Persistence of Symptoms 15 Months since COVID-19 Diagnosis: Prevalence, Risk Factors and Residual Work Ability

Abstract

Background: A proportion of patients’ ailments may last after recovering from acute COVID-19, with episodic and systemic symptoms of unclear etiology potentially involving different organs. Study aim: The aim of this study was to investigate the persistence of symptoms 15 months since COVID-19 diagnosis in patients referring to the post-COVID-19 clinic in Trieste (north-eastern Italy). Methods: Two-hundred-forty-seven patients were medically examined between 8 December 2020–6 April 2021, after a median time of 49 days since first positive swab test for SARS-CoV-2. After a median time of 15 months since COVID-19 diagnosis, the same patients were contacted over the phone and investigated by standardized questionnaire collecting information on any persisting symptoms and work ability index (WAI). Four multivariable logistic regression models were fitted to investigate factors associated with persistence of any respiratory, neurological, dysautonomic, or psychiatric symptoms at first (median time 49 days since COVID-19 diagnosis) as well as second (median 15 months since COVID-19 diagnosis) follow up. A multiple linear regression was also employed to investigate factors associated with higher mean WAI, assessed only at second follow up. Additionally, factors associated with persistence of symptoms 200+ days since COVID-19 diagnosis between first and second follow-up were investigated by multivariable Generalized Estimating Equation (GEE). Results: At first follow up (median time of 49 days since COVID-19 diagnosis) symptoms more frequently reported were fatigue (80.2%), shortness of breath (69.6%), concentration deficit (44.9%), headache (44.9%), myalgia (44.1%), arthralgia (43.3%), and anosmia (42.1%). At second follow-up (median time of 15 months since COVID-19 diagnosis) 75% patients returned to their baseline status preceding COVID-19. At first follow up males were less likely to experience neurological (OR = 0.16; 95% CI: 0.08; 0.35) as well as psychiatric (OR = 0.43; 95% CI: 0.23; 0.80) symptoms as compared to females. At first follow up, the risk of neurological symptoms increased also linearly with age (OR = 1.04; 95% CI: 1.01; 1.08) and pre-existing depression was a major risk factor for persisting dysautonomic (aOR = 6.35; 95% CI: 2.01; 20.11) as well as psychiatric symptoms (omitted estimate). Consistently, at second follow up only females experience psychiatric symptoms, whereas males exhibited significantly higher mean WAI (RC = 0.50; 95% CI: 0.11; 0.88). Additionally, neurological symptoms at second follow up were more likely in patients with pre-existing comorbidities (OR = 4.31; 95% CI: 1.27; 14.7). Finally, persistence of symptoms lasting 200+ days since COVID-19 diagnosis increased linearly with age (OR = 1.03; 95% CI 1.01–1.05) and were more likely in patients affected by pre-existing depression (OR = 2.68; 95% CI 1.60; 4.49). Conclusions: Following a median time of 15 months since first positive swab test, 75% patients with symptoms returned to their baseline health status preceding COVID-19. Females had a significantly lower WAI and were more likely to experience psychiatric symptoms at second follow up (15 months since COVID-19 diagnosis). Furthermore, the risk of symptoms persisting 200+ days since COVID-19 diagnosis increased with history of depression, endorsing the hypothesis that long-COVID-19 symptoms may be at least partially explained by pre-existing psychological conditions. Patient rehabilitation and psychological support may therefore play a key role in caring patients with the so called long COVID-19 syndrome.

Course of fatigue among patients previously hospitalised due to COVID-19

“…Our study revealed that female sex was the only independent predictor of fatigue in a cohort of previously hospitalised patients, both in the acute phase of COVID-19 and also four and 12 weeks since the onset of infection. Our results accord with a recent Italian study of 247 patients that also confirmed the prognostic role of female sex in the persistence of neurological and psychiatric symptoms, including fatigue, seven weeks after the initial SARS-CoV-2 infection [31]. However, researchers also pointed to older age and the presence of comorbidities, especially depression, as additional risk factors for residual post-COVID symptoms, but that cohort comprised individuals approximately one decade younger than ours, with only less than half of them requiring hospitalisation due to COVID-19 [31].…”

“…Our results accord with a recent Italian study of 247 patients that also confirmed the prognostic role of female sex in the persistence of neurological and psychiatric symptoms, including fatigue, seven weeks after the initial SARS-CoV-2 infection [31]. However, researchers also pointed to older age and the presence of comorbidities, especially depression, as additional risk factors for residual post-COVID symptoms, but that cohort comprised individuals approximately one decade younger than ours, with only less than half of them requiring hospitalisation due to COVID-19 [31]. Another recent study revealed that among 400 Brazilian patients previously hospitalised due to COVID-19, female sex, hypercholesterolemia, obesity and prone position in the acute phase of disease increased the risk of post-COVID syndrome, with fatigue prevalent in 42% and 27% of cases within three and six months after discharge, respectively [32].…”

Post COVID-19 Condition, Work Ability and Occupational Changes: Results from a Population-based Cohort

“…An important factor that determines sustainable return to work is the perceived work ability, which is also more independent of the specific context than return to work and occupational changes. To date, few studies have evaluated work ability in the context of PCC within specific populations of health-care workers and patients attending a post COVID-19 clinic (17,22). Evidence from this study and other studies demonstrated lower work ability scores among those with PCC, with a higher reduction among those with occupational changes.…”

“…Evidence on the impact of PCC on the occupational situation and work-related impairments due to PCC is limited and heterogenous (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Prior studies have reported that between 11% and 50% of individuals do not return to work (2,14,26) and that 10% to 72% do not fully regain their work capacity 6 to 12 months after infection (7,23,26,27).…”

“…Few studies have evaluated the association of PCC with work-related functioning or subsequent occupational changes (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Most focused on describing work absenteeism and found that 11%-50% of workers do not return to work several months after COVID-19 (2,14).…”