Overlapping conditions in Long COVID at a multisite academic center.
Grach, Stephanie L, Dudenkov, Daniel V, Pollack, Beth et al. · Frontiers in neurology · 2024 · DOI
Quick Summary
This study looked at 247 patients with Long COVID who visited Mayo Clinic to see what new health problems developed after their COVID-19 infection. Researchers compared them to 40 people who had COVID-19 but recovered normally. The results showed that Long COVID patients experienced much higher rates of pain, neurological symptoms, sleep problems, and other issues. Importantly, 58% of Long COVID patients screened positive for ME/CFS—a serious fatigue and post-exertional symptom condition—compared to none of the control group.
Why It Matters
This study provides critical evidence of significant overlap between Long COVID and ME/CFS, with more than half of Long COVID patients screening positive for ME/CFS—a finding that could reshape how clinicians evaluate and treat post-COVID patients. For ME/CFS researchers, the data suggest Long COVID may provide an opportunity to study ME/CFS mechanisms in a more recently defined patient cohort, potentially advancing understanding of both conditions.
Observed Findings
94.4% of Long COVID patients reported new or worsening pain compared to 0% of controls (p < 0.001)
92.4% of Long COVID patients reported new or worsening neurological symptoms compared to 15.4% of controls (p < 0.001)
58% of Long COVID patients screened positive for ME/CFS versus 0% of controls (p < 0.001)
27% of Long COVID patients screened positive for generalized joint hypermobility versus 10% of controls (p = 0.026)
Orthostatic intolerance screening scores averaged 4.0 in Long COVID patients versus 0 in controls (p < 0.001)
Inferred Conclusions
Long COVID is characterized by a broad spectrum of new or worsening comorbidities across multiple organ systems, with pain and neurological symptoms being nearly universal.
There is substantial overlap between Long COVID and ME/CFS, with more than half of Long COVID patients meeting screening criteria for ME/CFS.
Orthostatic intolerance and generalized joint hypermobility are significantly more common in Long COVID patients than in COVID-recovered controls, suggesting potential autonomic and connective tissue involvement.
Remaining Questions
What percentage of Long COVID patients actually meet full diagnostic criteria for ME/CFS, and how do clinical presentations differ between Long COVID-associated ME/CFS and primary ME/CFS?
What This Study Does Not Prove
This study does not establish causation or prove that COVID-19 definitively causes ME/CFS or the other comorbidities; it only documents their co-occurrence. The low survey response rate (33.7% of LC patients) means the findings may not represent all Long COVID patients, particularly those who are very ill or less engaged with healthcare. The cross-sectional design cannot determine whether these conditions were truly new or represent pre-existing conditions that worsened.
Are the high rates of orthostatic intolerance and joint hypermobility in Long COVID primary features or consequences of deconditioning and other secondary changes?
What underlying physiological mechanisms explain the co-occurrence of pain, neurological dysfunction, sleep disturbance, and autonomic symptoms in Long COVID?
How do symptom profiles and comorbidity patterns differ across Long COVID patient subgroups defined by severity, symptom duration, or demographic characteristics?