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Document Type
Rapid Review
Review Code
EPM210601v2 RR
Question Submitted
June 22, 2021
Date Completed
March 31, 2022
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM210601v2 RR
Question Submitted
June 22, 2021
Date Completed
March 31, 2022
Status
3. Completed
Research Team
Epidemiology & Modelling
Updated Key Findings
March 31, 2022
Since the previous rapid review, a large amount of new research and reviews are available to draw upon. Many studies have addressed aspects previously identified as limitations such as the use of validated questionnaires, documenting pre-COVID health status, and control cohorts. Many studies now include only participants with RT-PCR verified infections and also focus on a range of disease severities from severe (hospitalized) to mild (managed in the community); PCR-validated infections ensure a higher quality of comparison between test-positive and control groups. Studies involving control groups contributed illuminating findings about prevalence and incidence of long COVID, which is lower than previous thought when compared to control groups. Comorbidities/factors that potentially indicate increased risk of developing long COVID-19 have been identified and widely agreed-upon, such as diabetes, cardiovascular diseases, obesity, and gender (female).
A case definition for long COVID has yet to be adopted but is commonly defined as COVID-related symptoms that persist or emerge beyond 4 weeks of infection with two subsequent phases: “ongoing symptomatic COVID-19 (OSC; signs and symptoms from 4 to 12 weeks from initial infection) and 2) post-COVID-19 syndrome (PCS; signs and symptoms beyond 12 weeks) with respect to symptomatology, abnormal functioning, psychological burden, and quality of life”. Long COVID includes both OSC and PCS.
It is estimated that 32% of non-hospitalized and 51% of hospitalized people experience Long COVID symptoms within 12 weeks of infection; however, higher estimates up to 92% have been reported in studies with a greater proportion in persons who were previously hospitalized. More than 200 symptoms affecting 10 organ systems have been identified in various reports or systematic reviews. Many patients (49%), experience at least one COVID-related symptom 12 months after infection (compared to 68% at 6 months).
For many persons, symptoms improve over time while others experience persistent and/or new symptoms. At 3 months post-infection the most frequently reported symptoms are fatigue (up to 98%), dyspnoea (up to 88%), headache (up to 91%) and taste/smell disorders (up to 58%).
Mechanism(s) leading to long COVID remain unclear, but these comorbidities/factors have been found to indicate potentially increased risk of developing long COVID: o Age (60+) o Greater number of symptoms during the acute phase of illness (typically 5+) o Manifestation of specific symptoms o Diabetes o Cardiovascular disease o Obesity or high BMI o Gender (female)
There is limited evidence to support the contention that vaccination lowers incidence of long COVID.
Key Findings
July 9, 2021
The frequency of Long COVID symptoms varies widely across studies based on populations studied, duration of follow up and methods of assessment of symptoms.
It is estimated that 1 in 50 persons experience Long COVID symptoms after 12 weeks; however, higher estimates up to 80% have been reported in studies with a greater proportion of persons who were previously hospitalized. A recent study of a mixed cohort of 96 persons found that only 22.9% had no symptoms at 12 months post diagnosis.
A wide range of symptoms affecting multiple organ systems has been reported. For many persons symptoms improve over time while others experience persistent and/or new symptoms. Among studies with the longest duration of follow up, the most frequently reported symptoms included fatigue (up to 65%), dyspnea (up to 50%), headache (up to 45%), anosmia/ageusia (up to 25%), cognitive memory/concentration (up to 39.6%) and sleep disorders (up to 26%).
Few studies estimated the duration of symptoms with estimates ranging from 2.2% for 6 months and 27% for 7-9 months.
The mechanism(s) leading to Long COVID remain unclear but those experiencing post acute sequelae tend to be older, have a greater number of symptoms during the acute phase of illness or manifest specific symptoms and live with multiple comorbid conditions such as obesity.
The lack of consensus on a definition of Long COVID contributes to marked variations in robust prevalence estimates.
Notes
A significant amount of evidence was produced since the previous review. This updated review was rewritten with extensive changes which have not been identified in red.
Category
Clinical Presentation
Epidemiology
Subject
Long Covid
Symptoms
Clinical Presentation
Population
All
Clinical Setting
Ambulatory
Community
ICU
Long Term Care
Medicine Unit
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
Hammond, B; Badea, A; Groot, G; Reeder, B; Howell-Spooner, B; Mueller, M. What is the incidence and duration of long COVID cases? 2022 Mar 31, Document no.: EPM210601v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2022. 18 p. (CEST rapid review report).
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Document Type
Rapid Review
Review Code
EPM210602 RR
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
4. Update in progress
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM210602 RR
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
4. Update in progress
Research Team
Epidemiology & Modelling
Key Findings
Long COVID-19 is likely to increase healthcare demands across the health system, including emergency departments, hospital admissions, primary care visits, specialists appointments, and home care and rehabilitation services.
The clinical care burden of long COVID-19 is the greatest in the first 3 months after testing and is likely to place the greatest demand on primary care services.
Patients with severe COVID-19 illness are more likely to place longer-term demands (4-6 months) on specialist care due to respiratory, circulatory, endocrine, metabolic, psychiatric and unspecified conditions.
Category
Clinical Presentation
Epidemiology
Subject
Long Covid
Health Planning
Clinical Presentation
Population
All
Clinical Setting
Ambulatory
Community
Emergency
ICU
Long Term Care
Medicine Unit
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
McLean, M; Williams-Roberts, H; Reeder, B; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2021 Jul 12, Document no.: EPM210602 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 23 p. (CEST rapid review report).
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Document Type
Rapid Review
Review Code
EPM072101 RR
Question Submitted
July 21, 2020
Date Completed
July 23, 2020
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM072101 RR
Question Submitted
July 21, 2020
Date Completed
July 23, 2020
Status
3. Completed
Research Team
Epidemiology & Modelling
Key Findings
· Diagnostic accuracy of tests for SARS CoV-2 varies based on the type of test, target antigen, type of sample and time of testing. · There is heterogeneity in clinical performance of rapid antigen tests; however, clinical sensitivity is lower than amplification-based assays. · Information is limited about test strategies that combine multiple approaches (e.g. molecular and serological methods) but may add value by increasing sensitivity and specificity.
Category
Diagnostics
Subject
Antigens
Testing
Serology
Polymerase Chain Reaction
Priority Level
Level 2 completed within 8 hours
Cite As
Williams-Roberts, H; Waldner, C; Dalidowicz, M; Howell-Spooner, B. What is the accuracy of diagnostic tests for the detection of SARS-CoV-2? 2020 Jul 23; Document no.: EPM072101 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 13 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
EPM051301 RR
Question Submitted
May 13, 2020
Date Completed
June 3, 2020
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM051301 RR
Question Submitted
May 13, 2020
Date Completed
June 3, 2020
Status
3. Completed
Research Team
Epidemiology & Modelling
Key Findings
· There is marked heterogeneity across studies in reported estimates of the proportion of asymptomatic SARS CoV-2 infections that range from 1% to 80%. · The proportion of SARS CoV-2 infections that are asymptomatic is related to the method of estimation, the population studied, setting and the timing of the estimation during the epidemic.
Category
Clinical Presentation
Epidemiology
Subject
Symptoms
Asymptomatic
Transmission
Natural History
Priority Level
Level 4 completed within 1 week
Cite As
Williams-Roberts, H; Basran, J; Dalidowicz, M; Young, C; Mueller, M. What proportion of disease transmission is due to persons who are asymptomatic over the entire course of illness? 2020 Jun 2; Document no.: EPM051301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
EPM051201 RR
Question Submitted
May 12, 2020
Date Completed
May 12, 2020
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM051201 RR
Question Submitted
May 12, 2020
Date Completed
May 12, 2020
Status
3. Completed
Research Team
Epidemiology & Modelling
Key Findings
·      A wide range of tests are available for detection of viral RNA as well as serological and immunoassays for antibodies developed due to exposure to SARS CoV-2 in infected persons. Despite the emerging research, information about clinical validity of tests is limited. ·      Multiple factors affect test performance including the nature of the specific test, type of specimen and its quality, severity and duration of illness at the time of testing. These individual variations hamper assessment of diagnostic accuracy and suggest that a combination of tests on multiple types of specimens at serial time points might be needed to confirm a COVID 19 diagnosis. ·      Point of care tests are desirable and needed to scale up testing in low resource settings; however, tests are of variable quality and more research is needed before they can be relied on for clinical decision making.
Notes
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Category
Diagnostics
Subject
Antigens
Testing
Serology
Polymerase Chain Reaction
Priority Level
Level 4 completed within 1 week
Cite As
Williams-Roberts, H; Waldener, C. What is the accuracy of diagnostic tests for COVID-19 detection? 2020 May 12; Document no.: EPM051201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. (CEST rapid review report)
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EPM051201 RR

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