Nearly one-third of patients with symptomatic COVID-19 developed symptoms of postacute sequelae of SARS-CoV-2 (PASC), according to a study published in the Journal of General Internal Medicine.
Patients who have recovered from COVID-19 frequently report PASC symptoms such as fatigue, dyspnea, and anosmia. Prior studies describing PASC have focused on hospitalized adult patients or patients with mild COVID-19 treated in outpatient settings up to 9 months following infection. Cohorts of patients with PASC have included small proportions of individuals of minority groups. This is the first study to examine the association of ethnicity, social vulnerability, and insurance status with developing PASC, according to the researchers.
They analyzed data of 1038 participants (aged 60 years; interquartile range [IQR], 37 to 83 years; 42% Latino, 30% White) in the University of California Los Angeles (UCLA) Health COVID Ambulatory Monitory Program. The patients completed follow-up surveys at 30, 60, or 90 days after hospital discharge or outpatient diagnosis. Eighty percent of patients followed up after their illness.
PASC were reported by 29.8% of patients at least 60 days after acute illness (30.8% of patients treated in hospitals, 26.5% of high-risk outpatients).
At 30 days, the most commonly reported symptoms were fatigue (73.2%), shortness of breath (63.6%), fevers and chills (51.5%), and muscle aches (50.6%). At 60 days, fatigue (31.4%), shortness of breath (13.9%), and loss of taste or smell (9.8%).
Fatigue was the most common symptom among both hospitalized and outpatient patients. About 15% of hospitalized patients experienced shortness of breath, and about 16% of outpatients experienced loss of taste or smell.
PASC patients in outpatient care were more likely to be younger, White, women, and commercially insured. Hospitalized patients were more likely to report PASC symptoms if they were women. Patients with history of organ transplant were less likely to develop PASC.
Hospitalization for COVID-19 (OR, 1.49 95% CI 1.04-2.14), having diabetes (odds ratio [OR], 1.39; 95% CI, 1.02-1.88), and higher body mass index (OR, 1.02; 95% CI, 1.0002–1.04), were linked with developing PASC. Patients with Medicaid (OR, 0.49; 95% CI, 0.31-0.77) or history of organ transplant (OR, 0.44; 95% CI, 0.26-9.76) were less likely to develop PASC.
The researchers said the lack of association between age or race with developing PASC may be influenced by access to the same health system with standardized follow-up, importance of risk factors for contracting COVID-19 compared with recovering from COVID-19, or variance in symptoms and expectations across demographic groups and ability of tools detecting PASC to realize those differences. Variation in symptoms between hospitalized patients and outpatient treated patients is likely due to differences in clinical phenotypes, according to the researchers.
Study limitations included potential self-report bias, referral bias, survivorship bias, evaluation of a limited number of PASC symptoms, no control group of patients with persistent symptoms following hospital admissions unrelated to COVID, and limited knowledge of pre-existing conditions.
“Understanding the effects of long COVID will allow for more effective education among patients and providers, and allow for appropriate healthcare resource utilization in the evaluation and treatment of PASC,” the researchers concluded.
Yoo SM, Liu TC, Motwani Y, et al. Factors associated with post-acute sequelaeof SARS-CoV-2 (PASC) after diagnosis of symptomatic COVID-19 in the inpatient and outpatient setting in a diverse cohort. J Gen Intern Med. Published online April 7, 2022. doi: 10.1007/s11606-022-07523-3