A new study sheds light on the nature of ‘long covid’. The researchers say that SARS-CoV-2 should be viewed not as a respiratory virus but as a virus with systemic effects.
Many people have felt stressed and lost sleep over the disruption and uncertainty caused by the COVID-19 pandemic, but a new report suggests the infection itself may be associated with long-term risk sleep disturbances and mental health problems.
Ziyad Al-AlyMD, who directs the Center for Clinical Epidemiology at the St. Louis Veterans Health Care System, explained that most of the existing research on the impacts of the pandemic on mental health has focused on the acute phase of illness and the first few months after.
“A comprehensive assessment of mental health manifestations in people with COVID-19 at one year has not been undertaken,” Al-Aly and colleagues wrote. “Improving our understanding of the long-term risk of mental health disorders in people with COVID-19 can help guide care strategies during the post-acute phase.
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Investigators organized Veterans Health Administration data into three cohorts: a group of 153,848 veterans who had been infected with the SARS-CoV-2 virus and survived at least 30 days, a control group of more than 5 million veterans with no evidence of SARS-CoV-2 infection, and a historical control group based on 5 million patients who used the healthcare system before the pandemic (in this case, the year 2017). The goal was to find out whether patients in the COVID-19 group had higher rates of a wide range of mental and sleep disorders.
In several categories, from anxiety and depressive disorders to sleep disorders and stress, patients in the COVID-19 group were more likely to be included.
The same is true for drug use associated with these disorders, as well as substance abuse, such as opioid use.
In the case of sleep, after one year, people in the COVID-19 group were 41% more likely to have been diagnosed with a sleep disorder and 61% more likely to take a sleeping pill than the contemporary control group.
Notably, the risk of sleep and mental disorders does not appear to be limited to people with severe COVID-19. The risk of such disorders was elevated even in patients who did not require hospitalization during the acute phase of COVID-19, though. in most cases, hospitalized patients were at higher risk for mental and sleep disorders.
“Overall, the results suggest that people with COVID-19 experience increased rates of mental health problems, which could have far-reaching consequences,” Al-Aly said. wrote in an accompanying opinion piece. Al-Aly cautioned against using these mental health data to dismiss the long COVID as mere psychosomatic manifestations associated with sleep and mental disorders: some may use our findings to light the gas or dismiss the long covid as a psychosomatic condition or explaining the myriad manifestations of long covid as the result of mental illness.
Instead, he said, the results of his new study should be seen as examining one facet of a multifaceted disease.
“The body of evidence on the long COVID — from our work and others — suggests the need to reframe our thinking about SARS-CoV-2,” he wrote. “It’s not just a respiratory virus; it is a systemic virus that can cause damage and clinical consequences in almost all organ systems, including mental health disorders and neurocognitive decline.
Al-Aly said it is incumbent on government and public health officials to recognize the potential for long-term effects of infection with the virus.
“Failure to consider the risks of long covid risks magnifying the profound losses we have suffered in this global pandemic,” he wrote in BMJ.