Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study

  1. Dominik Menges
  2. Tala Ballouz
  3. Alexia Anagnostopoulos
  4. Hélène E. Aschmann
  5. Anja Domenghino
  6. Jan S. Fehr
  7. Milo A. Puhan

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Abstract

Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. Data on post-COVID-19 syndrome in the general population are required for the timely planning of healthcare services and resources. The objective of this study was to assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterize their healthcare utilization.

Methods

This population-based prospective cohort study (Zurich SARS-CoV-2 Cohort) enrolled 431 adults from the general population with polymerase chain reaction-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020 in the Canton of Zurich, Switzerland. We evaluated the proportion of individuals reporting not to have fully recovered since SARS-CoV-2 infection, and the proportion reporting fatigue (Fatigue Assessment Scale), dyspnea (mMRC dyspnea scale) or depression (DASS-21) at six to eight months after diagnosis. Furthermore, the proportion of individuals with at least one healthcare contact after their acute illness was evaluated. Multivariable logistic regression models were used to assess factors associated with these main outcomes.

Results

Symptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalized. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalized individuals were rehospitalized. Individuals that have not fully recovered or suffer from fatigue, dyspnea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care.

Conclusions

In this population-based study, a relevant proportion of participants suffered from longer-term consequences after SARS-CoV-2 infection. With millions infected across the world, our findings emphasize the need for the timely planning of resources and patient-centered services for post-COVID-19 care.

Article activity feed

  1. Version published to 10.1371/journal.pone.0254523
  2. Version published to 10.1101/2021.02.27.21252572v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2021.02.27.21252572: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All data was collected and managed through the Research Electronic Data Capture (REDCap) online survey system.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    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:
    Strengths and Limitations: The main strength of our study is its population-based approach, which provides a unique opportunity for the evaluation of post-COVID-19 syndrome across the spectrum of disease severity. By relying on official records of PCR-confirmed infections within the Department of Health of the Canton of Zurich for recruitment, we were able to reach individuals diagnosed with infection from the whole population, strengthening the validity of our results. However, our study also has several limitations. First, most participants included in this analysis were diagnosed with COVID-19 during the first pandemic wave in Switzerland. The limited capacity of SARS-CoV-2 testing at that time may have selected for a population with a higher risk of experiencing severe disease. However, we observed largely comparable results in sensitivity analyses stratified by time periods of limited and increased testing. Similarly, sensitivity analyses stratified by time periods with different levels of awareness of post-COVID-19 syndrome did not show a relevant difference in people reporting symptoms or not having recovered, indicating that the increased awareness did not result in markedly higher rates of health issues reported by participants (Supplementary Material, Table S2). Second, self-selection bias may have occurred if individuals who are more concerned with their health were more likely to join our study. Compared to the individuals that did not participate in our study, we...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN14990068NANA

    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.

    About SciScore

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  4. Version published to 10.1101/2021.02.27.21252572v1 on medRxiv