Long COVID is more likely for 9/11 responders with chronic disease

"Our findings point toward the need to monitor these chronically ill patients who contracted the infection even more closely," says Benjamin Luft. "They all suffer from various chronic conditions brought on by exposures at the World Trade Center site. This study alerts us to even more problems they may face in the future." (Credit: Spencer Platt/Getty Images)

First responders who have chronic conditions from World Trade Center exposures and the experience of 9/11 are more likely to get long COVID, researchers say.

The study of 1,280 patients treated and monitored at the Stony Brook World Trade Center Health and Wellness Program appears in the International Journal of Environmental Research and Public Health.

Researchers compared patients with World Trade Center (WTC) related chronic disease and those without such conditions. All of the patients tested positive for COVID-19. The study participants had a wide range of symptoms or had no symptoms from the infection. They were categorized as having moderate (n=536), mild (511), or severe symptoms (104), or asymptomatic (129).

The researchers found that responders with chronic diseases have more infection severity and long-term sequelae than responders who do not have chronic diseases resulting from WTC exposures.

“Our findings point toward the need to monitor these chronically ill patients who contracted the infection even more closely,” says lead author Benjamin Luft, director of the Stony Brook WTC Health and Wellness Program.

“They all suffer from various chronic conditions brought on by exposures at the World Trade Center site. This study alerts us to even more problems they may face in the future.”

The researchers found that a number of existing chronic conditions appeared to predispose the patients to COVID-19-related severity, and/or were associated with long-term COVID sequelae.

For example, they reported that among those with severe infections, 60% had previously diagnosed upper respiratory disease, 49% with gastroesophageal reflux disease (GERD), 35% have obstructive airway disease, and 20% have concomitant psychiatric disease.

It’s of note that researchers used self-reported severity scales to measure patients determined to have significant COVID-19 sequelae.

After an analysis of the data from each of the participant groups, the researchers determined that COVID-19 severity was independently associated with age (older with more severity), Black race, obstructive airway disease, and with worse self-reported depressive symptoms.

Luft and colleagues point out that why some individuals have more severe COVID-19 is unclear in any population and is not fully understood. The same can be said for this population, as scientists continue to explore the full reasons why some people develop severe infection and others do not.

The authors further write that in their patient cohort “COVID-19 disease severity was the strongest and the only factor significantly and consistently associated with the main post-acute COVID-19 sequelae outcome, as well as symptom-specific categories of post-acute COVID-19 sequelae.

“Taken together, the results contribute new evidence that both pre-existing respiratory and mental health conditions constitute risk factors for more severe COVID-19 symptoms, which in turn can put patients at a higher risk for long-term health sequela,” they write.

“Long-COVID was very common especially in those individuals with chronic conditions with more severe infection symptoms. In fact, 57% of WTC responders with symptoms severe enough to cause hospitalization had persistent COVID symptoms,” says coauthor Sean Clouston, associate professor in the department of family, population and preventive medicine at the Renaissance School of Medicine and Program in Public Health.

“With re-infections on the rise, it is incredibly important that we continue to monitor the impact of COVID on these responders and that we consider the possibility that these COVID infections have already left a lasting imprint on this group and much of the public’s health,” he emphasizes.

This patient population will be monitored closely as society moves further out from the COVID-19 pandemicā€”essentially to determine whether post-COVID-related health issues continue or increases more with this group compared to the program’s other WTC responder patients.

“We are doing further studies to see if the reason for persistent symptoms connected with the infection is due to continued inflammation in the brain and lungs,” adds Luft, citing one example of their follow-up clinical research of this particular responder population.

The National Institute of Occupational Safety & Health funded the work.

Source: Stony Brook University