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U.S. veterans’ study reveals key insights into Long COVID and protective role of vaccination

In a recent study published within the journal JAMA Network Open, researchers evaluated the clinical characteristics and patterns of post-COVID-19 condition (PCC) amongst United States veterans. Their study cohort included 388,980 veterans who were documented to experience shortness of breath, fatigue, cough, brain fog, and alterations to their olfactory and auditory sensitivity. Encouragingly, vaccination was found to have a protective effect on these individuals. This study highlights the necessity for intensive, routine, and accurate documentation of symptoms in COVID-19 survivors for each research and clinical care.

Study: Rates of ICD-10 Code U09.9 Documentation and Clinical Characteristics of VA Patients With Post–COVID-19 Condition. Image Credit: Lightspring / Shutterstock

What’s PCC?

The coronavirus disease 2019 (COVID-19) has been estimated to have claimed greater than 7 million lives and infected greater than 772 million people because the starting of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in late 2019. Along with the unprecedented socioeconomic, health, and infrastructure impacts of the pandemic, a growing body of evidence has identified a novel condition that plagues survivors of the disease.

Colloquially called ‘Long COVID,’ the clinically termed post-COVID-19 condition (PCC) or post-acute-COVID-19 syndrome (PCAS) refers back to the persistence and, in some cases, development of novel COVID-19 symptoms long after the initial infection has passed. Each the World Health Organization (WHO) and america (US) Centers for Disease Control and Prevention (CDC) have defined the condition because the persistence of COVID-19 symptoms for no less than 4 weeks following discharge from routine COVID-19 care.

Alarmingly, these symptoms have been found to persist for months and even years following recovery from COVID-19, leading to severe reductions to patients’ quality of life and socioeconomic loss on a world scale. Despite being novel and poorly understood, recent research has estimated that between 10-30% of COVID-19 survivors experience PCC, with numeric estimates of over 65 million afflicted individuals.

“An International Statistical Classification of Diseases, Tenth Revision (ICD-10) code for PCC became available within the US on October 1, 2021, which affords the potential for investigating the correlates of documentation of PCC care by clinicians.”

Unfortunately, greater than two years later, information on patients looking for medical treatment for PCC and clinicians’ documentation of care stays lacking. Understanding the patient and demographic characteristics involved in PCC care may give insight into the mechanisms underpinning the condition and the existence of multiple phenotypes of PCC, and most significantly, it could help evolve government policy to offer higher adequate care where it’s required most.

Concerning the study

In the current study, researchers aimed to judge the prevalence rates, clinical settings, risk aspects, and customary symptoms of Long COVID in US Army veterans (VA) with documented ICD-10 code U09.9. The study identified all VAs with positive VA electronic health records (EHR) between October 1, 2021, and January 31, 2023.

Of the 411,837 identified individuals, Vas who didn’t visit the US Veterans Affairs center within the 18 months preceding positive COVID-19 antigen/RT0PCR tests were excluded (n = 22,857), leaving a final analytic cohort of 388,980 patients (87.3% male). Study methodology and reporting complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

Data collection included sociodemographic (age, sex, ethnicity/race), geographic (pin code of the present residence), and clinical characteristics (medical prescriptions and records of symptoms and comorbidities) for the 2 years preceding initial COVID-19 infection. Moreover, vaccination status (and, if relevant, the kind of vaccine used) was recorded.

Of the greater than 200 symptoms listed by the WHO and CDC, researchers identified 15 prespecified symptoms commonest in US PCC patients via using the VINCI-CSDR natural language processing algorithm. To know the event of novel symptoms, 650 patients were chosen and randomized for monthly follow-up (for six months) following study enrolment.

Statistical analyses included calculating Cox proportional hazard regression coefficients (hazard ratios [HRs]), corrected for age, sex, and ethnicity/race.

Study findings

The current study revealed that the positive incidence of code U09.9 was 4.79% (at six months) and 5.28% (at twelve months following initial COVID-19 diagnosis). The very best-risk individuals included older-aged VAs, females, and Hispanic/Latino race/ethnicity. Infection and PCC severity were found to be probably the most crucial variables in VAs looking for medical assistance for PCC.

Encouragingly, vaccination (each primary and, to a greater extent, primary + booster) reduced the severity of PCC substantially despite leaving duration highly variable. Surprisingly, documentation and medical PCC care varied considerably as a result of geographic location.

“Probably the most common symptoms recorded within the medical record in patients with documented U09.9 code were shortness of breath, fatigue, cough, reduced cognitive function and alter in smell and/or taste.”

Of the patients chosen for monthly follow-up, 64.9% developed novel COVID-19 symptoms through the six months following study enrolment, highlighting that the PCC phenotype is each more variable and faster-evolving than previously thought.

“Future studies should examine the long-term trajectory of people with U09.9 documentation.”

Journal reference:

Wander PL, Baraff A, Fox A, et al. Rates of ICD-10 Code U09.9 Documentation and Clinical Characteristics of VA Patients With Post–COVID-19 Condition. JAMA Netw Open. 2023;6(12):e2346783, DOI – 10.1001/jamanetworkopen.2023.46783, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812721

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