Long COVID: health symptoms, impact on health-related quality of life and mapping to disability weights

Abstract Introduction Previous studies indicated that a significant share of COVID-19 patients experiences long lasting health complaints; a condition also referred to as “long COVID”. In order to assess the long term burden of disease of COVID-19, including long COVID, information is needed on health symptoms, health-related quality of life and duration of symptoms of long COVID patients. Therefore, the aim of this study was to assess health symptoms and health-related quality of life of long COVID in the general population of the Netherlands. Methods A total of 33,903 COVID-19 patients from the region South-Holland South (the Netherlands) whom tested positive between June 2020 and May 2021 at the municipal health services were invited to complete a web-based questionnaire on the presence, nature and consequences of long COVID and health-related quality of life, measured with the EQ-5D-5L. Results In total, 3,768 participants who completed the questionnaire experienced long COVID. Most commonly reporting symptoms were reduced physical condition (65.5%), fatigue (59.6%), problems concentrating (49.6%), loss of smell (41.2%) and shortness of breath (37.8%). 648 participants indicated that they experienced long COVID symptoms for 5 months or longer. Preliminary analysis showed that increasing number of symptoms was associated with a decrease in health-related quality of life. Discussion and conclusions Long COVID covers a range of health symptoms of varying severity and duration. This complicates the calculation of the non-fatal burden of disease of COVID-19, particularly because mapping of long COVID to existing disability weights is hampered.


Introduction:
An increasing number of individuals continue reporting symptoms following the acute stage of Covid-19 infection. Few studies have investigated the factors related to Long Covid. Our aim was to assess how multimorbidity, socioeconomic factors (immigration, education, employment, and income), and country of residence affect the presence and number of persistent symptoms attributable to Covid-19 illness in Europe.

Methods:
We used data from the SHARE Corona surveys collected in 2020 and 2021. The sample included 4,004 respondents aged 50 years and older who were affected by the Corona virus. The outcome was the number of persistent symptoms attributable to Covid-19 illness, including: fatigue; cough, congestion, shortness of breath; loss of taste or smell; headache; body aches, joint pain; chest or abdominal pain; diarrhoea, nausea; and confusion. We conducted a multilevel analysis for a hurdle model with negative binomial distribution.

Results:
Overall, 73% of respondents were estimated to have at least one persistent symptom associated with Covid-19 illness and, on average, they had 2.73 symptoms. However, there were some statistically significant across country differences in the presence and number of symptoms. Respondents who were employed were more likely to report at least one symptom (OR = 1.40) and those with higher levels of education were less likely to report any symptoms (OR = 0.67). Respondents with multimorbidity had an increased risk of experiencing an additional symptom (RR = 1.12) while respondents who were employed had a decreased risk of experiencing an additional symptom (RR = 0.85).

Discussion and conclusions:
Presence and number of persistent symptoms associated with Covid-19 illness was highly prevalent and varied significantly across European countries. Evidence from the present work underscores the need to target high-risk groups and those with multimorbidity to reduce long-term health consequences of Covid-19.

Introduction:
After COVID-19, many people continue to experience various symptoms for several weeks, even after a mild acute phase, and encounter difficulties when confronted with the healthcare system. Patient associations asked the Belgian Health Care Knowledge Centre to investigate the needs of these patients to improve their management. Purpose of research: An online quantitative survey was conducted in 2021 among Belgian patients with history of COVID-19; having/had persisting symptoms for at least 4 weeks. Alongside questions on symptoms, treatment and impact on employment, Health-Related Quality of Life (HRQoL) before and after COVID-19 was measured through the EQ-5D-5L. A regression analysis identified the factors associated with the impact of long COVID on HRQoL. The qualitative approach consisted in 33 interviews and forum discussions among 101 patients. Results: 1320 patients completed the online survey, most were symptomatic for more than 3 months. The average EQ-5D-5L index score was 0.85(95%CI:0.83-0.86) before and 0.65(95%CI:0.63-0.66) after infection. Duration, number and type of symptoms of long COVID significantly impacted HRQoL. More than half of the patients were unable to work. Qualitative part identified lack of empathy of health professionals, of systematic diagnostic approach, of interdisciplinary coordination. Patients felt misunderstood and developed their own diagnostic or treatment strategies. They questioned the value of medicine and resorted to non-reimbursed alternative therapies.

Conclusions:
Long COVID has a significant impact on HRQoL and employment. Because of long COVID, patients were confronted, sometimes for the first time, with the imperfections of the health system. Better informing the health professionals on Long COVID patterns and management options, including reimbursement possibilities, and a comprehensive interdisciplinary assessment would give them the tools to respond to the needs of these patients.

Introduction:
Previous studies indicated that a significant share of COVID-19 patients experiences long lasting health complaints; a condition also referred to as ''long COVID''. In order to assess the long term burden of disease of COVID-19, including long COVID, information is needed on health symptoms, healthrelated quality of life and duration of symptoms of long COVID patients. Therefore, the aim of this study was to assess health symptoms and health-related quality of life of long COVID in the general population of the Netherlands.

Methods:
A total of 33,903 COVID-19 patients from the region South-Holland South (the Netherlands) whom tested positive between June 2020 and May 2021 at the municipal health services were invited to complete a web-based questionnaire on the presence, nature and consequences of long COVID and health-related quality of life, measured with the EQ-5D-5L.

Results:
In total, 3,768 participants who completed the questionnaire experienced long COVID. Most commonly reporting symptoms were reduced physical condition (65.5%), fatigue (59.6%), problems concentrating (49.6%), loss of smell 15th European Public Health Conference 2022 iii59 (41.2%) and shortness of breath (37.8%). 648 participants indicated that they experienced long COVID symptoms for 5 months or longer. Preliminary analysis showed that increasing number of symptoms was associated with a decrease in healthrelated quality of life. Discussion and conclusions: Long COVID covers a range of health symptoms of varying severity and duration. This complicates the calculation of the non-fatal burden of disease of COVID-19, particularly because mapping of long COVID to existing disability weights is hampered.
Abstract citation ID: ckac129.140 Long COVID and NCDs: the Elephant in the Room Iveta Nagyova I Nagyova 1,2 1 Faculty of Medicine, Department of Social and Behavioural Medicine, PJ Safarik University, Kosice, Slovakia 2 EUPHA Contact: iveta.nagyova@upjs.sk Issue/problem: COVID-19 has now emerged as a public health concern that not only disrupted healthcare services of people living with non-communicable diseases (NCDs) but likely also increase the burden of NCDs. Description of the problem: Before the pandemic, SDG target 3.4, which calls for a reduction in premature mortality from NCDs by one third by 2030, was expected to be achieved by 17.5% of countries, and a further of 23% could achieve the target with a slight acceleration in decline. Currently, most countries are off track due to disruption of healthcare services for people with NCDs, overstretched health systems, and fewer resources than before the pandemic. In addition, only around one in four people who had COVID-19 reported feeling fully recovered within a year of being discharged from hospital. The adverse health effects from long COVID range from 'invisible symptoms' such as fatigue and difficulty concentrating, to neurological and neuropsychiatric symptoms, respiratory and cardiovascular problems, and metabolic disease.

Results:
The COVID-19 pandemic has shown that siloed programmes are increasingly unfit, and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Cost-effective, feasible, and relevant interventions that target both physical and mental health impairments are urgently required. Lessons: By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Protecting current investments and scaling up cost-effective public health interventions is especially crucial in the context of long haul COVID and NCDs. Policy makers and planners will need concrete guidance for making progress on SDG target 3.4, often with overburdened health systems and scarcer resources.

3.E. Workshop: Is (Planetary) health a priority in international deals?
Abstract citation ID: ckac129.141 Organised by: EUPHA-ENV Chair persons: Marija Jevtic (EUPHA-ENV), Vlatka Matkovic (Belgium) Contact: marija.jevtic@uns.ac.rs This workshop is dedicated to different types of deals/ arrangements relating environmental health to planetary health, healthy energy, arrangements linking science to actions, and statement given by experts to recognise health in ambitious initiatives toward zero pollution. By presentations about planetary health education, it will underline the role of training as a cornerstone for international sustainable public health deals. The Lancet Public Health underlines: ''No public health without planetary health'', the future health of the planet and human health are inextricably linked. Planetary health should be part of all global, national but also regional and local deals to improve sustainability worldwide. Further research and applications of the public health (PH) Education Framework are needed in order to increase evidence and awareness in PH and strengthen PH collaboration in Europe and beyond. Workshop will also discuss the European response and transformation towards healthy energy, as a part of many agreements/deals, especially European Green Deal. Science and the accelerating scale of environmental degradation tells us we have to be more ambitious and strive to zero pollution. Health-based approach can be the overarching principle to deliver on these ambitions. For a healthy planet for healthy people we need to have more determined action plans that will deliver on zero pollution and have a sound healthbased approach. To achieve better public health, false solutions to the current energy, unsustainable and polluting energy crisis, is to go ambitiously for zero-pollution solutions. Looking for a strong argument for Clean air deals, the researchers will present their preliminary results of costs of air pollution impact on health in the Western Balkans (WB). It is well documented that poor air quality is responsible for increased risk of mortality and morbidity. The WB region was selected for this study because it is one of the air pollution hotspots in Europe where the levels of PM2.5, PM10, NO2 and O3 are frequently above the EU Air Quality Directive guidelines. Air pollution impact on health has a relatively higher economic burden in the WB compared to EU27 due to both the higher pollution levels and the lower per capita GDP. The external costs of air pollution is a strong argument to consider health as a priority in every policy area at national level as well as international agreements. Furthermore workshop will also present an initiative regarding health experts' voice for Healthier Choice -a call for Zero Air Pollution in the WB. Health experts in the WB have joined forces to highlight the importance of air quality actions and achieving zero air pollution as a prevention intervention for public health. Health experts highlight that in Green Agenda for the WB the most needed are clear goals of achieving zero pollution and a timeline in the near future.

Key messages:
Planetary health should be part of all global, national but also regional and local deals to improve sustainability worldwide. The external costs of air pollution is a strong argument to consider health as a priority in every policy area at national level as well as international agreements.