Aims and Objectives: To determine the frequency, timing, and duration of post‐acute sequelae of SARS‐CoV‐2 infection (PASC) and their impact on health and function.Background: Post‐acute sequelae of SARS‐CoV‐2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised.Design: Descriptive cross‐sectional survey (n = 5163) was conducted from online COVID‐19 survivor support groups who reported symptoms for more than 21 days following SARS‐CoV‐2 infection.Methods: Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom‐specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data.Results: Participants reported experiencing a mean of 21 symptoms (range 1–93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise (M = 106.5 days), fatigue (M = 101.7 days) and difficulty concentrating, associated with memory impairment (M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and “brain pressure” among the most distressing and impacting daily life.Conclusions: Post‐acute sequelae of SARS‐CoV‐2 infection can be characterised by a wide range of symptoms, many of which cause moderate‐to‐severe distress and can hinder survivors' overall well‐being.Relevance to Clinical Practice: This study advances our understanding of the symptoms of PASC and their health impacts.

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

IMPORTANCE: Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) is a major public health concern. Studies suggest that 1 in 3 infected with SARS-CoV-2 may develop PASC, including those without initial symptoms or with mild COVID-19 disease. ^{1, 2} OBJECTIVE: To evaluate the timing, duration, and health impacts of PASC reported by a large group of primarily non-hospitalized COVID-19 survivors. DESIGN, SETTING, AND PARTICIPANTS: A survey of 5,163 COVID-19 survivors reporting symptoms for more than 21 days following SARS-CoV-2 infection. Participants were recruited from Survivor Corps and other online COVID-19 survivor support groups. MAIN OUTCOMES AND MEASURES: Participants reported demographic information, as well as the timing, duration, health impacts, and other attributes of PASC. The temporal distribution of symptoms, including average time of onset and duration of symptoms were determined, as well as the perceived distress and impact on ability to work. RESULTS: On average, participants reported 21.4 symptoms and the number of symptoms ranged from 1 to 93. The most common symptoms were fatigue (79.0%), headache (55.3%), shortness of breath (55.3%), difficulty concentrating (53.6%), cough (49.0%), changed sense of taste (44.9%), diarrhea (43.9%), and muscle or body aches (43.5%). The timing of symptom onset varied and was best described as happening in waves. The longest lasting symptoms on average for all participants (in days) were “frequently changing” symptoms (112.0), inability to exercise (106.5), fatigue (101.7), difficulty concentrating (101.1), memory problems (100.8), sadness (99.2), hormone imbalance (99.1), and shortness of breath (96.9). The symptoms that affected ability to work included the relapsing/remitting nature of illness (described by survivors as “changing symptoms”), inability to concentrate, fatigue, and memory problems, among others. Symptoms causing the greatest level of distress (on scale of 1 “none” to 5 “a great deal”) were extreme pressure at the base of the head (4.4), syncope (4.3), sharp or sudden chest pain (4.2), brain pressure (4.2), headache (4.2), persistent chest pain or pressure (4.1), and bone pain in extremities (4.1). CONCLUSIONS AND RELEVANCE: PASC is an emerging public health priority characterized by a wide range of changing symptoms, which hinder survivors’ ability to work. PASC has not been fully characterized and the trajectory of symptoms and long-term outcomes are unknown. There is no treatment for PASC, and survivors report distress in addition to a host of ongoing symptoms. Capturing patient reports of symptoms through open-ended inquiry is a critical first step in accurately and comprehensively characterizing PASC to ensure that medical treatments and management strategies best meet the needs of individual patients and help mitigate health impacts of this new disease.

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BACKGROUND Gaps exist between type 2 diabetes (T2D) clinical guideline recommendations for the use of cardioprotective glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and their observed real-world utilization and persistence. This discrepancy may be partly attributed to differences between patient and clinical mental models for risks and benefits of GLP-1RAs and SGLT-2is. OBJECTIVE We aimed to evaluate patient-reported perceptions of GLP-1RAs and SGLT-2is by analyzing health narratives collected from publicly available social media data and assess for differences between patient-defined and clinically-defined risks and benefits as approximations of mental models. METHODS We extracted all health narratives mentioning cardioprotective GLP-1RAs and SGLT-2is from posts (N=250) in public T2D Facebook groups (N=14) from January 1, 2019 to November 20, 2021. We used open coding to categorize all mentions of risks and benefits of these drugs as defined by the 2021 American Diabetes Association Standards of Care (SOC) to represent the clinically-defined perspective. We coded risks and benefits not explicitly mentioned in the SOC, but described in the health narratives, to represent the patient-defined perspective. RESULTS Of posts containing narratives, 70.8% referenced GLP-1RAs and 29.2% referenced SGLT-2is. Overall, 43.6% of posts mentioned 41 risks and 6 benefits not discussed in the SOC, such as difficulty eating, positive and negative emotions, general side effects, injection pen experiences, and diabetes remission. A total of 19 SOC-defined features were reported. Patient-defined mental models often focused on near-term concerns, such as daily quality of life, glucose control, or side effect management. In contrast, posts mapping to SOC-defined mental models emphasized disease management endpoints, like glucose and weight benefits. Posts rarely (<2.5%) mentioned cardiovascular or renal benefits. GLP-1RA discussion was distributed evenly through reports of both effective and ineffective glucose lowering, weight loss, and side effects like difficulty eating, nausea, vomiting, and diarrhea. Discussion of SGLT-2is tended to emphasize effective glucose lowering, with additional attention to high cost, ketoacidosis, and weight loss. CONCLUSIONS People with T2D express a range of concerns and perceptions regarding the risks and benefits of GLP-1RAs and SGLT-2is. Many represent nearer-term and more precise, individual-level concerns than what is represented in clinical guidelines. While cardiovascular and renal outcomes strongly inform T2D clinical guidelines, these are of lower awareness and priority in patient-defined mental models relative to tangible risks and benefits, indicating gaps between mental models for these medications. There is a need to develop strategies to reduce barriers to GLP-1RA and SGLT-2i utilization, initiation, and persistence that are attuned to patients’ mental models of the perceived risks and benefits of these medications. Understanding and bridging the gap between patient and provider perspectives has implications beyond these drug classes to achieving real-world effectiveness in therapeutic decision-making.