生物与医学2021journals.plos.org
新冠后遗症的疾病负担及其对医疗规划的影响
Burden of post-Covid-19 syndrome and implications for healthcare planning
入门 · 约 30 分钟读完前置知识：流行病学基础概念、Long Covid 背景
导读
这篇发表于 PLOS ONE 的研究调查了新冠感染后综合征（Long Covid）的负担及其对医疗资源规划的影响。研究通过问卷随访曾感染新冠的人群，统计疲劳、抑郁、睡眠障碍等长期症状的发生情况。作者也承认研究缺乏感染前的基线健康评估和未感染对照组，难以完全区分新冠本身与疫情大环境带来的心理影响。
HN 关注点：Long Covid 的真实严重程度和统计方法是否可靠是 HN 读者争论的焦点，不少人有亲身经历或对研究设计提出质疑。
HN 评论精选
这几条评论里：质疑 2 补充 1 亲历 1
亲历亲历者证实 Long Covid 症状严重但 17 个月来缓慢好转
我就是患者之一。症状是突然没力气、偶尔突然不会拼写，轻微运动就瘫倒（我之前身体相当好）。17 个月过去了还没恢复到从前，但按趋势看确实在好转：低谷没那么低了，脑雾在消散，精力慢慢回升，糟糕的日子越来越少。感染最严重时我差点叫救护车，那是最糟的时刻，之后就好转了。我总在想如果早点吸氧是否能避免一些损伤。
jacquesm查看英文原文
One of those cases here. Symptoms: suddenly out of energy, occasionally suddenly being unable to spell, even mild physical exercise leaves me floored (and I was pretty fit for my age prior to this). So, 17 months in: it's still not back to where it used to be but if you think of it in terms of trends instead of absolutes it is definitely still improving. The downs are less far down, the fog is lifting and the energy levels are creeping back up. But still, you can have down days every now and then. But they are getting fewer and further between and the downs are less far down. I hope to get it completely behind me one of these days. When I had COVID I was just one small step away from calling for an ambulance but that was rock bottom, after that it got better and I will always wonder if I had called them earlier if I could have avoided the worst of this (by having some oxygen earlier on and maybe avoiding some of the damage). But I figured other people had it much worse than I did (and I still believe that was the case). March last year was a pretty crazy time.
补充病毒感染后长期症状并非新冠独有，医生本不该惊讶
2018 年我女儿出生时我得了一次呼吸道感染，拖了三个月才就医。医生说病毒性呼吸道感染可以持续好几个月，没什么办法，只能等。咳嗽大约一年后才完全消失。我的疑问是：为什么 2019 年初医生就告诉我病毒感染可能持续数月，而现在医生却对新冠可能有同样情况感到惊讶？
iammisc查看英文原文
When my first daughter was born in 2018, I had a respiratory infection. It lasted three months before I went in to the doctor. I hesitated to seek medical advice because it was clearly viral. But the cough was so bad it was causing the newborn to wake up. The doctor (at a walk-in clinic) told me viral respiratory infections can last months and there's nothing you can do. Just wait. HE gave me some pills to stop the cough since it was interfering with my life. That was it. It was about one year later that the cough finally dissipated. It got better after about 5 months, but it took many more months for all symptoms to go away. I guess my question is... why did my doctor tell me that viral respiratory diseases can last for many months in early 2019, when according to what I gather here, doctors are surprised that COVID may do the same?
质疑研究缺乏基线和对照组，结论难以解读
论文自己承认：没有感染前的基线健康评估，无法区分新冠的影响和既有疾病；对抑郁和焦虑的解读还受疫情本身心理负担的限制，也缺乏可比的普通人群数据。没有对照或基线，很难说这个结果到底意味着什么。
Miner49er查看英文原文
> Third, we did not have a baseline (pre-COVID-19) assessment of participants’ physical and mental health. Thus, it is impossible to distinguish the effects of COVID-19 from pre-existing conditions. The interpretation of our findings regarding depression and anxiety is further limited by the psychological burden that the pandemic may impose in general [48, 49]. While we tried to compare our results with estimates from the general population, applicable comparison data was not available. Other studies investigating longer-term sequelae after SARS-CoV-2 infection found a relevant excess risk for longer-term symptoms among infected individuals compared to SARS-CoV-2-negative control groups [9, 50]. Kind of hard to tell what this result means without a control or baseline, IMO.
质疑批评研究方法粗糙，症状自报无法证明因果
总结一下这项研究：他们只是问了几百个曾感染新冠的人最近是否感到疲劳、抑郁、睡眠不好等，然后报告说不少人回答是。仅此而已。没有医学评估确认症状是否真有病理原因，也没有和未感染人群的随机对照样本比较。他们只是问了一群刚经历一年多封锁的人累不累、抑郁不抑郁。
Grim-444查看英文原文
So, to summarize this study, they basically just asked a few hundred people that had Covid in the past if they had recently felt tired, depressed, had trouble sleeping, etc., and then reported that a number of the people they asked this replied yes. That's it. There was no medical evaluation of whether the reported symptoms even had a medical cause. There was no comparison to the answers a random control sampling of the population that hadn't gotten Covid would have given. They just asked a bunch of people that had just finished living through 1+ years of lockdown if they had been tired or depressed recently.
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