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Long COVID – Updates from the ZOE app and other population studies Data from the COVID Symptom Study App and National Core Studies on Health and Wellbeing Claire Steves PI, COVID Symptom Study on Long-COVID,W) KCL Deputy Director TwinsUK, KCL Practicing Geriatrician seeing patients with Long-COVID, GSTTDisclosures I have consulted for ZOE Ltd, a Health Science Company behind the ZOE app My institution receives funding from Wellcome Trust, NIHR, MRC and CDRF for teams where I am principal investigator What are the symptoms of COVID-19 How do they map over time? How can we use this for real-time epidemiology? The COVID Symptom Study App Launched in March 2020 Reached 4.5 million people in weeks King’s Health Partners Annual Conference 2021 3 Case History “Some work colleagues are highly sceptical about her diagnosis, seem to have lost respect for her, and are resentful that she is isn’t returning to work” Evidence 1: Proving to the sceptics that long COVID exists 4 King’s Health Partners Annual Conference 2021Long COVID exists and is different from other viral illnesses. Analysed 4182 COVID+ cases from the ZOE / COVID Symptom Study logging new onset symptoms after a positive SARS CoV-2 PCR test Compared them to PCR-negative symptomatic control group 13.3% >28d 2.3% for >12 weeks Prospective data collection with continuous symptoms. Individuals logged as healthy and symptom free before contracting COVID-19 Evidence to support 28 days as a cut point. Sudre et al, Nature Medicine https://doi.org/10.1038/s41591-021-01292-y Case History “3 failed attempts to return to work when she briefly felt better “ Evidence 2: COVID-19+ individuals were more likely than controls to relapse after symptoms returned to normal Sudre et al, Nature Medicine https://doi.org/10.1038/s41591-021-01292-y 6 King’s Health Partners Annual Conference 2021NICE definitions formed by UK data from 2020: Long COVID Signs and symptoms that continue or develop after acute COVID-19, i.e. after 4 weeks. Ongoing symptomatic COVID-19 Signs and symptoms of COVID-19 from 4 weeks up to 12 weeks. Post-COVID-19 syndrome Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.Estimates of long COVID depend on population demographics High accuracy prediction of risk of long covid Sudre et al, Nature Medicine (>=28 days) considering age, sex and number of https://doi.org/10.1038/s41591-021-01292-y symptoms experienced over first week In adults, key risk factors are: • Severity of initial infection (hospitalisation / >5 symptoms) • Age • Sex Factors affecting estimates are: • Prospective/retrospective • Accounting of baseline reporting DE – delirium, AP – Abdominal Pain, HV – Hoarse Voice, DI – Diarrhoea, CP – Chest Pain, SM – LOS – Loss of smell, SOB – Shortness of breath, HA – Headache, FA – Fatigue – Persistent Cough,Our case is 37years old, female, and has asthma. While we have shown increased Odds of LC with these factors, these are not powerful and its possible to have Long COVID if you are male, young and have no comorbidities Inequity in access to Long COVID diagnosis…. And onward referral Our case is of Pakistani heritage Does who you are or where you live affect the likelihood of gaining a diagnosis of Long COVID? These data are from March 2021, and there may have been improvements since then… LONGCOVID - >8DAYS Post COVID Syndrome can be subdivided by timeseries clustering In all variants and vaccination types we saw: a multisystem cluster a respiratory cluster and a neurological cluster. Our case seems to fit cluster 5 (multisystem cluster) which accounts for 10% of all PCS in our analysis, but had the most impact on daily life. liane.dos_santos_canas@kcl.ac.uk Long Covid – Symptoms ClusteringOur patient was single vaccinated….. Double vaccination reduces risk of Long COVID Compared symptom profiles in 6,030 single vaccinated and 2,370 double vaccinated individuals with unvaccinated individuals infected at the same time. Antonelli et al, Lancet Infectious Diseases https://doi.org/10.1016/S1473-3099(21)00460-6What about Omicron and Long COVID? Compared 56,003 UK adult cases first testing positive between December 20 2021, and March 09 2022 (Omicron cases) with 41,361 UK adult cases first testing positive between June 1 2021 and November 272021, ( Delta cases). Antonelli et al, Lancet Calculated the OR for Long COVID (>28 days of continuous symptoms) Adjusted for by sex, IMD, (related to variants) as well as age, the presence of comorbidities, vaccination status (one, two, or three doses) and BMI (related to LC) Stratified by time since vaccination (allows for waning of immunity) Omicron LC and delta LC indicate, for each strata, the number of users with LC over the total number of users of that strata. With thanks to all our contributors National Core Studies for Health and Wellbeing ZOE team Seb Ourselin, Tim Spector and teams at DTR, DHSC, CDRF and our other funders Email me on claire.j.steves@kcl.ac.uk