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

  1. James B O’Keefe
  2. H Caroline Minton
  3. Mary Morrow
  4. Colin Johnson
  5. Miranda A Moore
  6. Ghazala A D O’Keefe
  7. Karima Benameur
  8. Jason Higdon
  9. Jessica K Fairley

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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 postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; PASC), have not been 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 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. The proportion of persistent symptoms did not differ based on duration since illness (<90 days: n = 32, 37.2%; vs >90 days: n = 80, 40.4%; P = .61). Predictors of persistent symptoms included provider-assessed moderate–severe illness (adjusted odds ratio [aOR], 3.24; 95% CI, 1.75–6.02), female sex (aOR, 1.99; 95% CI, 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.

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  1. Version published to 10.1093/ofid/ofab352
  2. ScreenIT

    SciScore for 10.1101/2021.04.24.21256054: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethical Approvals: The study was approved by the Emory University Institutional Review Board.
    Consent: All participants provided electronic consent at the outset of the emailed survey.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Patients in VOMC underwent standardized telemedicine assessment by Emory Healthcare providers as previously described (31).
    Emory Healthcare
    suggested: (One Mind Biospecimen Bank Listing, RRID:SCR_004193)
    Data analysis: Data from the survey were exported from Qualtrics into Microsoft Excel and analyzed using SAS v9.4 (Carey, NC).
    Microsoft Excel
    suggested: (Microsoft Excel, RRID:SCR_016137)

    Results 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:
    Many respondents to the survey reported lower quality of life on questions regarding limitations due to physical and emotional health, similar to a prior report indicating disrupted home, work, and social life for patients after acute COVID-19(6). These responses were associated with certain common symptoms (e.g. fatigue, dyspnea on exertion, mental fog) more than others (e.g. cough, change in smell or taste). These findings may suggest that specific symptom profiles are more significant in quality of life and may warrant particular emphasis in studies of PASC. More than half sought care for their symptoms indicating a level of concern leading to medical attention. Prior work indicates that patients encounter challenges due to limited recognition of PASC (5,32) and providers should be aware of the likelihood of PASC and evolving treatment guidelines. Comparison to prior studies: Similar to previous studies (23,25–27,33,34), this study represents a single institution report of persistent symptoms in patients after acute COVID-19 and finds a high rate of persistent symptoms. A novel aspect of this work is the prospective enrollment in the telemedicine program with standardized data collection by providers in the acute phase of illness, such that risk factors for later outcomes could be systematically analyzed. We found that the severity of symptoms at the time of the acute telemedicine visit was a significant predictor, which corroborates the prior reports relating acute illnes...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    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.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2021.04.24.21256054v1 on medRxiv