Reveal the clinical heterogeneity of "Changxinguan". Zhang Wenhong's team has followed up more than 20000 infected people for one year | Follow up | Patients | Infection | Infected people | Symptoms | Research | Changxinguan

Recently, the team of Zhang Wenhong from Huashan Hospital affiliated to Fudan University published a paper entitled "One year follow-up study on the systematic impact of COVID-19 Aomikerong patients' growing new crown symptoms" in the international medical journal Emerging Microbes and Effects. In this study, more than 20000 patients infected with COVID-19 for the first time in the Omikjon BA. 2 epidemic in Shanghai from March to June 2022 were followed up for up to one year, and it was found that "Changxinguan" showed "heterogeneity" and attenuation effect over time.

Although COVID-19 has been announced by WHO to withdraw from the "global public health emergency", the symptoms of "Changxinguan" have always troubled some former infected people, and also pose challenges to economic development, social mentality and medical resource supply. Although the international medical community attaches great importance to the impact of the "long new coronavirus" symptom, the existing research has such problems as a single research population, too many COVID-19 variants involved, and it is difficult to be used as a basis for public health policies. At the same time, most of the studies were initiated by European and American scientists, and most of the people targeted were European and American people who had been infected with multiple COVID-19 variants and had complex vaccination conditions. There was a lack of comprehensive research on "Long New Corona" for large populations in Asia and patients with Omikjon. The research of Zhang Wenhong's team has filled this gap.

Zhang Wenhong's team investigated the situation of "Changxinguan" after COVID-19 infection in Qingpu Community, Shanghai

The cohort of infected people in China suggests that "Changxinguan" shows "heterogeneity" and decay effect over time

From March to June 2022, a total of 28051 COVID-19 infected persons were discharged from the medical unit of Huashan Hospital, of which 21799 participated in the study. At the same time, the study set up a control group of non infected COVID-19, including 979 subjects who were not diagnosed as COVID-19 and met the recruitment criteria.

Among 21799 infected persons who were followed up, 1939 reported that they had "Changxinguan" symptoms during the telephone follow-up 6 months after leaving the hospital. The most common subjective symptoms were fatigue, insomnia, hair loss and cough. However, the proportion of COVID-19 severe patients with "long new crown" symptoms who reported that they had cough was higher than that of non severe patients.

In order to evaluate whether Changxin Corona will affect the quality of life and mental status of infected people, 450 "Changxin Corona" infected people and 75 non "Changxin Corona" infected people were included in the study, and were followed up for 6 months. Further, we received a detailed questionnaire survey on the symptoms and mental health of "Changxinguan". The proportion of patients with "Changxinguan" symptoms who reported pain or discomfort, anxiety or depression was significantly higher than those without "Changxinguan" symptoms; At the same time, the proportion of patients with "Changxinguan" symptoms who reported that they had difficulty in action/self-care, daily activity problems, pain or discomfort, anxiety, depression and post-traumatic stress disorder was also higher than that of the control group without COVID-19 infection. There was no significant difference in chest CT, blood routine test, liver and kidney function, ProBNP and C-reactive protein between patients with "Changxinguan" symptom and healthy control group.

Laboratory preparation for clinical research by team members

Among the above 1939 infected persons who reported that they had "Changxinguan" symptoms in the sixth month of telephone follow-up after leaving hospital, 856 "Changxinguan" respondents participated in the twelfth month of telephone follow-up after leaving hospital. Since December 2022, there was a wave of Omikjon pandemic in China, in order to exclude the impact of re infection on "Changxinguan", the research team removed 1939 infected people who were unwilling to continue to receive follow-up and re infected with COVID-19.

Of the 856 respondents who reported having the symptoms of "Changxinguan", 587 no longer have the symptoms of "Changxinguan". Of the 269 respondents who still had the symptoms of "Changxinguan", 105 went to the clinic to further improve the laboratory examination. Research shows that among the patients who still have the symptoms of "Changxinguan", the number of patients with fatigue, insomnia, hair loss, cough, sore throat, chest pain, dyspnea, olfactory failure, taste failure, headache, palpitations, rash, vertigo, muscle pain and joint pain is significantly reduced.

The study found that in the multivariate logistic analysis, women, young people, ≥ 2 comorbidities and severe or critical infection in the acute phase of COVID-19 were the risk factors for the development of "LongNewCrown". As for the sustainability comparison of "Changxin Corona", among the infected people with "Changxin Corona", middle-aged infected people have a higher risk of symptom persistence.

In this study, the common manifestation of "Changxinguan" is subjective symptoms, which can affect the quality of life and psychological status of some infected people. Compared with the control group without COVID-19 infection, the "Changxinguan" group did not observe a significant increase in liver, kidney, heart function damage and lung organic lesions. One year later, most of the "Changxinguan" respondents' symptoms were relieved. However, in the special population such as COVID-19 severe/critical disease, the impact of COVID-19 infection on "Long New Corona" symptoms still needs further research and exploration.

Professor Zhang Wenhong guided the diagnosis and treatment of COVID-19 in Pudong Community. All images provided by respondents

The clinical characteristics of "Changxin Crown" are still evolving

It is worth noting that in this study, the proportion of people infected with Omicron who have "Changxinguan" symptoms is significantly lower than that of Delta infected people who have "Changxinguan" symptoms in other studies. The most common "Changxinguan" symptoms in this study, such as fatigue, insomnia, hair loss and cough, are consistent with the common symptoms in other "Changxinguan" studies. However, these symptoms also frequently occurred in the follow-up of the non infected COVID-19 group in this study.

Two previous long-term follow-up studies on the first and second wave of wild type or alpha COVID-19 infected people in the UK found that more than half of COVID-19 patients had single organ damage, and about one-third of COVID-19 patients had multiple organ damage. In contrast, Zhang Wenhong's team targeted COVID-19 infected people infected with Omicron, and the research results showed that the "Changxinguan" infected people in this population did not observe significant organ damage. However, the study also shows that the symptoms of "Changxinguan" have a significant negative impact on the quality of life and mental status of infected people.

The research team stated that the study has certain limitations. First of all, the "Changxinguan" symptoms involved in the study all came from the private complaints of infected people in the telephone follow-up, so there is a possibility that the symptoms that are mild and have no significant subjective feelings are not recorded. Secondly, the small number of severely infected individuals receiving follow-up in the study has affected the universality of the research results among the population of severe COVID-19 patients. In order to further explore the impact of COVID-19 infection on the "long new coronavirus" symptoms in Asian populations, systematic research with a larger number of samples is still needed, especially to cover the group with severe COVID-19. It should also be noted that the so-called "growing new crowns" phenomenon is also common after other acute infections, such as dengue fever, Ebola, influenza and other pathogens. It is necessary to compare the long-term symptoms of these pathogens after infection to finally determine the specific clinical characteristics of "growing new crowns".