Mild antecedent COVID-19 associated with symptom-specific post-acute sequelae

Tiffany A Walker; Alex D Truong; Aerica Summers; Adviteeya N Dixit; Felicia C Goldstein; Ihab Hajjar; Melvin R Echols; Matthew C Woodruff; Erica D Lee; Seema Tekwani; Kelley Carroll; Ignacio Sanz; F Eun-Hyung Lee; Jenny E Han

doi:10.1371/journal.pone.0288391

Mild antecedent COVID-19 associated with symptom-specific post-acute sequelae

PLoS One. 2023 Jul 10;18(7):e0288391. doi: 10.1371/journal.pone.0288391. eCollection 2023.

Authors

Tiffany A Walker^{1

2}, Alex D Truong³, Aerica Summers², Adviteeya N Dixit³, Felicia C Goldstein⁴, Ihab Hajjar^{1

4}, Melvin R Echols⁵, Matthew C Woodruff⁶, Erica D Lee⁷, Seema Tekwani³, Kelley Carroll², Ignacio Sanz⁶, F Eun-Hyung Lee³, Jenny E Han^{2

3}

Affiliations

¹ Department of Medicine, Division of General Internal Medicine, Emory University, Atlanta, GA, United States of America.
² Grady Post-COVID Clinic, Grady Memorial Hospital, Atlanta, GA, United States of America.
³ Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University, Atlanta, GA, United States of America.
⁴ Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
⁵ Department of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, United States of America.
⁶ Department of Medicine, Division of Rheumatology, Lowance Center for Human Immunology, Emory University, Atlanta, GA, United States of America.
⁷ Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America.

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.

Copyright: © 2023 Walker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19* / complications
Cohort Studies
Disease Progression
Fatigue / etiology
Female
Headache / etiology
Humans
Male
Middle Aged
Post-Acute COVID-19 Syndrome* / epidemiology

Grants and funding

TAW and JEH were funded by the Woodruff Health Sciences Center COVID-19 CURE Award. There is no associated award number. http://whsc.emory.edu/research/covid-19-research/index.html The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.