Mild antecedent COVID-19 associated with symptom-specific post-acute sequelae

• Type of Material: Article
• Authors: Tiffany Walker, Emory University; Alex D. Truong, Emory University; Aerica Summers, Grady Memorial Hospital Atlanta; Adviteeya Dixit, Emory University; Felicia Goldstein, Emory University; Ihab Hajjar, Emory University; Melvin R. Echols, Morehouse School of Medicine; Matthew Woodruff, Emory University; Erica D. Lee, Emory University; Seema Tekwani, Emory University; Kelley Carroll, Grady Memorial Hospital Atlanta; Ignacio Sanz, Emory University; Frances Eun-Hyung Lee, Emory University; Jenny Han, Emory University
• Language: English
• Date: 2023-07-01
• Publisher: PLoS ONE
• Publication Version: Final Published Version
• Copyright Statement: © 2023 Walker et al
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0288391
• Title of Journal or Parent Work: PLoS ONE
• Volume: 18
• Issue: 7 July
• Start Page: e0288391
• End Page: e0288391
• Grant/Funding Information: TAW and JEH were funded by the Woodruff Health Sciences Center COVID-19 CURE Award. There is no associated award number. http://whsc.emory.edu/research/covid-19-research/index.html The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: Disease Progression; Headache; Adult; Male; Post-Acute COVID-19 Syndrome; Middle Aged; Female; Fatigue; COVID-19; Humans; Cohort Studies
• Research Categories: Health Sciences, Public Health; Biology, Virology

Abstract

Background The impact of COVID-19 severity on development of long-term sequelae remains unclear, and symptom courses are not well defined. Methods This ambidirectional cohort study recruited adults with new or worsening symptoms lasting >3 weeks from confirmed SARS-CoV-2 infection between August 2020–December 2021. COVID-19 severity was defined as severe for those requiring hospitalization and mild for those not. Symptoms were collected using standardized questionnaires. Multivariable logistical regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between clinical variables and symptoms. Results Of 332 participants enrolled, median age was 52 years (IQR 42–62), 233 (70%) were female, and 172 (52%) were African American. Antecedent COVID-19 was mild in 171 (52%) and severe in 161 (48%). In adjusted models relative to severe cases, mild COVID-19 was associated with greater odds of fatigue (OR:1.83, CI:1.01–3.31), subjective cognitive impairment (OR:2.76, CI:1.53–5.00), headaches (OR:2.15, CI:1.05–4.44), and dizziness (OR:2.41, CI:1.18–4.92). Remdesivir treatment was associated with less fatigue (OR:0.47, CI:0.26–0.86) and fewer participants scoring >1.5 SD on PROMIS Cognitive scales (OR:0.43, CI:0.20–0.92). Fatigue and subjective cognitive impairment prevalence was higher 3–6 months after COVID-19 and persisted (fatigue OR:3.29, CI:2.08–5.20; cognitive OR:2.62, CI:1.67–4.11). Headache was highest at 9–12 months (OR:5.80, CI:1.94–17.3). Conclusions Mild antecedent COVID-19 was associated with highly prevalent symptoms, and those treated with remdesivir developed less fatigue and cognitive impairment. Sequelae had a delayed peak, ranging 3–12 months post infection, and many did not improve over time, underscoring the importance of targeted preventative measures.