Abstract
Context:
Patients recovering from coronavirus disease 2019 (COVID-19) infection continue to have some persistent symptoms or develop new symptoms, resulting in impairment of everyday activities beyond the initial acute period. The current study was undertaken to understand the long term health implications of covid 19 and to analyse the correlation of post covid symptoms with the severity of infection and inflammatory markers at the time of hospitalisation.
Aims:
(1) To estimate the prevalence of post covid symptoms at the end of 1 month,3 months and 12 months after discharge, (2) To correlate post covid symptoms with the severity of infection and inflammatory markers at the time of hospitalisation.
Settings and Design:
The study design was a cross-sectional study.
Subjects and Methods:
A prospective observational study was done on 150 COVID-19 reverse transcription-polymerase chain reaction-positive patients aged 18 years and above recovering from acute infection discharged from Vydehi Institute of Medical Sciences and Research Centre. All the patients were followed up for 1 year, during which telephonic interviews were conducted, and a systematic enquiry was made regarding post-COVID-19 symptoms.
Statistical Analysis Used:
Data were entered in MS Excel and analyzed in SPSS V25. Descriptive statistics are represented with percentages, mean with standard deviation, or median with interquartile range depending on the nature of the data. The Kolmogorov–Smirnov test was applied to find normality. The Chi-square test, Independent t-test, or Mann–Whitney U-test were calculated depending on normality; P < 0.05 was considered statistically significant.
Results:
A total of 150 COVID-19-positive patients discharged from the hospital were included in the study. Sixty-seven percent of patients had symptoms at 1 month, 39% at 3 months, and 31% of patients persisted to have symptoms at 1 year. The most common symptoms at 1 year were fatigue (5%), breathlessness (5%), and insomnia (5%). No statistically significant correlation was found with the severity of infection, inflammatory markers, and other variables.
Conclusions:
Approximately one-third of patients who recover from acute COVID-19 infection may continue to have post-COVID-19 symptoms at 1 year after infection. Fatigue is the most common post-COVID-19 symptom. Post-COVID-19 symptoms can affect COVID-19 survivors regardless of the severity of the infection.
Keywords: Coronavirus disease 2019 infection, long coronavirus disease 2019 syndrome, post-coronavirus disease 2019 syndrome
Résumé
Contexte:
Les patients qui se remettent d’une infection à la maladie à coronavirus 2019 (COVID-19) continuent de présenter certains symptômes persistants ou développent de nouveaux symptômes, entraînant une altération des activités quotidiennes au-delà de la période aiguë initiale. L’étude actuelle a été entreprise pour comprendre les implications à long terme sur la santé du covid 19 et pour analyser la corrélation des symptômes post-covid avec la gravité de l’infection et les marqueurs inflammatoires au moment de l’hospitalisation.
Objectifs:
(1) Estimer la prévalence des symptômes post-covid au bout d’un mois, 3 mois et 12 mois après la sortie, (2) Corréler les symptômes post-covid avec la gravité de l’infection et les marqueurs inflammatoires au moment de l’hospitalisation.
Paramètres et conception:
La conception de l’étude était une étude transversale.
Sujets et méthodes:
Une étude observationnelle prospective a été réalisée sur 150 patients positifs à la réaction en chaîne par polymérase par transcription inverse au COVID-19, âgés de 18 ans et plus, en convalescence d’une infection aiguë, sortis de l’Institut des sciences médicales et du centre de recherche de Vydehi. Tous les patients ont été suivis pendant 1 an, au cours duquel des entretiens téléphoniques ont été menés et une enquête systématique a été réalisée sur les symptômes post-COVID-19.
Analyse statistique utilisée:
Les données ont été saisies dans MS Excel et analysées dans SPSS V25. Les statistiques descriptives sont représentées par des pourcentages, une moyenne avec un écart type ou une médiane avec un intervalle interquartile selon la nature des données. Le test de Kolmogorov-Smirnov a été appliqué pour rechercher la normalité. Le test du chi carré, le test t indépendant ou le test U de Mann – Whitney ont été calculés en fonction de la normalité; P <0,05 était considéré comme statistiquement significatif.
Résultats:
Au total, 150 patients positifs au COVID-19 sortis de l’hôpital ont été inclus dans l’étude. Soixante-sept pour cent des patients présentaient des symptômes à 1 mois, 39 % à 3 mois et 31 % des patients persistaient à avoir des symptômes à 1 an. Les symptômes les plus courants à 1 an étaient la fatigue (5 %), l’essoufflement (5 %) et l’insomnie.
Mots-clés: Long covid syndrome, post covid syndrome
INTRODUCTION
A significant number of patients recovering from coronavirus disease 2019 (COVID-19) infection continue to have some persistent symptoms or develop new symptoms, resulting in impairment of everyday activities beyond the initial acute period. The terms “long COVID-19 syndrome and “postacute COVID-19 syndrome” cover a range of features indicative of the involvement of many organs affecting people weeks and months after infection. Common reported features include fatigue, breathlessness, headache, chest pain, myalgia, fatigue, cognitive difficulties, as well as anxiety and depression.[1] The current study was undertaken to estimate the prevalence of post-COVID-19 symptoms at the end of 1 month, 3 months, and 12 months after acute COVID-19 infection and to correlate the occurrence of these symptoms with the severity of infection and inflammatory markers at the time of hospitalization.
Aims and objectives
To estimate the prevalence of post-COVID-19 symptoms at the end of 1 month, 3 months, and 12 months after discharge
To correlate post-COVID-19 symptoms with the severity of infection and inflammatory markers at the time of hospitalization.
SUBJECTS AND METHODS
A prospective study was done on 150 COVID-19 reverse transcription-polymerase chain reaction-positive patients aged 18 years and above recovering from acute infection and discharged from the hospital. All the patients were followed up for 1 year. Informed consent was taken from all the patients. Telephonic interview was conducted at 1 month, 3 months, and 1 year postdischarge, during which a systematic enquiry was done regarding the persistence of post-COVID-19 symptoms, recurrence of symptoms, or onset of new symptoms postdischarge. Post-COVID-19 manifestations were correlated with comorbidities, severity of COVID-19 infection, and inflammatory markers. The study was approved by the institutional ethics committee.
Statistical analysis
Data were entered in MS Excel and analyzed in SPSS V25 (IBM Corp. IBM SPSS statistics for windows, version 25.0. Armonk, NY:IBM Corp; 2018). Descriptive statistics are represented with percentages, mean with standard deviation, or median with interquartile range depending on the nature of the data. The Kolmogorov–Smirnov test was applied to find normality. The Chi-square test, Independent t-test, or Mann–Whitney U-test were calculated depending on normality; P < 0.05 was considered statistically significant.
RESULTS
A total of 150 COVID-19-positive patients discharged from the hospital were included in the study. The mean age of the patients was 46.62 ± 14.5 years. About 48.6% of patients were males. The severity of infection was mild in 30%, moderate in 60%, and severe in 10%. The mean duration of stay in hospital was 8.14 days. The mean neutrophil-to-lymphocyte ratio was 5.59 ± 5.3, mean C-reactive protein was 5.13 ± 6.4, mean D dimer was 369.3 ± 379.34, mean ferritin was 313.99 ± 338.75, and mean lactate dehydrogenase was 267.62 ± 134.57 [Table 1].
Table 1.
Baseline characteristics of study patients
| Characteristics | Observed Values |
|---|---|
| Age (mean) | 46.62±14.5 |
| Sex (%) | |
| Males | 48.6 |
| Females | 51.4 |
| Number of symptoms at presentation | 2.39±1.02 |
| Severity of infection (%) | |
| Mild infection | 30 |
| Moderate infection | 60 |
| Severe infection | 10 |
| Days of hospital stay | 8.14±4.03 |
| Comorbidities (%) | |
| Diabetes mellitus | 28 |
| Hypertension | 17 |
| IHD | 4 |
| Asthma | 3 |
| CKD | 0.6 |
| Other comorbidities | 9 |
| Blood reports (mean) | |
| Total count | 7.02±3.35 |
| Neutrophil count (%) | 68.5±16.3 |
| Lymphocyte count (%) | 21.4±12.05 |
| NLR | 5.59±5.3 |
| CRP | 5.13±6.4 |
| D-dimer | 369.3±379.34 |
| Ferritin | 313.99±338.75 |
| LDH | 267.62±134.57 |
| Treatment given in hospital (%) | |
| Remdesivir | 70.6 |
| Steroids | 84 |
| Enoxaparin | 78.6 |
| Discharge advice (%) | |
| Steroids | 58.6 |
| Apixaban | 74.6 |
LDH=Lactate dehydrogenase, CRP=C-reactive protein, NLR=Neutrophil-to-lymphocyte ratio, CKD=Chronic kidney disease, IHD=Ischemic heart disease
About 67% of individuals had symptoms at the end of 1 month, 39% at 3 months, and 31% of patients persisted to have symptoms at 1 year [Table 2]. The most common symptom at 1 month was fatigue (40 [26.6%]). Other common reported symptoms at 1 month were insomnia (18 [12%]), joint pain (5 [10]), breathlessness (11 [7.3%]), anxiety (10 [6.6%]), and myalgia (8 [5.3%]) [Table 3]. A statistically significant correlation of post-COVID-19 symptoms at 1 month was found with the presence of anosmia and ageusia. No statistically significant correlation was found with the severity of infection, inflammatory markers, and other variables [Table 4].
Table 2.
Post-COVID-19 symptoms
| Prevalence of Post covid Symptoms | Frequency (%) |
|---|---|
| 1st month | 67 (44.7) |
| 3rd month | 39 (26.0) |
| 1 year | 31 (20.7) |
Table 3.
Post-COVID-19 symptoms at 1 month, 3 months, and 1 year
| 1 month, n (%) | 3 months, n (%) | 1 year, n (%) | |
|---|---|---|---|
| Symptom-free | 83 (53.3) | 108 (72) | 119 (79.3) |
| Fatigue | 40 (26.6) | 19 (12.6) | 8 (5.3) |
| Breathlessness | 11 (7.3) | 9 (6) | 8 (5.3) |
| Cough | 6 (4) | 3 (2) | 0 |
| Anxiety | 10 (6.6) | 5 (10) | 0 |
| Insomnia | 18 (12) | 12 (8) | 8 (5.3) |
| Loss of smell | 2 (1.3) | 0 | 0 |
| Loss of taste | 2 (1.3) | 0 | 0 |
| Headache | 3 (2) | 1 (0.6) | 0 |
| Myalgia | 8 (5.3) | 5 (3.3) | 1 (0.6) |
| Joint pain | 5 (10) | 3 (2) | 0 |
| Hair loss | 8 (5.3) | 11 (7.3) | 4 (2.6) |
| Palpitation | 1 (0.6) | 1 (0.6) | 0 |
| Itching | 1 (0.6) | 1 (0.6) | 0 |
| Weight gain | 2 (1.3) | 0 | 1 (0.6) |
| Short-term memory loss | 1 (0.6) | 1 (0.6) | 2 (1.3) |
| Rashes over the body | 4 (2.6) | 3 (2) | 1 (0.6) |
| Synovitis of elbow | 1 (0.6) | 0 | 0 |
| Acne | 0 | 1 (0.6) | 0 |
| Menstrual irregularities | 0 | 3 (2) | 1 (0.6) |
| Uncontrolled diabetes | 0 | 3 (2) | 1 (0.6) |
| Depression | 0 | 1 (0.6) | 0 |
| Dry eyes | 0 | 0 | 0 |
Table 4.
Correlation of post-COVID-19 symptoms at 1 month and 1 year with the severity of infection and other parameters
| Variable | Condition | Symptoms 1 month, count (%) |
P | Symptoms 1 year, count (%) |
P | ||
|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | ||||
| Sex | Male | 28 (38.4) | 45 (61.6) | 0.14 | 9 (12.3) | 64 (87.7) | 0.02 |
| Female | 39 (50.6) | 38 (49.4) | 22 (28.6) | 55 (71.4) | |||
| Symptoms at presentation | |||||||
| Fever | Present | 52 (45.2) | 63 (54.8) | 0.85 | 22 (19.1) | 93 (80.9) | 0.48 |
| Cough | Present | 49 (45.8) | 58 (54.2) | 0.72 | 21 (19.6) | 86 (80.4) | 0.66 |
| Breathlessness | Present | 22 (53.7) | 19 (46.3) | 0.2 | 8 (19.5) | 33 (80.5) | 1 |
| Anosmia | Present | 9 (75.0) | 3 (25.0) | 0.035 | 3 (25.0) | 9 (75.0) | 0.71 |
| Ageusia | Present | 6 (85.7) | 1 (14.3) | 0.045 | 2 (28.6) | 5 (71.4) | 0.63 |
| Fatigue | Present | 0 | 7 (100.0) | 0.02 | 0 | 7 (100.0) | 0.35 |
| Myalgia | Present | 9 (56.3) | 7 (43.8) | 0.43 | 2 (12.5) | 14 (87.5) | 0.53 |
| Other symptoms | Present | 21 (51.2) | 20 (48.8) | 0.46 | 6 (14.6) | 35 (85.4) | 0.36 |
| Comorbidities | |||||||
| Diabetes | Present | 20 (47.6) | 22 (52.4) | 0.72 | 9 (21.4) | 33 (78.6) | 1 |
| Hypertension | Present | 12 (48.0) | 13 (52.0) | 0.83 | 2 (8.0) | 23 (92.0) | 0.11 |
| IHD | Present | 3 (50.0) | 3 (50.0) | 1 | 1 (16.7) | 5 (83.3) | 1 |
| Asthma | Present | 4 (80.0) | 1 (20.0) | 0.17 | 1 (20.0) | 4 (80.0) | 1 |
| CKD | Present | 0 | 1 (100.0) | 1 | 0 | 1 (100.0) | 1 |
| Other comorbidities | Present | 5 (35.7) | 9 (64.3) | 0.58 | 2 (14.3) | 12 (85.7) | 0.74 |
| Oxygen requirement | Yes | 47 (47.0) | 53 (53.0) | 0.34 | 19 (19.0) | 81 (81.0) | 0.65 |
| NIV requirement | Yes | 2 (66.7) | 1 (33.3) | 0.59 | 0 | 3 (100.0) | 1 |
| Ventilator requirement | Yes | 1 (100.0) | 0 | 0.45 | 0 | 1 (100.0) | 1 |
| ICU requirement | Yes | 1 (100.0) | 0 | 0.45 | 0 | 1 (100.0) | 1 |
| Severity of infection | Mild | 18 (40.0) | 27 (60.0) | 0.64 | 13 (28.9) | 32 (71.1) | 0.06 |
| Moderate | 43 (47.8) | 47 (52.2) | 18 (20.0) | 72 (80.0) | |||
| Severe | 6 (40.0) | 9 (60.0) | 0 | 15 (100.0) | |||
| Treatment given in hospital | |||||||
| Remdesivir | Given | 45 (42.5) | 61 (57.5) | 0.47 | 17 (16.0) | 89 (84.0) | 0.045 |
| Dexamethasone | Given | 54 (42.9) | 72 (57.1) | 0.49 | 23 (18.3) | 103 (81.7) | 0.09 |
| Enoxaparin | Given | 53 (44.9) | 65 (55.1) | 0.51 | 19 (16.1) | 99 (83.9) | 0.02 |
| Discharge advice | |||||||
| Steroids | Given | 34 (38.6) | 54 (61.4) | 0.13 | 14 (15.9) | 74 (84.1) | 0.1 |
| Apixaban | Given | 45 (40.2) | 67 (59.8) | 0.08 | 20 (17.9) | 92 (82.1) | 0.16 |
|
| |||||||
|
Symptoms at 1 month, mean±SD
|
P |
Symptoms 1 year, mean±SD
|
P | ||||
| Yes | No | Yes | No | ||||
|
| |||||||
| Age | 47.02±14.08 | 46.23±14.59 | 0.742 | 47.06±14.85 | 46.44±14.25 | 0.831 | |
| Day of illness on admission | 5.45±3.15 | 5.19±2.76 | 0.598 | 5.03±3.64 | 5.38±2.73 | 0.560 | |
| Total days of stay in hospital | 7.61±3.85 | 8.67±4.21 | 0.112 | 6.73±3.27 | 8.57±4.18 | 0.027 | |
| Number of symptoms at admission | 2.63±1.14 | 2.16±0.90 | 0.005 | 2.06±0.89 | 2.45±1.06 | 0.069 | |
| HR on admission | 92.52±12.05 | 92.63±13.19 | 0.960 | 94.26±10.28 | 92.14±13.20 | 0.409 | |
| SBP on admission | 118.36±11.26 | 120.42±10.78 | 0.255 | 118.45±11.65 | 119.77±10.87 | 0.553 | |
| DBP on admission | 75.36±7.67 | 76.00±7.29 | 0.601 | 75.23±6.98 | 75.84±7.59 | 0.684 | |
| SpO2 (RA) on admission | 92.82±5.07 | 92.89±4.14 | 0.925 | 93.26±5.59 | 92.76±4.27 | 0.587 | |
| RR on admission | 23.72±5.51 | 23.78±4.93 | 0.938 | 23.48±6.17 | 23.82±4.91 | 0.746 | |
| Hb (g/dL) | 12.81±2.30 | 12.96±2.13 | 0.664 | 12.73±2.45 | 12.94±2.14 | 0.649 | |
| White blood count (103 μL) | 7.06±3.57 | 6.99±3.10 | 0.906 | 6.60±3.38 | 7.13±3.29 | 0.423 | |
| Neutrophils (%) | 68.74±16.30 | 68.55±16.23 | 0.367 | 65.9217.96 | 69.09±18.66 | 0.590 | |
| Lymphocytes (%) | 21.30±12.72 | 21.55±11.86 | 0.904 | 24.65±13.61 | 20.60±11.74 | 0.101 | |
| Eosinophils (%) | 0.64±1.14 | 0.38±0.52 | 0.071 | 0.63±1.14 | 0.46±0.77 | 0.342 | |
| Monocytes (%) | 8.27±3.86 | 7.12±3.50 | 0.060 | 8.47±4.54 | 7.41±3.44 | 0.156 | |
| Basophils (%) | 0.34±0.34 | 0.48±1.13 | 0.326 | 0.56±1.27 | 0.38±0.74 | 0.303 | |
| Platelet count (103 μL) | 242.33±96.63 | 222.07±79.88 | 0.162 | 246.19±96.35 | 227.19±85.73 | 0.286 | |
| ANC (103 μL) | 5.47±3.54 | 5.04±2.70 | 0.403 | 5.28±3.72 | 5.22±2.94 | 0.922 | |
| ALC (103 μL) | 1.23±0.69 | 1.36±0.84 | 0.285 | 1.30±0.71 | 1.30±0.80 | 0.967 | |
| NLR | 6.02±5.33 | 5.53±5.17 | 0.573 | 5.66±5.14 | 5.78±5.27 | 0.907 | |
| Ferritin (ng/mL) | 298.21±309.47 | 329.77±368.04 | 0.612 | 217.15±294.62 | 341.93±350.60 | 0.099 | |
| CRP ( mg/dL) | 3.73±4.36 | 6.53±8.44 | 0.015 | 2.89±3.36 | 5.90±7.60 | 0.034 | |
| D-dimer (ng/mL) | 346.92±181.37 | 391.73±395.95 | 0.402 | 368.48±191.99 | 371.98±343.58 | 0.957 | |
| LDH (U/L) | 251.19±95.84 | 284.06±173.31 | 0.169 | 235.35±80.15 | 278.04±155.34 | 0.142 | |
| Creatinine (mg/dL) | 0.83±0.26 | 0.94±0.70 | 0.235 | 0.76±0.22 | 0.92±0.60 | 0.150 | |
| Urea (mg/dL) | 29.57±20.19 | 31.93±30.23 | 0.597 | 25.98±13.09 | 32.18±28.49 | 0.250 | |
| Na/K | 32.93±6.08 | 34.84±5.03 | 0.072 | 32.99±7.98 | 34.30±4.71 | 0.309 | |
| SGOT/SGPT | 1.05±0.40 | 1.09±0.42 | 0.534 | 1.01±0.41 | 1.090.41 | 0.319 | |
| Procalcitonin (ng/mL) | 0.12±0.07 | 0.14±0.26 | 0.785 | 0.14±0.08 | 0.13±0.21 | 0.924 | |
LDH=Lactate dehydrogenase, CKD=Chronic kidney disease, IHD=Ischemic heart disease, NIV=Noninvasive ventilation, ICU=Intensive care units, NLR=Neutrophil-to-lymphocyte ratio, SD=Standard deviation, CRP=C-reactive protein, Hb=Hemoglobin, SGPT=Serum glutamate pyruvate transaminase, SGOT=Serum glutamic oxaloacetic transaminase, SBP=Systolic blood pressure, DBP=Diastolic blood pressure, RR=Respiratory rate, HR=Heart rate, ANC=Absolute neutrophil count, ALC=Absolute lymphocyte count, RA=Room air
The most common symptoms at 1 year were fatigue (8 [5.3%]), breathlessness (8 [5.3%]), and insomnia seen in 8 (5.3%) [Table 3]. No statistically significant correlation was noted between the prevalence of post-COVID-19 symptoms at 1 year with the severity of infection, inflammatory markers, and other variables [Table 4].
DISCUSSION
Globally, there have been over 760 million (766,440,796) confirmed cases of COVID-19 and ~6.9 million deaths (6,932,591), reported to the WHO as of May 2023 (WHO COVID-19 dashboard). Many COVID-19 survivors recovering from acute infection have a persistence of initial symptoms or the emergence of new symptoms. A diversity of clinical phenotypes has been recognized, ranging from symptom clusters, discrete clinical events, organ-specific presentations, and multisystem syndromes.
Postacute COVID-19 syndrome is defined as persistent symptoms and/or delayed or long-term complications of SARS-CoV-2 infection beyond 4 weeks from the onset of symptoms. Based on recent literature, it is further divided into two categories:
Subacute or ongoing symptomatic COVID-19, which includes symptoms and abnormalities present from 4 to 12 weeks beyond acute COVID-19
Chronic or post-COVID-19 syndrome, which includes symptoms and abnormalities persisting or present beyond 12 weeks of the onset of acute COVID-19 and not attributable to alternative diagnoses.[2]
In our study, 67% of patients had symptoms at 1 month, 39% at 3 months, and 31% of patients persisted to have symptoms at 1 year. Several meta-analyses investigating the prevalence of post-COVID-19 symptoms have been published, concluding that around 30%–50% of subjects who recover from a SARS-CoV-2 infection develop persistent symptoms lasting up to 1 year.[3] In a study by Taquet et al., the incidence, co-occurrence, and evolution of long COVID-19 features in 6 months after COVID-19 diagnosis were calculated for nine core features of long-COVID-19 (breathing difficulties/breathlessness, fatigue/malaise, chest/throat pain, headache, abdominal symptoms, myalgia, other pain, cognitive symptoms, and anxiety/depression). It was found that COVID-19 was associated with long-term effects that are common and diverse, with 57% of patients having at least one long-COVID-19 feature recorded in the 180 days after infection and 37% having them in the 90–180 days after diagnosis. However, 40% had not had any symptoms in the first 3 months.[1]
The most common symptom noted at 1 month in our study was fatigue (26%). Other common reported symptoms at 1 month were insomnia (12%), joint pain (10%), breathlessness (7%), anxiety (6%), and myalgia (5%). The most common symptoms at 1 year were fatigue (5%), breathlessness (5%), and insomnia (5%). No statistically significant correlation was noted between the prevalence of post-COVID-19 symptoms and the severity of COVID-19 infection, inflammatory markers, and other variables.
A study that evaluated the occurrence of post-COVID-19 symptoms found that the incidence of each feature was abnormal breathing (18.71% in the 1–180-day period and 7.94% in the 90–180-day period), fatigue/malaise (12.82%; 5.87%), chest/throat pain (12.60%; 5.71%), headache (8.67%; 4.63%), other pain (11.60%; 7.19%), abdominal symptoms (15.58%; 8.29%), myalgia (3.24%; 1.54%), cognitive symptoms (7.88%; 3.95%), and anxiety/depression (22.82%; 15.49%). Specifically, some features (e.g., abnormal breathing) are more common in the first 90 days post-COVID-19 than in the next 90 days, whereas others (e.g., anxiety/depression) are more common in the “long” phase. It was also seen that fatigue when it occurs in the “long” phase, tends to be a first occurrence rather than a recurrence, whereas the opposite is true of depression/anxiety.[1]
Another study noted that among the COVID-19 survivors, 5%–29% complain of chest pain, dyspnea, or palpitations postrecovery (even 6 months after the acute infection). Late cardiac magnetic resonance findings indicative of subacute myocarditis have been also reported in COVID-19 patients.[4]
In a study aimed at comprehensive health assessment 3 months after recovery from acute COVID-19, it was found that about one-third of the patients in the cohort had abnormal outcomes on mental status or cognitive function 3 months after COVID-19. This should raise awareness among health-care professionals in COVID-19 aftercare. Post traumatic stress syndrome generally develops over time and therefore requires long follow up for it to be formally diagnosed.[5]
Studies have identified a few risk factors to be commonly associated with the development of long COVID-19, such as female gender, increasing age, presence of more than five symptoms in the acute stage of illness, and presence of comorbidities.[6] Females were significantly more likely to have headaches, abdominal symptoms, and anxiety/depression, whereas males were significantly more likely to have breathing difficulties and cognitive symptoms. Younger patients were significantly more likely to have headaches, abdominal symptoms, and anxiety/depression, whereas older patients were more likely to have breathing difficulties, cognitive symptoms, pain, and fatigue. However, in our study, we did not find a statistically significant correlation of post-COVID-19 symptoms with these variables. In our study, a statistically significant correlation of post-COVID-19 symptoms at 1 month was found with the presence of anosmia and ageusia.
A study noted that patients with more severe illnesses had significantly more features overall, and significantly more cognitive difficulties, but were less likely to have myalgia or headaches.[1] However, several studies have shown that long COVID-19 affects even mild-to-moderate cases and younger adults who did not require respiratory support or hospital or intensive care.[7] In our study, no statistically significant correlation was found with the severity of infection, inflammatory markers, and other variables. No statistically significant correlation was noted between the prevalence of post-COVID-19 symptoms at 1 year and severity of infection, inflammatory markers, and other variables.
CONCLUSIONS
Approximately one-third of patients who recover from acute COVID-19 infection may continue to have post-COVID-19 symptoms at 1 year after infection. Fatigue is the most common post-COVID-19 symptom. Post-COVID-19 symptoms can affect COVID-19 survivors regardless of the severity of infection.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
We would like to thank Dr Soumiya.
Funding Statement
Nil.
REFERENCES
- 1.Taquet M, Dercon Q, Luciano S, Geddes JR, Husain M, Harrison PJ. Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19. PLoS Med. 2021;18:e1003773. doi: 10.1371/journal.pmed.1003773. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601–15. doi: 10.1038/s41591-021-01283-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Notarte KI, de Oliveira MH, Peligro PJ, Velasco JV, Macaranas I, Ver AT, et al. Age, sex and previous comorbidities as risk factors not associated with SARS-CoV-2 infection for long COVID-19: A systematic review and meta-analysis. J Clin Med. 2022;11:7314. doi: 10.3390/jcm11247314. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Korompoki E, Gavriatopoulou M, Hicklen RS, Ntanasis-Stathopoulos I, Kastritis E, Fotiou D, et al. Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review. J Infect. 2021;83:1–16. doi: 10.1016/j.jinf.2021.05.004. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Van den Borst B, Peters JB, Brink M, Schoon Y, Bleeker-Rovers CP, Schers H, et al. Comprehensive health assessment 3 months after recovery from acute coronavirus disease 2019 (COVID-19) Clin Infect Dis. 2021;73:e1089–98. doi: 10.1093/cid/ciaa1750. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: An overview. Diabetes Metab Syndr. 2021;15:869–75. doi: 10.1016/j.dsx.2021.04.007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Yong SJ. Long COVID or post-COVID-19 syndrome: Putative pathophysiology, risk factors, and treatments. Infect Dis (Lond) 2021;53:737–54. doi: 10.1080/23744235.2021.1924397. [DOI] [PMC free article] [PubMed] [Google Scholar]