Are we close to solving the riddle of “long COVID”?

Reviewed by Dr. Michael Oji, NAHAL Consults, Lekki, Lagos, Nigeria

Researchers at the NYU are leading efforts to develop a symptom-based definition for post-acute sequelae of SARS-CoV-2 (PASC) infection (“long COVID”). A framework for identifying PASC cases based on symptoms is a first step to defining PASC as a new condition. This was a prospective, multicentre (85 enrolment centres) observational study of adults with or without SARS-CoV-2 infection in the US that compared previously infected vs uninfected patients.

A total of 9764 participants (8646 infected; 1118 uninfected) median age, 47 years, participated in the study and reported their symptoms using a self-reporting standardized questionnaire. From a spectrum of 44 self-reported symptoms, each symptom was assigned a score based on the estimated coefficients using least absolute shrinkage and selection operator (LASSO) with balancing weights; participants were assigned a total score by summing the symptom score for each reported symptom. By using a 10 fold cross-validation, an optimal score threshold for PASC was selected. Those that met the threshold were categorized as PASC positive while those not meeting were unspecified. Post-exertional malaise, brain fog, and fatigue were the most commonly reported symptoms among patients who were identified as having PASC.

This PASC definition will require validation globally. While this work will certainly require further studies, it demonstrates a significant objective effort to define PASC as a new condition.

Development of a Definition of Post-acute Sequelae of SARS-CoV-2 Infection. Tanayott Thaweethai, PhD; Sarah E. Jolley, MD, MS; Elizabeth W. Karlson, MD, MS; Emily B. Levitan, ScD; Bruce Levy, MD; Grace A. McComsey, MD; Lisa McCorkell, MPP; Girish N. Nadkarni, MD, MPH; Sairam Parthasarathy, MD; Upinder Singh, MD; Tiffany A. Walker, MD; Caitlin A. Selvaggi, MS; Daniel J. Shinnick, MS; Carolin C. M. Schulte, PhD; Rachel Atchley-Challenner, PhD; RECOVER Consortium Authors; Leora I. Horwitz, MD; Andrea S. Foulkes, ScD; for the RECOVER Consortium JAMA. doi:10.1001/jama.2023.8823 Published online May 25, 2023.

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