Clinical Spectrum and Outcomes of Post-COVID Syndrome Among Adults in Rural Kerala—A Cohort Study

Background and objective: Despite ongoing research on post-COVID syndrome, key gaps remain, including short follow-up, absence of control groups, small sample sizes, and limited representation of mild to moderate cases. We determined incidence and outcomes of post-COVID syndrome over 12 months in a rural district of Kerala. Methods: Among 596 participants, 298 had previous COVID-19 infection confirmed by RT-PCR or antigen test (exposure group) while remaining had no evidence of COVID-19 (control group). Field workers collected data by direct interviews. Study variables, including blood pressure, blood sugar, oxygen saturation and 6-minute walk distance were recorded at 6-, 9- and 12-months following recruitment. Results: Incidence of post-COVID syndrome was 91.9%. At 9 months, 12 (4.4%) exposure group participants required readmission compared to 4 (1.6%) of the control cohort (p=0.05). At 9 months, 203 (68.1%) exposure group participants reported at least one ongoing symptom. After 6 months, 28.1% participants in the exposure cohort had 6 to 10 symptoms, while 0.7% participants experienced more than 10 symptoms. The differences in 6-minute walk distance at 6, 9, and 12 months were statistically significant (p=0.037), with nadir at 9 months. Mean systolic and diastolic BP were significantly higher in the exposure than control group at 6 and 9 months. Conclusion: Post-COVID symptoms persisted after one year, even in individuals with mild or moderate initial infections. Exercise tolerance and blood pressure are also impaired in post-COVID patients compared to controls. This highlights the need for long-term monitoring and care for those recovering from acute COVID-19.