Incidence of Post-Covid Syndrome and Associated Symptoms in Outpatient Care in Bavaria, Germany

  1. Ewan Donnachie
  2. Alexander Hapfelmeier
  3. Klaus Linde
  4. Martin Tauscher
  5. Roman Gerlach
  6. Anna Greißel
  7. Antonius Schneider

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Abstract

Objectives

To estimate the treatment incidence of Post-Covid Syndrome in the context of office-based care in Bavaria, Germany, and to establish whether related diagnoses occur more frequently than in patients with no known history of COVID-19.

Design

Retrospective analysis of routinely collected claims data.

Setting

Office-based care in Bavaria, Germany.

Participants

391,990 patients with confirmed COVID-19 diagnosis, 62,659 patients with other respiratory infection, and a control group of 659,579 patients with no confirmed or suspected diagnosis COVID-19.

Primary and Secondary Outcome Measures

Primary outcome is diagnosis of a Post-COVID Syndrome by an office-based physician. Secondary outcomes are: Chronic Fatigue Syndrome (CFS), psychological disorder, fatigue, mild cognitive impairment, disturbances of taste and smell, dyspnea, pulmonary embolism and myalgia.

Results

Among all patients with confirmed COVID-19 infection, 14.2% (95% CI: 14.0-14.5) received a diagnosis of a Post-COVID Syndrome, and 6.7% (6.5-6.9) received the diagnosis in at least two quarterly periods during a two-year follow-up. Compared with patients with other respiratory infections and with controls, patients with COVID-19 more frequently received a variety of diagnoses including CFS (1.6% vs. 0.6% and 0.3%, respectively), fatigue (13.3% vs. 9.2% and 6.0%), dyspnea (9.9% vs. 5.1% and 3.2%) and disturbances of taste and smell (3.2% vs. 1.2% and 0.5%). The treatment incidence of Post-COVID Syndrome was highest among adults aged 40-59 (19.0%) and lowest among children aged below 12 years (2.6%).

Conclusions

Our results demonstrate a moderately high incidence of Post-COVID Syndrome two years after infection with COVID-19. There is an urgent need to find efficient and effective solutions to help patients with mental disorders, dyspnea, fatigue and loss of smell. Guidelines and treatment algorithms, including referral criteria, occupational and physical therapy, require promptly and coherent implementation. Further research is required both to find new therapeutic options and to assess the implications of Post-COVID Syndrome for health services.

Strengths and Limitations of the Study

  • The data cover all statutory health insurance companies in Bavaria and have high generalisability to the general population.

  • By considering the proportion of COVID-19 patients consulting a physician, our results are better able to differentiate between everyday complaints and medically significant illness than data from a self-reported questionnaire.

  • Follow-up of up to two years enables first assessment of the proportion requiring continuous care for a Post-COVID Syndrome.

  • The routinely collected data are not audited and contain little information regarding the severity of the symptoms.

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  1. ScreenIT

    SciScore for 10.1101/2022.05.29.22275262: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The use of secondary claims data brings both strengths and limitations that must be considered when interpreting our results. A major strength is the coverage of 85% of the Bavarian population, allowing the formation of a large and representative cohort with comparable control groups over a period of up to two years post-infection. However, the data are collected for billing purposes and are not subject to systematic audit. They are influenced by the treatment provided and the coding practices of the physician. A large proportion of patients with physician contact related COVID-19 have no record of a test result, and it is possible that those with confirmation of the test result had more severe symptoms during the acute infection that required treatment. This impacts somewhat on the generalisability of the results. Our results show however that the newly-introduced code for Post-COVID Syndrome has been used extensively by GPs and office-based physicians, with incidence in the expected range. In contrast, a study by the OpenSAFELY group found that the corresponding SNOMED-CT codes were used rarely by GPs in England [23]. A further strength of the use of routinely collected data is the ability to differentiate between pre-existing and new-onset conditions. This is especially important because some symptoms of Post-COVID Syndrome are common in the general population and may be mistaken for a post-infectious sequalae of COVID-19. However, the deterioration of a previously existin...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.05.29.22275262v1 on medRxiv