Is Recovery Just the Beginning? Persistent Symptoms and Health and Performance Deterioration in Post-COVID-19, non-hospitalised University Students - A Cross-Sectional Study

Abstract

Many individuals experience persistent symptoms such as deteriorated physical and mental health, increased fatigue, and reduced cognitive performance months after recovering from COVID-19. Current data are limited on the long-term trajectory of these symptoms and their prevalence in milder cases. Our study aimed to assess the persistent effects of COVID-19 on physical and mental health, fatigue, and cognitive performance in a cohort of 214 students, averaging 21.8 years of age. Of these, 148 had contracted COVID-19 but were not hospitalized, with the time since infection ranging from 1 to 39 months. We utilized a comprehensive panel of cognitive tests to measure intelligence, memory, and psychomotor skills, and a detailed anamnestic questionnaire to evaluate physical and mental health. While contracting COVID-19 did not significantly impact overall health and performance, it was associated with increased reports of fatigue. However, the reported severity of the disease had a pronounced negative influence on physical health, mental well-being, fatigue, and reaction time. Trends of improvement in physical and mental health, as well as error rate, were observed within the first two years post-infection. However, fatigue and reaction time showed a trend of deterioration. Beyond the two-year mark, physical health and error rate continued to improve, while mental health began to deteriorate. Fatigue and reaction time continued to decline. Overall, our findings suggest that some effects of contracting COVID-19 can persist or even deteriorate over time, even in younger individuals who had mild cases that did not require hospitalization.

COVID’s long shadow: How SARS-CoV-2 infection, COVID-19 severity, and vaccination status affect long-term cognitive performance and health

“…Our results also demonstrated that age had a significant and positive association with the course of COVID so the older the patient, the more severe the disease. Again, these results align with previous research findings [ 2 , 38 , 39 ]. It was suggested that older adults may be more vulnerable to the effects of COVID-19 due to their weaker immune systems [ 40 ].…”

“…A certain tendency toward improvement was also observed in the reaction times achieved in the Stroop test (Tau = −0.018, P = .192). Our findings, as it regards the persistence of some of the symptoms years beyond the initial COVID-19 infection, are consistent with those from university students [ 2 ], which demonstrated that the effects of COVID on health and performance could persist for several years, even though the participants were young (mean age 21.8) and none required hospitalization during their infection. That study reported that specific effects on mental health, reaction times, and particularly fatigue, may even begin to deteriorate again in the third year after infection, following an initial period of improvement.…”

“…In addition, the performance measured as reaction times, precision, and memory were also negatively (but non-significantly) correlated with the severity of the disease; the negative effect of the severity of the disease on the performance in all five tests suggests that the total effect is statistically significant ( P = .031, Fisher’s exact test). Therefore, our results align with studies indicating that severe COVID has a negative impact on cognitive performance [ 2 , 10 ] and contradict those suggesting the opposite [ 7 ].…”

“…These adverse effects of COVID-19 are not limited to the immediate symptoms of the infection but also include post-infection sequelae affecting mental and physical health, cognition, and fatigue. Notably, some of these aspects, specifically mental health and fatigue, may even begin to deteriorate again after a long period of improvement [ 2 ]. A comprehensive review of the neuropsychiatric pathogenicity of long COVID reported that common complications included fatigue, cognitive impairment, sleep disorders, depression, anxiety, and post-traumatic stress disorder [ 3 ].…”