Long Term Health Consequences of COVID-19 in Hospitalized Patients from North India: A follow up study of upto 12 months

  1. Sandeep Budhiraja
  2. Mona Aggarwal
  3. Rebecca Wig
  4. Akansha Tyagi
  5. RS Mishra
  6. Monica Mahajan
  7. Jay Kirtani
  8. Rommel Tickoo
  9. Supriya Bali
  10. Arun Dewan
  11. Ritesh Aggarwal
  12. Prashant Saxena
  13. Namrita Singh
  14. Ashok Kumar
  15. I. M. Chugh
  16. Pankaj Aneja
  17. Sanjay Dhall
  18. Vandana Boobna
  19. Vineet Arora
  20. Sujeet Jha
  21. Abhaya Indrayan

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Abstract

Background

Long-COVID syndrome is now a real and pressing public health concern. We cannot reliably predict who will recover quickly or suffer with mild debilitating long COVID-19 symptoms or battle life-threatening complications. In order to address some of these questions, we studied the presence of symptoms and various correlates in COVID-19 patients who were discharged from hospital, 3 months and up to 12 months after acute COVID-19 illness.

Methods

This is an observational follow-up study of RT-PCR confirmed COVID-19 patients admitted at 3 hospitals in north India between April – August 2020. Patients were interviewed telephonically using a questionnaire regarding the post-COVID symptoms. The first tele-calling was done in the month of September 2020, which corresponded to 4-16 weeks after disease onset. All those who reported presence of long COVID symptoms, were followed-up with a second call, in the month of March 2021, corresponding to around 9-12 months after the onset of disease.

Results

Of 990 patients who responded to the first call, 615 (62.2%) had mild illness, 227 (22.9%) had moderate and 148 (15.0%) had severe COVID-19 illness at the time of admission. Nearly 40% (399) of these 990 patients reported at least one symptom at that time. Of these 399 long-COVID patients, 311 (almost 78%) responded to the second follow-up. Nearly 8% reported ongoing symptomatic COVID, lasting 1-3 months and 32% patients having post-COVID phase with symptoms lasting 3-12 months. Nearly 11% patients continued to have at least one symptom even at the time of the second interview (9-12 months after the disease onset). Overall, we observed Long-COVID in almost 40% of our study group. Incidence of the symptoms in both the follow-ups remained almost same across age-groups, gender, severity of illness at admission and presence of comorbidity, with no significant association with any of them. Most common symptoms experienced in long COVID phase in our cohort were fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder, and breathlessness. Fatigue was found to be significantly more often reported in the elderly population and in those patients who had a severe COVID-19 illness at the time of admission. Persistence of breathlessness was also reported significantly more often in those who had severe disease at the onset. The overall median duration of long COVID symptoms was 16.9 weeks with inter-quartile range of 12.4 to 35.6 weeks. The duration of symptom resolution was not associated with age, gender or comorbidity but was significantly associated with severity of illness at the time of admission (P=0.006).

Conclusions

Long-COVID is now being recognized as a new disease entity, which includes a constellation of symptoms. Long-COVID was in almost 40% of our study group with no correlation to age, gender, comorbidities or to the disease severity. The duration of symptom resolution was significantly associated with severity of illness at the time of admission (P = 0.006). In our study, all patients reported minor symptoms such as fatigue, myalgia, neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder and persistence of breathlessness. Severe organ damage was not reported by our subjects. This might be the longest post-COVID follow-up study on a sample of nearly 1000 cases from India.

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  1. Version published to 10.1101/2021.06.21.21258543v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2021.06.21.21258543: (What is this?)

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

    Table 1: Rigor

    EthicsConsent: All patients admitted in these 3 hospitals gave a generic consent at the time of admission for their data to be used anonymously for research purpose.
    IRB: Ethic Committee Approval – The study titled “ Long term health consequences of COVID-19 in hospitalized patients from North India: A follow up study of upto 12 months” was approved by the Institutional Ethics Committee, Devki Devi Foundation; address: service floor, office of Ethics Committee, East Block, Next to Conference Room, Max Super Speciality Hospital, Saket
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    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: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.06.21.21258543v1 on medRxiv