Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study

Chithira V Nair; Merlin Moni; Fabia Edathadathil; Appukuttan A; Preetha Prasanna; Roshni Pushpa Raghavan; Dipu T Sathyapalan; Aveek Jayant

doi:10.2196/40028

Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study

JMIR Form Res. 2023 Apr 18:7:e40028. doi: 10.2196/40028.

Authors

Chithira V Nair¹, Merlin Moni¹, Fabia Edathadathil², Appukuttan A¹, Preetha Prasanna³, Roshni Pushpa Raghavan⁴, Dipu T Sathyapalan¹, Aveek Jayant⁵

Affiliations

¹ Division of Infectious Diseases, Department of General Medicine, Amrita Institute of Medical Science and Research Centre, Kochi, India.
² Department of Infection Control and Epidemiology, Amrita Institute of Medical Science and Research Centre, Kochi, India.
³ Department of Medical Administration, Amrita Institute of Medical Science and Research Centre, Kochi, India.
⁴ Department of Pharmacy Practice, Amrita School of Pharmacy, Kochi, India.
⁵ Department of Anaesthesia, Critical Care and Pain, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India.

PMID: 36920842
PMCID: PMC10131721
DOI: 10.2196/40028

Abstract

Background: Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome.

Objective: We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations.

Methods: A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks.

Results: The mean age of the cohort was 55 years and 55% were men. Only 5% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. In addition, 60.8% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8%, followed by dyspnea (20%) and weight loss (16.7%). Female sex (odds ratio [OR] 2.4, 95% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis.

Conclusions: Overall, 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks.

Keywords: COVID-19; fatigue; follow-up; incidence; intensive care; long COVID; post-COVID; post-COVID-19 symptoms; postdischarge; prospective observational study; questionnaire; steroid; symptom monitoring; tertiary-care center; treatment; viral therapy.

©Chithira V Nair, Merlin Moni, Fabia Edathadathil, Appukuttan A, Preetha Prasanna, Roshni Pushpa Raghavan, Dipu T Sathyapalan, Aveek Jayant. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.04.2023.