Nearly 25% of patients who tested positive for Covid-19 experienced post-Covid symptoms one month after infection that they did not have previously—including a substantial number of patients whose Covid-19 infection was mild or asymptomatic, according to a white paper from FAIR Health.

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Study details

For the study, researchers looked at health insurance data on nearly two million people who had tested positive for the coronavirus between February and December 2020. The database included only those with private health insurance or Medicare Advantage.

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Because of the difficulty in distinguishing between certain pre-existing conditions and new symptoms related to coronavirus infection, the researchers excluded patients with some pre-existing conditions, such as cancer, kidney disease, or HIV.

According to FAIR Health, the study has not been peer-reviewed but was evaluated by an independent academic reviewer. The study also had several limitations, the New York Times reports, including the fact that it did not:

• Identify whether people who were first diagnosed with an issue after their Covid-19 infection simply had not previously sought treatment for it prior to infection; or

• Compare people with Covid-19 and those without to determine whether the rates of post-Covid symptoms were higher than among the general population.

Key findings

The researchers found that 23% of patients one month after their coronavirus infection sought medical care for conditions for which they hadn't sought treatment prior to their infection. That total included nearly half of patients who had been hospitalized with Covid-19, 27% of people who had either mild or moderate Covid-19 symptoms, and 19% of people who identified as asymptomatic.

According to the study, the most common medical issue patients sought care for was pain, including nerve and muscle pain, which affected just over 5% of patients. Just under 3% of patients sought care for malaise or fatigue, which can include exhaustion or brain fog.

Another 3% and 2.4% of post-Covid patients were diagnosed with high cholesterol and high blood pressure, respectively, making it "increasingly clear that post-Covid or long Covid has a metabolic signature marked by derangements in the metabolic machinery," according to Ziyad Al-Aly, chief of the research and development service at the VA St. Louis Health Care System.

Overall, 594 patients included in the study, most of whom had been hospitalized for Covid-19, died 30 days or more after their Covid-19 infection.

According to Robin Gelburd, president of FAIR Health, the finding that asymptomatic Covid-19 patients can have post-Covid symptoms is important for health care providers to know.

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"There are some people who may not have even known they had Covid, but if they continue to present with some of these conditions that are unusual for their health history, it may be worth some further investigation by the medical professional that they're working with," she said.

She added that the report "should alert physicians and other providers to being attentive to those kinds of symptoms, because they may not have had a Covid-19 diagnosis in their chart."

The study "drives home the point that long Covid can affect nearly every organ system," Al-Aly said. "Some of these manifestations are chronic conditions that will last a lifetime and will forever scar some individuals and families," Al-Aly added.

CDC releases guidance on caring for long Covid patients

The study comes as CDC—in consultation with physician and patient advocacy groups—on Monday posted new guidelines for health care providers treating patients experiencing symptoms at least four weeks following an acute case of Covid-19.

"For most patients, the goal of medical management of post-COVID conditions is to optimize function and quality of life," the guidelines say. "Ideally, health care professionals, in consultation with the appropriate specialists, should develop a comprehensive management plan based on their patients' presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals."

The guidelines also emphasize the importance of listening to patients and being aware that long Covid may present more often among minority populations, as minority populations have been more likely to become ill during the pandemic.

"It is important for health care professionals to listen to and validate patients' experiences, recognizing that diagnostic testing results may be within normal ranges even for patients whose symptoms and conditions negatively impact their quality of life, functioning (e.g., with activities of daily living), and ability to return to school or work," the guidelines say.

According to John Brooks, CDC's CMO for Covid-19, one main goal for putting out the guidelines "is to raise awareness about the problem." Roll Call also reports that NIH is embarking on research into long Covid, including whether certain patients are more likely to develop long-term symptoms and how long the condition lasts.

"There is no treatment for the underlying problem of these long haulers," Aaron Glatt, chair of the department of medicine at Mount Sinai South Nassau, said. "It is a significant issue in terms of education. We need to learn a lot more about this" (Belluck, New York Times, 6/15; Kelley, The Hill, 6/15; Gillespie, Modern Healthcare, 6/15; McIntire, Roll Call, 6/15).