I saw a post today discussing palpitations after COVID. Folks, what I tell my patients is: if you get palpitations in the weeks to months after COVID, call your doc and get seen. Here’s why — palpitations after COVID are common, and one prevalent cause is atrial fibrillation. This is often detected by a wearable event recorder such as a Holter monitor, because a 1-time ECG (as if often done in the ER) is worthless if you aren’t in a-fib at the time. A-fib dramatically increases stroke risk.
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Common? Patients who have had COVID have only a 20% increased risk of AFib post infection. Thats hardly "common" that would make it fairly rare.
@freemo I said palpitations are common (10-20% of folks with post-COVID syndromes have them). A-fib is one of the many causes of this, and I would argue is not all that rare compared to many things we consider quite serious in Emergency Medicine, particularly since a-fib has a significant stroke risk associated with it. We can quibble over what exact cutoff makes something a concern I suppose, but to what end?
> but to what end?
Largely my concern is fear mongering (perhaps unintentional). There has been a great deal of over-hyping COVID and has caused people to be dispreportionaltly scared of the disease and its consequences. While it is of course a serious disease people have heard so much disinformation to make it sound scarier than it is that people are often irrationally afraid of it relative to the risks.
Saying its common makes people think most people who catch it will start having heart problems when in fact a very very small portion of people who catch it will. So that needs pointing out.
@freemo up to 30% of people who get COVID get some form of post-COVID syndrome. Estimates vary widely on the number who experience cardiovascular complications, but there are entire clinics dedicated the problem, so it isn’t exactly a rare presentation to healthcare. I agree that there is overhyping of some of the risk, but overall, I would argue that in fact the risks associated with infection have been downplayed quite a bit.
See this is what I'm talking about. An actual review of the literature would show the prevelance of post-covid syndroms is not yet known, the studies we do have range from <10% to 30%/35% at the absolute highest end. Yet you are 1) quoting it as if its well established, it is not 2) picking from the highest end of the spectrum (fear mongering).
Couple this with the fact that there is a great deal of fear, and an impossiblity to test for this in a double-blind fashion you get a recipe for disaster one would expect highly inflated numbers due to the placebo effect alone.
As a COVID Research scientist myself, and you as a doctor, we need to hold ourselves to higher standards when we state things as fact. You cant just cherry pick a study that gives the number you want, we have to be mindful of the consensus and the body of literature and leave our personal biases out of it.
@freemo while the prevalence is not well established, the estimates of long COVID range from 10-80%, with most studies I’ve seen landing somewhere around 30%. Arrhythmias are a commonly cited concern, and prevalence there again is variable, but 10-20% is a pretty reasonable slice of the published literature. The intro to this Nature review pretty well sums up the concerns…
Sorry but thats just not true. I will try to find it for you but the last attempt i saw at finding a mean for the prevalence among existing studies produced a value from 11% to 16%. Couple that with the fact, again we cant remove the placebo effect from the reality the actual numbers are almost certainly skewd quite a bit below this.
@freemo the CDC study I posted specifically cites a range from 10-80% for PCS, and the Nature review also shows a range up to 70% (the higher estimates are for people who were hospitalized, which is obviously not the same as ambulatory cases). Literally right there in the papers I cited, one of which is a recent and broad review in Nature…
Thats not how science is done. The existence of low-confidence studies that produce outliers is not the same as saying a literature review has consensus within that range.
No reasonable person would look at the literature on this and assert that ANY of the numbers have enough confidence to start telling the general public figures. The only responsible response is "We dont know what the figures are but the highest confidence studies are in the 15% and less range, and almost all studies show very little consensus"
I just double checked your study... its worse than I thought, you are even misrepresenting the study in what your saying here now.
You are citing upwards of an 80% figure, that is NOT what the study says. It says that in patients who were hospitalized with covid (so people who had extremely unusually bad casis) have upwards of the 80% figure. That is NOT saying 80% of all people with covid.
So turns out this was a much worse and damning misrepresentation on your part than I first thought. Given your credentials I'd go so far as to say its a lie and deceptive the way you stated it based onn the very source you used.
@freemo I never (and have never) said that the 80% number is representative. What I said, and is the case, is that estimates run that high in some studies. The higher bounds tens to be in much higher risk populations, in studies from early waves, and in studies with high risk of selection bias. Similarly, low bound estimates in the single digits are likely underestimates.
@mcnado @freemo
Just wanted to point out a potential skew you both might be missing here: Long COVID isn't very thuroughly defined, because it's not yet even understood as anything beyond "symptoms after infection has cleared due to damage."
This could include the type of permanently crippling nervous system damage that I have, but it could, in some studies, include ANY symptom which lingers for more than a couple weeks after infection.
Could it be possible that 80% of patients who test positive and end up in the study haven't fully recovered by a month later? Could it be that the study only includes more severe cases?
Agreed, and no i didnt miss it, that is kinda part of my point. i am arguing there is nothing remotely approaching consensus or high quality studies on this topic as of yet. As you point out it isnt even well defined in a useful way. So any assertion about long covid being real or its prevelance is negligent. The only honest answer any doctor or scientist can give right now is "we just dont know"
@freemo @Raccoon is it? Here’s the study (linked below). It’s a meta-analysis from earlier in the pandemic, which looked at studies that included hospitalized and ambulatory patients. The study concludes jn multiple places that 80% of people with COVID will experience one or more long-term symptoms. Do I think that’s representative? No. Is it what the study says, yes.
Didnt miss it, not concluding anything different than the authors. You however did misrepresent the paper and the authors, they did not say what you keep asserting they said. They are not saying 80% of people who get COVID will likely have long-COVID. You are trying to claim they are saying something they very much are not saying.
Explain to me what it is you are getting from this that is different than what the authors repeatedly conclude.
Absolutely nothing. What I conclude is exactly the same as what the authors conclude and is exactly the same as what you have posted here.
It is you who are disagreeing with the authors and dont know it. I have explained to you three times now exactly what your misunderstanding and you just ignore it and keep repeating yourself. Again this is not appropriate for a medical doctor.
I will explain to you again, in this study “the patients with COVID” are specifically explained to NOT be a random sampling of the population of people with COVID. It is not meant to be representative of the COVID population. It is specifically only people who have unusually bad cases and wind up hospitalized. Therefore it is only representative of hospitalized COVID infected people, it is NOT representative of COVID infected people in general.
I quote fromt he study you linked:
"The incidence is estimated at 10–30% of non-hospitalized cases, 50–70% of hospitalized cases"
It specifically states in no uncertain terms that the higher ranges above 50% were only in the case of hospialized patients, and for non-hospitalized diagnosed people it is 10-30%.
This also implies that the non-diagnosed asymptomatic crowd, which is not in this study would be even lower, implying the overall number once those people are factored in is likely to be lower still.
But as is very cleraly stated in the metareview what you said is straight up false, no study suggests an 80% figure for all people who catch covid.
@freemo @Raccoon that’s the Nature paper. The 80% number is from the previously cited CDC paper, which is in turn citing this
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352980/
So, before you go accusing me of not having read the papers, back up a second, follow the citations, and read it. You got confused in the back and forth (fine), but then are accusing me of misstating something, when in fact I am not.
@freemo @Raccoon literally what they said is “…80% of the patients with COVID-19 have long term symptoms”. Explain to me what it is you are getting from this that is different than what the authors repeatedly conclude.