor for the oversight and administration of the funds.The recipients have until January 31 to spend the allocated funds.

Here is the full breakdown of costs and projects provided by OMES:

1:eDynamic / Learning Blade: $400,000.00 This project will help develop Oklahoma students academic skills while improving their interest in high-demand jobs by increasing their awareness of careers. These systems are proven to increase student awareness and interest in STEM, computer science, and CTE pathways while also addressing learning loss. The Learning Blade resource prioritizes students who have been disproportionately impacted by COVID-19 by providing easy access to STEM, CS, and CTE resources that can be used in school, blended or at home

2: DonorsChoose: $11,610,000.00 This project will allow preK-12 Oklahoma public school teachers to request classroom resources to support their students' in-person learning recovery from the pandemic.

3: Special Care: $600,000.00 This project is focused on supporting teachers and support staff who served a greatly underserved Oklahoma population during the pandemic children with special needs and their families. Through this program, Special Care will receive funding for salaries of new positions and retention bonuses for eligible teachers and support staff that are working to support special needs children

4: Boys & Girls Clubs of Oklahoma County $1,880,000.00 This project for the Boys and Girls Clubs of Oklahoma County is focused on helping students around the Capitol Hill/south OKC location who were negatively impacted by the effects of COVID-19. This program will support them through physical building enhancements to host engaging programs, such as academic enrichment/tutoring, STEM activities, recreational and competitive sports, programs in the arts (dance, visual arts, music, and drama), life skill development, special interest clubs (i.e. photography, chess, creative writing, etc.), workforce development and more

5: Boys & Girls Clubs of Oklahoma County $200,000.00 This "Club-on-the-Go" Mobile Clubhouses project with the Boys and Girls Club of OK County is focused on supporting students who have been disproportionately impacted by the pandemic and will bring the Boys and Girls Club student development efforts to kids beyond BGC physical locations and meet kids where they are.

6: Healthy Schools Oklahoma $2,500,000.00 This project is focused on providing health and wellness resources to elementary schools across the State of Oklahoma. This project will help address educational gaps created by the COVID-19 pandemic by including evidence-based learning and wellness strategies for schools.

7: Guidehouse $250,000.00Assisting in oversight and administration of GEER II

8. $272,950 for other administrative costs.

More here:

Gov. Stitt Allocates Remaining COVID-19 Relief Fund Towards Education - news9.com KWTV

In this Norwegian nationwide registry-based study of primary care patients we found that the risk of fatigue or shortness of breath were more than doubled 3 to 12 months after COVID-19 compared to a control group of unexposed persons. The likelihood for memory disturbance, other respiratory symptoms, pain in abdomen, chest and musculoskeletal system and headache were also significantly higher in the COVID-19 group.

The risk of fatigue, memory disturbance and shortness of breath varied with sex, age, education and country of origin among patients after COVID-19. These risk factors generally acted in the same way in the unexposed control group, but pre-pandemic registration of comorbidities was less associated with shortness of breath after COVID-19 compared to unexposed. Having had the same symptom before the pandemic increased the risk for fatigue, memory disturbance and shortness of breath after COVID-19, but the associations were weaker in the exposed than in the unexposed group. Yet, a higher prevalence of outcome symptoms among the exposed support the hypothesis that such symptoms may be attributed to COVID-19, also in a low-risk primary care population. Post-COVID-19 symptoms were more frequent among those who were hospitalised during the acute infection compared to COVID-19 patients who were not hospitalised.

This is a nationwide registry-based study including all persons with a positive PCR test for SARS-CoV-2 and all contacts in a GP list patient system for the whole population, ruling out potential bias from selection or loss to follow up. The diagnoses were recorded by GPs in a business as usual situation, which strengthens the generalizability of the findings.

Another strength was the comprehensive data of the chosen outcome symptoms, comorbidities, and GP utilisation before the pandemic.

Most of the included COVID-19 patients in this study were unvaccinated since vaccination started in Norway at the turn of the year 2020/2021. At the end of our inclusion period (20 February 2021), only 7.5% of the Norwegian population had had a first dose and 3.7% of the population had two doses vaccinated [21] of whom many were nursing homes residents not included in our study population, 85 years of age or older, or health care workers. Consequently, the present study can be seen as a baseline study regarding post-COVID-19 symptoms in a predominantly unvaccinated population.

A limitation of our study is that for GPs, it is common to register only one or two ICPC-2 diagnosis codes, while patients may have presented several problems in one consultation. This is likely to limit the number of symptoms that we identified from registered codes, resulting in underestimation of the symptom burden. Since the data are from GP consultations which do not capture all symptoms in the population, the present study cannot be interpreted as prevalence study of post-COVID-19 symptoms in the general population.

Also, under-registration of COVID-19 is likely, as not all infected persons were tested. This was particular the case in the first 23 months of the pandemic due to a shortage of test kits. However, during the first phase in 2020 the incidence of COVID-19 in Norway was low due to lockdowns. This is supported by a study among 27 700 randomly selected persons at the end of 2020 detecting antibodies against SARS-CoV-2 only among 0.9% of the sample, which is close to the prevalence in the population with a positive PCR test at that time at 0.8% [22]. Therefore, in the whole population without positive PCR test the undiagnosed cases represent a very low share and should have neglectable effect on the results in the current study.

Having had COVID-19 may alter the utilisation of healthcare, but according to a Norwegian study the increased use of GP services related to COVID-19 gradually decreased to a normal level during the first three months after COVID-19 [23].

The lack of a specific diagnostic code for post-COVID-19 makes it difficult to assess the epidemiology of post-COVID-19 health issues. Walker et al. [24] found little use of codes for post-COVID-19 introduced for British GPs and recommended more awareness on coding of post-COVID-19 symptoms to increase possibilities for research and care planning. The current study is based on diagnoses irrespectively of the GPs interpretation of a possible connection to the prior COVID-19.

Still, those who have undergone COVID-19 may be more alert to symptoms reported as post-COVID-19 and present them to their GP. GPs may also have altered their coding practice, being more attentive to and record symptoms that could be related to prior COVID-19. This could result in confirmation and detection bias in our study. If so, the differences between exposed and unexposed may be overestimated in the current study. However, this is a challenge in all studies on registered symptoms that may be related to a certain disease.

The number of individuals with positive PCR test for SARS-CoV-2 was not very high during the exposure period used in this study. This leads to a small number of individuals in some of the risk factor strata within the COVID-19 group, and this is also reflected in the wide confidence intervals for some RRs in Fig.3. The findings regarding these risk factors should be interpreted cautiously.

Determining the prevalence of post-COVID-19 symptoms in the population is methodologically challenging, including confirmation of infection (self-report, health care reports or registries) and approaches to define post-COVID-19.

The prevalence of symptoms reported in meta-analyses published early during the pandemic were generally much higher than our findings [12, 18, 19]. Not all patients seek a GP for symptoms and the GP reported diagnoses do not reflect all symptoms experienced by the patients. When an early meta-analysis reports a prevalence of fatigue of 23 to 60%, compared to 6% in the present study, this may reflect different patient populations. A strength of our study is that it is based in primary care and therefore closer to true population rates than hospital-based studies. A later study has indicated lower prevalence, with 6% reporting post-COVID-19 symptoms after three months and about 1% after 12 months, which is more line with our data [6]. Further, a Norwegian cohort study among young adults found no association between serological signs of COVID-19 and symptoms 6 months later [25], using the broad WHO definition for post-COVID [8]. However, they showed a trend for increased prevalence of postinfectious fatigue, in line with our findings of a highest frequency and HR for this outcome symptom.

Unlike previous studies, particularly those relying on self-reported symptoms [18, 19], we found a lower likelihood for psychological symptoms in the post-COVID-19 period. This could indicate that these symptoms were frequently mild and not perceived as a reason to consult a GP, or it is possible that GPs chose to code other symptoms during the visit. On the other hand, as shown by others, we found an increase in prevalence of anxiety and depression also unexposed, possibly related to a more general effect of the pandemic [26]. It is worth noting that registry-based studies tend to report a lower prevalence of mild mental health problems compared to self-reported surveys [27].

A Dutch study, using data from a large population-based cohort study initiated before the pandemic, was able to establish a control group like we did [28]. The diagnostic categories are not quite comparable to the GP diagnostic codes used in our study, but the findings are similar to ours. Also, a study on non-hospitalised patients from UK showed hazard ratio for fatigue, shortness of breath and chest pain in the post-COVID-19 period in line with our findings [4]. In a recent study from Norway based on SARS-CoV-2 positive cases at the turn of year 2021/2022 there was marked lower HR for most symptoms [3], with HR for fatigue of 1.24 and 1.29 for Delta and Omicron respectively compared to the HR of 2.1 in our study. That study reported HRs of 1.29 (Delta) and 1.69 (Omicron) for shortness of breath compared to 2.8 in our study. These differences can be explained by a shorter observation period, maximum 4 months as compared to 12, and different covariates, as we included pre-pandemic health problems. However, this may also indicate a decrease in risk for post-COVID-19 symptom later in the pandemic, and an effect of vaccination of most of the population at that stage.

Recently, based on 9764 tested persons in the US, an attempt was made to develop a definition on post-acute sequelae of SARS-CoV-2 infection (PASC) [29]. However, only around 1300 were unexposed and symptoms were self-reported. It was acknowledged that developing a better definition would require analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Our study may add knowledge to this field using a large sample of both exposed and unexposed.

In general, after various infections a minority of patients experience long term post-acute health problems [10]. Such symptoms are common across different infectious diseases, suggesting some common underlying mechanisms that, however, are poorly understood. In light of this knowledge, a post-acute syndrome following COVID-19 is not surprising nor exceptional.

Female sex, higher age, belonging to an ethnic minority group and a high disease burden prior to infection are documented risk factors for post-COVID syndrome [4, 5, 13, 30]. We found that the risk factors for fatigue, memory disturbance and shortness of breath were rather similar in exposed and unexposed. However, some minor divergences were found, as belonging to the age group 25 to 60 years was a stronger risk factor for fatigue in the exposed compared to the unexposed group.

In the literature, comorbid conditions are found to increase the risk for post-COVID-19 symptoms [4, 5]. However, using a score for comorbidities, we found no increase in relative risk for fatigue or shortness of breath with increasing number of comorbid conditions among exposed and a slight increase in risk for memory disturbance with three or more comorbidities. For shortness of breath, we found a lower relative risk with increasing numbers of comorbidities after COVID-19 compared to unexposed. This could indicate shortness of breath to be part of post-COVID-19 syndrome unrelated to previous diseases since the infection affects the respiratory system, whereas among the unexposed the risk increased with increasing comorbidity score. On the other hand, in our study the diagnosis shortness of breath might not have been registered if other diagnosed conditions were considered to explain the symptom by the GP, and this may more often be the case with lung symptom compared to fatigue and memory disturbance.

Outcome symptoms such as fatigue, memory disturbance and shortness of breath are common in the general population, and having had the same symptom before the pandemic markedly increased the risk for having an outcome symptom in the observation period. In clinical practice it is difficult or impossible to determine in each case whether a symptom actually was present prior to the infection, whether it is caused or aggravated by the infection or whether it appears by chance. This underlines the challenge using post-COVID-19 as diagnosis in primary care, as shown by low-frequent use of such a code when introduced in the UK [24] and also indicate that a composite explanatory model is necessary to understand the mechanisms underlying post-COVID-19 symptoms [10, 25].

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Household hardships and responses to COVID-19 pandemic ... - BMC Public Health