Health Issues and Immunological Assessment Related to Wuhan's COVID-19 Survivors: A Multicenter Follow-Up Study

Abstract

Background: Currently, a large number of hospitalized coronavirus infectious disease-2019 (COVID-19) patients have met the clinical discharge criteria and have been discharged. Little is known about the sequelae and herd immunity, two important factors influencing the life quality and safety of COVID-19 survivors.Methods: Discharged COVID-19 patients from four medical facilities in Wuhan, China, were followed in order to record and investigate possible post-COVID-19 sequelae and herd immunity. After hospital discharge, patients reported to Fangcang shelter hospitals for an initial 14-day period of mandatory clinical monitoring. After release from these shelter hospitals, patients returned home for self-quarantine. Real-time quantitative PCR (RT-qPCR) was used for severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) detection. Colloidal gold-based immunochromatographic strip assay (ICGSA) was used for anti-SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody testing. The data for this study are derived from case reports, medical records, and self-reports.Results: A total of 3,677 COVID-19 survivors [median age = 59 years, interquartile range (IQR) = 47–68, range = 10–98; 55.5% female] who were released from four hospitals in Wuhan, China, between January 18 and March 29, 2020 were followed for a median of 144 days (IQR = 135–157). During follow-up, 976 (26.5%) patients had at least one post-COVID-19 sequela. The incidence of post-COVID-19 sequelae among elderly COVID-19 survivors (age ≥60 years) was slightly increased compared to that of young COVID-19 survivors (age <60 years; relative risk = 1.05, 95% CI = 1.02–1.10, p = 0.007). During follow-up, a dramatic reduction of anti-SARS-CoV-2 IgG (88.0%, 95% CI = 84.2–90.4) and IgM (93.2%, 95% CI = 88.5–96.4) antibodies was observed. Among these COVID-19 survivors, 1.2% (n = 45) retested positive for SARS-CoV-2 and 1.0% (n = 37) died during follow-up. Of those who died during follow-up, 70.3% were male and all were negative for both IgG and IgM, except for one person who was IgG-positive.Conclusions: Our study documents significant post-COVID-19 sequelae that impair functions of multiple organ systems in COVID-19 survivors, suggesting that the long-term effects of this disease will negatively impact survivors' quality of life, continue to strain health care systems, and result in extended periods of lost productivity. Furthermore, female gender and anti-SARS-CoV-2 immunity may play an essential role in the survival after COVID-19 infection.

Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis

“…, Savarraj et al, 2020 , Soldati et al, 2021 , Soraas et al, 2021 , Walle-Hansen et al, 2021 , Taboada et al, 2021 , Van Veenendaal et al, 2021 , Szende et al, 2014 , Amin-Chowdhury et al, 2021 , Augustin et al, 2021 , Cirulli et al, 2020 , Darley et al, 2021 , Ferrucci et al, 2021 , Kashif et al, 2021 , O’Keefe et al, 2021 , Peghin et al, 2021 , Shang et al, 2021 , Simani et al, 2021 , Stavem et al, 2021 , Xiong et al, 2021 , González-Hermosillo et al, 2021 , Petersen et al, 20212021 , Tawfik et al, 2021;18(3):em291. , Mei et al, 2021 , Evlice et al, 2021 ), p<0.001)…”

“…, Savarraj et al, 2020 , Soldati et al, 2021 , Soraas et al, 2021 , Walle-Hansen et al, 2021 , Taboada et al, 2021 , Van Veenendaal et al, 2021 , Szende et al, 2014 , Amin-Chowdhury et al, 2021 , Augustin et al, 2021 , Cirulli et al, 2020 , Darley et al, 2021 , Ferrucci et al, 2021 , Kashif et al, 2021 , O’Keefe et al, 2021 , Peghin et al, 2021 , Shang et al, 2021 , Simani et al, 2021 , Stavem et al, 2021 , Xiong et al, 2021 , González-Hermosillo et al, 2021 , Petersen et al, 20212021 , Tawfik et al, 2021;18(3):em291. , Mei et al, 2021 , Evlice et al, 2021 ), p<0.001) Significant worsening of health was found across all symptom categories, whereas no statistically significant reduction in health state was found among patients reporting no symptoms Female sex was associated with chronic fatigue O’Keefe et al, 2021 a, 85 USA Cross-sectional Emory Healthcare’s Virtual Outpatient Management Clinic (VOMC) N= 198 participants discharged from outpatient telemedicine program for COVID-19(including 35 previously hospitalized cases) Age Range: 18-84 Median Age: 44 ± 14 Sex (%F/%M): 74.2/25.8 Median 119 (range 26-220) days following diagnosis RT-PCR Subjective self-report via e-mail survey 21.2% (42/198) reported fatigue 90-220 days after the acute COVID-19 phase 13.6% (27/198) reported mental fog 90-220 days after the acute COVID-19 phase Moderate to severe acute COVID-19, female sex, and middle age were highly associated with persistent symptoms Ong...…”

“…Bashlyaeva Children’s Municipal Clinical Hospital N= 518 children (all previously hospitalized cases) Age Range: ≤18 Median Age: 10.4 (3–15.2) Sex (%F/%M): 52.1/47.9 Median 256 (223-271) days following discharge RT-PCR Subjective self-report via telephone surveyconducted by medical students 10.7% (53/518) reported fatigue scores on wellness scale for children with 2+ persistent symptoms significantly declined when compared to before COVID-19 onset (from 90 ( Augustin et al, 2021 , Cirulli et al, 2020 , Darley et al, 2021 , Ferrucci et al, 2021 , Kashif et al, 2021 , O’Keefe et al, 2021 , Peghin et al, 2021 , Shang et al, 2021 , Simani et al, 2021 , Stavem et al, 2021 , Xiong et al, 2021 , González-Hermosillo et al, 2021 , Petersen et al, 20212021 , Tawfik et al, 2021;18(3):em291. , Mei et al, 2021 , Evlice et al, 2021 ) to 70 ( Jacobson et al, 2021 , Johnsen et al, 2021 , Latronico et al, 2020 , Logue et al, 2021 , Menges et al, 2021 , Miskowiak et al, 2021 , Munblit et al, 2021 , Orrù et al, 2021 , Osmanov et al, 2021 , Pereira et al, 20212021 , Qu et al, 2021 , Rass et al, 2021;(ene.14803). , Savarraj et al, 2020 , Soldati et al, 2021 , Soraas et al, 2021 , Walle-Hansen et al, 2021 , Taboada et al, 2021 , Van Veenendaal et al, 2021 , Szende et al, 2014 , …”

“…, Savarraj et al, 2020 , Soldati et al, 2021 , Soraas et al, 2021 , Walle-Hansen et al, 2021 , Taboada et al, 2021 , Van Veenendaal et al, 2021 , Szende et al, 2014 , Amin-Chowdhury et al, 2021 , Augustin et al, 2021 ) Scores on wellness scale for children with 1 persistent symptom significantly declined when compared to before COVID-19 onset (from 90 ( Augustin et al, 2021 , Cirulli et al, 2020 , Darley et al, 2021 , Ferrucci et al, 2021 , Kashif et al, 2021 , O’Keefe et al, 2021 , Peghin et al, 2021 , Shang et al, 2021 , Simani et al, 2021 , Stavem et al, 2021 , Xiong et al, 2021 , González-Hermosillo et al, 2021 , Petersen et al, 20212021 , Tawfik et al, 2021;18(3):em291. , Mei et al, 2021 , Evlice et al, 2021 , Rauch et al, 2021 , Woo et al, 20202020 , Hopkins et al, 2020 , Jason et al, 2021 , Lam et al, 2009 ) to 82.5 [70-93.8]) Older age group and pre-existent allergic disease were associated with persistent symptoms Peghin et al, 2021 86 Italy Prospective Cohort Udine Hospital N= 599 (442 outpatient cases, 157 previously hospitalized, including 23 in ICU) Age Range: 18-94 Mean Age: 53 ± 15.8 Sex (%F/%M): 53.4/46.6 Median 191 (172-204) days following onset of acute COVID-19 Nucleic acid amplification tests and/or clinical diagnosis Subjective self-report via telephone questionnaire administered by trained nurses …”

“…Scores on wellness scale for children with 1 persistent symptom significantly declined when compared to before COVID-19 onset (from 90 ( Augustin et al, 2021 , Cirulli et al, 2020 , Darley et al, 2021 , Ferrucci et al, 2021 , Kashif et al, 2021 , O’Keefe et al, 2021 , Peghin et al, 2021 , Shang et al, 2021 , Simani et al, 2021 , Stavem et al, 2021 , Xiong et al, 2021 , González-Hermosillo et al, 2021 , Petersen et al, 20212021 , Tawfik et al, 2021;18(3):em291. , Mei et al, 2021 , Evlice et al, 2021 , Rauch et al, 2021 , Woo et al, 20202020 , Hopkins et al, 2020 , Jason et al, 2021 , Lam et al, 2009 ) to 82.5 [70-93.8])…”