Burden of Post-COVID-19 Syndrome and Implications for Healthcare Service Planning: A Population-based Cohort Study

Abstract

ObjectiveTo assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterise their healthcare utilisation.DesignPopulation-based prospective cohort study.SettingZurich SARS-CoV-2 Cohort, Zurich, Switzerland.Participants431 adults from the general population with PCR-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020.Main outcome measuresWe assessed the proportion of individuals reporting not having fully recovered since SARS-CoV-2 infection, the proportion reporting fatigue (assessed by Fatigue Assessment Scale), dyspnoea (assessed by mMRC dyspnoea scale) or depression (assessed by DASS-21) at six to eight months after diagnosis. We further evaluated the proportion of individuals with at least one healthcare contact since their acute illness. Multivariable logistic regression models were used to assess factors associated with the main outcomes.ResultsSymptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalised. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnoea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalised individuals were rehospitalised. Individuals that have not fully recovered or suffer from fatigue, dyspnoea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care.ConclusionIn our population-based study, a relevant proportion of individuals suffered from longer-term consequences after SARS-CoV-2 infection. Our findings indicate that a considerable number of individuals affected by post-COVID-19 syndrome is to be expected, and that a wide range of additional healthcare services and integrative approaches will be required to support the recovery of these individuals. Thus, the timely planning of resources and services for post-COVID-19 care will be necessary alongside public health measures to mitigate the effects of the pandemic.RegistrationISRCTN14990068

Post-COVID-19 syndrome in outpatients: a cohort study

“…In our study 23% of COVID-positive required at least one additional medical visit for COVID-19-related symptoms, which is close to the proportion of 36% found in another study (16).…”

“…In a systematic review and meta-analysis of studies evaluating the prevalence of persisting symptoms up to 110 days after COVID-19 of various severities, the five more common symptoms were fatigue (58%), headache (44%), attention disorder (27%), hair loss (25%) and dyspnea (24%), while agueusia, anosmia and memory loss were reported by 23%, 21% and 16% of the studies populations (24). Two studies evaluating hundreds of laboratory-confirmed COVID-19 outpatients have reported the prevalence of symptoms lasting more than 6 months after diagnosis: 33-39% participants with at least one symptom, 14-55% with fatigue, 22% with dyspnea, and 14% with loss of sense of smell or taste (15,16).…”

“…While previous studies showed that male gender is a risk factor for severe outcome in COVID-19 (37), we identified female gender as a predictor for post-COVID-19 syndrome and specifically for persisting fatigue and smell or taste disorder. Although not always consistent, some studies have described an association between female gender and long-COVID (31), persisting fatigue (12)(13)(14), post-exertional polypnea (13), decreased rates of recovery (16), and anxiety or depression (14,16). Gender differences in immunity, as illustrated by the higher representation of women in autoimmune diseases (38), may explain divergent findings with COVID-19.…”

“…While most affected people experience complete resolution of their symptoms after two to six weeks (3,4), symptoms lasting more than 3 months have been reported in social media (5)(6)(7) and in observational studies (8)(9)(10)(11)(12)(13). Three studies reported that a large number of patients have persisting symptoms for more than 6 months after COVID-19: one study including adults discharged from hospital (14) and two studies including outpatients with mild-to-moderate disease (15,16). Recent guidelines defined post-COVID-19 syndrome as the persistence of signs and symptoms for more than 3 months after infection in the absence of an alternative diagnosis (17).…”

Challenges in defining Long COVID: Striking differences across literature, Electronic Health Records, and patient-reported information

“…190 Understanding the needs of these patients will allow for the development of healthcare, rehabilitation, and other resources needed to support their recovery. 191,192 However, identifying patient needs is contingent on developing a research infrastructure that accurately assesses the natural history of this illness.…”