Prevalence and predictors of post-COVID-19-related symptoms: an extended follow-up among employees in health and welfare services in Germany: a short report

The aim of this study was to determine the prevalence and trajectory of persistent symptoms following COVID-19 and to investigate factors influencing these among employees in the health and welfare services in Germany. This exploratory, mixed retro- and prospective cohort study using paper-and-pencil questionnaires was conducted among insured persons of the German Social Accident Insurance Institution for the health and welfare services with a SARS-CoV-2 infection in 2020. The baseline survey in February 2021 was succeeded by two follow-up surveys after 8 and 13 months. Demographic data, information on the acute illness and persistent symptoms were collected. Kaplan-Meier curves were created to visualize the course of recovery. Factors influencing the time to recovery were analyzed using multivariate Cox regressions. Of the 4,325 people contacted, 2,053 took part in the survey (response rate: 47%). 1,810 people were included in the analysis. The most common persistent symptoms at all three survey time points were fatigue, concentration and memory problems, and dyspnea. After three months, 76.2% (95% CI: 74.2-78.2%) of participants still reported symptoms, after 18 months this dropped to 67.2% (95% CI: 65.0-69.4%). Significant risk factors for persistent symptoms were female sex (HR: 0.72; 95% CI: 0.58-0.88), age over 50 years (HR: 0.63; 95% CI: 0.50-0.78), a higher number of pre-existing illnesses and a higher number of severe acute symptoms. Respiratory and hormone-metabolic pre-existing conditions as well as severe dyspnea, smell or taste disorders, fatigue and memory or concentration problems during the acute COVID-19 illness also reduced the probability of complete recovery. Compared to other professions, working as a doctor had a protective effect (HR: 1.42; 95% CI: 1.11-1.80). More than a year after a COVID-19 illness, two-thirds of the healthcare staff surveyed reported persistent symptoms. This high number emphasizes the importance of long-term consequences of the COVID-19 pandemic for public health and the need for suitable therapy and rehabilitation concepts, especially for healthcare staff with post-COVID syndrome.

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.

Prevalence and risk factors for persistent symptoms after COVID-19: a systematic review and meta-analysis

Hypotheses to explain the associations between asthma and the consequences of COVID-19 infection.

Aim Asthma is a common chronic airway disease among children worldwide. Multiple risk factors including viral infections and environmental trigger factors could maintain the airway inflammation leading to persistent respiratory symptoms among children with asthma. This study was conducted to identify, patient reported symptoms and common environmental risk factors in a cohort of asthma children in 7–14 years with persistent symptoms. Method Cross sectional descriptive study conducted after obtaining the ethical clearance. The cohort consisted physician diagnosed asthma patients on regular steroid inhalers attending to outpatient clinics. Patients recruited after informed consent and data collected by an interviewer administered questionnaire over one month period. Data gathered on basic demographic details, comorbidities and common environmental risk factor based on ISAAC environmental risk factor assessment questionnaire. Patients demonstrated poor compliance (defined as forgetting inhaler steroids more than 5 days per month) and incorrect inhaler technique were excluded from the study. Results 115 patients in 7–14 years age category were interviewed and 82 reported having persistent respiratory symptoms. 22 patients had poor compliance and incorrect inhaler technique. Remaining 60 patients were assessed for reported symptoms and environmental risk factors. 28 (47%) were males. Patient reported symptoms were; wheezing (70%), dry cough (60%), exertional dyspnoea (33%) and chest tightness (13%). Half the patients reported more than one symptom. 77% (46) of them reported having allergic rhinitis. Daily exposed to vehicle fumes while travelling to school (97%), use of joss sticks inside the house (57%) were identified as most common environmental risk factors. Further, 27% of patients directly exposed to animal dander from domestic pets, 10% of them exposed to mosquito coils and cooking fumes inside the house and only 4% exposed to tobacco smoke at home. Conclusion Wheezing and dry cough were the commonest persistent respiratory symptoms and daily exposure to vehicle fumes while travelling to school and use of joss sticks inside the house were identified as most common environmental risk factors among the examined asthmatic children.

The risk of persistent symptoms after a brief resolved unexplained event (BRUE) is not known. Our objective was to determine the frequency and risk factors for persistent symptoms after BRUE hospitalizations. We conducted a prospective longitudinal cohort study of infants hospitalized with an admitting diagnosis of BRUE. Caregiver-reported symptoms, anxiety levels, and management changes were obtained by questionnaires during the 2-month follow-up period. Clinical data including repeat hospitalizations were obtained from a medical record review. Multivariable analyses with generalized estimating equations were conducted to determine the risk of persistent symptoms. Of 124 subjects enrolled at 51.6 ± 5.9 days of age, 86% reported symptoms on at least 1 questionnaire after discharge; 65% of patients had choking episodes, 12% had BRUE spells, and 15% required a repeat hospital visit. High anxiety levels were reported by 31% of caregivers. Management changes were common during the follow-up period and included 30% receiving acid suppression and 27% receiving thickened feedings. Only 19% of patients had a videofluoroscopic swallow study while admitted, yet 67% of these studies revealed aspiration/penetration. Many infants admitted with BRUE have persistent symptoms and continue to access medical care, suggesting current management strategies insufficiently address persistent symptoms. Future randomized trials will be needed to evaluate the potential efficacy of therapies commonly recommended after BRUE.

Changes in bowel symptoms 1 year after rectocele repair

BackgroundThe long‐term sequalae of COVID‐19 remain poorly characterized. We assessed persistent symptoms in previously hospitalized patients with COVID‐19 and assessed potential risk factors.MethodsData were collected from patients discharged from 4 hospitals in Moscow, Russia between 8 April and 10 July 2020. Participants were interviewed via telephone using an ISARIC Long‐term Follow‐up Study questionnaire.Results2,649 of 4755 (56%) discharged patients were successfully evaluated, at median 218 (IQR 200, 236) days post‐discharge. COVID‐19 diagnosis was clinical in 1291 and molecular in 1358. Most cases were mild, but 902 (34%) required supplemental oxygen and 68 (2.6%) needed ventilatory support. Median age was 56 years (IQR 46, 66) and 1,353 (51.1%) were women. Persistent symptoms were reported by 1247 (47.1%) participants, with fatigue (21.2%), shortness of breath (14.5%) and forgetfulness (9.1%) the most common symptoms and chronic fatigue (25%) and respiratory (17.2%) the most common symptom categories. Female sex was associated with any persistent symptom category OR 1.83 (95% CI 1.55 to 2.17) with association being strongest for dermatological (3.26, 2.36 to 4.57) symptoms. Asthma and chronic pulmonary disease were not associated with persistent symptoms overall, but asthma was associated with neurological (1.95, 1.25 to 2.98) and mood and behavioural changes (2.02, 1.24 to 3.18), and chronic pulmonary disease was associated with chronic fatigue (1.68, 1.21 to 2.32).ConclusionsAlmost half of adults admitted to hospital due to COVID‐19 reported persistent symptoms 6 to 8 months after discharge. Fatigue and respiratory symptoms were most common, and female sex was associated with persistent symptoms.

AimThe long-term sequelae of coronavirus disease 2019 (COVID-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with COVID-19 and associated risk factors.Material...

Although acute diverticulitis and its recurrence are well studied, little is known about the period after these attacks have passed. Many patients appear to be affected by persistent symptoms that impair quality of life. The few published studies on this topic are mostly limited by the lack of CT confirmation of the acute diverticulitis diagnosis, low numbers of patients, or cross-sectional design. This study longitudinally evaluated quality of life and symptoms after antibiotic or observational treatment of uncomplicated acute diverticulitis. This was an observational study of randomized clinical trial data. This study was conducted at a single tertiary care center. Patients with CT-proven, primary, left-sided, uncomplicated acute diverticulitis were randomly assigned to observational or antibiotic treatment. Quality of life was assessed using questionnaires (EuroQol 5D, Short Form-36, and Gastrointestinal Quality of Life Index) at baseline and 3, 6, 12, and 24 months after random assignment. Patients were considered to have persistent symptoms when specific quality-of-life scores at the 12- and 24-month follow-ups were among the lowest 16% of scores measured in a healthy reference group. A total of 528 patients were included. No difference was detected between the observational and antibiotic groups in any quality-of-life score during follow-up. Overall, 32.2% to 38.2% of patients had persistent symptoms after 1 or 2 years, depending on which questionnaire (sub)score was assessed. Risk factors for persistent symptoms based on to the Gastrointestinal Quality of Life index GI symptoms score included a mean pain score ≥3.75 (OR = 2.77 (95% CI, 1.60-4.80)) during the first 10 days of disease and prolonged (≥28 d) time to recovery (OR = 2.25 (95% CI, 1.31-3.88)). Flatulence, rumblings, bloating, fullness, and many stools were the top 5 complaints at the 12- and 24-month follow-ups. The study was limited by possible selection bias of patients included in a randomized controlled trial. More than one third of patients experience persistent symptoms after an episode of acute uncomplicated diverticulitis. Long-term quality of life is comparable after initial antibiotic or observational treatment. See Video Abstract at http://links.lww.com/DCR/A916.

With the number of coronavirus disease 2019 (COVID‐19) infected patients increasing all over the world, a large number of survivors have reported changes in their quality of life or experienced re‐infection. So, we aimed to detect the percentage, type, and risk factors of persistent symptoms after improvement from acute COVID‐19 infection and to detect the percentage of COVID‐19 re‐infection and degree of severity of the second infection. One hundred seventy‐two (59 male, 113 female) patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) were followed up via mobile phone every 2 months for 8 to 10 months. After recovery, 105 patients (61%) (30 male, 75 female) reported one or more COVID‐19 persistent symptoms. Fatigue, dyspnea, and depression were the most common persistent symptoms representing 37.3%, 22%, 22%, respectively. We found that age was independently related to the persistence of symptoms. During the follow‐up, six females (3.5%) had laboratory‐confirmed COVID‐19 re‐infection. Their mean age was 35.7 ± 11 years. The mean interval from the complete recovery of the first infection to the onset of the second one was 53 ± 22.2 days and ranged from 30 to 90 days. The second infection was milder in severity than the first infection in 83.33% of cases. There was a high percentage of patients who complained of persistent symptoms after recovery from COVID‐19. Fatigue and headache were the most common persistent symptoms. Age was considered a risk factor for persistent symptoms. Re‐infection with SARS‐CoV‐2 can occur after recovery.

BackgroundThe long-term sequelae of coronavirus disease 2019 (COVID-19) in children remain poorly characterised. This study aimed to assess long-term outcomes in children previously hospitalised with COVID-19 and associated risk factors.MethodsThis is a prospective cohort study of children (≤18 years old) admitted to hospital with confirmed COVID-19. Children admitted between 2 April 2020 and 26 August 2020 were included. Telephone interviews used the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 Health and Wellbeing Follow-up Survey for Children. Persistent symptoms (>5 months) were further categorised by system(s) involved.Results518 out of 853 (61%) eligible children were available for the follow-up assessment and included in the study. Median (interquartile range (IQR)) age was 10.4 (3–15.2) years and 270 (52.1%) were girls. Median (IQR) follow-up since hospital discharge was 256 (223–271) days. At the time of the follow-up interview 126 (24.3%) participants reported persistent symptoms, among which fatigue (53, 10.7%), sleep disturbance (36, 6.9%) and sensory problems (29, 5.6%) were the most common. Multiple symptoms were experienced by 44 (8.4%) participants. Risk factors for persistent symptoms were: older age “6–11 years” (OR 2.74, 95% CI 1.37–5.75) and “12–18 years” (OR 2.68, 95% CI 1.41–5.4), and a history of allergic diseases (OR 1.67, 95% CI 1.04–2.67).ConclusionsA quarter of children experienced persistent symptoms months after hospitalisation with acute COVID-19 infection, with almost one in 10 experiencing multisystem involvement. Older age and allergic diseases were associated with higher risk of persistent symptoms at follow-up.

The long-term impact of COVID-19 among those with mild infections is not well characterized. Among 81 adults who completed online assessments at 3- and 12-months following infection, quality of life scores did not significantly improve over time. Among 62 subjects who also completed telephone interviews, respiratory symptoms or exercise limitation were reported by 42% at a median follow-up of 387 days (IQR 251–402 days). Those with persistent respiratory symptoms scored lower on the EQ-5D visual analog score compared to those without. Persistent respiratory symptoms were associated with a lower likelihood of full-time employment at 1 year (aOR 0.09, 95%CI 0.01–0.91; P = 0.041). In an adjusted linear regression, persistent respiratory symptoms (P = 0.037) and female sex (P = 0.016) were both independent risks for increased visits to a primary care provider. This cohort study demonstrates that respiratory symptoms are frequent at 1 year following COVID-19 and more importantly, are associated with negative impacts on employment, quality of life, and health care utilization. Further research is needed to determine the pathophysiology and risk factors for persistent symptoms as well as optimal management strategies to improve the level of functioning and quality of life.

Background/Objectives: Healthcare and social workers were at increased risk of infection during the COVID-19 pandemic, and were therefore also at increased risk of long-term physical and mental health consequences due to infection. This study aimed to investigate the course of health-related quality of life (HRQoL) and mental health, in terms of depression and anxiety. Methods: A longitudinal study surveyed employees in health and social services diagnosed with SARS-CoV-2 in 2020 over a period of three years. Results: A total of 834 individuals participated in all four surveys. The mean age was 50.2 years (SD 5.8), with 82.3% of the participants being female. Mixed-model analyses were performed to examine the development over time. The results showed significant impairments in physical and mental HRQoL, as well as in mental health. Factors influencing physical HRQoL were gender, age, and pre-existing conditions. Pre-existing mental health conditions and self-reported health prior to infection were found to be predictors of mental HRQoL and symptoms of depression and anxiety. Those with persistent symptoms reported a significantly lower quality of life than those who had recovered. The mean physical HRQoL among participants with ongoing symptoms was 38.6, compared with 50.0 for those without symptoms, and the mean mental HRQoL was 40.4 versus 50.1 (p < 0.001). Conclusions: These findings suggest that health-related quality of life and mental health should continue to be monitored to prevent long-term psychological distress.

IntroductionA substantial proportion of individuals infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), report persisting symptoms weeks and months following acute infection. Estimates on prevalence vary due to differences in...