Some symptoms can persist even after recovering from a COVID-19 infection. How many people are affected by this and what factors contribute to this type of “post-COVID syndrome” (PCS) has been investigated by a team led by Professor Thomas Bahmer, internist and pulmonologist at the Department of Internal Medicine I at the University Medical Center Schleswig-Holstein (UKSH), Campus Kiel. For this purpose, the research group has developed an easy-to-use system to classify PCS symptoms in its COVIDOM study on the long-term effects of the coronavirus. It was also able to identify two major risk factors for the development of PCS. These initial findings from the COVIDOM study, in which the University Hospital Würzburg and Charité Universitätsmedizin in Berlin are also participating, were published in the specialist journal eClinicalMedicine, which is part of the LANCET Discovery Series.
For the evaluation of the COVIDOM study, Bahmer and his team analyzed 1,400 individuals following their recovery from a COVID infection. With the aid of a new classification system, the so-called PCS score, they were able to record the existence and degree of severity of PCS and by doing so are the first to incorporate the varied and complex long-term events following a coronavirus infection into a uniform schema. “This new score can differentiate objectively between different degrees of severity of the PCS complaints,” said Bahmer, member of the Cluster of Excellence “Precision Medicine in Chronic Inflammation” (PMI).
12 questions for the objective classification of the long-term effects of COVID
The PCS score is based on twelve questions that target different symptom areas. The test subjects were asked the questions following the acute phase of their infection in order to record as many aspects as possible of the suspected PCS.
“The simplicity of the PCS score calculation allows us to integrate it directly into routine follow-up care of patients infected with the coronavirus. Using the PCS score, the need for further specialist medical treatment can be assessed and treatment can be supported by findings that are as objective as possible, said Cluster of Excellence spokesperson Professor Stefan Schreiber, Director of the Department of Internal Medicine I, Campus Kiel, who is senior author and head of the study alongside Professor Michael Krawczak, Director of the Department of Medical Informatics and Statistics. Even if the medical care of patients with a post-COVID syndrome does not fall within the scope of emergency medical care, the often lengthy and time-consuming evaluation of their complaints threatens to exceed the limited resources available for patient care. Rapid and objective classification of the clinical events using the PCS score could at least provide some assistance in this respect, according to the authors.
“We are delighted that within a short period of time we have been able to obtain a large number of test subjects for the COVIDOM study and publish the first important findings. The newly developed classification system is not only progress for science, it is also very important as a management tool for the practical everyday care of patients,” said Prof. Dr. Dr. h.c. Jens Scholz, CEO of the UKSH and member of the national task force of the Nationales Forschungsnetzwerk der Universitätsmedizin (NUM) (national research network of university medicine), which funds the COVIDOM study.
Only 15 to 30 percent felt that they were back to full health after nine months
The overwhelming majority of test subjects for the COVIDOM study suffered mild to moderate symptoms during the acute phase of their COVID-19 infection. Fewer than 10 percent required hospital treatment. However, around half of the individuals participating in the study reported complaints that persisted long after the acute phase of the illness. Depending on the study location, only 15 to 30 percent of people described themselves as being back to full health after nine months. For the rest, the question of whether their coronavirus infection was the cause of their continuing symptoms remains unanswered. Using the score, clinically relevant PCS could be diagnosed for 10 to 20 percent of the test subjects.
Two strong risk factors for PCS were also identified in the COVIDOM study. “As expected, severe symptoms during the acute phase increased the risk of post-COVID syndrome. What was surprising, however, was that limited psychosocial capacity and low resilience can also result in PCS,” said Prof. Bahmer. For instance, he said, people were at particular risk if they considered their resilience against crises to be low and therefore may have coped poorly with this new type of viral illness.
The test subjects for the COVIDOM study are currently being surveyed for a second time approximately twelve months after their first visit to the study centers. The aim is to determine whether those who had a high PCS score after nine months are still suffering from complaints and what factors might have contributed to eliminating or improving the symptoms.
In the COVIDOM study, which is being conducted within the framework of the Nationales Pandemie-Kohorten-Netz (NAPKON/ NAPKON-POP) (national pandemic cohorts network), researchers from the UKSH, University Hospital Würzburg and Charité Berlin, Kiel University and the Cluster of Excellence "Precision Medicine in Chronic Inflammation" (PMI) have been examining the health effects on patients infected with Sars-CoV-2 to different degrees of severity since March 2020. Using a population-based approach, the test subjects are recruited for this study in Schleswig-Holstein, Lower Franconia and Berlin (Neukölln). NAPKON is a national COVID-19 research platform in which university hospitals, clinics and GP surgeries have joined together to form a network to generate a comparable clinical image of the acute and long-term effects of a SARS-CoV-2 infection that is based on common research standards. The study is funded by the Nationales Forschungsnetzwerk der Universitätsmedizin (NUM) (national research network of university medicine), which was initiated by the Federal Ministry of Education and Research at the start of the coronavirus pandemic in order to consolidate and reinforce the research activities of German university medical centers aimed at tackling the coronavirus pandemic. Under the umbrella of NUM and together with other components of NUM, associated projects like NAPKON create basic infrastructures for better understanding pandemics and therefore for combating pandemics based on the COVID-19 example.
Further information: https://www.covidom.de/
Bahmer T, Borzikowsky C, Lieb W, Horn A, Krist L, Fricke J, Scheibenbogen C, Rabe KF, Maetzler W, Maetzler C, Laudien M, Frank D, Ballhausen S, Hermes A, Miljukov O, Haeusler K, El Mokhtari NE, Witzenrath M, Vehreschild J, Krefting D, Pape D, Montellano F, Kohls M, Morbach C, Störk S, Reese JP, Keil T, Heuschmann P, Krawczak M, Schreiber S, on behalf of the NAPKON study group. Severity, predictors and clinical correlates of post-COVID syndrome (PCS) in Germany: A prospective, multicentre, population-based cohort study. eclinical Medicine (thelancet.com) 2022.
Prof. Dr. Thomas Bahmer
Department of Internal Medicine I, UKSH
+49 431 500-62629