Symptoms Compatible With Long Coronavirus Disease (COVID) in Healthcare Workers With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection—Results of a Prospective Multicenter Cohort
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Abstract
Background
The burden of long-term symptoms (ie, long COVID) in patients after mild COVID-19 is debated. Within a cohort of healthcare workers (HCWs), frequency and risk factors for symptoms compatible with long COVID are assessed.
Methods
Participants answered baseline (August/September 2020) and weekly questionnaires on SARS-CoV-2 nasopharyngeal swab (NPS) results and acute disease symptoms. In January 2021, SARS-CoV-2 serology was performed; in March, symptoms compatible with long COVID (including psychometric scores) were asked and compared between HCWs with positive NPS, seropositive HCWs without positive NPS (presumable asymptomatic/pauci-symptomatic infections), and negative controls. The effect of time since diagnosis and quantitative anti-spike protein antibodies (anti-S) was evaluated. Poisson regression was used to identify risk factors for symptom occurrence.
Results
Of 3334 HCWs (median, 41 years; 80% female), 556 (17%) had a positive NPS and 228 (7%) were only seropositive. HCWs with positive NPS more frequently reported ≥1 symptom compared with controls (73% vs 52%, P < .001); seropositive HCWs without positive NPS did not score higher than controls (58% vs 52%, P = .13), although impaired taste/olfaction (16% vs 6%, P < .001) and hair loss (17% vs 10%, P = .004) were more common. Exhaustion/burnout was reported by 24% of negative controls. Many symptoms remained elevated in those diagnosed >6 months ago; anti-S titers correlated with high symptom scores. Acute viral symptoms in weekly questionnaires best predicted long-COVID symptoms. Physical activity at baseline was negatively associated with neurocognitive impairment and fatigue scores.
Conclusions
Seropositive HCWs without positive NPS are only mildly affected by long COVID. Exhaustion/burnout is common, even in noninfected HCWs. Physical activity might be protective against neurocognitive impairment/fatigue symptoms after COVID-19.
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SciScore for 10.1101/2021.10.19.21265187: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the ethics committee of Eastern Switzerland (#2020-00502). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Anti-nucleocapsid protein antibodies (anti-N) were determined to assess seropositivity against SARS-CoV-2, as described previously [13]. Anti-nucleocapsid proteinsuggested: Noneanti-Nsuggested: NoneSARS-CoV-2suggested: NoneFor most of anti-N positive HCW, anti-spike protein antibodies (anti-S) were measured. anti-N positive HCW, anti-spike proteinsuggested: Noneanti-Ssuggested: NoneResults from OddPub: We did not detect open data. We also did not …
SciScore for 10.1101/2021.10.19.21265187: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the ethics committee of Eastern Switzerland (#2020-00502). Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Antibodies Sentences Resources Anti-nucleocapsid protein antibodies (anti-N) were determined to assess seropositivity against SARS-CoV-2, as described previously [13]. Anti-nucleocapsid proteinsuggested: Noneanti-Nsuggested: NoneSARS-CoV-2suggested: NoneFor most of anti-N positive HCW, anti-spike protein antibodies (anti-S) were measured. anti-N positive HCW, anti-spike proteinsuggested: Noneanti-Ssuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has limitations. First, assessing the presence of long-COVID symptoms at only one time point might have led to underestimation of their prevalence as symptoms are reported to be fluctuating [5]. Second, we cannot exclude that certain individuals with COVID-19 did not show any seroconversion or that anti-N had again waned below the detection level at time of our blood draw. However, we consider this effect to be small as most individuals, even after mild/moderate infection, show robust and prolonged antibody reaction [39]; also, individuals were asked to report any positive NPS, which further reduces the risk of misclassification. Third, participants knew about their SARS-CoV-2 status (both for serology and NPS) at time of the long-COVID questionnaire, which might be a source of recall bias. However, the fact that participants with the highest concentration of anti-S (titers not known to participants) had higher symptom scores suggests a true effect. Fourth, the delta variant, which was not yet the predominant strain when the study was conducted, might differently impact the occurrence of long-COVID symptoms [40]. Fifth, we did not assess long-COVID symptoms at baseline which precludes us from estimating the true impact of the pandemic on the prevalence of these symptoms. Nevertheless, the inclusion of a non-infected control group allowed us to assess the independent impact of SARS-CoV-2 on the occurrence of these often non-specific symptoms. In conclusion, we show t...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
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- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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