Saera Suhail Kidwai, Fatima Zahra, Mehrunnisa Umar, Ayaz Ahmed, Zahid Akhtar Rao, Rukhsana Abdul Sattar
Author affiliations:
Abstract
Background & Objective: Persistent or new appearance signs and symptoms in post–COVID patients is a well–recognized complication of the COVID-19 pandemic, the severity of which is still underestimated and, therefore, remains unaddressed. Multiple studies from all over the world have documented the prevalence of post–COVID symptoms; however, the frequency, the severity and the variety of post–COVID symptoms in our country has not been much investigated. We determined the prevalence of post–COVID syndrome in a cohort of faculty working in Fazaia Ruth Pfau Medical College (FRPMC), Karachi, Pakistan, and their family members.
Methodology: This cross–sectional, descriptive single–center study was conducted in a medical institute, data was gathered with a questionnaire sent to the cohort of medical faculty and their families. Data was analyzed on SPSS 20 and ODDs Ratio calculated using different variables.
Results: A total of 84 patients were enrolled which had suffered from COVID out of which 51 (60.7%) had post–COVID symptoms, with fatigability 40 (48%), muscle pain 16 (19%), inability to continue the normal chores 12(14%), dry cough 11 (13%), breathlessness 10(12%), sleep disturbance and brain fog or difficulty in concentration 11 (13%), and hair loss 9 (11%) being the common complaints. There was no positive or negative relationship between the severity of COVID infection and the presence of the post–COVID syndrome.
Conclusion: The prevalence of post–COVID symptoms in COVID infected population is high, however, no identifiable risk factor is observed. A multidisciplinary team approach is much needed to cater for the needs of the vulnerable post–COVID population, more observational studies are needed to follow the sequel of this comparatively new virus which may still be unidentified.
Key words: Post–COVID syndrome; Fatigue; COVID–19
Citation: Kidwai SS, Zahra F, Umar M, Ahmed A, Rao ZA, Sattar RA. Prevalence of post–COVID syndrome in a cohort of faculty of a medical institute and their family members. Anaesth. pain intensive care 2022;26(2): 154-160; DOI: 10.35975/apic.v26i2.1807
Received: January 03, 2022, Reviewed: February 20, 2022, Accepted: March 02, 2022
Introduction
As the global count of corona victims is continuously increasing with mutating corona virus, post–COVID signs and symptoms have become a well–recognized entity in the surviving victims of the ongoing pandemic. The persistent symptoms experienced following COVID–19 infection have been termed as ‘post–COVID syndrome’ (PCS) or ‘long COVID syndrome’ or ‘long haul syndrome’, and can be related to residual inflammation following infection, secondary to organ damage and/or due to social isolation and fear of death of self and near and dear ones. We define these as persistent symptoms and/or delayed or long–term complications of SARS–CoV–2 infection beyond 4 weeks from the onset of symptoms.1 PCS is not only limited to patients with severe acute COVID–19, it is also prevalent in people suffering from mild illness. However, the duration of post–COVID symptoms in such cases may last for a shorter duration.2
Fatigue, dyspnea, psychological distress such as post–traumatic stress disorder (PTSD), anxiety, depression and concentration / sleep abnormalities, were noted in approximately 30% of the participants in a study from UK.3 Another study from USA identified the presence of post–COVID symptoms in 32.6% of the discharged patients.3
Most of the studies published in the last two years include data from China, and European countries like Italy, Spain, and France.4 However, no such data is available from our population yet. We are in a dire need of a protocol to follow these patients after discharge from the hospital for at least 3 months of their initial presentation, or more, depending on the disease severity. We need to periodically evaluate our patients for the presence of these symptoms and provide necessary care required to decrease the morbidity. The future of COVID is still ambiguous and we need to prepare for its management and prevent its consequences.
We conducted this study to identify the frequency of PCS. It would highlight the importance of formulating a standardized protocol to follow the discharged patients, record any residual after-effects, and thus allow us to improve the quality of care in the hospital.
Methodology
This cross–sectional, descriptive single-center study was conducted in the Department of Medicine, PAF Base Faisal Hospital. After taking informed consent, all the male and female faculty members of Fazaia Ruth Pfau Medical College (FRPMC), who suffered from COVID infection and who tested positive by polymerase chain reaction (PCR) test, were included in the study. Ethical approval was taken from the Ethical Review Committee, Ref No. IRB/15. The study was conducted during September 2021, using non–probability convenient sampling technique. The data used in this study was collected through an online survey questionnaire comprising 22 feedback questions. The link of this online survey questionnaire was sent through e-mails or WhatsApp contacts of faculty members working in FRPMC, and filled by the faculty members themselves or by interviewing their family members who were 15 y or older. Pregnant females, and those who were known to have chronic kidney disease and were on dialysis, chronic liver disease or suffering from heart failure with ejection fraction of ≤ 40% before contracting the COVID, were excluded from the study, as these could have interfered with the fair and meaningful analysis of the results.
Statistical analysis: Responses were analyzed and evaluated by using Microsoft Excel & IBM–SPSS version 20. The comparisons among different variables are presented through tables and graphs. Level of significance was determined with 95% confidence interval and P values were obtained. Associations between disease severity, other explanatory variables and PCS is evaluated by Chi–square (χ²) test and Odds ratio (OR).
Results
A total of 84 responses were collected from the faculty and doctors that had suffered from COVID infection, with 43 males and 41 females, out of these 51 (60.7%) had post–COVID symptoms, which is an alarming figure. Mean age of the sample was 47 ± 14 y. Most of the subjects (44%) were affected in the second wave. The demographic characteristics are given in Table 1. 90% of the patients with COVID had mild to moderate symptoms; therefore, did not need hospitalization. Only 21 (25%) patients were hospitalized. Frequency of COVID was more in the first and second waves, compared to the period after the second wave, when it was affected due to aggressive vaccination campaign in the country.
The frequency of common symptoms of PCS is shown in Table 2. Fatigue was the most common complaint, e.g., 42 (50%) patients after COVID–19 infection; followed by myalgia 16 (19%), dry cough 13 (15%), sleep disturbance 13 (12%) and brain fog or impaired concentration 11 (13%). Tabulation of ODD’s Ratio analysis with different variables and its graphical representation is shown in Table 3 and Figure 4. The ODD’s of having PCS is shown to be more with patients suffering from severe disease, and patients who needed oxygen and hospitalization. Interestingly, male gender and hypertensive patients were observed to be more affected with post–COVID symptoms.
Discussion
PCS appears to be a multi-system disease, occurring even after a relatively mild acute illness.5,6 This observation has been replicated in our study too, which shows equal chances of having these symptoms in all patients even in those having mild fever or in afebrile patients. Our study observes the presence of PCS in 51 (60.7%) participants.
It is hypothesized that the body’s innate immune response during a SARs–COV–2 infection results in inflammatory cytokine production, which causes these lingering symptoms and signs of COVID–19 infection. It was also observed during the previous viral epidemics; e.g., SARS epidemic of 2003 and the Middle East Respiratory Syndrome (MERS) outbreak of 2012. In the post-infection period of both episodes a similar sequel was observed.7,8
Patients with COVID–19 may develop chronic fatigue syndrome, which presents with prolonged relapse of exhaustion, cognitive dysfunction, depression, and other symptoms after a minimal amount of activity.9 Fatigue is the most common symptom of PCS, the incidence ranging from 16 –72%, and it lasted for more than seven months in some studies. Additionally, it has a predilection for male gender and for individuals having diabetes and hypertension as comorbids.10 Our study is comparable to this data as fatigue was the commonest symptom experienced by participants in our study, e.g., 42 (50%), it also affirms the finding that the patients with hypertension have more Odds of having fatigue as post–COVID sequel (P = 0.001). Although the precise pathophysiology of the chronic fatigue in these patients is still being investigated, it is hypothesized that the pro–inflammatory cytokines such as interferon–gamma and interleukins are released following the viral infection, which cross the blood–brain barrier and affect the central nervous system (CNS) organs such as the hypothalamus.11 The autonomic involvement of hypothalamus results in cognitive abnormality, sleep/wake cycle dysregulation, fatigue and myalgia favoring chronic fatigue syndrome.9
The presence of PCS has shown a positive relationship with the severity of disease, hospitalization and need for oxygen requirement; although the intensity of fever has not shown any causal relationship with PCS. Low grade or high grade fever during acute COVID has similar chances of having PCS which is also documented by other published data.1
Hair loss is another finding which increases the morbidity associated with this pandemic. Our study has demonstrated 11 (13%) patients who suffered from severe hair loss, resulting in emotional stress in the already vulnerable post–COVID population. This finding is consistent with the diagnosis of telogen effluvium, which is characterized by diffuse hair loss within months of a significant systemic stressor, because of premature follicular transition from the anagen (active growth phase) to the telogen (resting phase). The telogen phase lasts approximately 3 months, after which excessive hair loss ensues.12 In individuals who suffered from COVID–19, the intense psychological pressure and massive inflammatory response are plausible triggers for acute/chronic telogen effluvium.13 Provision of proper reassurance and education about this physically and emotionally distressing post–COVID dermatologic manifestation is mandatory.
In our study 23 (28%) patients with PCS needed some treatment for their symptoms, whereas in 61(72%), the symptoms weaned off gradually over a period of 2 to 6 months. Two patients suffered from fever ranging from 99–102○ F approximately one month after the illness which persisted for 10–14 days, with a high C–reactive protein and no clinical or laboratory evidence of any systemic infection, the fever subsided with colchicine which was continued for 2 weeks. C–reactive protein also returned to normal. Colchicine was chosen in our study as evidence based with the rationale that it has inhibitory effects on neutrophil activity, cytokine generation and the inflammation / thrombosis interface. Most importantly no evidence of systemic immunosuppression has been associated with its use which can increase the risk of a secondary infection.14, 15 Although the data on use of colchicine in COVID–19 infected patients in OPD setting is sparse but it has shown a significant mortality benefit and less need of supplemental oxygen at day 7 in hospital setting in the published data.14
Cognitive impairment occurs relatively often, within several months of patients having had COVID–19, according to the results of a cross–sectional study published by Becker.16 He has also raised concern that SARS–CoV–2 poses an increased risk for neurodegenerative diseases. In our study, 11 (13%) patients suffered from reduced concentration power (brain fog) and 13 (15%) of our patients were unable to perform the daily activities secondary to fatigue and decrease in concentration.
Post–COVID symptoms were experienced by a large majority of patients in this study and although the symptoms were mild but were sufficient to jeopardize the quality of life in the affected individuals. Morbidity includes reduced working capacity secondary to increased fatigability and brain fog which persist till 3–4 months.
Limitations
Our sample size was small and cannot be generalized to the entire population although it is comparable with studies in different settings. Observational studies for longer duration are needed to follow the symptoms and minimize the disease burden associated with persistent or long term morbidity among individuals of all ages.
Recommendations
Early identification of post–COVID patients regardless of age and COVID–19 severity is crucial for the management and appropriate resource allocation to ensure reversibility and potential opportunities for interventions, such as cognitive rehabilitation. A close follow up will ensure unidentified patients with pyrexia as post–COVID sequel which is not to be dealt with the conventional methods.
Conclusion
The prevalence of post–COVID symptoms in the infected population is high, resulting in persistent and variable morbidity in post–COVID patients; however, no identifiable definitive risk factor is observed. Large-scale, observational studies are needed for a prolonged follow-up of the sequelae of this comparatively new virus which may still be unidentified.
Acknowledgments
We are thankful to Mr. Muhammad Azher Uddin for his guidance and contribution in statistical analysis of this study. We are also thankful to all of the participants for their time to complete this survey.
Conflicts of Interest
None declared by the authors. No funding was involved in this study.
Authors’ contribution
SSK: Conceived the idea, Literature review, manuscript writing, critical analysis and revision
FZ: Data analysis, manuscript writing
MU: Collecting sample and literature review
AA: Interpretation of the data, drafting of the manuscript
ZAR: Critical analysis and manuscript revision
RAS: Revising and editing the manuscript
References
Figure 1: Graphical representation of ODD’s Ratio of post-COVID Syndrome in relation to different variables
Author affiliations:
- Professor .Saera Suhail Kidwai, MCPS, FCPS, Head of Department of Medicine, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Main Shahrah –e- Faisal, Karachi; E-mail: saerakhan.sk@gmail.com.
- Dr Fatima Zahra, FCPS (Medicine), Associate Professor, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Main Shahrah –e- Faisal, Karachi; E-mail: fatima.fuzail@hotmail.com
- Dr Mehrunnisa Umar, FCPS (Medicine), Assistant Professor, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Main Shahrah –e- Faisal, Karach; E-mail: drmehrunnesa@gmail.com.
- Dr Ayaz Ahmed, FCPS (Medicine), Assistant Professor, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Main Shahrah -e- Faisal, Karachi; E-mail: drayazahmedpk@hotmail.com
- Professor Zahid Akhtar Rao, DA; MCPS; FCPS; M.Sc.(Pain Med); Chairman, Department of Anesthesiology & Critical Care, Director Postgraduate Medical Education, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Main Shahrah -e- Faisal, Karachi; E-mail: zahidrao57@hotmail.com
- Professor Rukhsana Abdul Sattar, FCPS (Medicine), Chairperson Medicine and Allied Department, Fazaia Ruth Pfau Medical College, PAF Base Faisal, Main Shahrah -e- Faisal, Karachi; E-mail: drrukhsana20@gmail.com.
Abstract
Background & Objective: Persistent or new appearance signs and symptoms in post–COVID patients is a well–recognized complication of the COVID-19 pandemic, the severity of which is still underestimated and, therefore, remains unaddressed. Multiple studies from all over the world have documented the prevalence of post–COVID symptoms; however, the frequency, the severity and the variety of post–COVID symptoms in our country has not been much investigated. We determined the prevalence of post–COVID syndrome in a cohort of faculty working in Fazaia Ruth Pfau Medical College (FRPMC), Karachi, Pakistan, and their family members.
Methodology: This cross–sectional, descriptive single–center study was conducted in a medical institute, data was gathered with a questionnaire sent to the cohort of medical faculty and their families. Data was analyzed on SPSS 20 and ODDs Ratio calculated using different variables.
Results: A total of 84 patients were enrolled which had suffered from COVID out of which 51 (60.7%) had post–COVID symptoms, with fatigability 40 (48%), muscle pain 16 (19%), inability to continue the normal chores 12(14%), dry cough 11 (13%), breathlessness 10(12%), sleep disturbance and brain fog or difficulty in concentration 11 (13%), and hair loss 9 (11%) being the common complaints. There was no positive or negative relationship between the severity of COVID infection and the presence of the post–COVID syndrome.
Conclusion: The prevalence of post–COVID symptoms in COVID infected population is high, however, no identifiable risk factor is observed. A multidisciplinary team approach is much needed to cater for the needs of the vulnerable post–COVID population, more observational studies are needed to follow the sequel of this comparatively new virus which may still be unidentified.
Key words: Post–COVID syndrome; Fatigue; COVID–19
Citation: Kidwai SS, Zahra F, Umar M, Ahmed A, Rao ZA, Sattar RA. Prevalence of post–COVID syndrome in a cohort of faculty of a medical institute and their family members. Anaesth. pain intensive care 2022;26(2): 154-160; DOI: 10.35975/apic.v26i2.1807
Received: January 03, 2022, Reviewed: February 20, 2022, Accepted: March 02, 2022
Introduction
As the global count of corona victims is continuously increasing with mutating corona virus, post–COVID signs and symptoms have become a well–recognized entity in the surviving victims of the ongoing pandemic. The persistent symptoms experienced following COVID–19 infection have been termed as ‘post–COVID syndrome’ (PCS) or ‘long COVID syndrome’ or ‘long haul syndrome’, and can be related to residual inflammation following infection, secondary to organ damage and/or due to social isolation and fear of death of self and near and dear ones. We define these as persistent symptoms and/or delayed or long–term complications of SARS–CoV–2 infection beyond 4 weeks from the onset of symptoms.1 PCS is not only limited to patients with severe acute COVID–19, it is also prevalent in people suffering from mild illness. However, the duration of post–COVID symptoms in such cases may last for a shorter duration.2
Fatigue, dyspnea, psychological distress such as post–traumatic stress disorder (PTSD), anxiety, depression and concentration / sleep abnormalities, were noted in approximately 30% of the participants in a study from UK.3 Another study from USA identified the presence of post–COVID symptoms in 32.6% of the discharged patients.3
Most of the studies published in the last two years include data from China, and European countries like Italy, Spain, and France.4 However, no such data is available from our population yet. We are in a dire need of a protocol to follow these patients after discharge from the hospital for at least 3 months of their initial presentation, or more, depending on the disease severity. We need to periodically evaluate our patients for the presence of these symptoms and provide necessary care required to decrease the morbidity. The future of COVID is still ambiguous and we need to prepare for its management and prevent its consequences.
We conducted this study to identify the frequency of PCS. It would highlight the importance of formulating a standardized protocol to follow the discharged patients, record any residual after-effects, and thus allow us to improve the quality of care in the hospital.
Methodology
This cross–sectional, descriptive single-center study was conducted in the Department of Medicine, PAF Base Faisal Hospital. After taking informed consent, all the male and female faculty members of Fazaia Ruth Pfau Medical College (FRPMC), who suffered from COVID infection and who tested positive by polymerase chain reaction (PCR) test, were included in the study. Ethical approval was taken from the Ethical Review Committee, Ref No. IRB/15. The study was conducted during September 2021, using non–probability convenient sampling technique. The data used in this study was collected through an online survey questionnaire comprising 22 feedback questions. The link of this online survey questionnaire was sent through e-mails or WhatsApp contacts of faculty members working in FRPMC, and filled by the faculty members themselves or by interviewing their family members who were 15 y or older. Pregnant females, and those who were known to have chronic kidney disease and were on dialysis, chronic liver disease or suffering from heart failure with ejection fraction of ≤ 40% before contracting the COVID, were excluded from the study, as these could have interfered with the fair and meaningful analysis of the results.
Statistical analysis: Responses were analyzed and evaluated by using Microsoft Excel & IBM–SPSS version 20. The comparisons among different variables are presented through tables and graphs. Level of significance was determined with 95% confidence interval and P values were obtained. Associations between disease severity, other explanatory variables and PCS is evaluated by Chi–square (χ²) test and Odds ratio (OR).
Results
A total of 84 responses were collected from the faculty and doctors that had suffered from COVID infection, with 43 males and 41 females, out of these 51 (60.7%) had post–COVID symptoms, which is an alarming figure. Mean age of the sample was 47 ± 14 y. Most of the subjects (44%) were affected in the second wave. The demographic characteristics are given in Table 1. 90% of the patients with COVID had mild to moderate symptoms; therefore, did not need hospitalization. Only 21 (25%) patients were hospitalized. Frequency of COVID was more in the first and second waves, compared to the period after the second wave, when it was affected due to aggressive vaccination campaign in the country.
The frequency of common symptoms of PCS is shown in Table 2. Fatigue was the most common complaint, e.g., 42 (50%) patients after COVID–19 infection; followed by myalgia 16 (19%), dry cough 13 (15%), sleep disturbance 13 (12%) and brain fog or impaired concentration 11 (13%). Tabulation of ODD’s Ratio analysis with different variables and its graphical representation is shown in Table 3 and Figure 4. The ODD’s of having PCS is shown to be more with patients suffering from severe disease, and patients who needed oxygen and hospitalization. Interestingly, male gender and hypertensive patients were observed to be more affected with post–COVID symptoms.
Discussion
PCS appears to be a multi-system disease, occurring even after a relatively mild acute illness.5,6 This observation has been replicated in our study too, which shows equal chances of having these symptoms in all patients even in those having mild fever or in afebrile patients. Our study observes the presence of PCS in 51 (60.7%) participants.
It is hypothesized that the body’s innate immune response during a SARs–COV–2 infection results in inflammatory cytokine production, which causes these lingering symptoms and signs of COVID–19 infection. It was also observed during the previous viral epidemics; e.g., SARS epidemic of 2003 and the Middle East Respiratory Syndrome (MERS) outbreak of 2012. In the post-infection period of both episodes a similar sequel was observed.7,8
Patients with COVID–19 may develop chronic fatigue syndrome, which presents with prolonged relapse of exhaustion, cognitive dysfunction, depression, and other symptoms after a minimal amount of activity.9 Fatigue is the most common symptom of PCS, the incidence ranging from 16 –72%, and it lasted for more than seven months in some studies. Additionally, it has a predilection for male gender and for individuals having diabetes and hypertension as comorbids.10 Our study is comparable to this data as fatigue was the commonest symptom experienced by participants in our study, e.g., 42 (50%), it also affirms the finding that the patients with hypertension have more Odds of having fatigue as post–COVID sequel (P = 0.001). Although the precise pathophysiology of the chronic fatigue in these patients is still being investigated, it is hypothesized that the pro–inflammatory cytokines such as interferon–gamma and interleukins are released following the viral infection, which cross the blood–brain barrier and affect the central nervous system (CNS) organs such as the hypothalamus.11 The autonomic involvement of hypothalamus results in cognitive abnormality, sleep/wake cycle dysregulation, fatigue and myalgia favoring chronic fatigue syndrome.9
The presence of PCS has shown a positive relationship with the severity of disease, hospitalization and need for oxygen requirement; although the intensity of fever has not shown any causal relationship with PCS. Low grade or high grade fever during acute COVID has similar chances of having PCS which is also documented by other published data.1
Hair loss is another finding which increases the morbidity associated with this pandemic. Our study has demonstrated 11 (13%) patients who suffered from severe hair loss, resulting in emotional stress in the already vulnerable post–COVID population. This finding is consistent with the diagnosis of telogen effluvium, which is characterized by diffuse hair loss within months of a significant systemic stressor, because of premature follicular transition from the anagen (active growth phase) to the telogen (resting phase). The telogen phase lasts approximately 3 months, after which excessive hair loss ensues.12 In individuals who suffered from COVID–19, the intense psychological pressure and massive inflammatory response are plausible triggers for acute/chronic telogen effluvium.13 Provision of proper reassurance and education about this physically and emotionally distressing post–COVID dermatologic manifestation is mandatory.
In our study 23 (28%) patients with PCS needed some treatment for their symptoms, whereas in 61(72%), the symptoms weaned off gradually over a period of 2 to 6 months. Two patients suffered from fever ranging from 99–102○ F approximately one month after the illness which persisted for 10–14 days, with a high C–reactive protein and no clinical or laboratory evidence of any systemic infection, the fever subsided with colchicine which was continued for 2 weeks. C–reactive protein also returned to normal. Colchicine was chosen in our study as evidence based with the rationale that it has inhibitory effects on neutrophil activity, cytokine generation and the inflammation / thrombosis interface. Most importantly no evidence of systemic immunosuppression has been associated with its use which can increase the risk of a secondary infection.14, 15 Although the data on use of colchicine in COVID–19 infected patients in OPD setting is sparse but it has shown a significant mortality benefit and less need of supplemental oxygen at day 7 in hospital setting in the published data.14
Cognitive impairment occurs relatively often, within several months of patients having had COVID–19, according to the results of a cross–sectional study published by Becker.16 He has also raised concern that SARS–CoV–2 poses an increased risk for neurodegenerative diseases. In our study, 11 (13%) patients suffered from reduced concentration power (brain fog) and 13 (15%) of our patients were unable to perform the daily activities secondary to fatigue and decrease in concentration.
Post–COVID symptoms were experienced by a large majority of patients in this study and although the symptoms were mild but were sufficient to jeopardize the quality of life in the affected individuals. Morbidity includes reduced working capacity secondary to increased fatigability and brain fog which persist till 3–4 months.
Limitations
Our sample size was small and cannot be generalized to the entire population although it is comparable with studies in different settings. Observational studies for longer duration are needed to follow the symptoms and minimize the disease burden associated with persistent or long term morbidity among individuals of all ages.
Recommendations
Early identification of post–COVID patients regardless of age and COVID–19 severity is crucial for the management and appropriate resource allocation to ensure reversibility and potential opportunities for interventions, such as cognitive rehabilitation. A close follow up will ensure unidentified patients with pyrexia as post–COVID sequel which is not to be dealt with the conventional methods.
Conclusion
The prevalence of post–COVID symptoms in the infected population is high, resulting in persistent and variable morbidity in post–COVID patients; however, no identifiable definitive risk factor is observed. Large-scale, observational studies are needed for a prolonged follow-up of the sequelae of this comparatively new virus which may still be unidentified.
Acknowledgments
We are thankful to Mr. Muhammad Azher Uddin for his guidance and contribution in statistical analysis of this study. We are also thankful to all of the participants for their time to complete this survey.
Conflicts of Interest
None declared by the authors. No funding was involved in this study.
Authors’ contribution
SSK: Conceived the idea, Literature review, manuscript writing, critical analysis and revision
FZ: Data analysis, manuscript writing
MU: Collecting sample and literature review
AA: Interpretation of the data, drafting of the manuscript
ZAR: Critical analysis and manuscript revision
RAS: Revising and editing the manuscript
References
- Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021 Apr;27(4):601-615. [PubMed] DOI: 1038/s41591-021-01283-z
- Moreno-Pérez O, Merino E, Leon-Ramirez J M, Andres M, Ramos MJ, Jimenez AJ, et al. Post-acute covid-19 syndrome. Incidence and risk factors: a Mediterranean cohort study. J Infect. 2021;82(3):378-383. [PubMed] DOI: 1016/j.jinf.2021.01.004
- Chopra V, Flanders SA, O'Malley M, Malani AN, Prescott HC. Sixty-day outcomes among patients hospitalized with COVID-19. Ann Intern Med. 2021 Apr;174(4):576-578. [PubMed] DOI: 7326/M20-5661
- Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Post discharge symptoms and rehabilitation needs in survivors of COVID-19 infection sectional evaluation. J Med Virol. 2021;93(2):1013-1022. [PubMed] DOI: 1002/jmv.26368
- National Institute of Health Director’s blog. Post-covid syndrome. Available at: https://directorsblog.nih.gov/tag/post-covid-syndrome/
- Greenhalgh T, Knight M, A ‘Court M, Buxton M, Hussain M. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026. [PubMed] DOI: 1136/bmj.m3026
- Ahmed H, Patel K, Greenwood CD, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis. J Rehabil Med. 2020;52(5):jrm00063. [PubMed] DOI: 2340/16501977-2694
- Moldofsky H. and Patcai J. Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol. 2011;11:37. [PubMed] DOI: 1186/1471-2377-11-37
- Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, et al. Myalgic encephalomyelitis: International Consensus Criteria. J Intern Med. 2011 Oct;270(4):327-38. [PubMed] DOI: 1111/j.1365-2796.2011.02428.x
- Simani L, Ramezani M, Darazam IA, Sagharichi M, Aalipour AM, Ghorbani F, et al. Prevalence and correlates of chronic fatigue syndrome and post-traumatic stress disorder after the outbreak of the COVID-19. J Neurovirol. 2021;(27):154–159. [PubMed] DOI: 1007/s13365-021-00949-1
- Hives L, Bradley A, Richards J, Sutton C, Selfe J, Basu B, et al. Can physical assessment techniques aid diagnosis in people with chronic fatigue syndrome/myalgic encephalomyelitis? A diagnostic accuracy study. BMJ Open. 2017 Nov13;7(11):e017521. [PubMed] DOI: 1136/bmjopen-2017-017521
- Asghar F, Shamim N, Farooque U, Sheikh H, Aqeel R. Telogen effluvium: a review of the literature. Cureus. 2020 May 27;12(5):e8320. [PubMed] DOI: 7759/cureus.8320
- Gadzhigoroeva A, Sanchez G D, Firooz A, Moravvej H, Espinoza N, Romanova Y, et al. COVID-19 can exacerbate pattern hair loss and trigger telogen effluvium - the role of proteoglycan replacement therapy with nourkrin® in clinical treatment of covid-19 associated hair loss. J Dermatol Res Ther. 2021;7:103. DOI: 23937/2469-5750/1510103
- Lopes MIF, Bonjorno LP, Giannini MC, Amaral BN, Menezes IP, Musse Dib S, et al. Beneficial effects of colchicine for moderate to severe COVID-19: an interim analysis of a randomized, double-blinded, placebo controlled clinical trial. RMD Open. 2021 Feb;7(1):e001455. [PubMed] DOI: 1136/rmdopen-2020-001455
- Scarsi M, Piantoni S, Colombo E, Airo P, Richini D, Miclini M, et al. Association between treatment with colchicine and improved survival in a single-centre cohort of adult hospitalized patients with COVID-19 pneumonia and acute respiratory distress syndrome. Ann Rheum Dis. 2020;79:1286–9. [PubMed] DOI: 1136/annrheumdis-2020-217712
- Becker H J, Lin JJ, Doernberg M, Stone K, Navis A, Festa RJ. Assessment of cognitive function in patients after covid-19 infection. JAMA Network Open. 2021;4(10):e2130645. [PubMed] DOI: 1001/jamanetworkopen.2021.30645
| Table 1: Detail of Information/feedbacks | |||
| Variables | n | (%) | |
| Gender | Male | 43 | 51.19 |
| Female | 41 | 48.81 | |
| Age Groups | 21 - 40 years | 33 | 39.29 |
| 41 - 60 years | 29 | 34.52 | |
| 61 - 80 years | 22 | 26.19 | |
| Mean Age Males - 50.86 ± 15.72 | |||
| Mean Age Female - 43.27 ± 12.86 | |||
| Mean Age Overall - 47.15 ± 14.81 | |||
| Association with Vaccination | Before Vaccination | 58 | 69.05 |
| Partially Vaccination | 7 | 8.33 | |
| After Complete Vaccination | 19 | 22.62 | |
| Wave - Infected with COVID | First Wave ( Apr 2020 - Aug 2020) | 16 | 19.05 |
| Second Wave ( Oct 2020 – Dec 2020) | 35 | 41.67 | |
| Third Wave ( Mar 2021 - Jun 2021) | 13 | 15.48 | |
| Fourth Wave ( from Jul 2021 onwards ) | 11 | 13.10 | |
| 1st & 4th Wave | 3 | 3.57 | |
| 1st, 2nd & 4th Wave | 1 | 1.19 | |
| 1st & 2nd Wave | 1 | 1.19 | |
| Twice in 1st wave | 1 | 1.19 | |
| Twice in 2nd wave | 2 | 2.38 | |
| Twice in 3rd wave | 1 | 1.19 | |
| Intensity of Fever (°F) | Afebrile | 14 | 16.67 |
| 99-100°F | 30 | 35.71 | |
| 101-102°F | 33 | 39.29 | |
| 103-104°F | 7 | 8.33 | |
| Need for Hospitaliza-
tion |
Yes | 21 | 25.00 |
| Severity of COVID | Mild | 39 | 46.43 |
| Moderate | 37 | 44.05 | |
| Severe | 8 | 9.52 | |
| Comorbid | Depression | 5 | 5.95 |
| Diabetes Mellitus | 6 | 7.14 | |
| Hypertension | 10 | 11.90 | |
| Hypertension; Diabetes Mellitus | 6 | 7.14 | |
| None of the above | 57 | 67.86 | |
| Post COVID Syndrome | Positive | 51 | 60.71 |
| Table 2: Frequency of post COVID 19 symptoms in the cohort (n = 84) | ||
| Post COVID Symptoms | n | (%) |
| Muscle pain | 16 | 19.05 |
| Headache | 0 | 0.00 |
| Fatigue | 42 | 50.00 |
| Change in smell or taste | 0 | 0.00 |
| Sleep disturbance | 10 | 11.90 |
| Dry cough | 13 | 15.48 |
| Breathlessness | 10 | 11.90 |
| Fever | 2 | 2.38 |
| Anxiety | 0 | 0.00 |
| Joint pain | 0 | 0.00 |
| Oxygen needed | 0 | 0.00 |
| Diarrhea | 0 | 0.00 |
| Rash | 0 | 0.00 |
| Palpitation | 6 | 7.14 |
| Depression | 5 | 5.95 |
| Unable to perform routine activities | 12 | 14.29 |
| Difficulty thinking or concentrating (brain fog) | 11 | 13.10 |
| Hair loss | 10 | 11.90 |
| Newly diagnosed diabetes | 1 | 1.19 |
| None of the above | 34 | 40.48 |
| Table 3: ODD’s Ratio of Post COVID Syndrome in relation to different variables | ||
| Risk Factors | Odds Ratio (95% CI) | |
| Gender (Male/Female) | 0.801 | (0.333 - 1.928) |
| Age Groups(years) | ||
| 21 - 40 years | 2.370 | (0.923 - 6.086) |
| 41 – 60years | 0.703 | (0.282 - 1.756) |
| 61 – 80years | 0.550 | (0.206 - 1.472) |
| Association with COVID vaccination | 0.650 | (0.219 - 1.924) |
| Wave - Infected with COVID | ||
| First Wave ( Apr 2020- Aug 2020) | 1.143 | (0.398 - 3.286) |
| Second Wave ( Oct 2020 - Feb 2021) | 0.495 | (0.203 - 1.205) |
| Third Wave ( Mar 2021-Jun 2021) | 1.768 | (0.505 - 6.192) |
| Fourth Wave ( from Jul 2021 onwards ) | 1.768 | (0.505 - 6.192) |
| Comorbid | ||
| Hypertension | 6.857 | (0.826 - 56.931) |
| Diabetes Mellitus | 0.625 | (0.118 - 3.300) |
| Depression | 2.723 | (0.291 - 25.502) |
| Hypertension and Diabetes Mellitus | 0.625 | (0.118 - 3.300) |
| None of the above | 0.539 | (0.203 - 1.433) |
| Severity of COVID | ||
| Mild | 0.583 | (0.241 - 1.411) |
| Moderate | 1.368 | (0.562 - 3.326) |
| Severe | 2.067 | (0.391 - 10.917) |
| Need for Hospitalization | 1.182 | (0.432 - 3.234) |
| Need for Oxygen | 1.153 | (0.310 - 4.296) |
| Intensity of Fever (°F) | ||
| Afebrile | 0.125 | (0.032 - 0.493) |
| 99-100°F | 3.051 | (1.122 - 8.297) |
| 101-102°F | 0.806 | (0.330 - 1.970) |
| 103-104°F | 4.267 | (0.490 - 37.181) |
Figure 1: Graphical representation of ODD’s Ratio of post-COVID Syndrome in relation to different variables