Postacute Sequelae of SARS-CoV-2 Infection and Impact on Quality of Life 1–6 Months After Illness and Association With Initial Symptom Severity

Abstract

Background Individuals with coronavirus disease 2019 (COVID-19) may have persistent symptoms following their acute illness. The prevalence and predictors of these symptoms, termed post-acute sequelae of SARS-CoV-2 (PASC), are not fully described. Methods Participants discharged from an outpatient telemedicine program for COVID-19 were emailed a survey (1-6 months after discharge) about ongoing symptoms, acute illness severity, and quality of life. Standardized telemedicine notes from acute illness were used for covariates (comorbidities and provider-assessed symptom severity). Bivariate and multivariable analyses were performed to assess predictors of persistent symptoms. Results Two hundred and ninety patients completed the survey, of whom 115 (39.7%) reported persistent symptoms including fatigue (n= 59, 20.3%), dyspnea on exertion (n=41, 14.1%), and mental fog (n=39, 13.5%) among others. Proportion of persistent symptoms did not differ based on duration since illness (<90 days: n=32, 37.2% versus >90 days: n=80, 40.4%, p = 0.61). Predictors of persistent symptoms included provider-assessed moderate-severe illness (aOR 3.24, 95% CI 1.75, 6.02), female sex (aOR 1.99 95% 0.98, 4.04; >90 days out: aOR 2.24 95% CI 1.01, 4.95), and middle age (aOR 2.08 95% CI 1.07, 4.03). Common symptoms associated with reports of worse physical health included weakness, fatigue, myalgias, and mental fog. Conclusions Symptoms following acute COVID-19 are common and may be predicted by factors during the acute phase of illness. Fatigue and neuropsychiatric symptoms figured prominently. Select symptoms seem to be particularly associated with perceptions of physical health following COVID-19 and warrant specific attention on future studies of PASC.

A New Look on Long-COVID Effects: The Functional Brain Fog Syndrome

“…Few studies reported brain fog prevalence separately, and data may range from 2% to 10% [ 60 , 61 ]. However, several studies described difficulties that might resemble brain fog, but under different denominations, such as difficulties in daily activities [ 62 , 63 ], mental slowness [ 64 ], mental fog [ 60 , 65 ], difficulty or problems with thinking [ 66 , 67 ]. This variability in naming corresponds to great variability in prevalence data, ranging from 10% to 68%.…”

Childhood Trauma Exposure Increases Long COVID Risk

“…Participants were recruited online, and it is possible that those who developed long COVID are more invested in participating, potentially inflating the number of individuals with the syndrome, although our rates of long COVID are notably consistent with other reports. [6][7][8][9][10] We also did not have COVID-19 positivity confirmed for all participants; however, we excluded participants who did not report a positive PCR-test, a clinician diagnosis, or smell/taste loss (which is the strongest indicator of COVID-19 positivity), 21 minimizing the likelihood of including participants with no SARS-CoV-2 exposure. The cross-sectional design also limits our ability to determine causality, as is the case in any research examining the impact of childhood trauma in adults.…”

“…Female sex, older age, higher body mass index (BMI), greater number of symptoms during acute illness, chemosensory impairment, and diarrhea are identified as predictors of long COVID. 6-9,12-15…”

“…It is estimated that approximately 30% to 50% of non-hospitalized COVID patients will develop the syndrome, [6][7][8][9][10] with even higher rates reported in hospitalized cases. 11,12 However, a study that employed a daily COVID-19 symptom tracking app found only two percent of participants reported symptoms three months after illness onset, 13 suggesting rates may vary by sample ascertainment.…”

“…Female sex, older age, higher body mass index (BMI), greater number of symptoms during acute illness, chemosensory impairment, and diarrhea are identified as predictors of long COVID. [6][7][8][9][12][13][14][15] Several mechanisms may ultimately be implicated in long COVID, but excess proinflammatory cytokines (e.g., interleukin-6 (IL-6), tumor necrosis factor alpha (TNFα), creactive protein), interacting with chronic neuroinflammation is one proposed mechanism. 16 Increased levels of proinflammatory cytokines are linked to depression, anxiety, and posttraumatic stress disorder (PTSD), 17,18 which may be mediated by the effect of childhood trauma and early adversity on brain development and immune response.…”