Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients

Sofie Bliddal,Ulla Feldt-Rasmussen,David Westergaard,Michael Schwinn,Bjarke Feenstra,Janna Nissen,Morten Tulstrup,Henrik Ullum,Susanne Dam Nielsen,Claus Henrik Nielsen,Ole Birger Pedersen,Sisse Rye Ostrowski,Kirsten Grønbæk,Frank Geller,Karina Banasik,Lisa Cantwell,Søren Brunak,Niels Tommerup

doi:10.1038/s41598-021-92045-x

Abstract

Reports of persistent symptoms after hospitalization with COVID-19 have raised concern of a “long COVID” syndrome. This study aimed at determining the prevalence of and risk factors for acute and persistent symptoms in non-hospitalized patients with polymerase chain reaction (PCR) confirmed COVID-19. We conducted a cohort study of non-hospitalized participants identified via the Danish Civil Registration System with a SARS-CoV-2-positive PCR-test and available biobank samples. Participants received a digital questionnaire on demographics and COVID-19-related symptoms. Persistent symptoms: symptoms > 4 weeks (in sensitivity analyses > 12 weeks). We included 445 participants, of whom 34% were asymptomatic. Most common acute symptoms were fatigue, headache, and sneezing, while fatigue and reduced smell and taste were most severe. Persistent symptoms, most commonly fatigue and memory and concentration difficulties, were reported by 36% of 198 symptomatic participants with follow-up > 4 weeks. Risk factors for persistent symptoms included female sex (women 44% vs. men 24%, odds ratio 2.7, 95% CI 1.4–5.1, p = 0.003) and BMI (odds ratio 1.1, 95% CI 1.0–1.2, p = 0.001). In conclusion, among non-hospitalized PCR-confirmed COVID-19 patients one third were asymptomatic while one third of symptomatic participants had persistent symptoms illustrating the heterogeneity of disease presentation. These findings should be considered in health care planning and policy making related to COVID-19.

Highlights

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has by May 2021 affected more than 158 million people worldwide and has been associated with 3.3 million deaths leading to a global health and financial crisis[1]
All individuals registered in the Danish Civil Registration System with a COVID-19 diagnosis confirmed by polymerase chain reaction (PCR) for SARS-CoV-2 by August 12th 2020 and an available biobank sample for genetic analyses were invited via the national digital postbox, e-Boks, to participate in a study on genetics in COVID-19 and related outcomes
More women than men participated in the study and significantly more women worked in the health care sector and had patient contact

Summary

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), has by May 2021 affected more than 158 million people worldwide and has been associated with 3.3 million deaths leading to a global health and financial crisis[1]. Clinical and public health interests are no longer limited to information on mortality and clinical outcomes in hospitalized patients, and to recovery and long-term consequences of COVID-19 post-hospitalization Among other initiatives, this has led to the Post-Hospitalization COVID-19 study (PHOSP-COVID) in the United Kingdom aiming at long-term follow-up of 10,000 patients discharged after hospitalization due to COVID-1915. Most studies on COVID-19 symptoms have recruited participants among hospitalized patients or patients attending outpatient clinics or specialized units, or support groups dealing with the consequences of COVID195,9,20,21 This confers a selection bias likely overestimating the true prevalence of symptoms and symptom severity. The aim of the present study was to determine the prevalence of and risk factors for acute and persistent symptoms in non-hospitalized patients with COVID-19 confirmed by a positive SARS-CoV-2 PCR

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