Factors associated with development and persistence of post-COVID conditions: A cross-sectional study

Epidemiology of post-COVID conditions beyond 3 years and factors associated with their persistence longer than 2 years: A cross-sectional study

OBJECTIVE

This study aimed to investigate the epidemiology of post-coronavirus disease 2019 (COVID-19) conditions (PCCs) beyond 3 years and identify factors associated with their persistence longer than 2 years.

STUDY DESIGN

Cross-sectional questionnaire-based survey.

METHODS

We surveyed patients who had recovered from COVID-19 and visited our institution from February 2020 to November 2021. Demographic and clinical data and information on the presence and duration of PCCs were obtained. We identified factors associated with the persistence of PCCs longer than 2 years using multivariate linear regression analyses.

RESULTS

Among 935 patients surveyed, 407 completed the survey. Among them, 360 patients had mild disease in the acute phase. The proportions of participants with at least one symptom at 1, 2, and 3 years after symptom onset or COVID-19 diagnosis were 33.2%, 29.8%, and 5.7%, respectively. The numbers of participants with and without any residual symptoms 2 years after the onset of COVID-19 were 87 and 193, respectively. After multivariate adjustment, persistence of PCCs longer than 2 years was associated with lower body mass index, presence of any underlying medical conditions, and number of symptoms lasting for more than 1 month ≥ 5.

CONCLUSIONS

The prevalence of PCCs decreased 2 years after symptom onset or COVID-19 diagnosis. We also identified factors associated with PCC persistence longer than 2 years, which could help primary care physicians and patients with PCCs predict the duration of PCCs and better understand their natural history, thus reducing patients' anxiety about their duration.

A Cross-sectional Study on the Impact of Unfair Treatment Associated With COVID-19 Infection and Psychological Distress in Japanese Workers

OBJECTIVE

Psychological distress is commonly reported sequela in COVID-19-infected people. We investigated the association between experiencing COVID-19 infection and psychological distress in Japan.

METHOD

A total of 14,901 persons who participated in a follow-up survey in December 2022 were included in the analysis. Odds ratios and regression coefficients were estimated by statistical analysis, with history of COVID-19 infection as the independent variable and presence of psychological distress as the dependent variable.

RESULT

Experiencing COVID-19 infection was associated with psychological distress. In a model adjusted for "feeling treated unfairly," the association between infection experience and a high K6 score was significantly attenuated.

CONCLUSIONS

The results showed that the experience of COVID-19 infection is associated with psychological distress. Moreover, most cases of psychological distress among those who experienced COVID-19 infection can be at least partly explained by a perception of unfair treatment.

Comprehensive analysis of long COVID in a Japanese nationwide prospective cohort study

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly since 2019, and the number of reports regarding long COVID has increased. Although the distribution of long COVID depends on patient characteristics, epidemiological data on Japanese patients are limited. Hence, this study aimed to investigate the distribution of long COVID in Japanese patients. This study is the first nationwide Japanese prospective cohort study on long COVID.

METHODS

This multicenter, prospective cohort study enrolled hospitalized COVID-19 patients aged ≥18 years at 26 Japanese medical institutions. In total, 1200 patients were enrolled. Clinical information and patient-reported outcomes were collected from medical records, paper questionnaires, and smartphone applications.

RESULTS

We collected data from 1066 cases with both medical records and patient-reported outcomes. The proportion of patients with at least one symptom decreased chronologically from 93.9% (947/1009) during hospitalization to 46.3% (433/935), 40.5% (350/865), and 33.0% (239/724) at 3, 6, and 12 months, respectively. Patients with at least one long COVID symptom showed lower quality of life and scored higher on assessments for depression, anxiety, and fear of COVID-19. Female sex, middle age (41-64 years), oxygen requirement, and critical condition during hospitalization were risk factors for long COVID.

CONCLUSIONS

This study elucidated the symptom distribution and risks of long COVID in the Japanese population. This study provides reference data for future studies of long COVID in Japan.

Prevalence and factors associated with long COVID and mental health status among recovered COVID-19 patients in southern Thailand

Mental health disorders have become a growing public health concern among individuals recovering from COVID-19. Long COVID, a condition where symptoms persist for an extended period, can predict psychological problems among COVID-19 patients. This study aimed to investigate the prevalence of long COVID and mental health status among Thai adults who had recovered from COVID-19, identify the association between the mental health status and long COVID symptoms, and investigate the risk factors associated with the correlation between long COVID and mental health outcomes. A cross-sectional study was conducted among 939 randomly selected participants in Nakhon Si Thammarat province, southern Thailand. The Depression, Anxiety, and Stress Scale-21 was used to investigate mental health symptoms, and a checklist comprised of thirteen common symptoms was used to identify the long COVID among participants. Logistic regression models were used to investigate the risk factors associated with mental health status and long COVID symptoms among participants. Among the 939 participants, 104 (11.1%) had depression, 179 (19.1%) had anxiety, and 42 (4.8%) were stressed. A total of 745 participants (79.3%) reported experiencing at least one symptom of long COVID, with fatigue (72.9%, SE±0.02), cough (66.0%, SE±0.02), and muscle pain (54.1%, SE±0.02) being the most frequently reported symptoms. All long COVID symptoms were significantly associated with mental health status. Shortness of breath, fatigue, and chest tightness were the highest risk factors for mental health status among COVID-19 patients. The final multivariable model indicated that female patients (OR = 1.89), medical history (OR = 1.92), and monthly income lower than 5,000 Thai baht (OR = 2.09) were associated with developing long COVID symptoms and mental health status (all p<0.01). This study provides valuable insights into the potential long-term effects of COVID-19 on mental health and enhances understanding of the mechanisms underlying the condition for predicting the occurrence of mental health issues in Thai COVID-19 patients.

Association between SARS-CoV-2 anti-spike antibody titers and the development of post-COVID conditions: A retrospective observational study

The symptoms that persist after an acute coronavirus disease 2019 (COVID-19) are referred to as post- COVID conditions. Although the cause of post-COVID conditions remains unclear, the host immune response to SARS-CoV-2 may be involved. Hence, we aimed to investigate the effect of serum antibody titers against SARS-CoV-2 on the development of post-COVID conditions. We conducted a retrospective observational study of COVID-19-recovered individuals who attended the clinic at the National Center for Global Health and Medicine between January 2020 and April 2021. Serum SARS-CoV-2 anti-spike antibody titers were measured and a questionnaire survey was used to collect information on the presence of post-COVID conditions and demographic characteristics of the participants. Participants were then divided into two groups: high peak antibody titer group [≥ 0.759 OD450 value], and low peak antibody titer group [< 0.759 OD450 value] and compared their frequency of post-COVID conditions. Of 526 individuals attending the clinic, 457 (86.9%) responded to the questionnaire. We analyzed the data of 227 (49.7%) participants with measurements of serum antibody titers during the peak period. The incidence of depressed mood was significantly higher in the group with higher antibody titers (odds ratio: 2.34, 95% CI: 1.17-4.67, p = 0.016). There was no significant difference in the frequency of the remaining symptoms between the two groups. Among post-COVID conditions, the depressed mood was more frequent in the group with high serum antibody titers which suggests a difference in pathogenesis between depressive mood and other post-COVID conditions that requires further investigation.

Epidemiology of post-COVID conditions beyond 1 year: a cross-sectional study

OBJECTIVE

The aim of this study was to investigate the epidemiology of post-COVID conditions beyond 12 months and identify factors associated with the persistence of each condition.

STUDY DESIGN

This was a cross-sectional questionnaire-based survey.

METHODS

We conducted the survey among patients who had recovered from COVID-19 and visited our institute between February 2020 and November 2021. Demographic and clinical data and data regarding the presence and duration of post-COVID conditions were obtained. We identified factors associated with the persistence of post-COVID conditions using multivariable linear regression analyses.

RESULTS

Of 1148 surveyed patients, 502 completed the survey (response rate, 43.7%). Of these, 393 patients (86.4%) had mild disease in the acute phase. The proportion of participants with at least one symptom at 6, 12, 18, and 24 months after symptom onset or COVID-19 diagnosis was 32.3% (124/384), 30.5% (71/233), 25.8% (24/93), and 33.3% (2/6), respectively. The observed associations were as follows: fatigue persistence with moderate or severe COVID-19 (β = 0.53, 95% confidence interval [CI] = 0.06-0.99); shortness of breath with moderate or severe COVID-19 (β = 1.39, 95% CI = 0.91-1.87); cough with moderate or severe COVID-19 (β = 0.84, 95% CI = 0.40-1.29); dysosmia with being female (β = -0.57, 95% CI = -0.97 to -0.18) and absence of underlying medical conditions (β = -0.43, 95% CI = -0.82 to -0.05); hair loss with being female (β = -0.61, 95% CI = -1.00 to -0.22), absence of underlying medical conditions (β = -0.42, 95% CI = -0.80 to 0.04), and moderate or severe COVID-19 (β = 0.97, 95% CI = 0.41-1.54); depressed mood with younger age (β = -0.02, 95% CI = -0.04 to -0.004); and loss of concentration with being female (β = -0.51, 95% CI = -0.94 to -0.09).

CONCLUSIONS

More than one-fourth of patients after recovery from COVID-19, most of whom had had mild disease in the acute phase, had at least one symptom at 6, 12, 18, and 24 months after onset of COVID-19, indicating that not a few patients with COVID-19 suffer from long-term residual symptoms, even in mild cases.

Neurological post-acute sequelae of SARS-CoV-2 infection

The novel coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can have two phases: acute (generally 4 weeks after onset) and chronic (>4 weeks after onset). Both phases include a wide variety of signs and symptoms including neurological and psychiatric symptoms. The signs and symptoms that are considered sequelae of COVID-19 are termed post-COVID condition, long COVID-19, and post-acute sequelae of SARS-CoV-2 infection (PASC). PASC symptoms include fatigue, dyspnea, palpitation, dysosmia, subfever, hypertension, alopecia, sleep problems, loss of concentration, amnesia, numbness, pain, gastrointestinal symptoms, depression, and anxiety. Because the specific pathophysiology of PASC has not yet been clarified, there are no definite criteria of the condition, hence the World Health Organization's definition is quite broad. Consequently, it is difficult to correctly diagnose PASC. Approximately 50% of patients may show at least one PASC symptom up to 12 months after COVID-19 infection; however, the exact prevalence of PASC has not been determined. Despite extensive research in progress worldwide, there are currently no clear diagnostic methodologies or treatments for PASC. In this review, we discuss the currently available information on PASC and highlight the neurological sequelae of COVID-19 infection. Furthermore, we provide clinical suggestions for diagnosing and caring for patients with PASC based on our outpatient clinic experience.

Fatigue after COVID-19 in non-hospitalized patients according to sex

BACKGROUND

Limited evidence exists on sex differences in post-COVID fatigue among non-hospitalized patients. Therefore, aim of the study was to evaluate the course of chronic fatigue symptoms in non-hospitalized subjects with the SARS-CoV-2 infection, according to sex.

METHODS

Patients and staff from the University Hospital in Krakow anonymously and retrospectively completed neuropsychological questionnaire that included eight symptoms of chronic fatigue syndrome. The presence of these symptoms was assessed before COVID-19 and 0-4, 4-12, and >12 weeks postinfection. The inclusion criteria were as follows: age 18 or more years, >12 weeks since the onset of the SARS-CoV-2 infection, and diagnosis confirmed by the RT-PCR from anasopharyngeal swab.

RESULTS

We included 303 patients (79.53% women, 47.52% medical personnel) assessed retrospectively after a median of 30 (interquartile range: 23-35) weeks since the onset of symptoms. A higher prevalence of at least one chronic fatigue symptom was found in females in all time intervals after the onset of COVID-19 compared to males (p < .036). Women, compared to men, more often experienced persistent fatigue, not caused by effort and persisting after rest (for <4 weeks, odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.13-4.73; for 4-12 weeks, OR = 1.95, 95% CI: 1.06-3.61), non-restorative sleep (for <4 weeks, OR = 2.17, 95% CI: 1.23-3.81; for >12 weeks, OR = 1.95, 95% CI: 1.03-3.71), and sore throat (for <4 weeks, OR = 1.97, 95% CI: 1.03-3.78; for 4-12 weeks, OR = 2.76, 95% CI: 1.05-7.27). Sex differences in headache, arthralgia, and prolonged postexercise fatigue were observed only during the first 4 weeks (OR = 2.59, 95% CI: 1.45-4.60, OR = 2.97, 95% CI: 1.02-8.64, and OR = 1.87, 95% CI: 1.01-3.51, respectively). There were no differences between women and men in myalgia and self-reported lymph node enlargement.

CONCLUSIONS

The course of post-COVID fatigue differs significantly between sexes in non-hospitalized individuals with COVID-19, with women more often suffering from persistent fatigue, not caused by effort and persisting after rest, non-restorative sleep, and sore throat.