Post‑COVID‑19 Syndrome in Outpatients: a Cohort Study

Abstract

Background After mild COVID-19, some outpatients experience persistent symptoms. However, data are scarce and prospective studies are urgently needed. Objectives To characterize the post-COVID-19 syndrome after mild COVID-19 and identify predictors. Participants Outpatients with symptoms suggestive of COVID-19 with (1) PCR-confirmed COVID-19 (COVID-positive) or (2) SARS-CoV-2 negative PCR (COVID-negative). Design Monocentric cohort study with prospective phone interview between more than 3 months to 10 months after initial visit to the emergency department and outpatient clinics. Main Measures Data of the initial visits were extracted from the electronic medical file. Predefined persistent symptoms were assessed through a structured phone interview. Associations between long-term symptoms and PCR results, as well as predictors of persistent symptoms among COVID-positive, were evaluated by multivariate logistic regression adjusted for age, gender, smoking, comorbidities, and timing of the survey. Key Results The study population consisted of 418 COVID-positive and 89 COVID-negative patients, mostly young adults (median age of 41 versus 36 years in COVID-positive and COVID-negative, respectively; p = 0.020) and healthcare workers (67% versus 82%; p = 0.006). Median time between the initial visit and the phone survey was 150 days in COVID-positive and 242 days in COVID-negative patients. Persistent symptoms were reported by 223 (53%) COVID-positive and 33 (37%) COVID-negative patients ( p = 0.006) and proportions were stable among the periods of the phone interviews. Overall, 21% COVID-positive and 15% COVID-negative patients ( p = 0.182) attended care for this purpose. Four surveyed symptoms were independently associated with COVID-19: fatigue (adjusted odds ratio 2.14, 95% CI 1.04–4.41), smell/taste disorder (26.5, 3.46–202), dyspnea (2.81, 1.10–7.16), and memory impairment (5.71, 1.53–21.3). Among COVID-positive, female gender (1.67, 1.09–2.56) and overweight/obesity (1.67, 1.10–2.56) were predictors of persistent symptoms. Conclusions More than half of COVID-positive outpatients report persistent symptoms up to 10 months after a mild disease. Only 4 of 14 symptoms were associated with COVID-19 status. The symptoms and predictors of the post-COVID-19 syndrome need further characterization as this condition places a significant burden on society. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07242-1.

Physical, Psychological, and Cognitive Profile of Post-COVID Conditions in Healthcare Workers, Quebec, Canada

“…As reported elsewhere, our hospitalized cases had a higher prevalence and severity of PCC than ambulatory cases [ 14 , 16 , 22 ], with female sex and increasing age also associated with higher PCC risk [ 11 , 14 , 17 , 18 , 27 , 35–37 ]. We could not properly assess the impact of vaccination, as few participants had been vaccinated before their COVID-19 illness.…”

“…Similar to our findings, several literature reviews found that fatigue, respiratory symptoms, and cognitive and mental health issues were most frequently reported [ 3 , 22 , 24–26 ]. Memory impairment, brain fog, poor attention, or difficulty thinking have been reported by other authors in 22%–88% of patients with lasting symptoms [ 5 , 25 , 27 , 28 ], but these prevalences did not take into consideration the contribution of mood disorders or fatigue, highly associated with cognitive abnormalities and also features of PCC [ 6 , 7 ]. Objectively measured cognitive deficits were reported among 46 patients 6 months after severe COVID-19, independent of mental health and fatigue [ 29 ].…”

“…A reporting bias is, however, possible considering that most symptoms are not specific and may be due to other conditions, as illustrated by the reported prevalence of fatigue before SARS-CoV-2 infection [ 38 ]. We did not collect information on some potentially relevant risk factors, such as comorbidity or initial COVID-19 symptoms and their severity [ 16 , 17 , 27 , 35 , 37 ]. Our questionnaire, designed in the fall of 2020, did not collect data on insomnia or postexertional malaise later, also considered to be PCC-qualifying symptoms [ 23 ].…”

Self-reported symptom severity, general health, and impairment in post-acute phases of COVID-19: retrospective cohort study of Swedish public employees

“…Participant characteristics. The online survey consisted of about 70 questions and took a median (IQR) of 11 (8)(9)(10)(11)(12)(13)(14)(15) minutes to complete. Self-reported occupation was categorized by following the Swedish version of the International Standard Classification of Occupations (ISCO-08) as closely as possible 23 .…”

Epipharyngeal Abrasive Therapy (EAT) Has Potential as a Novel Method for Long COVID Treatment

“…Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a frequently mentioned symptom of long COVID [ 4 ]. Hyperinflammation due to COVID-19 can cause ME/CFS, but the causal organs associated with ME/CFS have not been identified and no standardized treatment has been developed [ 4 , 5 , 6 , 7 , 8 ]. The epipharynx is a primary target for SARS-CoV-2 replication in the early stages of COVID-19 [ 9 ].…”