Assessment of Persistence of Symptoms Amongst Patients after their Recovery from COVID 19: A Cross-Sectional Study in England
Dr Muhammad Ghalib Zafar *1
Corresponding Author: Dr Muhammad Ghalib Zafar, MBBS, MRCGP, General Practitioner, Severn Valley Medical Practice, Worcester, United Kingdom.
Copy Right: © 2023 Dr Muhammad Ghalib Zafar, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received Date: March 08, 2023
Published Date: April 01, 2023
Abstract
Introduction: Coronavirus (COVID 19) is a fatal disease. It affects multiple organ systems including the pulmonary system, respiratory system, and cardiac system etc. Even patients experience symptoms after testing negative with its variant. The present study aims to assess persistence of symptoms among patients after their recovery from COVID 19.
Material & Methods: A quantitative, cross-sectional study was conducted in two settings of Worcestershire in the west midlands region. After scrutiny, a total of 508 patients were included in the study. A proforma was designed to evaluate the selected participants according to the set objectives. The symptoms of patients were congregated by systems as follows: general (fatigue, myalgia), respiratory (chest pain, cough, and wheezing), cardiovascular (palpitation), neuropsychiatric (headache, hypersomnia, depression, and anxiety), dermatologic (hair loss), gastrointestinal (diarrhea, and constipation). Participants were asked to score symptoms from 0 (no symptoms) to 10 (extreme symptoms) to assess the level of severity based on the scale of COVID?19 Yorkshire Rehabilitation Screening (C19?YRS). The collected data were evaluated by using SPSS.
Results: Among 508 patients, most of the study participants (65%) had been diagnosed with COVID 19 almost 3-6 months ago. Among them, 79% had developed symptoms during infections, while 75% of them didn’t feel that they had recovered from the infection. Among 508 participants, 49 participants had developed no symptoms, while 459 of them had to suffer from long COVID 19 symptoms after their recovery. Thus, among 459 participants, most of them suffered with loss of taste (79.9%), anxiety (74.5%), poor smell (73.2%), and fatigue (72.9%). Also, long term COVID 19 symptoms were significantly associated with age, education level, socioeconomic status and comorbidities.
Conclusion: Long term COVID 19 symptoms included loss of taste, anxiety, and poor sense of smell. All these symptoms had strong association with age, education level, socioeconomic status and comorbidities.
Keywords: COVID 19; Long term symptoms; Persistence; Hospitalization, Dyspnea
Introduction
Corona virus (COVID 19) is a human infection that causes respiratory contaminations and illnesses known as COVID-19. Coronavirus has primarily caused respiratory issues that began in December 2019 in Wuhan, China, and has quickly spread around the world. Around 156 million cases were analyzed, and roughly 134 million recuperated by May 15, 2021 (Struyf et al., 2021). Coronavirus side effects change among people and reach from gentle to direct to serious. Weariness, dry hack, sleepiness, loss of smell and taste, and cerebral pain are normal side effects. Besides, breathing hardships, loss of discourse and development, and chest torment are viewed as genuine ones (Elibol, 2021). The serious side effects were tracked down in patients more than 60 years old or those with attending illnesses like hypertension, diabetes, heart, and respiratory issues. Simultaneously, gentle to-direct side effects were tracked down in kids and patients under 19 years (Chen et al., 2021).
The beginning of this disease is the underlying appearance of the illness’s signs and side effects. The middle time from illness beginning to recuperation is 3 a month and a half for serious cases and fourteen days for gentle cases. Many individuals have recuperated from the infection, a large number of them don't get back to their daily existence; at the end of the day, COVID-19 influences individuals' well-being over the long haul, including heart muscle, cardiovascular breakdown, harmed lungs, mental issues, outer muscle issues, mind and sensory system harm, and vein issues. A few side effects continue after recuperation, like exhaustion, windedness, loss of taste and smell, hacks, and migraines.
A review directed to 179 members in Italy revealed the constancy of no less than one side effect in recuperated patients with COVID-19. A sum of 53.1% of subjects experienced weakness; 43.4% had proceeded with dyspnea; 27.3% joint torment; and 21.7% experienced chest torment (Fernández-de-Las-Peñas et al., 2021). One more review directed in Tours, France, uncovered that 68% of members had somewhere around one side effect 30 days after side effects began; in addition, 66% of the patients were all the while experiencing the illness' side effects, predominantly ageusia anosmia, after 60 days. A similar report showed that on day 30, 36.7% of patients were experiencing windedness (dyspnea), and on day 60, 30% of patients experienced dyspnea (Wang et al., 2020). Also, half and forty percent of patients experienced exhaustion and sleepiness on days thirty and sixty, separately. The concentrate likewise showed that members who encountered side effects at day sixty were hospitalized or had extreme COVID-19 contamination. One more review directed by Columbia University medical clinic in May 2020 detailed numerous persevering side effects after COVID-19, for example, weakness, body throbs, windedness, migraine, mental issues like melancholy, change in smell or taste, hack, and others (Day, 2020). A local report in Egypt showed that weariness was the most widely recognized side effect revealed by members post-COVID-19 contamination. In a foundational survey of 69 examinations on COVID-19 complexities, Al-Jumaili et al. detailed that numerous patients experienced lung anomalies, practice narrow-mindedness, and have neurological issues. By May 2021, around 300,000 cases were analyzed in Palestine, and 281,000 recuperated. No examinations have been directed in Palestine to evaluate patients' well-being status post-COVID-19 contamination (Nehme et al., 2021). The present research aims to assess the continuing manifestations among patients after their recovery from COVID-19.
Material & Methods
A quantitative, cross-sectional, and descriptive study was employed to evaluate the objectives of this study.
Study setting
The study was conducted in the Severn Valley Medical practice which was the biggest general practice in the county of Worcestershire in the west midlands region. There were two different sites managing an equal number of patients; which at the time of the study was about 21000 in total.
Study population
The study was conducted on those patients who were infected with and found positive for COVID 19 from October 2021 to January 2022. During the study period, there was a peak time for the omicron variant. We had a total of 1803 positive patients and we contacted 1636 of them via electronic links to fill in the form. A total of 508 patients responded.
Sample size
There were 1803 patients who had been diagnosed with COVID 19. Among them, 1636 patients were contacted via electronic links to fill in the form. Out of them, 508 patients responded.
Data collection tool
A proforma was designed to evaluate the selected participants according to the set objectives. It had the following sections. The 1st section consisted of the demographic information of the participants. The 2nd section of proforma had 9 questions about their medical diagnosis of the COVID 19 variant and the personal experience of each patient. The third part of the study tool was to evaluate any other long COVID 19 symptoms that had bothered them since infection. Participants who earned >£100,000 were referred to as an upper class, those who had up to £60,000 annual income were included in the upper middle class, those who had £40,000 annual income were included in lower income group, and <£20,000 annual family income were included in lower class. All participants were asked to describe about the date and time when they were fully recovered from COVID 19. However, some responded that when they experienced long-term COVID 19 symptoms after recovery, they again underwent Polymerase Chain Reaction (PCR) test. The symptoms of patients were congregated by systems as follows: general (fatigue, cold), respiratory (Bad breathing, shortness of breath, and sinus enlargement, issues with sense of smell), cardiovascular (palpitation), neuropsychiatric (headache, mood swings, and anxiety), gastrointestinal (diarrhea, and constipation). Participants were asked to score symptoms from 0 (no symptoms) to 10 (extreme symptoms) to assess the level of severity based on the scale of COVID?19 Yorkshire Rehabilitation Screening (C19?YRS). The C19-YRS assesses symptom severity and functional disability performance. The tool has been recommended in England by the National Institute for Health and Care Excellence (NICE) in its guidelines for managing the long-term effects of COVID-19. A pilot research was conducted to determine when COVID 19 individuals began to have manifestations. For this purpose, 20 participants were selected to fill out the proforma. The internal reliability of the study tool was calculated using Cronbach’s Alpha as 0.754. It implied that the proforma of this study was highly reliable. Also, a correlation coefficient was evaluated by Pearson correlation as 0.795 which highlighted that a significant and positive correlation exists between the variables.
Data analysis
SPSS was used to analyze the data gathered. Descriptive demographic details including frequency and percentages were employed to analyze the data. Regression analysis was utilized to determine the statistical significance of the variables,
Results
Demographic features of the study participants
Among 508 patients, 62.9% were males while 37% were females. A large proportion of the participants (44.3%) belonged to the middle age group i.e. 36-55 years of age. Most of them belong to low-middle class families (33.7%) and acquired primary education (38.9%). More then two third of the participants (88.2%), had to be admitted to the hospital when they were diagnosed with COVID 19. Also, 70.5% of these participants had no co-morbidity. Interestingly, 0.09% of these individuals were asymptomatic, while 46.8% had been developed mild to moderate symptoms after recovery from COVID 19 (Table 1).
Medical diagnosis and personal experiences of the participants
Most of the study participants (65%) had been diagnosed with COVID 19 almost 3-6 months ago. Among them, 79% had developed symptoms during infections, while 25% of them didn’t feel that they had recovered from the infection (Table 2).
Symptoms at the time of infection
After diagnosing with COVID 19 variant, 76% of the patients complained about nausea, while 67% of them experienced breathing complications and abdominal pain within 10 days. However, 29% of the patients had bad smell, while 22% of them had coughs, and altered bowel habits within 28 days. Also, memory of 42% participants was affected within 90 days of their diagnosis (Table 2).
Prevalence of COVID 19 symptoms among patients after their recovery
Among 508 participants, 49 participants had developed no symptoms, while 459 of them had to suffer from long COVID 19 symptoms after their recovery as shown in Table 1. Thus, among 459 participants, most of them had loss of taste (79.9%), anxiety (74.5%), poor smell (73.2%), and fatigue (72.9%) as shown in Table 4.
Regression Analysis
Statistical significant correlation was found between variables. It was found that age (p-value=<0.05, 95%CI=0.7808-1.322), Odd ratio=0.8338), education level (p-value=<0.05, odd ratio=3.540, 95%CI=2.159-5.061), co-morbidities (p-value < 0.05,odds ratio=4.23,95% CI=2.898-5.524) and socio economic status (p-value=<0.05,odds ratio=3.759, 95%CI=2.451-5.763) were found significantly correlated with long term symptoms of COVID 19 among recovered patients (Table 5).
Discussion
The purpose of our study was to determine symptoms that persist after recovery from COVID 19 infection. It is becoming increasingly recognized that COVID 19 infection is linked with prolonged consequences following recovery from initial infection. The symptoms vary from general manifestations to systemic manifestations. Systemic manifestations mainly involve skeletal system, reproductive system and respiratory system, CNS, Gastrointestinal and CVS. Another purpose of our study was to determine variable associated with continuing prolonged manifestations following resolution of COVID 19 infection. We revealed that age, socioeconomic status of patients, level of education and co-morbidities were most commonly associated with continuing manifestations following resolution of COVID 19 infection with P value <0.05. Previously published reports revealed that middle aged woman (40-60 years) were at higher risk of developing continuing manifestations following recovery from initial infection. They further concluded that patients with more than one co-morbidities and white ethnicity were at risk of developing long term consequences following COVID 19 infection. However, the extent of COVID 19 infection was not associated with long term sequelae (Evans et al., 2021; Torjesen, 2021). These findings were comparable with our findings.
Earlier, a meta-analysis was performed to determine fatigue and cognitive impairment in post COVID 19 syndrome (Ceban et al., 2022). They confirmed that fatigue and cognitive impairment were the most common disorders associated with post COVID 19 infection. Approximately 80% of patients experienced consequences of post COVID 19 symptoms following hospital admission. Symptoms such as fatigue, cognitive impairment, depression and dyspnea were the common symptoms that persist at least 4 weeks following COVID-19 infection (Tenforde et al., 2020). We also encountered neuropsychological issues following COVID 19 infection in our series. We didn’t find cognitive impairment in any patient suffered from COVID-19 infection, but 342 (74.5%) patients suffered long term anxiety in our series. In 40% cases, the anxiety remained persisted for about 90 days in as shown in table 3. Similar findings also observed in a study performed in Brazil (Nalbandian et al., 2021).An observational study was performed in 2021 regarding symptoms associated with COVID-19 infection. They reported that dyspnea while going upstairs (22.9%) was the most common symptom along with cough (15.4%) and persistent loss of smell or taste (13.1%) (Goularte et al., 2021). Similar findings were also observed in studies conducted in Europe. They reported shortness of breath in 43.4% patients followed by joint pain in 27.3% and chest pain in 21.7% patients (Carfì, Bernabei, & Landi, 2020; Goularte et al., 2021). Among respiratory symptoms, we also encountered abnormality in sense of smell in 366 (73.2%) patients followed by shortness of breath in 273 (59.4%), tingling sensation in nose in 232 (50.5%), bad breathing in 211 (45.9%), sinus enlargement in 199 (42.4%) and constantly smell smoke in 179 (38.9%) patients. In 2020, PCR based diagnosed cases of COVID-19 infection were selected for proforma based research study among three German administrative districts (Förster, Colombo, Wetzel, Martus, & Joos, 2022). They also performed multiple regression analysis to predict the most common variable associated with long term consequences following COVID-19 infection. They found female genders; co-morbidities and extent of acute COVID-19 infection were the most common prognosticator. Another important finding was that patients who were not hospitalized were also prone to develop consequences. In contrast to these findings, both hospitalization history and severity of COVID-19 infection were not linked with long term sequelae in our study (P value >0.05).
Patient-reported outcomes (PROS) are an effective technique for addressing patient health or mental state to evaluate long-term assessment of COVID-19 patients. The use of PROS is useful in identification of victims with continuing manifestations of COVID-19 who were not hospitalized initially so was not on routine follow-up. Previous literature supports that PROS can effectively discern patients long term consequences due to long COVID prior clinical parameters. This may also help in the early detection of life threatening complications due to COVID-19 infection (Basch et al., 2017; Nalbandian et al., 2021). Numerous studies were performed earlier which confirms that PROS is a useful tool to determine whether patients are scuffle both physically and mentally to cope with their disease process. Another important advantage of using PROS is that it also gives valuable information regarding effectiveness of any drug intervention especially in research setting (Aiyegbusi & Calvert, 2020; Huang et al., 2021; Taboada et al., 2021). PROS are actually used to measure symptoms and patient functions such as physical, emotional and social. During the COVID-19 pandemic, the relationship between socioeconomic status and mental health consequences was studied among Nigerian population. Their data revealed that standard (middle income) class was more prone to develop depression as compared to above and below income class (Calvert, O’Connor, & Basch, 2019). Another study concluded that patients with above income class were more affected as compared to middle and lower socioeconomic class (Agberotimi, Akinsola, Oguntayo, & Olaseni, 2020). We also divide our patients into four standards based on socioeconomic status such as upper class, upper middle class, lower middle class and lower class. We found socioeconomic status a significant variable associated with long term symptoms of COVID-19 infection (P value <0.05) as shown in table 5. In our study, middle class makes up 56% patients, whereas 44% belongs to upper and lower class.
In our study of 508 patients, 49 (9.64%) patients were asymptomatic. So in general 459 (90.3%) patients had prolonged symptoms following recovery from initial infection with COVID-19. The persistence of symptoms categorized into 10 days, 28 days and 90 days. Although the patients encountered general and systemic manifestations initially but they remain persisted for many days following COVID-19 infection. In first 10 days majority of patients suffered with systemic manifestations and at 90 days the percentage of systemic manifestations declines as shown in table 3. Previously longitudinal study concluded that 105(61%) patients reported one or more symptoms following initial COVID-19 infection. In their study, fatigue and dyspnea were the most common continuing symptoms. Older age was commonly associated with persistent symptom (Abdelrahman, Abd?Elrahman, & Bakheet, 2021).
Our study's primary limitation was that it was a single-center longitudinal study with limited sample size and no control group. The respondents were less; therefore there is possibility that results will vary if measured from large number of participants.
Conclusion
We concluded that number of patients with continuing symptoms following convalescence from initial COVID-19 infection were 459 (90.3%). 49 (9.64%) patients were asymptomatic. Age, education level, socioeconomic status and comorbidities were the significant variables related with continuing symptoms following recovery from COVID-19 infection.
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