In a recent study posted to the medRxiv* preprint server, researchers evaluated the symptoms and quality of life (QoL) among individuals with post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or PASC.
Background
Despite the high global burden of PASC, there is a lack of data on its symptoms beyond 12 months from acute infection. It is crucial to evaluate the relationship between PASC symptoms and QoL in the long term.
About the study
In the present study, researchers recruited a cohort of non-hospitalized individuals from a large academic health system who suffered from acute coronavirus disease 2019 (COVID-19). The study participants covered adults positive for SARS-CoV-2, as confirmed via reverse transcription-polymerase chain reaction (RT-PCR). Regardless of PASC status, 70 of 144 participants completed a survey at 12 and 18 months.
For one participant for whom the first COVID-19 positive RT-PCR test date was used, the researchers approximated the infection date using the symptom onset date for the remaining study population. The study participants self-reported the presence and severity of 49 symptoms experienced in the past week on a scale of one to five. Those who reported fatigue completed the Fatigue Severity Scale (FSS). Likewise, those endorsing sleep disturbances completed the Insomnia Severity Index (ISI).
The researchers used a set of five surveys to assess each participant’s mental health and QoL. These surveys covered the Generalized Anxiety Disorder 7-item (GAD-7), General Practitioner Assessment of Cognition (GPCOG), EuroQuol EQ-5D-5L overall health question, Personal Health Questionnaire Depression 8-item (PHQ-8), and 36-Item Short Form Survey (SF-36). To compare continuous variables between groups, the team used T-tests and Pearson’s chi-squared tests to compare categorical variables.
Study findings
The study recruitment began in April 2022 and by May 2022, 144 adult participants experiencing PASC were over a year from acute infection, with a median of 699 days since SARS-CoV-2-infection. Five participants received at least one dose of a messenger ribonucleic acid (mRNA) COVID-19 vaccine before infection, with a median of 31 days since the first dose. Regarding demographics, the median age of the study cohort at enrollment was 53, 61% were women, and the median body mass index (BMI) was 30. Close to 50% of the study participants identified themselves as non-Hispanic White, 23% as African American, and 19% identified as Hispanic of any ethnicity.
At 12 and 18 months post-COVID-19, 67% and 77% of study participants had returned to their usual pre-COVID-19 health, respectively. During the same timeframe, 80% and 83% had returned to their routine pre-COVID-19 activities, respectively. Attaining pre-COVID health was significantly associated with increased QoL in several domains at six and 12 months post-COVID-19. Conversely, having multiple symptoms lowered QoL over a year after SARS-CoV-2 infection. Nevertheless, the study analyses revealed that a high proportion of individuals with non-severe acute COVID-19 experienced a wide range of symptoms at six, 12, and 18 months post-infection.
The most commonly reported PASC symptoms were fatigue, nasal congestion and discharge, brain fog, headache, sleep disorders, and body aches. Of the 34 participants experiencing fatigue at any timepoint, seven reported fatigue at more than one timepoint and two at all three-time points, showcasing the potential waning character of PASC symptoms. Subsequently, the mean FSS-9 score for participants reporting fatigue at six, 12, and 18 months was 3.61, 4.21, and 4.03.
Notably, at 18 months post-COVID-19, neurological and systemic symptoms persisted in over half of the study participants, and close to one-fourth of the study participants had not returned to their usual pre-COVID-19 health. Among participants with no pre-existing depression, 18% and 38% had mild depression at 12 and 18 months post-COVID-19 and a PHQ-8 score in the range of five to nine. Around 7.7% and 0% had symptoms of moderate to moderately-severe depression with a PHQ-8 score in the range of 10 to 19. Scores across the eight SF-36 QoL domains did not vary substantially across timepoints but remained lower for physical function, fatigue, emotional well-being, pain, and general health QoL domains. However, based on SF-36 scores, participants at six, 12, and 18 months post-infection generally reported high QoL.
Conclusion
To conclude, future research should characterize and address the long-term symptoms associated with PASC, especially in the face of breakthrough infections by Omicron.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
