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© 2023 Walker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Background

The impact of COVID-19 severity on development of long-term sequelae remains unclear, and symptom courses are not well defined.

Methods

This ambidirectional cohort study recruited adults with new or worsening symptoms lasting ≥3 weeks from confirmed SARS-CoV-2 infection between August 2020–December 2021. COVID-19 severity was defined as severe for those requiring hospitalization and mild for those not. Symptoms were collected using standardized questionnaires. Multivariable logistical regression estimated odds ratios (OR) and 95% confidence intervals (CI) for associations between clinical variables and symptoms.

Results

Of 332 participants enrolled, median age was 52 years (IQR 42–62), 233 (70%) were female, and 172 (52%) were African American. Antecedent COVID-19 was mild in 171 (52%) and severe in 161 (48%). In adjusted models relative to severe cases, mild COVID-19 was associated with greater odds of fatigue (OR:1.83, CI:1.01–3.31), subjective cognitive impairment (OR:2.76, CI:1.53–5.00), headaches (OR:2.15, CI:1.05–4.44), and dizziness (OR:2.41, CI:1.18–4.92). Remdesivir treatment was associated with less fatigue (OR:0.47, CI:0.26–0.86) and fewer participants scoring >1.5 SD on PROMIS Cognitive scales (OR:0.43, CI:0.20–0.92). Fatigue and subjective cognitive impairment prevalence was higher 3–6 months after COVID-19 and persisted (fatigue OR:3.29, CI:2.08–5.20; cognitive OR:2.62, CI:1.67–4.11). Headache was highest at 9–12 months (OR:5.80, CI:1.94–17.3).

Conclusions

Mild antecedent COVID-19 was associated with highly prevalent symptoms, and those treated with remdesivir developed less fatigue and cognitive impairment. Sequelae had a delayed peak, ranging 3–12 months post infection, and many did not improve over time, underscoring the importance of targeted preventative measures.

Details

Title
Mild antecedent COVID-19 associated with symptom-specific post-acute sequelae
Author
Walker, Tiffany A  VIAFID ORCID Logo  ; Truong, Alex D; Summers, Aerica; Dixit, Adviteeya N; Goldstein, Felicia C; Hajjar, Ihab; Echols, Melvin R  VIAFID ORCID Logo  ; Woodruff, Matthew C; Lee, Erica D; Tekwani, Seema; Carroll, Kelley; Sanz, Ignacio; Lee, F Eun-Hyung; Han, Jenny E
First page
e0288391
Section
Research Article
Publication year
2023
Publication date
Jul 2023
Publisher
Public Library of Science
e-ISSN
19326203
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2835427449
Copyright
© 2023 Walker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.