Persistence of Coronavirus Disease 2019 Symptoms in Postacute Phase: Does Age, Sex, Comorbidities, and Severity of Infection Have an Impact?

Background and objective: Post-coronavirus disease (COVID) persistence of symptoms and the development of complications have become frequently encountered clinical problems due to multiple waves of the pandemic over the past 3 years across the world. Identifying risk factors would enable us to direct our limited resources toward the subgroups requiring long-term follow-up and treatment. With this prospective observational study, we aim to establish a statistical correlation between the persistence of symptoms and four of the most attributed risk factors for prolonged recovery: severity of acute illness, elderly age, presence of multiple comorbidities, and female gender in the Indian population.

Materials and methods: Three hundred patients with positive COVID reverse transcription polymerase chain reaction (RTPCR) or antigen tests were enrolled over 10 months (from December 2020, after obtaining ethical clearance, to October 2021). Symptoms were recorded at baseline and followed up with a predesigned questionnaire to assess their persistence at 1-, 2-, and 4-month intervals post-COVID recovery. Appropriate statistical analysis [Pearson's correlation/analysis of variance (ANOVA) test] was used to establish the correlation between the persistence of symptoms and their severity with the presence of risk factors.

Results: Severity of acute illness was the single most important determining factor of persistence of symptoms as well as their severity in our study (p < 0.001) at each follow-up interval. The correlation observed between average number or severity of persistent symptoms increased with female gender, increasing age-group and presence of multiple comorbidities was not significant statistically (p > 0.05) with exception of persistent fatigue in females at 2-month interval.

Interpretation and conclusion: Persistent symptoms and its prevalence recorded so far represents tip of the iceberg of patients suffering with long COVID. Patients with history of severe acute illness should be followed up closely for prompt identification and rehabilitation of these cases as it had maximum bearing on the outcome of these patients.