Persistence of Symptoms after Acute COVID-19 Infection- An Experience from a Tertiary Care Centre in South India

Abstract

Introduction: Coronavirus Disease-19 (COVID-19) pandemic is posing a challenge not only with sheer number of people infected but also with the large number of patients with persistent symptoms of COVID-19 infection. A proper understanding of the magnitude and associated factors of persistent COVID-19 symptoms will go a long way in planning treatment and control strategies. Aim: To determine the proportion of patients who have persistent symptoms post acute COVID-19 infection and to determine the factors associated with it, among those who have been discharged from Government Medical College, Thrissur, Kerala, India. Materials and Methods: The current cross-sectional study was conducted among 335 patients who were admitted and discharged with COVID-19 infection in Government Medical College, Thrissur, Kerala, a tertiary care institution in southern India between December 2020 and February 2021. They were contacted through a telephonic interview 28 days from symptom onset through a semi-structured interview schedule. The questions included basic demographic details, symptomatology at admission, persistent symptoms at 28 days after onset and other clinical details including comorbidities. For defining post COVID-19 symptom persistence National Institute for Health and Care (NICE) guidelines were used. Association between persistent symptoms and selected factors was done by Chi-square test. Results: Out of the 335 patients, the persistence of symptoms of COVID-19 infection after 28 days of symptom onset was 221 (66%) (CI 60.7-79.8). Persistence of two or more COVID-19 symptoms after 28 days of onset was seen in 120 (35.8%). The most common persistent symptoms among the patients were fatigue in 109 (32.5%) of people followed by dyspnoea in 77 (23%), cough in 45 (13.4%) and myalgia in 37 (11%) patients. Highest persistence was seen in Category C patients where symptoms were persisting in 75%. Persistence was also higher in those with Diabetes Mellitus (DM), those who received oxygen support and those who were in Intensive Care Unit (ICU) or on ventilator and the association was statistically significant (p-value <0.05). Conclusion: The study shows that two-third of patients still continues to have persistent symptoms even after 28 days of symptom onset. Health systems should be prepared to face the consequences of morbidities caused by post COVID-19 syndrome.