Jacqueline Niewolik

The long-term symptoms of COVID-19 are the subject of public and scientific discussions. Understanding how those long COVID symptoms co-occur in clusters of syndromes may indicate the pathogenic mechanisms of long COVID. Our study objective was to cluster the different long COVID symptoms. We included persons who had a COVID-19 and assessed long-term symptoms (at least 4 weeks after first symptoms). Hierarchical clustering was applied to the symptoms as well as to the participants based on the Euclidean distance h of the log-values of the answers on symptom severity. The distribution of clusters within our cohort is shown in a heat map.From September 2021 to November 2023, 2371 persons with persisting long COVID symptoms participated in the study. Self-assessed long COVID symptoms were assigned to three symptom clusters. Cluster A unites rheumatological and neurological symptoms, cluster B includes neuro-psychological symptoms together with cardiorespiratory symptoms, and a third cluster C shows an association of general infection signs, dermatological and otology symptoms. A high proportion of the participants (n = 1424) showed symptoms of all three clusters. Clustering of long COVID symptoms reveals similarities to the symptomatology of already described syndromes such as the Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) or rheumatological autoinflammatory diseases. Further research may identify serological parameters or clinical risk factors associated with the shown clusters and might improve our understanding of long COVID as a systemic disease. Furthermore, multimodal treatments can be developed and scaled for symptom clusters and associated impairments.

Zusammenfassung Hintergrund Die getroffenen Maßnahmen zur Eindämmung der Ausbreitung der Coronavirus-2019-Erkrankung (COVID-19) schränken die sozialen Teilhabemöglichkeiten vieler Menschen ein. Insbesondere Menschen mit chronischen Erkrankungen waren hiervon betroffen. Ziel dieser Beobachtungsstudie war die Untersuchung der sozialen Teilhabe bei Patient:innen mit fortgeschrittenem malignem Melanom mit Immuntherapie unter Pandemiebedingungen. Damit wurde erstmalig soziale Teilhabe als Endpunkt in einer sehr spezifischen Gruppe untersucht. Dies kann als Basis für folgende Studien im wachsenden Kollektiv von Tumorlangzeitüberlebenden in Pandemiezeiten verstanden werden. Methodik Querschnittuntersuchung von Melanompatient:innen mit Erhebung des Index zur Messung von Einschränkungen der Teilhabe (IMET). Ergebnisse werden mit publizierten Normdaten verglichen. Ergebnisse Es wurden 47 Patient:innen mit malignem Melanom in der Auswertung berücksichtigt. Sie waren im Mittel 58,5 Jahre (SD 13,2) alt, 18 Patient:innen befanden sich im Stadium III und erhielten eine adjuvante Immuntherapie; 29 Patient:innen wurden wegen eines metastasierten Melanoms (Stadium IV) behandelt. Die Ergebnisse des IMET ergaben im Gesamtscore keine signifikanten Einschränkungen der sozialen Teilhabe im Vergleich zu den publizierten vorpandemischen Normdaten. Teilnehmerinnen hatten jedoch eine signifikant eingeschränktere Teilhabe. Diskussion Der Endpunkte soziale Teilhabe rückt bei Langzeitüberlebenden mit malignem Melanom in den Vordergrund. Unter Pandemiebedingungen sind insbesondere Patientinnen von Einschränkungen der sozialen Teilhabe gefährdet. Eine Differenzierung zwischen Pandemieeinflüssen und erkrankungsspezifischen Faktoren geht aus unseren Daten nicht hervor. Ausgehend von dieser Studie können und sollten weitere Erhebungen zur sozialen Teilhabe in Zeiten von pandemischen Infektionserkrankungen, insbesondere im wachsenden Kollektiv onkologischer Langzeitüberlebender erfolgen. Graphic abstract

Background: With population-wide vaccination availability, the global COVID-19 pandemic entered a new phase. Despite vaccination status, some people who were infected with SARS-CoV-2 experience long-term symptoms. Objective: In this study, we aim to characterize the long-term effects of SARS-CoV-2 infection and the pandemic. We also aim to build symptom clusters and determine risk factors for developing long COVID symptoms. Furthermore, we assess social participation and health-related quality of life in patients with long COVID and in the general population during a global pandemic. Methods: With a mixed-methods, web-based approach, we aim to recruit 2000 people in Germany who are older than 18 years and can provide informed consent. In the quantitative arm of the study, we identify symptoms of and predictive factors for long COVID manifestations with cluster analysis and assess social participation during the pandemic with standardized questionnaires. The qualitative arm of the study uses individual interviews and focus group discussions to better understand the illness experience of persons who experience long COVID. Results: Recruitment started in September 2021. Up until July 2022, we recruited approximately 4500 participants via our web-based database. Conclusions: This study aims to build an innovative, patient-centered, web-based research platform appropriate for the pandemic by minimizing physical contact between study personnel and participants. All study activities are designed to better understand the long COVID syndrome, social participation during the pandemic, and the illness experiences of persons affected by long COVID. Trial Registration: German Clinical Trial Registry DRKS00026007; https://tinyurl.com/yh282fkt International Registered Report Identifier (IRRID): DERR1-10.2196/38718

Background: Patients who are post-COVID-19 will require more treatment soon. Therefore, it is important to understand the root cause of their psychological and somatic conditions. Previous studies showed contradictory results on the influence of pre-existing mental conditions. The present study examines the influence of these pre-existing conditions and their pre-treatment on the severity of post-COVID-19 symptoms. Methods: This analysis employs questionnaire data from a large study sample in Germany. Overall, 801 participants were included. All participants rated their health status on a scale from 0 to 100. Fatigue, depression, and anxiety were measured using the FAS, PHQ-9, and GAD-7 scales. Results: All pre-pandemic values showed no significant differences between the groups. The current health status was rated similarly by the recovered patients (μ = 80.5 ± 17.0) and the control group (μ = 81.2 ± 18.0) but significantly worse by acutely infected (μ = 59.0 ± 21.5) and post-COVID-19 patients (μ = 54.2 ± 21.1). Fatigue, depression, and anxiety were similar for recovered patients and the control group. By contrast, there were significant differences between the control and the post-COVID-19 groups concerning fatigue (45.9% vs. 93.1%), depression (19.3% vs. 53.8%), and anxiety (19.3% vs. 22.3%). Conclusion: Fatigue and psychological conditions of post-COVID-19 patients are not associated with pre-existing conditions.