Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study - The Lancet
Patients often report various symptoms after recovery from acute #COVID-19. Previous studies on post-COVID-19 condition have not corrected for the prevalence and severity of these common symptoms before COVID-19 and in populations without #SARS-CoV-2 infection. We aimed to analyse the nature, prevalence, and severity of long-term symptoms related to COVID-19, while correcting for symptoms present before SARS-CoV-2 infection and controlling for the symptom dynamics in the population without infection.
This study is based on data collected within #Lifelines, a multidisciplinary, prospective, population-based, observational cohort study examining the health and health-related behaviours of people living in the north of the Netherlands. All Lifelines participants aged 18 years or older received invitations to digital COVID-19 questionnaires. Longitudinal dynamics of 23 somatic symptoms surrounding COVID-19 diagnoses (due to SARS-CoV-2 alpha [B.1.1.7] variant or previous variants) were assessed using 24 repeated measurements between March 31, 2020, and Aug 2, 2021. Participants with COVID-19 (a positive SARS-CoV-2 test or a physician’s diagnosis of COVID-19) were matched by age, sex, and time to COVID-19-negative controls. We recorded symptom severity before and after COVID-19 in participants with COVID-19 and compared that with matched controls.
76 422 participants (mean age 53·7 years [SD 12·9], 46 329 [60·8%] were female) completed a total of 883 973 questionnaires. Of these, 4231 (5·5%) participants had COVID-19 and were matched to 8462 controls. Persistent symptoms in COVID-19-positive participants at 90–150 days after COVID-19 compared with before COVID-19 and compared with matched controls included chest pain, difficulties with breathing, pain when breathing, painful muscles, ageusia or anosmia, tingling extremities, lump in throat, feeling hot and cold alternately, heavy arms or legs, and general tiredness. In 12·7% of patients, these symptoms could be attributed to COVID-19, as 381 (21·4%) of 1782 COVID-19-positive participants versus 361 (8·7%) of 4130 COVID-19-negative controls had at least one of these core symptoms substantially increased to at least moderate severity at 90–150 days after COVID-19 diagnosis or matched timepoint.
To our knowledge, this is the first study to report the nature and prevalence of #post-COVID-19 condition, while correcting for individual symptoms present before COVID-19 and the symptom dynamics in the population without SARS-CoV-2 infection during the pandemic. Further research that distinguishes potential mechanisms driving post-COVID-19-related symptomatology is required.
Survey data suggests millions of people aren’t working because of long COVID
As the number of people with post-COVID symptoms soars, researchers and the government are trying to get a handle on how big an impact long COVID is having on the U.S. workforce. It’s a pressing question, given the fragile state of the economy. For more than a year, employers have faced staffing problems, with jobs going unfilled month after month.
Now, millions of people may be sidelined from their jobs due to long COVID. Katie Bach, a senior fellow with the Brookings Institution, drew on survey data from the Census Bureau, the Federal Reserve Bank of Minneapolis and the Lancet to come up with what she says is a conservative estimate: 4 million full-time equivalent workers out of work because of long COVID.
“That is just a shocking number,” says Bach. “That’s 2.4% of the U.S. working population.”
Economically inactive Britons with long Covid have ‘doubled’ in a year | UK unemployment and employment statistics | The Guardian (04/08/2022)
One in 20 people unemployed and not seeking work have symptoms, says ONS
One in 20 people in the UK who are neither employed nor seeking paid work are suffering from long Covid, with the figure more than doubling in the past year, official data has revealed.
The proportion is far higher than for the one in 29 people who are unemployed but seeking work who have long Covid symptoms, or the one in 30 employed people who are sufferers, data released by the Office for National Statistics (ONS) shows.
Individuals who are not employed and are not looking for paid work are classified as being economically inactive.
The data suggests the long-term impacts of the virus could be driving people into this category, or into retirement.
The self-reported data shows that the proportion of economically inactive people with long Covid symptoms jumped from 2.4% in August 2021 to 5% in July 2022. Students and retirees, while also classed as economically inactive, are not included in this figure.
The level of long Covid among retired people has also increased from 1.3% to 2.9% during the same period – and from 1.9% to 3.5% among the unemployed. The level has risen more slowly, from 2% to 3.3% for those who are employed.
The ONS said the increase in long Covid among retired people and the economically inactive “may be driven by people already in these groups developing long Covid symptoms, or people with long Covid moving into these groups from other employment status categories”.
Long Covid has been defined by the ONS as people with symptoms of coronavirus that have persisted for more than four weeks after the initial infection. The most common symptoms are fatigue, shortness of breath, loss of smell and muscle aches.
The total number of people in the UK suffering from long Covid was estimated to be just under 1.8 million at the beginning of July.
The significant number of people suffering the long-term consequences of the virus is costing the UK up to £1.5bn a year in lost earnings, according to the research from the the Institute for Fiscal Studies.
People left unable to work by the virus are losing an average of £1,100 a month, according to the thinktank.
The rapid spread of Covid-19 infections throughout the UK in the past month has seen staff absence rates soar.
Some employers were forced to close their businesses as the BA.4 and BA.5 Omicron subvariants left staff too unwell to work.
#Long_Covid: U.S. scientists to enroll 40,000 in high-stakes, $1.2 billion Recover study
The U.S. government is rolling out a massive study of long Covid in an effort to understand the mysterious condition.
The study, Recover, aims to complete enrollment of nearly 40,000 people by year-end.
The National Institutes of Health also plans to launch clinical trials on potential treatments in coming months.
However, critics say the study’s rollout is moving too slowly.
Scientists, physicians and public health officials are worried millions of Americans may have long-term health complications from #Covid-19.
55% of Hospitalized COVID Patients Still Had Symptoms at 2 Years | MedPage Today
“Regardless of initial disease severity, #COVID-19 survivors had longitudinal improvements in physical and mental health, with most returning to their original work within 2 years; however, the burden of symptomatic sequelae remained fairly high,” the group wrote. “COVID-19 survivors had a remarkably lower health status than the general population at 2 years.”
Study limitations included the lack of a control group of hospital survivors with a respiratory infection other than COVID, so there was no way to tell if these abnormalities are specific to COVID. There may have also been participation bias, where participants with fewer symptoms might have been less likely to participate. Finally, the data came from a single center early in the pandemic, which may limit its generalizability.
Predicting #Long_COVID at Initial Point of #COVID-19 Diagnosis : Institute for Systems Biology-Led Study Finds Several Warning - Bloomberg
[…] researchers have identified several factors that can be measured at the initial point of COVID-19 diagnosis that anticipate if a patient is likely to develop long COVID. These “PASC factors” are the presence of certain autoantibodies, pre-existing Type 2 diabetes, #SARS-CoV-2 RNA levels in the blood, and #Epstein-Barr virus DNA levels in blood.
“Identifying these PASC factors is a major step forward for not only understanding long COVID and potentially treating it, but also which patients are at highest risk for the development of chronic conditions,” said IS President, Dr. Jim Heath, co-corresponding author of a research paper published online by the journal Cell “These findings are also helping us frame our thinking around other chronic conditions, such as post-acute Lyme syndrome, for example.”
Additionally, researchers found that mild cases of COVID-19, not just severe cases, are associated with long COVID . They also suggest that administering antivirals very early in the disease course may potentially prevent some PASC.
Researchers collected blood and swab samples from 309 COVID-19 patients at different time points to perform comprehensive phenotyping which was integrated with clinical data and patient-reported symptoms to carry out a deep multi-omic, longitudinal investigation.
A key finding from the study deals with viral load, which can be measured near diagnosis to predict long COVID symptoms. “We found that early blood viral measurements are strongly associated with certain long COVID symptoms that patients will develop months later,” said Dr. Yapeng Su, a co-first and co-corresponding author of the paper.
In addition, researchers found the Epstein-Barr virus (#EBV) – a virus that infects 90 percent of the human population and is normally inactive in the body after infection – is reactivated early on after SARS-CoV-2 infection, which is significantly associated with future long COVID symptoms. “This may be related to immune dysregulation during COVID-19 infection,” Su added.
The team also found that PASC is anticipated by autoantibodies (which associate with autoimmune diseases like lupus) at diagnosis, and that as autoantibodies increase, protective SARS-CoV-2 antibodies decrease. This suggests a relationship between long COVID, autoantibodies and patients at elevated risk of re-infections.
“Many patients with high autoantibodies simultaneously have low (protective) antibodies that neutralize SARS-CoV-2, and that’s going to make them more susceptible to breakthrough infections,” said Daniel Chen, a co-first author of the paper.
Multiple Early Factors Anticipate Post-Acute COVID-19 Sequelae ▻https://www.cell.com/cell/pdf/S0092-8674(22)00072-1.pdf
We had several major findings. First, we observed that patients with autoAbs at T3 (44%) already exhibited mature (class-switched) autoAbs as early as at diagnosis (56%) (Figure 2A), indicating the autoAbs may predate COVID-19 , as reported elsewhere (Paul et al., 2021). Analysis of EHR data confirmed that only 6% of autoAb-positive patients had documented autoimmune conditions before COVID-19, suggesting that the autoAbs may reflect subclinical conditions .
Les auto-anticorps seraient donc corrélés non seulement aux formes graves mais aussi aux covid-long ; de plus ce type d’anticorps (un sous-type ?) semble pouvoir se rencontrer dans les formes légères de Covid-19.
L’âge ne semble pas être un facteur de risque.
Un autre article publié il y a quelques mois incriminait également la réactivation du virus d’Epstein-Barr comme facteur de risque de covid-long
Long Covid: nearly 2m days lost in NHS staff absences in England | Long Covid | The Guardian
“Thousands of frontline workers are now living with an often debilitating condition after being exposed to the virus while protecting this country,” she said. “They cannot now be abandoned.”
The Office for National Statistics estimates that 1.3 million people, or 2% of the population, are living with long Covid, based on people self-reporting symptoms that last more than a month after a Covid infection. More than half a million have had symptoms for at least a year, with ailments ranging from breathlessness, fatigue and a cough to muscle aches and pains, “brain fog”, headaches and palpitations.
Long COVID could become Finland’s largest chronic disease, warns minister | Reuters
“Long COVID”, where symptoms of COVID-19 persist for months after an initial infection, could be emerging as a chronic disease in Finland, Minister of Family Affairs and Social Services Krista Kiuru said on Friday.
Speaking at a news conference, she referred to a Finnish expert panel’s summary of more than 4,000 international studies which showed one in two adults and around 2% of children may experience prolonged symptoms connected to COVID-19.
Le #covidlong pourrait devenir la plus importante maladie chronique en Finlande, prévient le ministre | Mais en France, Jean-Michiel expose les gosses et les épidémios de comptoir envisagent de laisser toute la population s’infecter.
COVID-19 isn’t just a cold
This thread is long, and hard to read - not just because of the technical language, but because “it’s just a cold,” “the vaccine protects me,” and “at least our children are safe” are comforting fairy tales.
I wish they were true.
This virus is like measles and polio: a virus with long-term impact.
Even a “mild” case in a vaccinated individual can lead to long-term issues which cause a measurable uptick in all-cause mortality in the first 6 months, and get progressively worse with time.
SARS-CoV-2 is a systemic disease which has multiple avenues to induce long-term impairment, attacking the brain, heart, lungs, blood, testes, colon, liver, and lymph nodes, causing persistent symptoms in more than half of patients by six months out.
The CoVHORT study, limited to non-hospitalized patients in Arizona - “mild” cases - found a 68% prevalence of 1 or more Covid symptom after 30 days, rising to 77% after 60 days. (We will explore an explanation later).
To prevent panic, @CDCgov has been using the term “mild” to describe any case of COVID-19 which does not require hospitalization.
#LongCOVID, however, is anything but “mild”, as the replies to @ahandvanish’s thread make heartbreakingly clear.
A University of Washington study found that 30% of Covid patients had reduced Health Related Quality of Life, with 8% of the patients limited in routine daily activities.
These patients are struggling with real physical issues.
This Yale study demonstrated reduced aerobic capacity, oxygen extraction. and ventilatory efficiency in “mild” COVID patients even after recovery from their acute infection.
It’s also a vascular disease. A Columbia study found “significantly altered lipid metabolism” during acute disease, which “suggests a significant impact of SARS-CoV-2 infection on red blood cell structural membrane homeostasis.”
Oregon Health & Science University found that “symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of [fatal] cardiovascular outcomes and has causal effect on all-cause mortality.”
Let’s review: SARS-CoV-2 causes an increase in mortality and reduced aerobic capacity even after asymptomatic cases, and remains in the body months after the initial infection.
No, it’s not “just a cold.”
But we’re just getting started. It gets worse. Way worse.
The virus appears to be able to cross the blood-brain barrier and cause significant neurological damage.
The ability of the spike protein to cross the blood-brain barrier was demonstrated in mice at the University of Washington.
A joint study by Stanford and Germany’s Saarland University found inflammation in the brain, and “show[ed] that peripheral T cells infiltrate the parenchyma.”
For context, the parenchyma is the functional tissue of the brain - your neurons and glial cells. It isn’t normally where T cells are:
“In the brain of healthy individuals, T cells are only present sporadically in the parenchyma.”
The Stanford study also discovered microglia and astrocytes which displayed “features .. that have previously been reported in human neurodegenerative disease.”
Post-mortem neuropathology in Hamburg, Germany found “Infiltration by cytotoxic T lymphocytes .. in the brainstem and cerebellum, [with] meningeal cytotoxic T lymphocyte infiltration seen in 79% [of] patients.”
An autopsy of a 14-month-old at Brazil’s Federal University of Rio de Janeiro found that “The brain exhibited severe atrophy and neuronal loss.”
The UK Biobank COVID-19 re-imaging study compared before and after images of “mild” cases, and found “pronounced reduction in grey matter” and an “increase of diffusion indices, a marker of tissue damage” in specific regions of the brain.
That seems to explain why there is evidence of persistent cognitive deficits in people who have recovered from SARS-CoV2 infection in Great Britain.
Also worrisome are syncytia, where an infected cell extrudes its own spike protein and takes over its neighbors, fusing together to create a large multi-nucleus cell.
Delta’s particular aptitude for this may partly explain its severity.
And, yes, syncytia formation can happen in neurons. For our visual learners, here is video of syncytia and apoptosis (cell death) in a (bat) brain:
Luckily, the University of Glasgow found that “Whilst Delta is optimised for fusion at the cell surface, Omicron .. achieves entry through endosomal fusion. This switch .. offers [an] explanation for [its] reduced syncytia formation.”
If you’re interested in further understanding the host of neurological symptoms and the mechanisms underlying them, this Nature article is an excellent primer:
Let’s review: SARS-CoV-2 can cross the blood-brain barrier, and even “mild” or asymptomatic cases can cause loss of neurons and persistent cognitive defects?
That doesn’t sound “mild” to me; I like my brain.
But it keeps getting worse.
The brain isn’t the only organ affected: Testicular pathology has found evidence of “SARS-Cov-2 antigen in Leydig cells, Sertoli cells, spermatogonia, and fibroblasts” in post-morten examination.
A Duke pathology study in Singapore “detected SARS-CoV-2 .. in the colon, appendix, ileum, haemorrhoid, liver, gallbladder and lymph nodes .. suggesting widespread multiorgan involvement of the viral infection.”
The same study found “evidence of residual virus in .. tissues during the convalescent phase, up to 6 months after recovery, in a non-postmortem setting,” suggesting that “a negative swab result might not necessarily indicate complete viral clearance from the body.”
It also causes microclots: “Fibrin(ogen) amyloid microclots and platelet hyperactivation [were] observed in [Long COVID] patients,” in this work by Stellenbosch University of South Africa, which also explored potential treatments.
Let’s review - SARS-CoV2 attacks our veins, blood, heart, brain, testes, colon, appendix, liver, gallbladder and lymph nodes?
No, it’s not “just a respiratory virus”.
Not even close.
There are also immunology implications:
Johns Hopkins’ @fitterhappierAJ found that “CD95-mediated [T cell] differentiation and death may be advancing T cells to greater effector acquisition, fewer numbers, and immune dysregulation.”
This Chinese military study of the initial Wuhan outbreak concluded that “T cell counts are reduced significantly in COVID-19 patients, and the surviving T cells appear functionally exhausted.”
The study authors went on to warn, “Non-ICU patients with total T cells counts lower than 800/μL may still require urgent intervention, even in the immediate absence of more severe symptoms due to a high risk for further deterioration in condition.”
Those warnings have since been proven by discovery of autoimmune features.
This study of 177 Los Angeles healthcare workers found that all had persistent self-attacking antibodies at least 6 months after infection, regardless of illness severity.
In the words of T-cell immunologist Dr. Leonardi (@fitterhappierAJ)
This Kaiser Permanente S.California study found that, although natural immunity provided substantial protection against reinfection, “Hospitalization was more common at suspected reinfection (11.4%) than initial infection (5.4%).”
In fact, remember those cytokine storms? It turns out that even that even severe COVID-19 may not be a viral pneumonia, but an autoimmune attack of the lung.
Let’s review - it’s autoimmune: SARS-CoV2 convinces our body to attack itself.
That might explain why the Arizona study saw more symptoms after 60 days than at 30 days.
It also means “natural immunity” isn’t something to count on.
But if you’re counting on vaccination to feel safe, there’s even more bad news.
A study of Israel healthcare workers found that “Most breakthrough cases were mild or asymptomatic, although 19% had persistent symptoms (>6 weeks).”
Perhaps the most terrifying study is from Oxford University, which examined the effects of vaccination on long COVID symptoms, because not only did it find that vaccination does not protect against Long Covid, but that Long Covid symptoms become more likely over time:
In the words of the study authors, “vaccination does not appear to be protective against .. long-COVID features, arrhythmia, joint pain, type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders."
“The narrow confidence intervals rule out the possibility that these negative findings are merely a result of lack of statistical power. The inclusion of death in a composite endpoint with these outcomes rules out survivorship bias as an explanation.”
That finding contradicts the findings from the UK Zoe app study, which found that “the odds of having symptoms for 28 days or more after post-vaccination infection were approximately halved by having two vaccine doses.”
However, the structural limitations of the Zoe study - discussed in detail by @dgurdasani1 in the linked thread - may explain why it is particularly susceptible to bias against detecting a progressive degenerative condition.
Let’s review: we’ve now shown that vaccination appears to offer no protection against the long-term autoimmune effects of COVID - which we know causes T-cells to attack the lungs, and can cause T-cells to enter the brain.
Why are we letting this run wild?!
You may think, at least our children are safe.
They are not.
The CDC is tracking incidence of a life-threatening multisystem inflammatory syndrome in children following an acute COVID-19 infection, with 5,973 cases as of November 30, 2021.
Children also suffer from Long Covid.
“More than half [of pediatric patients] reported at least one persisting symptom even 120 days [after] COVID-19, with 42.6% impaired by these symptoms during daily activities.”
Focusing exclusively on pediatric deaths is vastly underselling the danger to children.
Anybody telling you that SARS-CoV-2 is “just a cold” or “safe for children” is lying to you. They are ignoring the massive body of research that indicates that it is anything but.
Since our vaccines don’t stop transmission, and don’t appear to stop long-term illness, a “vaccination only” strategy is not going to be sufficient to prevent mass disability.
This isn’t something we want to expose our kids to.
Let’s review: even for children and vaccinated people, a “mild” case of COVID causes symptoms that point to long-term autoimmune issues, potentially causing our own body to attack our brains, hearts, and lungs.
Now we’re ready to get to work.
“This is the virus most Americans don’t know. We were born into a world where a virus was a thing you got over in a few weeks.” — @sgeekfemale, to whom I owe a “thank you” for her editing assistance on this thread.
The viruses they know in Kolkota, Kinshasa, and Wuhan are different: dangerous, lethal beasts.
Since 2020, the field has been leveled. Willing or no, we’ve rejoined the rest of the world. We are, all of us, vulnerable in the face of an unfamiliar threat.
The first step is acknowledging the threat.
That means acknowledging that our response has been woefully inadequate, and that is going to be uncomfortable.
The thought that we could have prevented this, but didn’t, will feel unconscionable to some.
The knowledge that we could start preventing this today, but haven’t, is unconscionable to me.
It’s time to quit pretending “it’s just a cold,” or that there is some magical law of viruses that will make it evolve to an acceptable level.
There’s no such law of evolution, just wishful thinking, easily disproven by:
Ebola. Smallpox. Marburg. Polio. Malaria.
There are things we can do to reduce our individual risk, immediately.
That starts with wearing a good mask - an N95 or better - and choosing to avoid things like indoor dining and capacity-crowd stadiums.
This isn’t a choice of “individual freedom” vs “public health”. It isn’t “authoritarian” to ask people to change their behavior in order to save lives.
As Arnold @Schwarzenegger argued so convincingly in @TheAtlantic, it is our patriotic duty:
“Generations of Americans made incredible sacrifices, and we’re going to throw fits about putting a mask over our mouth and nose?”
“Those who would sacrifice essential liberty for a little bit of temporary security deserve neither!”
What is the essential liberty here?
It is the liberty to be able to breathe clean air, to live our lives without infecting our families and risking disability.
To get there, we need to listen to our epidemiologists and public health experts - the ones who have been trying to tell us this since the beginning:
It is time — long past time — to give up on the lazy fantasy that we can let it become “endemic” and “uncontrolled” because it inconveniences us, because it is killing our political opponents, or because the virus will magically evolve to some “mild” state.
It is time — long past time — to begin controlling this virus.
It’s possible: Japan, New Zealand, and South Korea have done it.
It saves lives:
It’s even good for the economy:
“Globally, economic contraction and growth closely mirror increases and decreases in COVID-19 cases... Public health strategies that reduce SARS-CoV-2 transmission also safeguard the economy.”
Reduced Incidence of #Long_COVID Symptoms Related to Administration of COVID-19 Vaccines Both Before COVID-19 Diagnosis and Up to 12 Weeks After | medRxiv
In this study, patients who had been vaccinated prior to COVID-19 infection were significantly less likely to have long-COVID symptoms. This result applies even if only a single dose of the vaccine is documented, regardless of the manufacturer of the vaccine. Although these results show that other factors, such as demographic factors and chronic conditions, also influence the likelihood that an individual will exhibit long-COVID symptoms, vaccination status had a consistently and substantially larger effect on this outcome than any other factor measured.
Furthermore, patients whose first vaccination occurred within 12 weeks after COVID-19 diagnosis were significantly less likely to have long-COVID symptoms than if they had remained unvaccinated. This finding is consistent with the hypothesis that a vaccine may accelerate clearance of the remaining SARS-CoV-2 virus from specific body compartments or reduce part of the body’s immune response related to development of long-COVID (3).
Do vaccines protect against #long_COVID? What the data say
Vaccines reduce the risk of developing #COVID-19 — but studies disagree on their protective effect against long COVID.
And while the data trickle in, Alwan worries that countries with high vaccine coverage will put COVID-19 testing on the back burner as concerns about hospitalizations and deaths decrease and as more people receive boosters. That not only hurts efforts to determine the influence of vaccination on long COVID, but also means that those with long COVID after a mild or asymptomatic infection might not have the documentation they need for treatment. “It’s important to get that lab confirmation for care,” she says. “Otherwise, people struggle a lot.”
Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study - The Lancet Infectious Diseases
Les #Covid_longs sont deux fois moins fréquents chez les infectés entièrement vaccinés.
We found that the odds of having symptoms for 28 days or more after post-vaccination infection were approximately halved by having two vaccine doses. This result suggests that the risk of #long_COVID is reduced in individuals who have received double vaccination, when additionally considering the already documented reduced risk of infection overall.
Twelve-month systemic consequences of #COVID-19 in patients discharged from hospital: a prospective cohort study in Wuhan, China | Clinical Infectious Diseases | Oxford Academic
Physiological, laboratory, radiological or electrocardiogram abnormalities, particularly those related to renal, cardiovascular, liver functions are common in patients who recovered from COVID-19 up to 12months post-discharge.
Suivi des patients ayant survécu après une hospitalisation pour #covid-19
1-year outcomes in hospital survivors with #COVID-19: a longitudinal cohort study - The Lancet
1276 COVID-19 survivors completed both visits [6 months, 12 months]. The median age of patients was 59·0 years (IQR 49·0–67·0) and 681 (53%) were men. The median follow-up time was 185·0 days (IQR 175·0–198·0) for the 6-month visit and 349·0 days (337·0–361·0) for the 12-month visit after symptom onset. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (p<0·0001). The proportion of patients with dyspnoea, characterised by mMRC score of 1 or more, slightly increased from 26% (313/1185) at 6-month visit to 30% (380/1271) at 12-month visit (p=0·014). Additionally, more patients had anxiety or depression at 12-month visit (26% [331/1271] at 12-month visit vs 23% [274/1187] at 6-month visit; p=0·015). No significant difference on 6MWD was observed between 6 months and 12 months. 88% (422/479) of patients who were employed before COVID-19 had returned to their original work at 12 months. Compared with men, women had an odds ratio of 1·43 (95% CI 1·04–1·96) for fatigue or muscle weakness, 2·00 (1·48–2·69) for anxiety or depression, and 2·97 (1·50–5·88) for diffusion impairment. Matched COVID-19 survivors at 12 months had more problems with mobility, pain or discomfort, and anxiety or depression, and had more prevalent symptoms than did controls.
Most COVID-19 survivors had a good physical and functional recovery during 1-year follow-up, and had returned to their original work and life. The health status in our cohort of COVID-19 survivors at 12 months was still lower than that in the control population.
Understanding #long_COVID: a modern medical challenge - The Lancet
Most evidence about long COVID has been limited and based on small cohorts with short follow-up. However, in The Lancet, Lixue Huang and colleagues report 12-month outcomes from the largest longitudinal cohort of hospitalised adult survivors of COVID-19 so far. Including adults (median age 59 years) discharged from Jin Yin-tan Hospital in Wuhan, China, this study advances our understanding of the nature and extent of long COVID.
At 1 year, COVID-19 survivors had more mobility problems, pain or discomfort, and anxiety or depression than control participants (matched community-dwelling adults without SARS-CoV-2 infection). Fatigue or muscle weakness was the most frequently reported symptom at both 6 months and 12 months, while almost half of patients reported having at least one symptom, such as sleep difficulties, palpitations, joint pain, or chest pain, at 12 months. The study shows that for many patients, full recovery from COVID-19 will take more than 1 year, and raises important issues for health services and research.
First, only 0·4 of patients with COVID-19 said that they had participated in a professional rehabilitation programme. The reason for such low use of rehabilitation services is unclear, but poor recognition of long COVID and lack of clear referral pathways have been common problems worldwide. Second, the effect of long COVID on mental health warrants further and longer-term investigation. The proportion of COVID-19 survivors who had anxiety or depression slightly increased between 6 months and 12 months, and the proportion was much greater in COVID-19 survivors than in controls. Third, the outcomes from this cohort cannot be generalised to other populations—eg, patients not admitted to hospital, younger people, and those from racially minoritised and other disadvantaged groups who have been disproportionately affected by the pandemic. Research in these populations needs to be prioritised urgently.
Thread by chrischirp on Thread Reader App – Thread Reader App
Prof. Christina Pagel sur Twitter : "#LONG_COVID THREAD:
The people running the BBC Horizon “Great British Intelligence Test” challenge on over 80,000 people took the opportunity to see if they could detect any differences by whether people had had covid or not..." / Tw
10. What if by the time there can be no doubt of long term problems in many people who’ve had covid, we’ve allowed millions more infections leaving hundreds of thousands more people affected.
ONS estimated 634K people with long covid that impacts their life in June.
11. For comparison, c. 260K people are diagnosed with diabetes & 500K with heart disease each year.
I worry that we are creating a chronic disease tragedy right now.
Cognitive deficits in people who have recovered from #COVID-19 - EClinicalMedicine
People who had recovered from COVID-19, including those no longer reporting symptoms, exhibited significant cognitive deficits versus controls when controlling for age, gender, education level, income, racial-ethnic group, pre-existing medical disorders, tiredness, depression and anxiety. The deficits were of substantial effect size for people who had been hospitalised (N = 192), but also for non-hospitalised cases who had biological confirmation of COVID-19 infection (N = 326). Analysing markers of premorbid intelligence did not support these differences being present prior to infection. Finer grained analysis of performance across sub-tests supported the hypothesis that COVID-19 has a multi-domain impact on human cognition.
Interpretation. These results accord with reports of ‘#Long_Covid’ cognitive symptoms that persist into the early-chronic phase. They should act as a clarion call for further research with longitudinal and neuroimaging cohorts to plot recovery trajectories and identify the biological basis of cognitive deficits in #SARS-COV-2 survivors.
Lead researcher Prof Russell Viner said complex decisions around vaccinating and shielding children required input from many sources - not their work alone.
But he said if there were adequate vaccines, their research suggested certain groups of children could benefit from receiving Covid jabs.
He added: “I think from our data, and in my entirely personal opinion, it would be very reasonable to vaccinate a number of groups we have studied, who don’t have a particularly high risk of death, but we do know that their risk of having severe illness and coming to intensive care, while still low, is higher than the general population.”
He said further vaccine data - expected imminently from other countries, including the US and Israel - should be taken into account when making the decision.
Dr Elizabeth Whittaker, from the Royal College of Paediatrics and Child Health and Imperial College London, said […] “[a]lthough this data covers up to February 2021, this hasn’t changed recently with the #Delta #variant. We hope this data will be reassuring for children and young people and their families.”
…infections come with a high burden of #long_Covid. The Office for National Statistics estimates about 1 million people, including 33,000 children , currently live with long Covid in the UK, with 385,000 having symptoms for more than a year and over 600,000 saying it adversely impacts their daily life. With infections falling mainly on the unvaccinated young, we risk burdening a generation with long-term ill health.
Coronavirus disease 2019 (#COVID-19) patients sometimes experience long-term symptoms following resolution of acute disease, including fatigue, brain fog, and rashes. Collectively these have become known as long COVID.
Our aim was to first determine long COVID prevalence in 185 randomly surveyed COVID-19 patients and, subsequently, to determine if there was an association between occurrence of long COVID symptoms and reactivation of Epstein–Barr virus (#EBV) in 68 COVID-19 patients recruited from those surveyed.
We found the prevalence of long COVID symptoms to be 30.3% (56/185), which included 4 initially asymptomatic COVID-19 patients who later developed long COVID symptoms.
Next, we found that 66.7% (20/30) of long COVID subjects versus 10% (2/20) of control subjects in our primary study group were positive for EBV reactivation based on positive titers for EBV early antigen-diffuse (EA-D) IgG or EBV viral capsid antigen (VCA) IgM. The difference was significant (p < 0.001, Fisher’s exact test). A similar ratio was observed in a secondary group of 18 subjects 21–90 days after testing positive for COVID-19, indicating reactivation may occur soon after or concurrently with COVID-19 infection.
These findings suggest that many long COVID symptoms may not be a direct result of the #SARS-CoV-2 virus but may be the result of COVID-19 inflammation-induced EBV reactivation.
The four most urgent questions about long COVID
It seems unlikely that the virus itself is still at work, says Evans. “Most of the studies have shown that after a few weeks you’ve pretty much cleared it, so I very much doubt it’s an infective consequence.”
However, there is evidence that fragments of the virus, such as protein molecules, can persist for months7, in which case they might disrupt the body in some way even if they cannot infect cells.
A further possibility is that long COVID is caused by the immune system going haywire and attacking the rest of the body. In other words, long COVID could be an autoimmune disease. “#SARS-CoV-2 is like a nuclear bomb in terms of the immune system,” says Steven Deeks, a physician and infectious-disease researcher at the University of California, San Francisco. “It just blows everything up.” Some of those changes might linger — as has been seen in the aftermath of other viral infections (see ‘What is the relationship between long COVID and other #post-infection syndromes?’).
Still, it is too early to say which hypothesis is correct, and it might be that each is true in different people: preliminary data suggest that #long_COVID could be several disorders lumped into one
Symptoms and Functional Impairment Assessed 8 Months After Mild #COVID-19 Among Health Care Workers | Infectious Diseases | JAMA | JAMA Network
Symptômes persistant après un Covid-19 léger dans une étude suédoise appelée « COMMUNITY (COVID-19 Biomarker and Immunity) »
Comparing seropositive vs seronegative participants, 26% vs 9% reported at least 1 moderate to severe symptom lasting for at least 2 months (RR, 2.9 [95% CI, 2.2-3.8]) and 15% vs 3% reported at least 1 moderate to severe symptom lasting for at least 8 months (RR, 4.4 [95% CI, 2.9-6.7]) (Table). The most common moderate to severe symptoms lasting for at least 2 months in the seropositive group were anosmia, fatigue, ageusia, and dyspnea.
COVID LONG : [Plus d’] 1 patient sur 10 a toujours des symptômes 8 mois après | santé log
COVID léger ne signifie pas COVID court.
Strain on NHS as tens of thousands of staff suffer #long_Covid | NHS | The Guardian
La diminution du nombre de cas de covid ne doit pas faire oublier les #covid_long
... a detailed report [...] showed 1.1 million people in the UK were affected by the condition.
Study reveals seven in ten patients hospitalised with #COVID-19 not fully recovered five months post-discharge
Étude (en cours) #PHOSP-COVID, britannique sur 1077 patients,
[...] “While the profile of patients being admitted to hospital with COVID-19 is disproportionately male and from an ethnic minority background, our study finds that those who have the most severe prolonged symptoms tend to be white women aged approximately 40 to 60 who have at least two long term health conditions, such as asthma or diabetes.”
The researchers were able to the classify types of recovery into four different groups or ‘clusters’ based on the participants’ mental and physical health impairments.
One cluster group in particular showed impaired cognitive function, or what has colloquially been called ‘#brain_fog’. Patients in this group tended to be older and male. Cognitive impairment was striking even when taking education levels into account, suggesting a different underlying mechanism compared to other symptoms.
[...] much of the wide variety of persistent problems was not explained by the severity of the acute illness - the latter largely driven by acute lung injury - indicating other, possibly more systemic, underlying mechanisms.”
The research has also uncovered a potential biological factor behind some post-COVID symptoms.
Professor Louise Wain, GSK/British Lung Foundation Chair in Respiratory Research at the University of Leicester and co-investigator for the PHOSP-COVID study, said: “When we looked at the symptom severity of patients five months after they were discharged from hospital, we found that in all but the mildest cases of persistent post-COVID symptoms, levels of a chemical called C-reactive protein [CRP], which is associated with inflammation, were elevated.
“From previous studies, it is known that systemic inflammation is associated with poor recovery from illnesses across the disease spectrum. We also know that autoimmunity, where the body has an immune response to its own healthy cells and organs, is more common in middle-aged women. This may explain why post-COVID syndrome seems to be more prevalent in this group, but further investigation is needed to fully understand the processes. The evidence for different recovery ‘clusters’, and ongoing inflammation, really is important in guiding how we conduct further research into the underlying biological mechanisms that drive ‘Long-COVID’.”
One of the purposes of the PHOSP-COVID study is to measure the impact of medicines given during hospitalisation to see if they affect patients’ recovery. Early indicators from the study show that while giving corticosteroids is a factor in reducing mortality in hospital, it does not appear to have an impact on longer term recovery.
» Royaume-Uni : Plus d’un patient #Covid sur dix est mort dans les cinq mois suivant sa sortie de l’hôpital
Plus d’un patient covid sur dix est mort dans les cinq mois suivant la sortie de l’hôpital, tandis que près d’un tiers des personnes ayant survécu au virus ont dû être réadmises, selon de nouvelles recherches.
Des documents publiés par le groupe consultatif scientifique gouvernemental pour les urgences (le Sage, [ndr : Royaume-Uni]) ont également révélé que la moitié des patients hospitalisés à cause du virus ont souffert de complications, un quart d’entre eux ayant des difficultés une fois à la maison.
Les jeunes patients de moins de 50 ans sont plus susceptibles de souffrir de complications.
Charles Bangham, professeur d’immunologie à l’Imperial College de Londres, a déclaré qu’il pourrait y avoir jusqu’à 50 symptômes de ‘longue covid’, certaines études en ayant trouvé jusqu’à 100.
Selon lui : « Il est maintenant clair que vaincre une première infection de ce virus n’est pas la fin de l’histoire. Pour une proportion significative de gens, la Covid-19 s’avère être une maladie de longue durée.
Avec plus de 100 millions de cas de Covid-19 dans le monde, le fardeau sanitaire dû aux longues Covid pourrait être énorme. Rien qu’au Royaume-Uni, des centaines de milliers de patients pourraient présenter des symptômes pendant de nombreux mois, ce qui accentuerait la pression sur un service de santé déjà sous tension.
Cela aura non seulement un impact sur la vie de ceux qui souffrent, mais pourrait également devenir un fardeau économique permanent s’ils se trouvent dans l’incapacité de travailler. »
Source : Independent, Shaun Lintern, 19-02-2021
Traduit par les lecteurs du site Les Crises
Vous seriez pas un peu « complotistes », là ? ;-)
Tiens, à propos, dans la médiasphère, on diffuse à l’envi que la vaccination nous ferait retrouver une vie sociale comme celle « d’avant ». Or, on nous dit aussi que la vaccination nous protège contre les formes GRAVES du Covid mais qu’on peut aussi héberger de la bestiole, donc être re-contaminé et contaminant. Et donc, continuer à porter un masque et pratiquer la « distanciation sociale », c’est à dire vivre avec des avatars numériques et gober tout ce qui est diffusé par les médiacrates. Alors dans ce cas, à quoi sert le vaccin sauf si l’on admet que « un jour » tout le monde (enfin, 99% de tout le monde) sera vacciné ?
A mon humble avis, on en a pour une décennie.
Donc la seule stratégie qui aurait prévalu si on avait voulu encore pouvoir se « socialiser », c’est #zéro_covid, comme au Vietnam pour ne citer que ce pays. Le « tester, tracer, isoler », ça ne peut marcher que s’il y a un nombre très limité de cas, pas comme en ce moment où c’est « open bar » pour le virus. Et donc, c’est trop tard à moins d’un confinement dur de plusieurs années pour toute l’Europe. Et là, on peut toujours essayer d’imaginer que l’idée puisse germer dans leurs petites caboches de profiteurs blindés aux as et de jouisseurs hédonistes court-termistes. Les #surnuméraires n’ont qu’à bien se tenir. Nous sommes en train d’assister à une grande manœuvre de #darwinisme_social ... (Mais non, ch’uis pas « complotiste »).
Effets à long terme de #COVID-19
Une méta-analyse sur plusieurs études déjà publiées, incluant près de 48000 patients, a montré que :
🔴 80% des malades COVID-19 ont développé au moins un symptôme qui persiste sur le long terme après la guérison (durée de suivi maximale de 110 jours)
🔴 Au moins 55 symptômes ont été identifiés
🔴 Les cinq symptômes les plus fréquents sont : la fatigue (58 %), les maux de tête (44 %), les troubles de l’attention (27 %), la perte de cheveux (25 %) et la dyspnée (24 %).
via Infos Coronavirus Tunisie ▻https://www.facebook.com/groups/218921892639567/permalink/436226764242411
Covid-19 : fatigue, faiblesse musculaire, atteintes pulmonaires… trois patients sur quatre présenteraient des symptômes durables
« The Lancet » a publié samedi une étude portant sur une cohorte de plus de 1 700 patients chinois hospitalisés au printemps 2020, qui montre que 76 % d’entre eux souffraient encore, six mois plus tard, d’au moins un symptôme.
6-month consequences of COVID-19 in patients discharged from hospital: a cohort study - The Lancet
The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity.
We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences.
In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up.
At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery.
article complet accessible
Persistent Poor Health Post-#COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity | Annals of the American Thoracic Society | Articles in Press
Persistent Poor Health Post-COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity
Les poumons sont l’organe cible de l’infection par le SRAS-CoV-2, et facteur pronostic évident.
MAIS le virus peut se propager à de nbx organes :
le cœur, les vaisseaux sanguins, les reins, l’intestin et le cerveau ...
Des #symptômes persistants sont signalés après la phase aigue du COVID-19, y compris chez les personnes qui souffrent initialement d’une maladie légère.
–au delà de 12 semaines
–10-20% des infectés (?)
Une approche multidisciplinaire est nécessaire
on sait déja que
les coronavirus (SARS COV 1 et MERS-CoV)
Double triangle pointant vers la droite
Double triangle pointant vers la droite
persistance de symptômes débilitants
cf altération des scores de qualité de vie, de santé mentale, à 1 an ds une cohorte canadienne infectée en 2003
Tansey et al. Arch Intern Med. 2007 ;167(12):1312-1320
Quels sont les symptômes persistants après COVID 19 ?
La Cohorte COVICARE suisse a suivi 669 patients ambulatoires entre le 18 mars et le 15 mai.
Parmi eux, 1/3 souffraient toujours de symptômes à 30-45 jours de l’infection initiale. Parmi les signes les plus fréquents : fatigue, dyspnée, dysosmie/dysgueusie
Il ne faut pas confondre les
1-symptômes dûs à 1 inflammation chronique persistante
2- conséquences (csq) des dommages aux organes (lésions de la phase aiguë au cœur / poumon/ cerveau/ reins)
3- Csq aspécifiques de l’hospitalisation/immobilisation par la maladie/isolement social/SSPT
4- Effets du déconditionnement périphérique lié au confinement et/ou à la maladie elle-même
Long covid could be 4 different syndromes, review suggests
D’ailleurs à quoi seraient dus les symptômes persistants :
– persistance du virus dans l’organisme / les organes ?
– réinfection ?
– dysfonction immunitaire ( système immunitaire affaibli ou surstimulé ) ?
On ne sait pas exactement (cf SARS)
Les complications physiques évidentes sont de toutes façons prises en compte en sortie d’hospitalisation. Cela dirigera les patients vers un SSR (quand ils sont dénutris, ont une atteinte neuromusculaire séquellaire...)
HAS : ▻https://www.has-sante.fr/upload/docs/application/pdf/2020-06/rr_parcours_covid_parcours_de_readaptation_du_patient_covid_-_domicile_mel
un bilan fonctionnel respiratoire complet est déjà recommandé pour évaluer les séquelles respiratoires (fibrose post SDRA), trois mois après la sortie de l’hôpital
quelles sont les données de la littérature sur les symptômes de #LongCovid et leur origine/étiologie ?
atteinte neurologique (1/2) :
~ 10 à 35% souffrent de symptômes persistants, principalement neurologiques : dysfonctionnement du système nerveux autonome, troubles du sommeil, syndromes douloureux, étourdissements, difficultés cognitives.
atteinte neurologique (2/2) : origine ?
– invasion virale directe du SNC par SARS COV2
– réponse immunitaire à médiation virale
Emerging Neurological and Psychobiological Aspects of COVID-19 Infection
atteinte respiratoire (1/2) :
~ 30% des patients hospitalisés après la phase aigue
* atteinte TDM et de fonction respiratoire s’améliore au cours du suivi
Recovery after COVID-19 – an observational prospective multi-center trial
atteinte respiratoire (2/2) :
pour les patients ambulatoires c’est moins clair :
*intolérance à l’effort
dysfonction autonomique (1/2) : prévalence non connue
~ syndrome d’intolérance orthostatique
– douleurs thoraciques
– hypotension orthostatique
dysfonction autonomique (2/2) physiopathiologie :
– conséquence de l’orage cytokinique ?
– Atteinte directe du système nerveux autonome par le coronavirus ?
– déconditionnement ou hypovolémie ?
– neuropathie à médiation immunitaire ou virale ?
atteinte cardiaque (1/2) : risque de maladie cardiovascu.
suite à 1 infection à coronavirus, MAIS l’att. myocardique persistante n’est pas avérée pour SARS COV2 malgré la présence (autopsie) de virus dans cellules
update on COVID-19 Myocarditis
atteinte cardiaque (2/2) : arythmies persistantes
~ tachycardie sinusale inappropriée
– hyperactivité intrinsèque du nœud sinusal,
– dysfonctionnement autonome
– état hyperadrénergique
atteinte digestive ~ 35% des patients à la phase aigue.
tube digestif : taux élevé d’ACE2, le récepteur de liaison au SRAS-COV-2,
= site d’infection virale efficace
= site d’excrétion virale périodique
Symptômes persistants peu étayés
Plutôt à la phase aigue = lésions acrales ~ pseudo-engelures, éruptions érythémateuses maculopapuleuses, éruptions vésiculaires, des éruptions urticariennes, des éruptions vasculaires
An Evidence-Based Review
en CCL :
–symptômes (liste non exhaustive) persistants de #LongCovid nombreux
– physiopathologie n’est pas élucidée
– études de cohorte sont donc NECESSAIRES
–avec une action COORDONNEE de recherche/prise en charge sur notre territoire
Oui, c’est connu depuis cet été, d’où mon refus absolu de laisser ma fille être exposée à l’école (elle est parfaitement en phase) et le fait que je pense que les gouvernements qui laissent les écoles ouvertes sont des criminels et que je veux que tous ces types finissent devant une CPI spéciale.
Un thread du Prof. Logos (twitter) sur le #long-covid :
2/ Même des pathologies pulmonaires qui n’envoient pas à l’hôpital peuvent provoquer des lésions pulmonaires importantes.
3/ Et/ou des lésions cardiaques.
4/ Les connaissances sur ces formes longues de Covid restent très parcellaires — certains évoquent même des fatigues psychosomatiques ou des dépression, en fait de Covid long…
5/ Que sait-on des symptômes du Covid qui persistent longtemps après avoir contracté le virus ?https://pbs.twimg.com/media/EsDUP85XcAAeUX0?format=png&name=small#.jpg https://www.economist.com/img/b/1280/796/90/sites/default/files/images/2021/01/articles/main/20210123_woc971.png
6/ Prendre en charge dès maintenant le Covid de longue durée avant la vague qui menace.