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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 7  |  Issue : 2  |  Page : 15-19

Assessment of post-COVID 19 symptoms: An observational cohort study from a level 3 COVID hospital


Department of Respiratory Medicine, Santosh Deemed to be University, Santosh Medical College Hospital, Ghaziabad, Uttar Pradesh, India

Date of Web Publication6-Dec-2021

Correspondence Address:
Sanjay Sahay
Department of Respiratory Medicine, Santosh Deemed to be University, Santosh Medical College Hospital, Ghaziabad, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2455-1732.331794

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  Abstract 


Introduction: A substantial number of patients continue to have symptoms even after testing negative for COVID 19. Ours is a single-center, observational, cross-sectional study that describes the prevalent symptoms in patients who have recovered from mild-to-moderate COVID 19 disease.
Materials and Methods: In a span of 3 months, from November 2020 to January 2021, we collected self-reported data from all post-COVID patients who consulted the post-COVID 19 outpatient department. Data on the pertinent history related to their diagnosis of COVID-19 disease like the date of reverse transcriptase-polymerase chain reaction positive and negative reports and length of stay in hospital were collected. Self-reported data were collected in simple Yes/No format for the presence of common respiratory and general post-COVID-19 symptoms. The final data were analyzed and presented using the using R software version 4.0.2.
Results: The mean age of the patients was 42.89 years with majority being from the age group of above 50 years of age. The mean duration of hospital stay was found to be 14 ± 7 days. A higher percentage were admitted for >10 days among all age groups, more predominantly among >60 years of age. Only 5 male patients gave a history of receiving noninvasive ventilation. Significantly a greater number of females complained of fatigue. Other symptoms that were found more commonly in females were headache, loss of hearing, and wheeze.
Conclusion: In our study, fatigue is the most common presenting symptoms followed by cough and breathlessness. Further evaluation and regular follow-up required to substantiate this observation.


How to cite this article:
Saxena P, Chandra E, Sahay S, Mahendran C S, Das P, Jose JV, Reddy B, Sivaji S. Assessment of post-COVID 19 symptoms: An observational cohort study from a level 3 COVID hospital. Santosh Univ J Health Sci 2021;7:15-9

How to cite this URL:
Saxena P, Chandra E, Sahay S, Mahendran C S, Das P, Jose JV, Reddy B, Sivaji S. Assessment of post-COVID 19 symptoms: An observational cohort study from a level 3 COVID hospital. Santosh Univ J Health Sci [serial online] 2021 [cited 2022 Jul 6];7:15-9. Available from: http://www.sujhs.org/text.asp?2021/7/2/15/331794




  Introduction Top


COVID-19 pandemic has affected millions of lives globally. As per the Ministry of Health estimates, there have been 1.07 crore cases and 154,000 deaths so far in India, as of February 3, 2021.[1] The recovery rate for our country has been an encouraging 97.3%. However, a substantial number of patients continue to have symptoms even after testing negative for COVID. Many new terms such as “long COVID,” “long haulers,” and “post-COVID syndrome” have emerged to describe these sets of symptoms, but at present, there is no delineated consensus definition.[2]

Numerous studies have been published globally regarding the clinical characteristics, epidemiological data, and complications seen after the acute phase of infection with coronavirus. There is, however, a dearth of research in the study of long-term consequences after recovery from COVID-19 disease. One study done in Italy by Carfi et al. described persistent symptoms after hospitalization for COVID-19.[3] Such evidence has not been reported for mild-to-moderate COVID-19.

A large cohort study with a follow-up of 6 months conducted in China has revealed that COVID-19 survivors mainly suffer from fatigue, muscle weakness, sleep difficulties, and anxiety or depression.[4] No study from India has been published till date. Ours is a single-center, observational, cross-sectional study that describes the prevalent symptoms in patients who have recovered from mild-to-moderate COVID-19 disease.
Figure 1: Gender distribution

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Figure 2: Age distribution

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Figure 3: Distribution of post-COVID symptoms in percentage

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Figure 4: Gender distribution of post-COVID symptoms

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  Materials and Methods Top


Since March 2020, when Santosh Medical College and Hospital was declared as a dedicated COVID-19 treatment level 3 facility, around 1500 patients have been treated. In November 2020, Silchar Medical College and Hospital started a post-COVID-19 outpatient department (OPD) in the Department of Pulmonary Medicine to particularly cater to the patients who have recovered from the acute phase of SARS-CoV-19 infection but continue to have symptoms, respiratory, and/or systemic. In a span of 3 months, from November 2020 to January 2021, we collected self-reported data from 99 post-COVID patients who consulted the OPD.

After taking informed consent, a simple questionnaire was administered to all the patients reporting to the post-COVID OPD in the study period defined above. The answers were recorded in a simple YES or NO format. Both English and Hindi formats were used for the ease of understanding of the patients.

Patients were offered a comprehensive medical assessment with a detailed history and physical examination. Data on the pertinent history related to their diagnosis of COVID-19 disease such as the date of reverse transcriptase-polymerase chain reaction positive and negative reports and length of stay in hospital were collected. After recording vital signs of pulse rate, blood pressure, and sPO2, patients were asked to answer the pro forma about the presence or absence of the six cardinal symptoms of respiratory diseases, namely cough, sputum, breathlessness, wheeze, hemoptysis, and chest pain. Systemic symptoms such as fatigue, muscle weakness, body ache, joint pains, loss of taste, loss of smell, and decrease in mental concentration were also inquired.

The data thus collected were entered into a structured electronic data collection system. The post-COVID-19 outpatient service is currently active, and further details about the patient evaluation protocol are described in the annexures. There are other ongoing studies in the department in collaboration with other clinical and paraclinical departments that further examine the effects of COVID-19 on mental health and lung functions.

Statistical analysis

Demographic characteristics and long-term health consequences of COVID-19 in patients were presented as median interquartile range for continuous variables and expressed as absolute values along with/side percentages for categorical variables. The data were collected and entered in MS 2010. Different statistical analysis was performed using R software version 4.0.2. The one-sample Kolmogorov–Smirnov test was employed to determine whether the data differed from a normal distribution or not. Normally distributed data were analyzed using parametric tests and nonnormally distributed data were analyzed using nonparametric tests. Descriptive statistics were calculated for qualitative and categorical variables. Graphical representation of the variable was shown to understand the results clearly and to measure the association for the categorical dataset was analyzed using the Chi-square test. Independent t-test or Student's t-test was applied to measure the mean difference between the two groups. The correlation was estimated to measure the strength of the relationship between two or more quantitative variables.

  • If P <0.05, it was considered as statistically significant and
  • If P >0.05, then it was considered statistically insignificant.



  Results Top


During the study period, a total of 99 patients consulted the post-COVID OPD. The mean age of the patients was 42.89 years [Table 1]. Out of 99 patients, 56.6% were males and 43.4% were females [Table 2]. The age distribution revealed 37.3% of patients from the age group of above 50 years of age [Table 3]. The patients in other age groups as per frequency were 33% (18–30 years), 15.2% (31–40 years), and 14.1% (41–50 years).
Table 1: Mean age and mean hospital stay

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Table 2: Gender distribution

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Table 3: Age distribution

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The mean duration of hospital stay was found to be 14 ± 7 days [Table 1]. The majority of patients (68.7%) were admitted for 10 or more days. This distribution was almost maintained in both genders (P = 0.839). As per age distribution, we found that a higher percentage were admitted for >10 days among all age groups, more predominantly among >60 years of age [Table 4].
Table 4: Age and gender distribution with duration of hospital stay

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Only 5 male patients gave a history of receiving noninvasive ventilation (P = 0.044), indicating that mainly mild or moderate cases consulted the OPD. However, only 12% of patients were completely asymptomatic on presentation to the OPD [Table 5].
Table 5: History of invasive ventilation and presence of post-COVID symptoms

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The most common symptom reported was fatigue/weakness or lethargy [Table 6]. The next most prevalent complaint was body ache or joint pain. An equal percentage reported cough and shortness of breath. Some also reported other symptoms such as headache, chest pain, and decrease in mental concentration not a single patient complained of hemoptysis.
Table 6: Distribution of post-COVID symptoms in percentage

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In our study, significantly a greater number of females complained of fatigue [Table 7]. Other symptoms that were found more commonly in females were headache, loss of hearing, and wheeze. Rest all symptoms were more common in males. These results were, however, not significant.
Table 7: Gender distribution of post-COVID symptoms

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In age distribution with symptoms, the majority of patients belonged to 2 age groups, namely 18–30 years and 51–60 years [Table 8]. Elderly patients (>60 years) had predominant complaints of persistent loss of taste, smell, and hearing. Rest all symptoms were found to be more in the young and middle-aged group.
Table 8: Age distribution of post-COVID symptoms

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  Discussion Top


To our knowledge, this is the first cohort study from western Uttar Pradesh, India, assessing the post-COVID symptoms. The sample size of 99 patients is similar to that taken in other studies.[3],[5],[6] A large cohort study from China with 6-month follow-up had a higher mean age (57 years, range: 47–65 years) as compared to our study.[4] Other studies, two done in France and one in Italy too reported a higher mean age.[3],[5],[6] This indicates that the majority of mild-to-moderate cases of post-COVID-19 reporting to our hospital were relatively younger (42.89 years).

Our study had a higher proportion of male patients, similar to other comparable studies.[3],[4],[6] As reported by other studies, almost 80% reported at least one symptom after recovering from the acute phase of COVID-19 infection. The average length of hospital stays, found to be 2 weeks ± 1 week, was also consistent with the finding of other studies. The WHO stated that the median time from illness onset to recovery is about 2 weeks from mild cases and 3–6 weeks with severe or critical disease.[7]

Similar to a study by Carfi et al.,[3] only a minority of patients received invasive ventilation. In our study, the most common symptom was fatigue which was significantly more in females. In comparison to other studies, more respiratory symptoms such as cough and shortness of breath were reported by many patients in our study. This may be because patients are more perceptive to the respiratory complaints as the study is being conducted by the department of pulmonary medicine. General symptoms that were prevalent included headache and body pain. Loss of taste, loss of smell, hearing loss found more commonly in elderly (>60 years) patients. This is in contrast with the study of Carvalho et al.[5] who reported persistent symptoms in the 40–60-year age group, with anosmia/ageusia being the most common symptoms. This may be explained by the over-representation (75/150) of health-care professionals in the study.

This study has several limitations. First, only patients reporting to the post-COVID-19 OPD were enrolled in the study. There will be many cases, especially the severe cases of COVID-19, who might have reported to other departments or other hospitals. Furthermore, only self-reported data was recorded. The symptoms are subjective, and patients reported information may not be reliable unless backed by investigations. It is an observational study with no follow-up. For more reliable and detailed information, work up with investigation is required with follow-up of at least 3–6 months. More research is required in this area to better understand the spectrum of post-COVID-19 symptoms and complications.


  Conclusion Top


In the present epidemic of COVID-19 infection, although number of patients admitted in our hospital are more, ours study consists of small percentage of those cases who attended post-COVID-19 OPD. Fatigue is the most common symptom followed by malaise, joint pain, cough, and shortness of breath. A long-term follow-up with large number of the post-COVID-19 patients is required to come to a conclusion.
Figure 5: Age distribution of post-COVID symptoms

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Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mohfw.gov.in. MoHFW I Home. Available from: https://www.mohfw.gov.in/. [Last accessed on 2021 Feb 03].  Back to cited text no. 1
    
2.
Post COVID/Long COVID. Available from: https://www.idsociety.org/covid-19-real-time-learning-network/disease-manifestations--complications/post-covid-syndrome/. [Last accessed 2021 Feb 03].  Back to cited text no. 2
    
3.
Carfì A, Bernabei R, Landi R. For the gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603-5.  Back to cited text no. 3
    
4.
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. Lancet J 2021;397:220-32.  Back to cited text no. 4
    
5.
Carvalho-Schneider C, Laurent E, Lemaignen A, Beaufils E, Bourbao-Tournois E, Laribi S, et al. Follow-up of adults with noncritical COVID-19 two months after symptom onset. Clin Microbiol Infect 2020;27:258-63.  Back to cited text no. 5
    
6.
Tarentino AL, Maley F. A comparison of the substrate specificities ofendo-beta-N-acetylglucosaminidases from Streptomyces griseus and Diplococcus pneumoniae.Biochem Biophys Res Commun 1975;67:455-62.  Back to cited text no. 6
    
7.
Report of the World Health Organization (WHO)-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available from: https://www.who.int/publications-detail-redirect/report-of-the-who-china-joint-mission-on coronavirus-disease-2019-(covid-19). [Last accessed on 2021 Feb 03].  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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