Background While the leading symptoms during coronavirus disease 2019 (COVID-19) are acute and the majority of patients fully recover, a significant fraction of patients now increasingly experience long-term health consequences. However, most data available focus on health-related events after severe infection and hospitalisation. We present a longitudinal, prospective analysis of health consequences in patients who initially presented with no or minor symptoms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection. Hence, we focus on mild COVID-19 in non-hospitalised patients. Methods 958 Patients with confirmed SARS-CoV-2 infection were observed from April 6th to December 2nd 2020 for long-term symptoms and SARS-CoV-2 antibodies. We identified anosmia, ageusia, fatigue or shortness of breath as most common, persisting symptoms at month 4 and 7 and summarised presence of such long-term health consequences as post-COVID syndrome (PCS). Predictors of long-term symptoms were assessed using an uni- and multivariable logistic regression model. Findings We observed 442 and 353 patients over four and seven months after symptom onset, respectively. Four months post SARS-CoV-2 infection, 8•6% (38/442) of patients presented with shortness of breath, 12•4% (55/442) with anosmia, 11•1% (49/442) with ageusia and 9•7% (43/442) with fatigue. At least one of these characteristic symptoms was present in 27•8% (123/442) and 34•8% (123/353) at month 4 and 7 post-infection, respectively. A lower baseline level of SARS-CoV-2 IgG, anosmia and diarrhoea during acute COVID-19 were associated with higher risk to develop long-term symptoms. Interpretation The on-going presence of either shortness of breath, anosmia, ageusia or fatigue as long-lasting symptoms even in non-hospitalised patients was observed at four and seven months post-infection and summarised as post-COVID syndrome (PCS). The continued assessment of patients with PCS will become a major task to define and mitigate the socioeconomic and medical long-term effects of COVID-19. Funding COVIM:„NaFoUniMedCovid19“(FKZ: 01KX2021)
In order to understand the kinetics, timing and persistence of SARS-CoV2 neutralizing antibodies (Nabs) we used a surrogate viral neutralization test to evaluate their levels in patients with varying severity of illness, in those with prolonged shedding and those with mild/asymptomatic illness at various time points. Patients with severe or moderate COVID-19 illness had earlier appearance of Nabs at higher levels compared to those with mild or asymptomatic illness. Furthermore, those who had prolonged shedding of the virus, had Nabs appearing faster and at higher levels than those who cleared the virus earlier. Although all individuals appeared to be antibody positive by end of week 5, the positivity rates declined thereafter, especially in those who had mild or asymptomatic illness.
We discovered that values for 2 out of 79 antibodies have unfortunately been wrongly reported. For antibody FnC1t1p2_A5, the IC 100 is 50 mg/mL instead of 16 mg/mL; for antibody CnC2t1p1_B10, the IC 100 is >100 mg/mL instead of 12.5 mg/mL. For the latter antibody, binding characteristics were also corrected. As a consequence, the total number of neutralizing antibodies reported is 27 instead of 28. Changes affect Figures 3, 4, S3, S4, and S5, Tables S3 and S4, and text on pages 1, 3, 5, and 7. Importantly, the corrections have no impact on the conclusions in this paper. We apologize for any inconvenience that may have been caused by this error.
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