long covid neurological

Interaction analyses between age and exposure suggested that the risks of episodic disorders, mental health disorders, musculoskeletal disorders and any neurologic disorder increased as age increased (P for interaction <0.001, <0.001 and 0.003, respectively), and risks of cognition and memory disorders, sensory disorders and other neurologic or related disorders decreased as age increased (P for interaction 0.001, <0.001, <0.001, respectively) (Extended Data Fig. To further understand the association between COVID-19 and incident neurologic outcomes across age, we conducted spline analyses, where age was treated as restricted cubic spline with knots placed at the 10th, 35th, 65th and 90th percentiles. The CDW Outpatient Pharmacy and CDW Barcode Medication Administration domains provided information about medication prescriptions and fillings. High-dimensional characterization of post-acute sequelae of COVID-19, Long-term gastrointestinal outcomes of COVID-19, Long-term cardiovascular outcomes of COVID-19, Burdens of post-acute sequelae of COVID-19 by severity of acute infection, demographics and health status, Association of preexisting psychiatric disorders with post-COVID-19 prevalence: a cross-sectional study, Clinical progression and outcomes of 260 patients with severe COVID-19: an observational study, Effect of remdesivir post hospitalization for COVID-19 infection from the randomized SOLIDARITY Finland trial, More than 50 long-term effects of COVID-19: a systematic review and meta-analysis, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England. All information used for algorithmically selected covariates was collected within 1 year before the exposure. 59.5% reported difficulty. Most of the first recognized cases of long COVID were in patients who needed extended respiratory therapy or who had obvious organ damage that caused lasting symptoms. Novak, P. et al. The CDW Patient domain provided patient demographic information. Researchers are examining inflammatory signals in patients with long COVID in increasingly fine detail. Science 375, 11221127 (2022). She mostly recovered from this acute phase within a few weeks, but, she says, I never really got better., Soon after coming home from the hospital, Ghormley developed what her husband called goldfish brain. I'd put something down and have no idea where I put it, she recalls. Multisystem involvement in post-acute sequelae of coronavirus disease 19. Yang, A. C. et al. Nature 604, 697707 (2022). The respective risk and burden of a composite of these disorders of peripheral nerves were 1.34 (1.29, 1.39) and 8.64 (7.44, 9.87). Extended Data Fig. 3b,c). Outcomes were ascertained 30d after the COVID-19-positive test until the end of follow up. A P value of <0.05 suggests that age modifies the association between COVID-19 and the neurologic outcome. A neurological disorder, peripheral neuropathy is a general term for damage to . Adjusted HRs (dots) and 95% (error bars) CIs are presented, as are estimated excess burdens (bars) and 95% confidence intervals (error bars). They come and start chewing things up; they produce all kinds of free radicals, cytokines. (Auckl., NZ) 15, 15511556 (2021). . Risks and burdens of individual neurologic outcomes are provided in Fig. Here we leverage the breadth and depth of the US Department of Veterans Affairs national healthcare databases to build a cohort of 154,068 people who survived the first 30 days of COVID-19 and two control groups: a contemporary cohort consisting of 5,638,795 users of the US Department of Veterans Health Care System (VHA) with no evidence of SARS-CoV-2 infection, and a historical cohort (predating the global COVID-19 pandemic) consisting of 5,859,621 VHA users during 2017. One study found that in people with neurological COVID symptoms, the immune system seems to be activated specifically in the central nervous system, creating inflammation. Cai, M., Bowe, B., Xie, Y. Because we aimed to examine outcomes at 12 months, our cohorts were enrolled before 15 January 2021 (before SARS-CoV-2 vaccines were widely available in the US), and less than 1% of people in the COVID-19 group and contemporary control group were vaccinated before T0. Google Scholar. This study was approved by the institutional review board of the VA St. Louis Health Care System, which granted a waiver of informed consent (protocol number 1606333). The dashed line marks a HR of 1.00; lower limits of 95% CIs with values greater than 1.00 indicate significantly increased risk. COVID-19 cohort (n=154,068) and contemporary control cohort (n=5,638,795). People with post-COVID conditions (or long COVID) may experience many symptoms. 3 Standardized mean difference of predefined and algorithmically selected high-dimensional variables. Taquet, M., Geddes, J. R., Husain, M., Luciano, S. & Harrison, P. J. Carfi, A., Bernabei, R., Landi, F. & Gemelli Against COVID-19 Post-Acute Care Study Group. 6 and 7 and Supplementary Table 11) and by care setting of the acute phase of the disease (Extended Data Figs 8 and 9 and Supplementary Table 12). We then examined the risks and burdens of neurologic outcomes in mutually exclusive groups by the care setting of the acute infection (whether people were nonhospitalized (n=131,915), hospitalized (n=16,764) or admitted to intensive care (n=5,389) during the acute phase of COVID-19). Stopping those sometimes leads to improved symptoms, she says. & Al-Aly, Z. VA electronic healthcare databases are updated daily. I had a patient who told me everything, and after, I just said, This must be so hard for you. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Xie, Y., Xu, E., Bowe, B. We estimated the risk of each incident neurologic outcome by first building a subcohort of participants without a history of the outcome of interest (for example, the risk of incident stroke was estimated within a subcohort of participants without history of stroke in the year before cohort enrollment). To further test the robustness of our study design, we conducted multiple sensitivity analyses. As the world attempts to move forward . But people who experience PEM face a particular challenge when using movement therapies. Veterans who were users of the VHA in 2019 (n=6,244,069) and had a positive COVID-19 test between 1 March 2020 and 15 January 2021 were selected for the COVID-19 cohort (n=169,476). CAS Sometimes the symptoms can even go away or come back again. She gets exhausted quickly, her heartbeat suddenly races, and she goes through periods where she can't concentrate or think clearly. Several studies have found evidence of autoimmune components called autoantibodies that interact with nerve cells in people with long COVID. One of the patterns we see is patients who definitely meet the criteria for ME/CFS. What are possible long-term neurological complications of COVID-19? Outcomes were ascertained 30d after the COVID-19-positive test until the end of follow up. From the 6,152,185 participants who were alive on 1 March 2018, 6,009,794 participants who were not already part of the COVID-19 group were enrolled into the historical control group. For most people, the primary symptoms of COVID-19 are respiratory. Although the symptoms may seem to affect the body, they stem from nervous system dysfunction. Delorey, T. M. et al. Merad, M., Blish, C. A., Sallusto, F. & Iwasaki, A. Individual outcomes were also aggregated into a related composite outcome (for example, cerebrovascular disorders consisted of an aggregation of ischemic stroke, hemorrhagic stroke, cerebral venous thrombosis and TIAs). And a therapy called rituximab that targets antibody-producing B cells provides a time-tested therapy for a lot of autoantibody-mediated syndromes, Nath says. The syndrome is known by medical professionals as postacute sequelae of COVID-19, or PASC. COVID-19 cohort (n=154,068) and historical control cohort (n=5,859,621). In Part 2 of this series, we take a closer look. Epstein-Barr virus, which causes mononucleosis, is one of several viruses linked to a condition called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which is estimated to affect at least one and a half million people in the U.S. ME/CFS bears striking resemblances to long COVID, with symptoms such as immune system dysregulation, fatigue and cognitive dysfunction. Follow her on Twitter @SutherlandPhDCredit: Nick Higgins. The virus that causes COVID-19 can cause strokes, inflammation, oxygen deprivation and infection in the brain. Burdens are presented per 1000 persons at 12 months of follow up. Neurological issues like loss of taste and smell, difficulty concentrating, memory issues, and brain fog are common among long COVID patients. Google Scholar. Two other studies, both published last year in the Proceedings of the National Academy of Sciences USA, showed evidence that SARS-CoV-2 may infect astrocytes, a type of neural support cell, gaining entrance via neurons in the skin lining the nose. To further reduce the influence of extreme weights, the stabilized weights were truncated at 30 (refs. Since COVID-19 can impact so many parts of the body, it can cause a wide range of symptoms. and Y.X.) 130, 39503953 (2020). All authors approved the final version of the report. In all analyses, evidence of statistical significance was considered when a 95% CI excluded unity. Extended Data Fig. 16, 103112 (2021). Alzheimers Dement. Long-Term Immunological Health Consequences of COVID-19 (British Society for Immunology, 2020); https://www.immunology.org/sites/default/files/BSI_Briefing_Note_August_2020_FINAL.pdf. Maybe overactive immune cells continue to perturb the nervous system and nearby blood vessels. Post-COVID Care: A Neurologist's Perspective. Torgerson hopes that researchers will ultimately come to better understand ME/CFS because of COVID. Neurological issues such as brain fog, memory loss, speech problems, and attention deficits plague up to 80% of COVID-19 patients. 18, e1003773 (2021). The Mount Sinai Health System was among the first to create a Center for Post-COVID Care. Patients with long COVID frequently rank cognitive function and mental health at the top of their concerns, Jackson said, which is why seeking psychological support can be so vital. Natl Acad. She finished at the top of her class in high school, graduated summa cum laude from college and earned top honors in veterinary school. If it's a macrophage-mediated inflammatory process intravenous immunoglobulin could make a difference [to] dampen the macrophages, Nath says. Extended Data Fig. The risk and burden of a composite of these episodic disorders were 1.32 (1.26, 1.39) and 4.75 (3.79, 5.76), respectively. For more information, please visit https://www.virec.research.va.gov or contact the VA Information Resource Center (VIReC) at VIReC@va.gov. Briggs, A. Continue reading with a Scientific American subscription. Comparative evaluation of clinical manifestations and risk of death in patients admitted to hospital with covid-19 and seasonal influenza: cohort study. Austin, P. C. & Stuart, E. A. Many physicians are not familiar with POTS, but Agarwal is particularly attuned to it, having seen it in some of her patients before COVID hit. Z.A.A. Now she believes POTS is really what long-haul COVID is causing in many patients. Post-COVID conditions may not affect everyone the same way. Article Risks and burdens were assessed at 12 months in mutually exclusive groups comprising nonhospitalized individuals with COVID-19 (green), individuals hospitalized for COVID-19 (orange) and individuals admitted to intensive care for COVID-19 during the acute phase (first 30 d) of COVID-19 (purple). and Y.X. ISSN 1078-8956 (print). Those alive after 30 days after the start of follow up (n=5,638,795) were selected as the contemporary control cohort. The P value for cerebrovascular disorders=0.57, cognition and memory disorders=0.009, disorders of the peripheral nerves=0.04, episodic disorders<0.001, extrapyramidal and movement disorders=0.05, mental health disorders<0.001, musculoskeletal disorders<0.001, sensory disorders<0.001, other neurologic or related disorders=0.002, and any neurologic disorder<0.001. Researchers are following some known acute effects of the virus to determine their relationship to the post-acute complications of COVID-19 infection. & Al-Aly, Z. Some of the neurologic disorders reported here are serious chronic conditions that will impact some people for a lifetime. & Vassall, A. We see many patients who have gotten better with time. The dashed line marks a HR of 1.00; lower limits of 95% CIs with values greater than 1.00 indicate significantly increased risk. 6 Subgroup analyses of the risks of incident postacute COVID-19 composite neurologic outcomes compared with the historical control cohort. Research on other viruses, and on neurological damage from the human immunodeficiency virus (HIV) in particular, is guiding work on long COVID. The association between COVID-19 and risks of postacute neurologic outcomes was evaluated in mutually exclusive groups based on participants care setting during the acute phase of COVID-19 infection (that is, whether participants were nonhospitalized, hospitalized or admitted into the intensive care unit during the first 30 days of infection). Med. The dashed line marks a HR of 1.00; lower limits of 95% CIs with values greater than 1.00 indicate significantly increased risk. contributed to data analysis and interpretation of results. To obtain Evaluations of the 17 patients studied found evidence of peripheral neuropathy in 59 percent of them, or 10 people. Specialists are working together to address the wide range of systemic cardiovascular, pulmonary, renal, neurologic, and other issues and complications seen increasingly in the aftercare setting. and JavaScript. Adjusted HRs (dots) and 95% (error bars) CIs are presented, as are estimated excess burdens (bars) and 95% confidence intervals (error bars). Cohort construction for COVID-19 group (blue), contemporary control group (orange) and historical control group (pink). Am. Soc. Experimental evidence in mice . We also constructed a historical control group composed of 6,463,487 participants who were users of the VHA in 2017. Our analyses by age as a continuous variable reveal two key findings. ACS Chem. Nat. Sharma, A., Oda, G. & Holodniy, M. COVID-19 vaccine breakthrough infections in Veterans Health Administration. P value was based on 2 sided Wald Chi-Squared test on interaction between age and exposure, without multiple comparisons adjustment. These included abnormal involuntary movements (HR 1.41 (1.32, 1.50); burden 2.85 (2.24, 3.49)), tremor (HR 1.37 (1.25, 1.51); burden 1.10 (0.73, 1.51)), Parkinson-like disease (HR 1.50 (1.28, 1.75); burden 0.89 (0.50, 1.34)), dystonia (HR 1.57 (1.29, 1.90); burden 0.40 (0.21, 0.63)) and myoclonus (HR 1.42 (1.13, 1.79); burden 0.14 (0.04, 0.26)). And they're very hard to shut down, so they persist for a long time. Both predefined and algorithmically selected covariates were used in the modeling and were assessed in the year before T0. The changes were jarring to Ghormley, who prided herself on her sharp mind. 3 and Supplementary Table 3. I have patients whose symptoms have disappeared in the course of a year, or they disappear and occasionally flare up again. But for some, she says, it could last many years., We're going to be addressing this for probably decades, Viswanathan says. PubMed The risks of incident composite neurologic outcomes were evident in all subgroups based on age, race, sex, obesity, smoking, area deprivation index (ADI), diabetes, chronic kidney disease, hyperlipidemia, hypertension and immune dysfunction (Fig. In some people, post- COVID-19 syndrome lasts months or years or causes disability. Mayumi Kataoka, Megumi Hazumi, Daisuke Nishi, Olli P. O. Nevalainen, Saana Horstia, Kari A. O. Tikkinen, Sandra Lopez-Leon, Talia Wegman-Ostrosky, Sonia Villapol, Nature Medicine Bowe, B. et al. When you look at the COVID brain, you don't actually find [huge amounts of virus, but] we found a lot of immune activation, he says, particularly around blood vessels. For Ghormley, the combination led to real improvements, so now she doesn't feel like she ran the Boston Marathon when all she did was sit down and stand up at work or take a shower, Agarwal says. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. In conclusion, our report provides a comprehensive analysis of neurologic outcomes at 12 months. Thanks for reading Scientific American. Studies show those who have had COVID demonstrate measurable increases in brain fog compared to their counterpartseven if they didn't notice itbut also that those symptoms cleared up around six. Even though her symptoms are rooted in nervous system dysfunction, she needed an array of medical specialists to treat them. Long COVID is linked to reduced oxygen uptake in the brain, a new study reports. Ann. The examinations suggested that immune cells called macrophages had been stirred up. Long COVID New, continuing, or recurring symptoms that occur four or more weeks after initial coronavirus infection Symptoms can include respiratory, neurological, psychological, and cardiac problems Treatments include medication, physical therapy, counseling, pulmonary and cardiac rehabilitation, memory exercises, olfactory training McCaffrey, D. F. et al. Fortunately, the increasing ability to recognize specific problems is helping clinicians hone treatments that give patients the best chance of recovery. The results suggested that COVID-19 was associated with increased risk of fatigue in comparison with the contemporary control and the historical control (Supplementary Table 15). Jafari, Z., Kolb, B. E. & Mohajerani, M. H. Hearing loss, tinnitus, and dizziness in COVID-19: a systematic review and meta-analysis. The respective risk and burden of a composite of these extrapyramidal and movement disorders were 1.42 (1.34, 1.50) and 3.98 (3.24, 4.77). Our subgroup analyses were designed to estimate the risk of outcomes in each subgroup, the strength of the association for any specific outcome may not be necessarily comparable across subgroups. 34, 36613679 (2015). Schneeweiss, S. et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Weight change and the onset of cardiovascular diseases: emulating trials using electronic health records. Even after the acute illness has passed, these symptoms can linger, affecting someor allof the same body systems. Xie, Y., Bowe, B., Maddukuri, G. & Al-Aly, Z. What is the treatment for long-haul COVID? And each of these may lead to long-term neurological problems. Still, he says, patients have so many questions, and I can't lead them down a physiological pathway. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. Researchers explore solutions for Covid long haulers April 15, 202206:10 Most neurological symptoms persisted after an average of 15 months, the study found. That's a sledgehammer approach, and you can see if it makes a difference. CAS Nevertheless, 'long-COVID' is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Google Scholar. Altogether, our results show that the risks and burdens of neurologic disorders in the COVID-19 group at 12 months are substantial. Acute kidney injury in a national cohort of hospitalized US veterans with COVID-19. I could have done without being first at this, she says. 91, 367379 (2022). Persistent symptoms in patients after acute COVID-19. 32, 33883414 (2013). Nasiri, N. et al. Nature Medicine thanks Avindra Nath and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. New studies show that this may be due to damage to the frontal lobe, brain aging, or symptoms associated with oxygen deprivation in the brain. Ghormley's dysautonomia led her to see cardiologist Megha Agarwal at a UCLA clinic near her home. Can. Bowe, B., Xie, Y., Xu, E. & Al-Aly, Z. Kidney outcomes in Long COVID. Adjusted HRs (dots) and 95% (error bars) CIs are presented, as are estimated excess burdens (bars) and 95% CIs (error bars). For each subcohort, multinomial logistic regression was built to estimate the probability of a participant belonging to the observed group (COVID-19, contemporary control and historical control group) conditional on all predefined covariates listed in the covariate section and algorithmically selected high-dimensional variables denoted by L (ref. The top 100 variables with the highest relative risk were selected51. provided administrative, technical and material support. Boldrini, M., Canoll, P. D. & Klein, R. S. How COVID-19 affects the brain. Sociological Methodol. The response to the virus turns the autoimmunity on, and that doesn't get better even when the virus goes away, he says. Long COVID after breakthrough SARS-CoV-2 infection. Researchers are working to pinpoint certain biological factors, called biomarkers, that correlate with persistent Covid symptoms. Stephani Sutherland is a neuroscientist and science journalist based in southern California. The historical control cohort served as the referent category. ME/CFS has been difficult to study because it often arises long after a mild infection, making it hard to identify a viral trigger. Robust sandwich variance estimators were used to provide an estimation of variance when applying weightings. The prespecified outcomes were selected based on our earlier work on the systematic characterization of Long Covid1,10,14 and evidence from previous literature38,39,40,41,42,43,44. She spent several days at home, struggling to breathe, and then she went to the hospital, where her blood pressure soared and her blood glucose dropped precipitously. . Several early studies showed that COVID attacks endothelial cells, which line blood vessels. Additionally, we specified the composite of any neurologic outcome defined as the first incident occurrence of any of the predefined neurologic outcomes examined in this study. Several comorbidities were also selected as predefined variables, including cancer, chronic kidney disease, chronic lung disease, diabetes and hypertension. Epidemiology 20, 512522 (2009). Lancet 395, 14171418 (2020). (1) Regardless of age and across the age spectrum, people with COVID-19 had a higher risk of all the neurologic outcomes examined in this analysis. BMJ 376, e068993 (2022). The Johns Hopkins Post-Acute COVID-19 Team (JH PACT) is a special multidisciplinary clinic to support the recovery of people who have had COVID-19, and similar clinics are emerging at other hospitals. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. She said, No one has told me that. Symptoms of Long-Haulers. Al-Aly, Z., Xie, Y. Some are easily recognized as brain- or nerve-related: many people experience cognitive dysfunction in the form of difficulty with memory, attention, sleep and mood. The virus could linger in the brain for months, according to research conducted at the NIHand reported in Nature in December 2022. The P value for cerebrovascular disorders=0.38, cognition and memory disorders=0.001, disorders of the peripheral nerves=0.15, episodic disorders<0.001, extrapyramidal and movement disorders=0.88, mental health disorders<0.001, musculoskeletal disorders<0.001, sensory disorders<0.001, other neurologic or related disorders<0.001, and any neurologic disorder=0.003. J. Ophthalmic Vis. To test the robustness of study results, we evaluated the associations between COVID-19 and the prespecified neurologic outcomes in analyses considering a historical control group (from an era predating the pandemic) as the referent category; the demographic and health characteristics before and after weighting are presented in Supplementary Tables 1, 2, 8 and 9, examination of standardized mean differences suggested that covariates were balanced after application of inverse weighting (Extended Data Fig. Three cell-signaling moleculestumor necrosis factor alpha, interleukin 6 and interferon betastood out in long COVID patients. To further test the rigor of our approach, we tested a battery of negative-outcome controls, for which no prior evidence supports the existence of a causal relationship between COVID-19 exposure and any of these negative-outcome controls53. Outcomes were ascertained 30 days after the COVID-19-positive test until the end of follow up. & Al-Aly, Z. Neurol. Outcomes were ascertained 30 days after the COVID-19-positive test until the end of follow up. PubMed The risks were evident in all examined subgroups and were evident even in people who were not hospitalized during the acute phase of the disease. Median follow-up time in the COVID-19, contemporary control and historical control groups was 408 (interquartile range: 378500), 409 (379505) and 409 (379504) days, respectively. Song, W.-C. & FitzGerald, G. A. COVID-19, microangiopathy, hemostatic activation, and complement. Z.A.A., E.X. Risks and burdens were assessed at 12 months in mutually exclusive groups comprising nonhospitalized individuals with COVID-19 (green), individuals hospitalized for COVID-19 (orange) and individuals admitted to intensive care for COVID-19 during the acute phase (first 30 days) of COVID-19 (purple). People with long COVID have symptoms such as pain, extreme fatigue and brain fog, or difficulty concentrating or remembering things. This was achieved by gathering all patient encounter, prescription and laboratory data and categorizing the information into 540 diagnostic groups, 543 medication types and 62 laboratory test abnormalities. Although Ghormley says her care has dramatically improved her symptoms and allowed her to do some normal things again, she continues to experience flare-ups that make it impossible for her to work for weeks at a time. The images or other third party material in this article are included in the articles Creative Commons license, unless indicated otherwise in a credit line to the material. The term long COVID is an umbrella, and I think there are multiple diseases under that umbrella. Although each long COVID patient is unique, Pittman says, we start to see patterns developing. A Chronicle analysis revealed a remarkable trend: a consistently lower . 3a). Extended Data Fig. Lipsitch, M., Tchetgen Tchetgen, E. & Cohen, T. Negative controls: a tool for detecting confounding and bias in observational studies. Adjusted HRs (dots) and 95% (error bars) CIs are presented, as are estimated excess burdens (bars) and 95% CIs (error bars). Up to a third of people with COVID-19 have long-term neuropsychiatric symptoms, including psychosis and anxiety. Google Scholar. There was no understanding around the condition; we were just trying to see what we could offer them. Viswanathan and others convened a biweekly meeting of UCLA Health doctors in pulmonology, cardiology, neurology, psychiatry and other specialties to discuss individual cases and overall trends. Adjusted HRs (dots) and 95% (error bars) CIs are presented. VA data are made freely available to researchers behind the VA firewall with an approved VA study protocol. PubMed The corresponding author (Z.A.A.) Burdens are presented per 1,000 persons at 12 months of follow up. My husband opening a paper bag felt like knives stabbing me in the ear, she recounts. (1) We modified our covariate selection by restricting covariate inclusion to only predefined variables when constructing the inverse probability weight (that is, we did not include any algorithmically selected covariates). 1. The respective risk and burden of a composite of these sensory disorders were 1.25 (1.22, 1.28) and 17.03 (14.85, 19.26). Sci. It is imperative that we recognize the enormous challenges posed by Long Covid and all its downstream long-term consequences. 7 The risks of incident postacute COVID-19 composite neurologic outcomes across age compared with the historical control cohort. Perhaps because she was a professional from a medical field, no one brushed me aside., That's unusual for people with long COVID, many of them women, who are often dismissed by physicians who doubt their complaints are real. Z.A.A. An average of 58,794 COVID survivors nationwide responded to the nine long COVID surveys offered so far by the Census bureau. Long COVID is a condition where the effects of COVID-19 linger for weeks or months after the initial illness, even when the virus is no longer detected in the body. People with post-COVID conditions can have a wide range of symptoms that can last weeks, months, or even years after infection. Risks and burdens were assessed at 12 months in mutually exclusive groups comprising nonhospitalized individuals with COVID-19 (green), individuals hospitalized for COVID-19 (orange) and individuals admitted to intensive care for COVID-19 during the acute phase (first 30 d) of COVID-19 (purple). Any exertionphysical or mentalleft her exhausted and in pain. 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