Mild COVID-19 cases: still at risk?

COVID-19 is often only measured through the narrow scope of its mortality rate. While the death toll is undeniably high, some disregard the disease due to the mortality rate now being between a range of one and two percent. However, some individuals, even those with mild symptoms, can experience lasting effects.

So-called “Long COVID” is the concept of ongoing effects and symptoms far beyond the initial infection. Our understanding of this phase of the disease is constantly changing based on new information. Given the rapid pace at which the pandemic took hold, little could be said for a long period regarding the long term effects.

These ongoing symptoms are thought to be fairly common. As Health Issues India previously reported, regarding a study conducted on COVID-19 patients published in The Lancet, “76 percent of patients reported at least one ongoing symptom. Fatigue or muscle weakness was reported by 63 percent; 26 percent reported sleep difficulties; and 23 percent experienced anxiety or depression.”

A more recent Lancet study has added to this body of evidence. While previously assumed that only those with an initially severe COVID-19 infection developed long COVID symptoms, this appears to not be the case. Senior author, Professor Anton Pottegård from the University of Southern Denmark says 

“Until now, most research investigating long-term complications from COVID-19 has been focused on hospitalised patients. But the reality is that the majority of people with COVID-19 are not admitted to the hospital. Our study finds a very low risk of severe delayed effects from COVID-19 in people who didn’t require hospitalisation for the infection. However, our research provided evidence for some long-term effects that did not require hospitalisation or the use of new medicines, which we found reflected in higher use of primary health-care services after infection. This highlights the need to ensure clinicians have the resources and support to manage any potential long-term conditions.”

The study analysed data from the Danish health registries on all individuals who were tested for COVID-19 between Feb 27, 2020, and May 31, 2020. The study followed up 8,983 non-hospitalised COVID-19 positive people and 80,894 SARS-CoV-2-negative people during the period from two weeks to six months after the test. By comparing data from the two groups, researchers assessed the relative risk of starting new medications and of receiving a diagnosis of a new health condition during this time. The study took into account other factors that may increase the risk of more severe symptoms occurring during a COVID-19 infection, such as obesity, cancer, and kidney disease.

The study noted that “compared with individuals who tested negative, those with a positive SARS-CoV-2 test were at an increased risk of receiving a first diagnosis of breathing difficulties (1.2 percent compared with 0.7 percent) and blood clots in the veins (0.2 percent compared with 0.1 percent). No increased risk of serious complications identified by previous research conducted among individuals hospitalised for COVID-19, such as stroke, encephalitis, and psychosis, was identified among individuals who did not require hospitalisation.”

They also found that “those with a positive SARS-CoV-2 test visited their general practitioners around 20 percent (1.2 times) more often than those that tested negative, and visited outpatient clinics 10 percent (1.1 times) more often. However, there was no difference in the visits to [the] emergency department or being hospitalised.”

Limitations to the study were noted, specifically the fact that only symptoms that generated the need for contact with a hospital or medical services were noted. This leaves out minor symptoms such as fatigue or breathing issues that are not severe enough to warrant a visit to the hospital.

The study indicates that in those that tested positive for COVID-19, but were not hospitalised, there lies an increased risk of further complications in the coming months. However, it does appear to suggest that these complications were rarely severe, as visits to the emergency department were not increased in this group. 

The findings underline a considerable issue in India. Hospitals are already overwhelmed by COVID-19 cases. Due to the rapid increase in cases associated with the second wave, individuals seeking medical attention for long COVID symptoms may persist for months, further adding to the burden.

The findings have already been confirmed across numerous countries, with doctors and researchers noting that the long COVID symptoms are not isolated to the elderly or the vulnerable. Many noted that the symptoms present themselves in young people who have no prior medical history, with symptoms such as irregular heartbeats and autonomic dysfunction.

What is clear is that India has a long way to go in addressing COVID-19 cases. As cases remain at an all time high the issue could potentially extend far beyond the initial cases. The hospital system and systemic infrastructure issues must be addressed if a colossal death toll is to be averted.