Study identifies implications of long-COVID on long term physical and mental health

By Bhavana KunkalikarMar 31 2022Reviewed by Aimee Molineux

A recent study published in the Influenza and Other Respiratory Viruses journal assessed the characteristics of persistent coronavirus disease 2019 (COVID-19) symptoms lasting beyond six months in some COVID-19 patients.

Various studies suggest that a significant number of patients suffering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection develop post-acute sequelae of COVID-19 (PASC), also called long-COVID.

However, the mechanisms and risk factors involved in the various manifestations of PASC are still poorly understood.

About the study

The present multicenter prospective cohort study characterized the trajectories of COVID-19 symptoms before, during, and six to 11 months post-acute and mild COVID-19 infection and evaluated the long-term self-reported aspects of health, quality of life (QoL), and psychological distress.

The team obtained lists of outpatient adults who had previously tested reverse transcription-polymerase chain reaction (RT-PCR)-positive for SARS-CoV-2 infection. Nasal swabs were collected for two weeks between 1 April 2020 and 28 July 2020.

Participants with COVID-19 symptoms at the time of SARS-CoV-2 diagnosis were treated as outpatients. The study defined outpatient status as SARS-CoV-2 testing conducted at an ambulatory testing center, a clinic, or an emergency department without any subsequent hospitalization.

Data were collected through the electronic medical records of the local sites and by Twilio, a cloud communications platform. A survey was conducted in two parts on the basis of symptoms assessed six to 11 months post the initial SARS-CoV-2 infection as well as self-reported health status, QoL, and psychological distress.

Part 1 of the survey with Twilio required the participants to answer questions regarding any physical or mental problems that they were still experiencing that were related to COVID-19. Participants having persistent symptoms at the long-term follow-ups reported persisting symptoms that were the most severe. Those who reported no persisting symptoms at long-term follow-up had to note the duration they required to fully recover from their SARS-CoV-2 symptoms.

Part 2 of the survey collected participant demographic data. It also required the participants to categorize the severity of eight PASC-associated symptoms, namely, fatigue, difficulty concentrating, sleeplessness, difficulty in completing usual daily tasks, lack of breath, loss of smell, loss of taste, and hair loss. These symptoms were reported at three different time points including a month before COVID-19 symptom onset, during the worst symptomatic phase of acute COVID-19, and at the time of survey completion.

The classification of symptom severity was performed using a four-level ordinal scale ranging from 0 (not present) to 3 (severe and persistent symptom). This severity score was computed for each participant by evaluating the difference between the long-term follow-up score and pre-illness baseline score.

The participants also reported self-assessed health status using the EuroQol visual analog scale (EQ-VAS) for a month before the COVID-19 illness and at the long-term follow-up. The EQ-VAS score ranged from 0 (worst health imaginable) to 100 (best health imaginable).

Results

The study results showed that a total of 2,092 outpatients who were previously SARS-CoV-2-positive were eligible among which 397 participants responded to the first part of the survey. Among these, 44% reported persistent COVID-19 symptoms during the long-term follow-up. Almost 31% of the participants reported fatigue as the most severe symptom, while 20% reported shortness of breath, 9% had difficulty in concentrating, and 9% suffered from a loss of smell. Out of the 221 participants who reported no persistent symptoms at the long-term follow-up, recovery was reported by 55% of participants in less than a month after COVID-19 diagnosis, 33% in one to three months, 9% in three to six months, and 2% after six months.

The study found that the loss of smell and taste was very rare in participants prior to their COVID-19 diagnosis. However, this condition was severe in participants suffering from acute COVID-19, which was completely resolved for most of the participants during the long-term follow-up. Also, shortness of breath, fatigue, difficulty to perform usual tasks, and difficulty in concentrating were uncommon before COVID-19, became severe during peak COVID-19 infection, and were persistent in a few individuals at long-term follow-up.

Persistent symptom score was 1 or higher in 33% and 32% of the participants experiencing difficulty in concentrating and shortness of breath. Also, 31% of the subjects had at least one symptom with a persistent symptom score of 2 or more. Moreover, a persistent symptom score of 2 or more was found in 4% of participants with sleeping difficulties and 11% suffering from fatigue.

Conclusion

The study findings showed that the presence of persistent symptoms of long-COVID was significantly related to poorer long-term health status, poorer QoL, and psychological distress.

The researchers believe that medical professionals should be aware of the implications of long-term COVID-19 symptoms even among mild and acute SARS-CoV-2 cases and provide therapeutic approaches to the patients accordingly.