A recent study posted to the medRxiv* preprint server assessed the physical, cognitive, psychological profile of post-coronavirus disease 2019 (COVID-19) condition (PCC) in healthcare workers (HCWs).
Various reports of PCC have been observed in hospitalized as well as non-hospitalized patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, knowledge regarding the risk factors, prevalence, and time-span of PCC is still insufficient.
About the study
The present case-control study examined the risk factors and prevalence of PCC symptoms as evaluated five to 28 weeks post-acute COVID-19 among hospitalized and non-hospitalized HCWs in Québec.
PCC was defined as the perseverance of any of the 15 symptoms, namely shortness of breath, wheezing, cough, runny nose, sore throat, chest pain, fever, fatigue, headache, loss of taste, loss of smell, difficulty walking, joint or muscle pain, diarrhea, and abdominal pain, post-acute COVID-19 for either four or more weeks (PCC4w) or 12 or more weeks (PPC12w).
Eligible participants for the study included symptomatic HCWs who were polymerase chain reaction (PCR)-confirmed for SARS-CoV-2 infection between 12 July 2020 and 29 May 2021. The test-negative cohort included HCWs who tested PCR-negative for SARS-CoV-2 and had no history of COVID-19 infection.
Consenting participants answered a standardized online or phone questionnaire through which sociodemographic data, COVID-19 vaccination status, and employment characteristics were collected. COVID-19-infected HCWs also answered questions regarding symptom onset, COVID-19-related hospitalization, and the number of weeks taken to recover fully, while non-recovered patients provided information regarding the presence and severity of symptoms.
For all the eligible participants, the questionnaire examined four facets of cognitive function: difficulty in maintaining concentration, difficulty in organizing oneself, forgetfulness, and losing essential items. These questions were answered using a five-level Likert scale with values ranging from never, rarely, sometimes, often, to very often. Psychological distress was assessed using the Kessler scale (K6) on a scale of 0 to 24, where a score between 7 and 12 indicated high psychological distress and a score over 12 indicated a very high level of psychological distress. The K6 scale evaluated the frequency of feeling hopeless, depressed, nervous, restless, and worthless as experienced by the individuals in the preceding month.
Results
The study results showed that a total of 31,091 HCWs were infected with COVID-19 during the study period and included 79% women, 48% of participants aged over 40 years, and 1.2% hospitalized patients. The PCC4w analysis was conducted on 6061 COVID-19-infected HCWs, among which 2% were hospitalized while 98% were non-hospitalized. The PCC12w analysis comprised 1,783 HCWs, including 2% hospitalized and 98% non-hospitalized COVID-19 patients. Also, the control cohort included 4,390 participants.
A total of 46.2% of the non-hospitalized COVID-19 patients had symptoms persisting for four weeks and longer, while 39.9% had symptoms lasting 12 weeks and more. On the other hand, 76.3% of the hospitalized COVID-19 patients had symptoms for four weeks, and more and 67.6% had symptoms for 12 weeks and more. Approximately 49% of the non-hospitalized COVID-19 cases reported persistent symptoms four to seven weeks after the onset of acute-COVID-19, while 36.6% had persistent symptoms for 24 to 27 weeks.
In the hospitalized and non-hospitalized patient cohorts, 64% and 30% reported fatigue, 17% and 20% reported a loss of taste or smell, 56% and 20% had shortness of breath, 33% and 15% suffered from cognitive dysfunction, 23%, and 13% had headaches, and 22% and 10% reported muscle and joint pain that lasted four weeks and more. Among patients suffering from persistent post-COVID-19 fatigue, 99% also experienced pre-COVID-19 fatigue. Furthermore, 84% of the patients reported mild pre-COVID-19 fatigue, while 63% and 28% reported moderate and severe post-COVID-19 fatigue, respectively.
Among the non-hospitalized PCC4w patients, the prevalence of difficulty in maintaining concentration, difficulty in organizing oneself, forgetfulness, and losing essential items was reported as often or very often by 33%, 23%, 20%, and 10% of the patients, respectively, in comparison to 39%, 28%, 34%, and 15% reported by hospitalized PCC4w patients. Similar observations were also reported by the hospitalized and non-hospitalized PCC12w patients. Notably, 6%, 26%, and 68% of patients experiencing mild, moderate, and severe COVID-19 symptoms reported losing necessary items often or very often, indicating an association between disease severity and significant memory loss.
Conclusion
The study findings showed that PCC significantly affects cognition among hospitalized COVID-19 patients. With the high risk of infection to HCWs, understanding the whole impact of PCC symptoms like cognitive dysfunction can help prevent further severe implications on the indispensable delivery of quality healthcare.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
