Department of Public Health and Preventive Medicine, St. George's University School of Medicine, True Blue, Grenada, West Indies.
J Clin Epidemiol. 2022 Feb;142:54-59. doi: 10.1016/j.jclinepi.2021.10.018. Epub 2021 Oct 26.
Calculations of disease burden of COVID-19, used to allocate scarce resources, have historically considered only mortality. However, survivors often develop postinfectious 'long-COVID' similar to chronic fatigue syndrome; physical sequelae such as heart damage, or both. This paper quantifies relative contributions of acute case fatality, delayed case fatality, and disability to total morbidity per COVID-19 case.
Healthy life years lost per COVID-19 case were computed as the sum of (incidencedisability weightduration) for death and long-COVID by sex and 10-year age category in three plausible scenarios.
In all models, acute mortality was only a small share of total morbidity. For lifelong moderate symptoms, healthy years lost per COVID-19 case ranged from 0.92 (male in his 30s) to 5.71 (girl under 10) and were 3.5 and 3.6 for the oldest females and males. At higher symptom severities, young people and females bore larger shares of morbidity; if survivors' later mortality increased, morbidity increased most in young people of both sexes.
Under most conditions most COVID-19 morbidity was in survivors. Future research should investigate incidence, risk factors, and clinical course of long-COVID to elucidate total disease burden, and decisionmakers should allocate scarce resources to minimize total morbidity.
用于分配稀缺资源的 COVID-19 疾病负担计算，历史上仅考虑了死亡率。然而，幸存者通常会出现类似于慢性疲劳综合征的感染后“长新冠”；身体后遗症，如心脏损伤，或两者兼有。本文量化了每例 COVID-19 病例的急性病死率、延迟病死率和残疾对总发病率的相对贡献。
每例 COVID-19 病例丧失的健康寿命年数计算为按性别和 10 年年龄组计算的死亡和长新冠的（发病率残疾权重持续时间）的总和，共三种可能的情况。
在所有模型中，急性死亡率只是总发病率的一小部分。对于终身中度症状，每例 COVID-19 病例丧失的健康寿命年数范围为 0.92（30 多岁男性）至 5.71（10 岁以下女孩），年龄最大的女性和男性为 3.5 和 3.6。在更严重的症状严重程度下，年轻人和女性承担更大的发病率份额；如果幸存者的后期死亡率增加，那么发病率在两性年轻人中增加最多。
在大多数情况下，大多数 COVID-19 发病率是在幸存者中。未来的研究应调查长新冠的发病率、风险因素和临床过程，以阐明总疾病负担，决策者应分配稀缺资源以最大程度地减少总发病率。
