1
|
Carlile O, Briggs A, Henderson AD, Butler-Cole BF, Tazare J, Tomlinson LA, Marks M, Jit M, Lin LY, Bates C, Parry J, Bacon SC, Dillingham I, Dennison WA, Costello RE, Walker AJ, Hulme W, Goldacre B, Mehrkar A, MacKenna B, Herrett E, Eggo RM. Impact of long COVID on health-related quality-of-life: an OpenSAFELY population cohort study using patient-reported outcome measures (OpenPROMPT). THE LANCET REGIONAL HEALTH. EUROPE 2024; 40:100908. [PMID: 38689605 PMCID: PMC11059448 DOI: 10.1016/j.lanepe.2024.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
Background Long COVID is a major problem affecting patient health, the health service, and the workforce. To optimise the design of future interventions against COVID-19, and to better plan and allocate health resources, it is critical to quantify the health and economic burden of this novel condition. We aimed to evaluate and estimate the differences in health impacts of long COVID across sociodemographic categories and quantify this in Quality-Adjusted Life-Years (QALYs), widely used measures across health systems. Methods With the approval of NHS England, we utilised OpenPROMPT, a UK cohort study measuring the impact of long COVID on health-related quality-of-life (HRQoL). OpenPROMPT invited responses to Patient Reported Outcome Measures (PROMs) using a smartphone application and recruited between November 2022 and October 2023. We used the validated EuroQol EQ-5D questionnaire with the UK Value Set to develop disutility scores (1-utility) for respondents with and without Long COVID using linear mixed models, and we calculated subsequent Quality-Adjusted Life-Months (QALMs) for long COVID. Findings The total OpenPROMPT cohort consisted of 7575 individuals who consented to data collection, with which we used data from 6070 participants who completed a baseline research questionnaire where 24.6% self-reported long COVID. In multivariable regressions, long COVID had a consistent impact on HRQoL, showing a higher likelihood or odds of reporting loss in quality-of-life (Odds Ratio (OR): 4.7, 95% CI: 3.72-5.93) compared with people who did not report long COVID. Reporting a disability was the largest predictor of losses of HRQoL (OR: 17.7, 95% CI: 10.37-30.33) across survey responses. Self-reported long COVID was associated with an 0.37 QALM loss. Interpretation We found substantial impacts on quality-of-life due to long COVID, representing a major burden on patients and the health service. We highlight the need for continued support and research for long COVID, as HRQoL scores compared unfavourably to patients with conditions such as multiple sclerosis, heart failure, and renal disease. Funding This research was supported by the National Institute for Health and Care Research (NIHR) (OpenPROMPT: COV-LT2-0073).
Collapse
Affiliation(s)
- Oliver Carlile
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Ben F.C. Butler-Cole
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Laurie A. Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Hospital for Tropical Diseases, University College London Hospital, London, WC1E 6JD, UK
- Division of Infection and Immunity, University College London, London, WC1E 6BT, UK
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Liang-Yu Lin
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Sebastian C.J. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Iain Dillingham
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | | | - Ruth E. Costello
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Alex J. Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - William Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Emily Herrett
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Rosalind M. Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
2
|
do Amaral CMSSB, da Luz Goulart C, da Silva BM, Valente J, Rezende AG, Fernandes E, Cubas-Vega N, Borba MGS, Sampaio V, Monteiro W, de Melo GC, Lacerda M, Arêas GPT, Almeida-Val F. Low handgrip strength is associated with worse functional outcomes in long COVID. Sci Rep 2024; 14:2049. [PMID: 38267519 PMCID: PMC10808118 DOI: 10.1038/s41598-024-52401-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/18/2024] [Indexed: 01/26/2024] Open
Abstract
The diagnosis of long COVID is troublesome, even when functional limitations are present. Dynapenia is the loss of muscle strength and power production that is not caused by neurologic or muscular diseases, being mostly associated with changes in neurologic function and/or the intrinsic force-generating properties of skeletal muscle, which altogether, may partially explain the limitations seen in long COVID. This study aimed to identify the distribution and possible associations of dynapenia with functional assessments in patients with long COVID. A total of 113 patients with COVID-19 were evaluated by functional assessment 120 days post-acute severe disease. Body composition, respiratory muscle strength, spirometry, six-minute walk test (6MWT, meters), and hand-grip strength (HGS, Kilogram-force) were assessed. Dynapenia was defined as HGS < 30 Kgf (men), and < 20 Kgf (women). Twenty-five (22%) participants were dynapenic, presenting lower muscle mass (p < 0.001), worse forced expiratory volume in the first second (FEV1) (p = 0.0001), lower forced vital capacity (p < 0.001), and inspiratory (p = 0.007) and expiratory (p = 0.002) peek pressures, as well as worse 6MWT performance (p < 0.001). Dynapenia, independently of age, was associated with worse FEV1, maximal expiratory pressure (MEP), and 6MWT, (p < 0.001) outcomes. Patients with dynapenia had higher intensive care unit (ICU) admission rates (p = 0.01) and need for invasive mechanical ventilation (p = 0.007) during hospitalization. The HGS is a simple, reliable, and low-cost measurement that can be performed in outpatient clinics in low- and middle-income countries. Thus, HGS may be used as a proxy indicator of functional impairment in this population.
Collapse
Affiliation(s)
- Camila Miriam Suemi Sato Barros do Amaral
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
- Universidade do Estado Do Amazonas, Manaus, AM, Brazil
| | - Cássia da Luz Goulart
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
| | - Bernardo Maia da Silva
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
| | - Jefferson Valente
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
| | | | | | - Nadia Cubas-Vega
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, FM, Honduras
| | - Mayla Gabriela Silva Borba
- Universidade do Estado Do Amazonas, Manaus, AM, Brazil
- Hospital e Pronto-Socorro Delphina Rinaldi Abdel Aziz, Manaus, AM, Brazil
| | | | - Wuelton Monteiro
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
- Universidade do Estado Do Amazonas, Manaus, AM, Brazil
| | - Gisely Cardoso de Melo
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
- Universidade do Estado Do Amazonas, Manaus, AM, Brazil
| | - Marcus Lacerda
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil
- Universidade do Estado Do Amazonas, Manaus, AM, Brazil
- Instituto Todos Pela Saúde, São Paulo, SP, Brazil
- Instituto Leônidas & Maria Deane/Fundação Oswaldo Cruz (ILMD/Fiocruz Amazônia), Manaus, Brazil
| | | | - Fernando Almeida-Val
- Fundação de Medicina Tropical Dr Heitor Vieira Dourado, Av. Pedro Teixeira, -25 - Bairro Dom Pedro, Manaus, AM, Brazil.
- Universidade do Estado Do Amazonas, Manaus, AM, Brazil.
- Universidade Federal do Amazonas, Manaus, AM, Brazil.
| |
Collapse
|
3
|
Bai J, Wang J. Modeling long COVID dynamics: Impact of underlying health conditions. J Theor Biol 2024; 576:111669. [PMID: 37977479 PMCID: PMC10754059 DOI: 10.1016/j.jtbi.2023.111669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
We propose a new mathematical model to investigate the population dynamics of long COVID, with a focus on the impact of chronic health conditions. Our model connects long COVID with the transmission of COVID-19 so as to accurately predict the prevalence of long COVID from the progression of the infection in the host population. The model additionally incorporates the effects of COVID-19 vaccination. We implement the model with data from both the US and the UK to demonstrate the real-world applications of this modeling framework.
Collapse
Affiliation(s)
- Jie Bai
- School of Mathematics and Statistics, Liaoning University, Shenyang 110036, China.
| | - Jin Wang
- Department of Mathematics, University of Tennessee at Chattanooga, Chattanooga TN 37403, USA.
| |
Collapse
|
4
|
Owen R, Ashton RE, Ferraro FV, Phillips BE, Skipper L, Faghy MA. Acute COVID-19, the Lived Experience, and Lessons to Learn for Future Pandemics. Disaster Med Public Health Prep 2023; 17:e534. [PMID: 37990549 DOI: 10.1017/dmp.2023.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVES The study aimed to increase the understanding of the lived experience of patients during the acute phase of a coronavirus disease 2019 (COVID-19) infection. METHOD A Web-based survey was distributed through established patient and public engagement and involvement groups and networks, social media, and by means of word of mouth. The survey covered questions relating to patient demographics, COVID-19 diagnosis, symptom profile, and patient experience during acute COVID-19. RESULTS The findings demonstrate the varying symptom profiles experienced by people in the acute stage of COVID-19 infection, with participants sharing how they managed care at home, and/or accessed medical advice. Findings also highlight themes that people were concerned with being unable to receive care and believed they needed to rely heavily on family, with extreme thoughts of death. CONCLUSIONS Although the urgent threat to public health has been negated by efficacious vaccines and enhanced treatment strategies, there are key lessons from the lived experience of COVID-19 that should be used to prepare for future pandemics and public health emergencies.
Collapse
Affiliation(s)
- Rebecca Owen
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Ruth Em Ashton
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection Network (HL-Pivot), Chicago, USA
| | - Francesco V Ferraro
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK
| | - Bethan E Phillips
- School of Medicine, MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, Derby, UK
| | - Lindsay Skipper
- Patient and Public Involvement and Engagement Representative, UK
| | - Mark A Faghy
- Biomedical Research Theme, School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection Network (HL-Pivot), Chicago, USA
| |
Collapse
|
5
|
Dennis A, Cuthbertson DJ, Wootton D, Crooks M, Gabbay M, Eichert N, Mouchti S, Pansini M, Roca-Fernandez A, Thomaides-Brears H, Kelly M, Robson M, Hishmeh L, Attree E, Heightman M, Banerjee R, Banerjee A. Multi-organ impairment and long COVID: a 1-year prospective, longitudinal cohort study. J R Soc Med 2023; 116:97-112. [PMID: 36787802 PMCID: PMC10041626 DOI: 10.1177/01410768231154703] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVES To determine the prevalence of organ impairment in long COVID patients at 6 and 12 months after initial symptoms and to explore links to clinical presentation. DESIGN Prospective cohort study. PARTICIPANTS Individuals. METHODS In individuals recovered from acute COVID-19, we assessed symptoms, health status, and multi-organ tissue characterisation and function. SETTING Two non-acute healthcare settings (Oxford and London). Physiological and biochemical investigations were performed at baseline on all individuals, and those with organ impairment were reassessed. MAIN OUTCOME MEASURES Primary outcome was prevalence of single- and multi-organ impairment at 6 and 12 months post COVID-19. RESULTS A total of 536 individuals (mean age 45 years, 73% female, 89% white, 32% healthcare workers, 13% acute COVID-19 hospitalisation) completed baseline assessment (median: 6 months post COVID-19); 331 (62%) with organ impairment or incidental findings had follow-up, with reduced symptom burden from baseline (median number of symptoms 10 and 3, at 6 and 12 months, respectively). Extreme breathlessness (38% and 30%), cognitive dysfunction (48% and 38%) and poor health-related quality of life (EQ-5D-5L < 0.7; 57% and 45%) were common at 6 and 12 months, and associated with female gender, younger age and single-organ impairment. Single- and multi-organ impairment were present in 69% and 23% at baseline, persisting in 59% and 27% at follow-up, respectively. CONCLUSIONS Organ impairment persisted in 59% of 331 individuals followed up at 1 year post COVID-19, with implications for symptoms, quality of life and longer-term health, signalling the need for prevention and integrated care of long COVID.Trial Registration: ClinicalTrials.gov Identifier: NCT04369807.
Collapse
Affiliation(s)
| | - Daniel J Cuthbertson
- Institute of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, L7 8TX, UK
| | - Dan Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, CH64 7TE, UK
| | - Michael Crooks
- Department of Respiratory Medicine, Hull and East Yorkshire Hospitals NHS Foundation Trust, Hull, HU3 2JZ, UK
- Institute of Clinical and Applied Health Research, University of Hull, Hull, HU6 7RX, UK
| | - Mark Gabbay
- Institute of Population Health, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GF, UK
| | | | | | - Michele Pansini
- Department of Radiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 0AG, Oxford, UK
| | | | | | | | | | - Lyth Hishmeh
- Long Covid SOS, Faringdon, Oxfordshire, SN7 7EX, UK
| | | | - Melissa Heightman
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
| | | | - Amitava Banerjee
- Department of Medicine, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
- Department of Cardiology, Barts Health NHS Trust, London, EC1A 7BE, UK
| |
Collapse
|
6
|
Selective visuoconstructional impairment following mild COVID-19 with inflammatory and neuroimaging correlation findings. Mol Psychiatry 2023; 28:553-563. [PMID: 35701598 PMCID: PMC9196149 DOI: 10.1038/s41380-022-01632-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 01/07/2023]
Abstract
People recovered from COVID-19 may still present complications including respiratory and neurological sequelae. In other viral infections, cognitive impairment occurs due to brain damage or dysfunction caused by vascular lesions and inflammatory processes. Persistent cognitive impairment compromises daily activities and psychosocial adaptation. Some level of neurological and psychiatric consequences were expected and described in severe cases of COVID-19. However, it is debatable whether neuropsychiatric complications are related to COVID-19 or to unfoldings from a severe infection. Nevertheless, the majority of cases recorded worldwide were mild to moderate self-limited illness in non-hospitalized people. Thus, it is important to understand what are the implications of mild COVID-19, which is the largest and understudied pool of COVID-19 cases. We aimed to investigate adults at least four months after recovering from mild COVID-19, which were assessed by neuropsychological, ocular and neurological tests, immune markers assay, and by structural MRI and 18FDG-PET neuroimaging to shed light on putative brain changes and clinical correlations. In approximately one-quarter of mild-COVID-19 individuals, we detected a specific visuoconstructive deficit, which was associated with changes in molecular and structural brain imaging, and correlated with upregulation of peripheral immune markers. Our findings provide evidence of neuroinflammatory burden causing cognitive deficit, in an already large and growing fraction of the world population. While living with a multitude of mild COVID-19 cases, action is required for a more comprehensive assessment and follow-up of the cognitive impairment, allowing to better understand symptom persistence and the necessity of rehabilitation of the affected individuals.
Collapse
|
7
|
Mannucci PM, Nobili A, Tettamanti M, D'Avanzo B, Galbussera AA, Remuzzi G, Fortino I, Leoni O, Harari S. Impact of the post-COVID-19 condition on health care after the first disease wave in Lombardy. J Intern Med 2022; 292:450-462. [PMID: 35373863 PMCID: PMC9115275 DOI: 10.1111/joim.13493] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Lombardy was affected in the early months of 2020 by the SARS-CoV-2 pandemic with very high morbidity and mortality. The post-COVID-19 condition and related public health burden are scarcely known. SETTING AND DESIGN Using the regional population administrative database including all the 48,932 individuals who survived COVID-19 and became polymerase-chain-reaction negative for SARS-CoV-2 by 31 May 2020, incident mortality, rehospitalizations, attendances to hospital emergency room, and outpatient medical visits were evaluated over a mid-term period of 6 months in 20,521 individuals managed at home, 26,016 hospitalized in medical wards, and 1611 in intensive care units (ICUs). These data were also evaluated in the corresponding period of 2019, when the region was not yet affected by the pandemic. Other indicators and proxies of the health-care burden related to the post-COVID condition were also evaluated. MAIN RESULTS In individuals previously admitted to the ICU and medical wards, rehospitalizations, attendances to hospital emergency rooms, and out-patient medical visits were much more frequent in the 6-month period after SARS-CoV-2 negativization than in the same prepandemic period. Performances of spirometry increased more than 50-fold, chest CT scans 32-fold in ICU-admitted cases and 5.5-fold in non-ICU cases, and electrocardiography 5.6-fold in ICU cases and twofold in non-ICU cases. Use of drugs and biochemical tests increased in all cases. CONCLUSIONS These results provide a real-life picture of the post-COVID condition and of its effects on the increased consumption of health-care resources, considered proxies of comorbidities.
Collapse
Affiliation(s)
- Pier M Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and University of Milan, Milan, Italy
| | - Alessandro Nobili
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Mauro Tettamanti
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessia A Galbussera
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giuseppe Remuzzi
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Ida Fortino
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - Olivia Leoni
- Direzione Generale Welfare, Regione Lombardia, Milan, Italy
| | - Sergio Harari
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy.,Division of Internal Medicine, Multimedica IRCSS, Milano, Italy
| |
Collapse
|
8
|
Ramasawmy M, Mu Y, Clutterbuck D, Pantelic M, Lip GYH, van der Feltz-Cornelis C, Wootton D, Williams NH, Montgomery H, Mallinson Cookson R, Attree E, Gabbay M, Heightman M, Alwan NA, Banerjee A, Lorgelly P. STIMULATE-ICP-CAREINEQUAL (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways) study protocol: Defining usual care and examining inequalities in Long Covid support. PLoS One 2022; 17:e0271978. [PMID: 35969597 PMCID: PMC9377596 DOI: 10.1371/journal.pone.0271978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Individuals with Long Covid represent a new and growing patient population. In England, fewer than 90 Long Covid clinics deliver assessment and treatment informed by NICE guidelines. However, a paucity of clinical trials or longitudinal cohort studies means that the epidemiology, clinical trajectory, healthcare utilisation and effectiveness of current Long Covid care are poorly documented, and that neither evidence-based treatments nor rehabilitation strategies exist. In addition, and in part due to pre-pandemic health inequalities, access to referral and care varies, and patient experience of the Long Covid care pathways can be poor. In a mixed methods study, we therefore aim to: (1) describe the usual healthcare, outcomes and resource utilisation of individuals with Long Covid; (2) assess the extent of inequalities in access to Long Covid care, and specifically to understand Long Covid patients' experiences of stigma and discrimination. METHODS AND ANALYSIS A mixed methods study will address our aims. Qualitative data collection from patients and health professionals will be achieved through surveys, interviews and focus group discussions, to understand their experience and document the function of clinics. A patient cohort study will provide an understanding of outcomes and costs of care. Accessible data will be further analysed to understand the nature of Long Covid, and the care received. ETHICS AND DISSEMINATION Ethical approval was obtained from South Central-Berkshire Research Ethics Committee (reference 303958). The dissemination plan will be decided by the patient and public involvement and engagement (PPIE) group members and study Co-Is, but will target 1) policy makers, and those responsible for commissioning and delivering Long Covid services, 2) patients and the public, and 3) academics.
Collapse
Affiliation(s)
- Mel Ramasawmy
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Yi Mu
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Donna Clutterbuck
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christina van der Feltz-Cornelis
- Institute of Health Informatics, University College London, London, United Kingdom
- Department of Health Sciences, HYMS, University of York, York, United Kingdom
| | - Dan Wootton
- Institute of Infection Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Nefyn H. Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Hugh Montgomery
- Department of Medicine, Centre for Human Health and Performance, University College London, London, United Kingdom
| | | | | | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Melissa Heightman
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Paula Lorgelly
- School of Population Health and Department of Economics, University of Auckland, Auckland, New Zealand
| | | |
Collapse
|
9
|
Angeles MR, Wanni Arachchige Dona S, Nguyen HD, Le LKD, Hensher M. Modelling the potential acute and post-acute burden of COVID-19 under the Australian border re-opening plan. BMC Public Health 2022; 22:757. [PMID: 35421963 PMCID: PMC9009167 DOI: 10.1186/s12889-022-13169-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
Background Concerns have grown that post-acute sequelae of COVID-19 may affect significant numbers of survivors. However, the analyses used to guide policy-making for Australia’s national and state re-opening plans have not incorporated non-acute illness in their modelling. We, therefore, develop a model by which to estimate the potential acute and post-acute COVID-19 burden using disability-adjusted life years (DALYs) associated with the re-opening of Australian borders and the easing of other public health measures, with particular attention to longer-term, post-acute consequences and the potential impact of permanent functional impairment following COVID-19. Methods A model was developed based on the European Burden of Disease Network protocol guideline and consensus model to estimate the burden of COVID-19 using DALYs. Data inputs were based on publicly available sources. COVID-19 infection and different scenarios were drawn from the Doherty Institute’s modelling report to estimate the likely DALY losses under the Australian national re-opening plan. Long COVID prevalence, post-intensive care syndrome (PICS) and potential permanent functional impairment incidences were drawn from the literature. DALYs were calculated for the following health states: the symptomatic phase, Long COVID, PICS and potential permanent functional impairment (e.g., diabetes, Parkinson’s disease, dementia, anxiety disorders, ischemic stroke). Uncertainty and sensitivity analysis were performed to examine the robustness of the results. Results Mortality was responsible for 72-74% of the total base case COVID-19 burden. Long COVID and post-intensive care syndrome accounted for at least 19 and 3% of the total base case DALYs respectively. When included in the analysis, potential permanent impairment could contribute to 51-55% of total DALYs lost. Conclusions The impact of Long COVID and potential long-term post-COVID disabilities could contribute substantially to the COVID-19 burden in Australia’s post-vaccination setting. As vaccination coverage increases, the share of COVID-19 burden driven by longer-term morbidity rises relative to mortality. As Australia re-opens, better estimates of the COVID-19 burden can assist with decision-making on pandemic control measures and planning for the healthcare needs of COVID-19 survivors. Our estimates highlight the importance of valuing the morbidity of post-COVID-19 sequelae, above and beyond simple mortality and case statistics. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13169-x.
Collapse
|
10
|
Fink G, Tediosi F, Felder S. Burden of Covid-19 restrictions: National, regional and global estimates. EClinicalMedicine 2022; 45:101305. [PMID: 35224471 PMCID: PMC8856030 DOI: 10.1016/j.eclinm.2022.101305] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/13/2022] [Accepted: 01/28/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND A growing literature has documented the high global morbidity, mortality and mental health burden associated with the current Covid-19 pandemic. In this paper, we aimed to quantify the total utility and quality of life loss resulting from Covid-19-related government restrictions imposed at the national, regional and global levels. METHODS We conducted quality of life online surveys in France, India, Italy, UK and the United States of America between June 21st and September 13th 2021, and used regression models to estimate the average quality of life loss due to light and severe restrictions in these countries. We then combined estimated disutility weights from the pooled sample with the latest data on Covid-19 restrictions exposure in each country to estimate the total disutility generated by restrictions at the national, regional and global level. We also embedded a discrete choice experiment (DCE) into the online survey to estimate average willingness to pay to avoid specific restrictions. FINDINGS A total of 947 surveys were completed. Thirty-five percent of respondents were female, and 69.5% were between 18 and 39 years old. The weighted average utility weight was 0.71 (95% CIs 0.69-0.74) for light restrictions, and 0.65 (0.63-0.68) for severe restrictions. At the global scale, this implies a total loss of 3259 million QALYs (95% 3021, 3496) as of September 6th, 2021, with the highest burden in lower and upper middle-income countries. Utility losses appear to be particularly large for closures of schools and daycares as well as restaurants and bars, and seem relatively small for wearing masks and travel restrictions. INTERPRETATION The results presented here suggest that the QALY losses due to restrictions are substantial. Future mitigation strategies should try to balance potential reductions in disease transmission achievable through specific measures against their respective impact on quality of life. Additional research is needed to determine differences in restriction-specific disutilities across countries, and to determine optimal policy responses to similar future disease threats. FUNDING No funding was received for this project.
Collapse
Affiliation(s)
- Günther Fink
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
- Corresponding author at: Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland.
| | - Fabrizio Tediosi
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland
- University of Basel, Switzerland
| | - Stefan Felder
- Faculty of Business and Economics, University of Basel, Basel, Switzerland
| |
Collapse
|