Tracking Health Beyond Recovery: A Study on Identifying Post-COVID Syndrome Symptoms

HIGHLIGHTS

This pioneering research on post-COVID syndrome in 228 individuals recovered from Karad Taluka unveils a persistent impact, with 43% experiencing symptoms for up to 12 months. Notably, fatigue, shortness of breath, and cough endure in varying severity. These findings underscore the immediate need for ongoing research and precise medical interventions to address the nuanced and enduring manifestations of post-COVID syndrome.

INTRODUCTION

The 2019 coronavirus disease pandemic (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulted in the deaths of approximately 5.3 million people worldwide as of November 2021.¹ Despite most individuals recovering from the acute stage of the virus within a few weeks, some continue to experience new or persistent symptoms months after their diagnosis. This phenomenon, known as post-COVID syndrome, protracted COVID-19, or post-acute sequelae of SARS-CoV-2 infection (PASC)/long COVID has emerged as a significant public health concern.

Post-COVID syndrome is characterized by the continuation or development of symptoms that cannot be explained by an alternative diagnosis, occurring at least 3 months after the onset of COVID-19 and persisting for at least 2 months or more without any conclusive diagnosis.² These symptoms can vary widely in type, severity, and duration, affecting multiple organ systems and domains of functioning. Commonly reported symptoms include fatigue, shortness of breath, brain fog, chest pain, joint or muscle pain, headaches, depression, and anxiety. However, more than 200 different symptoms have been associated with post-COVID syndrome.

Estimating the prevalence of post-COVID syndrome is challenging due to the condition’s heterogeneity and the absence of standardized diagnostic criteria. However, various studies suggest that between 10 and 20% of those infected with SARS-CoV-2 might develop post-COVID syndrome.³ According to a recent analysis by the Institute for Health Metrics and Evaluation (IHME), by the end of 2021, 3.92 billion people had contracted SARS-CoV-2. Of these, 3.7% (144.7 million) developed post-COVID syndrome as defined by the World Health Organization (WHO) clinical case definition,² with 15.1% (22 million) still exhibiting symptoms 12 months after infection onset.⁴

The global burden of post-COVID syndrome likely varies across regions and countries, influenced by the epidemiology of COVID-19, healthcare availability and accessibility, and socioeconomic and cultural factors that shape health-seeking behaviors and outcomes. In India, with over 34 million cases and 460 thousand deaths reported as of November 2021, post-COVID syndrome presents a significant challenge to the health system and society. A study by the Indian Council of Medical Research (ICMR) from August 2021 revealed that nearly 6.5% of those hospitalized with COVID-19 died within the following year, and 17.1% experienced post-COVID conditions, such as fatigue, breathlessness, or cognitive abnormalities. This study also indicated that vaccination reduced the risk of death by 60% among post-COVID patients.⁵ Given the potential impact of post-COVID syndrome on morbidity, mortality, quality of life, and healthcare utilization, there is an urgent need to identify its symptoms, risk factors, mechanisms, and management strategies.^6–8

Past experiences with another coronavirus, the severe acute respiratory syndrome coronavirus (SARS-CoV), revealed post-viral fatigue syndrome/myalgic encephalomyelitis as a prevalent symptom. As previously reported, the virus can reach the hypothalamus via the olfactory pathway, disrupting its lymphatic drainage. This disruption leads to the formation of pro-inflammatory cytokines, interleukins, and interferon gamma within the hypothalamus, resulting in post-viral fatigability.^9,10

This research study aims to enhance our understanding of post-COVID syndrome by identifying specific symptoms, thereby informing future research and policy interventions to address its challenges and implications.

MATERIALS AND METHODS

Sample and Sampling Technique

About 221 recovered individuals from COVID-19 and discharged from Karad tertiary care hospital were included as study subjects.

The desired sample size was calculated using the following formula:

Z² = 1.96

P = % of symptoms

q = 100-P

d² = 6% Allotment error

Using a reference from a study by Reaz Mazhmud et al. (2021), “Post-COVID-19 syndrome among symptomatic COVID-19 patients: A prospective cohort study in a tertiary care center in Bangladesh”.

Following the consecutive sampling technique, the target population was approached and screened until the desired number was obtained.

RESULTS

DISCUSSION

The concerns surrounding persistent symptoms in COVID-19 survivors are well founded, considering the lingering effects observed in survivors of previous coronavirus outbreaks, such as severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) in 2012.⁹ As of SARS (2003) and MERS (2012), its impact on the body was shown in the form of various symptoms. So, after recovery from COVID-19, this virus is somewhat cleared from the body but that remnants in pockets show its presence in the form of symptoms.

In this study, 228 COVID-19 people recovered and discharged from a tertiary care hospital were studied. Considering the facts about COVID-19 and its post-COVID syndrome that shows symptoms with other evidences such as comprehensive review conducted by Lopez-Leon et al., it was found that a significant proportion of post-COVID-19 patients, approximately 80% (with a 95% confidence interval ranging from 65 to 92%), continued to experience one or more symptoms beyond 2 weeks following the initial acute infection.¹¹

Considering the nature and trajectory of infection with the COVID-19 virus, it was thought that whatever the severity of the COVID-19 infection, it will cause certain symptoms to all individuals in more or less a way. This was evident with study by Morin et al. reported that 51% of patients in a cohort of 478 hospitalized individuals still reported at least one persistent symptom 4 months after their initial COVID-19 diagnosis.¹²

Similarly, a review by Pavli et al. estimated the incidence of post-COVID syndrome to range from 10 to 35% among outpatient patients, increasing to a substantial 85% among hospitalized patients.¹³ The study also highlighted the presence of post-COVID syndrome in individuals who were hospitalized and proved its presence.

The demographic factors considered in this study, including age, gender, education status, COVID-19 symptoms on admission, and HRCT score, provide valuable insights into the profile of post-COVID syndrome in this specific population. Notably, Table 1 presents the age distribution revealed a higher prevalence of COVID-19 recovery among individuals aged 30–44 years (45%) and 45–60 years (43%), with males comprising 53% of the study cohort. A significant proportion of subjects (38%) had a secondary education level.

As this study was conducted in Karad taluka which had a tertiary care hospital (Krishna Hospital and Medical Research Center, Karad) a COVID dedicated center, more of residentials of Karad successfully got treated and recovered. Taking into account the geographic area of Karad, the large number of infected cases and the available treatment facilities also impacted this research.

When comparing demographic variables with other studies, such as, for instance, Mahmud et al. reported that 60% of their patients were under 40 years of age, with only 8% over 60 years.¹⁴ This study also had an age-group like the present study. Additionally, a study by Khodeir et al. conducted in Saudi Arabia found that the majority of subjects (57.1%) were between 20 and 39 years of age, and 36.2% were within the age-group of 40–59 years age-group.¹⁵ These variations can be attributed to factors such as geographical differences and local spread of infections.

Regarding post-COVID syndrome symptoms, Figure 1 revealed that 60.5% of the 228 COVID-19 recovered individuals experienced a moderate level of symptoms, with 10.9% reporting mild symptoms and 28.5% exhibiting severe symptoms. This highlights the lasting impact of COVID-19 on individuals, with a diverse array of symptoms persisting even after recovery.

A detailed analysis of these symptoms on a 4-point severity scale (no, mild, moderate, and severe) revealed several key findings. Fatigue, shortness of breath, cough, sore throat, chest pain, joint pain, headache, negative thoughts, anorexia, loss of taste and smell, stomachache, diarrhea, insomnia, and brain fog were consistently reported by all subjects, albeit to varying degrees.

Table 2 depicted that fatigue emerged as the most common symptom, affecting 116 (50.8%) of subjects at a moderate level. Similarly, shortness of breath 135 (58.3%), cough 116 (50.8%), and sore throat 115 (50.4%) were prevalent at varying intensities. Interestingly, joint pain 151 (66.2%), chest pain 130 (mild 57%), anorexia 115 (50.4%), and stomachache and diarrhea 130 (57%), headache 115 (50.4%), negative thoughts 145 (63.5%) exhibited varying degrees of severity. Insomnia 105 (45%) and brain fog 103 (45%) were also reported by a substantial number of individuals. The duration for which these symptoms persisted varied, with the majority (43%) experiencing symptoms for up to 12 months post-recovery.

Comparing these findings with other studies, it becomes evident that post-COVID syndrome manifests differently between. Interestingly, the results reveal individuals, with fatigue being a consistent and predominant symptom. Possible mechanisms underlying these persistent symptoms include inflammation, nervous system involvement, psychological stress, altered immune responses, disruptions in the gut microbiome, and viral reservoirs.¹⁶ Geographical differences, infection spread patterns, age, and gender could also influence symptom profiles.

CONCLUSION

In conclusion, this study adds to the growing body of evidence on post-COVID syndrome, underscoring its complex and varied nature. The high prevalence of persistent symptoms emphasizes the need for continued research and medical attention to address the enduring and diverse symptoms associated with this condition.

ORCID

Shreyas S Walvekar https://orcid.org/0009-0009-5368-6732

Vaishali R Mohite https://orcid.org/0000-0002-1066-851X

REFERENCES

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