Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study

Abstract

Background: Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. Data on post-COVID-19 syndrome in the general population are required for the timely planning of healthcare services and resources. The objective of this study was to assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterize their healthcare utilization.

Methods: This population-based prospective cohort study (Zurich SARS-CoV-2 Cohort) enrolled 431 adults from the general population with polymerase chain reaction-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020 in the Canton of Zurich, Switzerland. We evaluated the proportion of individuals reporting not to have fully recovered since SARS-CoV-2 infection, and the proportion reporting fatigue (Fatigue Assessment Scale), dyspnea (mMRC dyspnea scale) or depression (DASS-21) at six to eight months after diagnosis. Furthermore, the proportion of individuals with at least one healthcare contact after their acute illness was evaluated. Multivariable logistic regression models were used to assess factors associated with these main outcomes.

Results: Symptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalized. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalized individuals were rehospitalized. Individuals that have not fully recovered or suffer from fatigue, dyspnea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care.

Conclusions: In this population-based study, a relevant proportion of participants suffered from longer-term consequences after SARS-CoV-2 infection. With millions infected across the world, our findings emphasize the need for the timely planning of resources and patient-centered services for post-COVID-19 care.

Fig 1. Flow chart for the inclusion of SARS-CoV-2 infected individuals from the Canton of Zurich, diagnosed between 27 February 2020 and 05 August 2020.

Fig 2. Associations for non-recovery, fatigue, dyspnea and depression at six to eight months after SARS-CoV-2 infection.

Panel (a) shows associations for not having fully recovered among initially symptomatic participants from multivariable logistic regression models adjusted for age, sex, initial hospitalization, symptom severity and presence of comorbidities. Panel (b) demonstrates associations for presence of fatigue (based on Fatigue Assessment Scale) from models adjusted for age, sex, and initial hospitalization. Panel (c) displays associations for presence of dyspnea (mMRC grade ≥1) from models adjusted for age, sex, initial hospitalization, smoking status, respiratory comorbidity and body mass index. Panel (d) shows associations for presence of depressive symptoms (based on DASS-21) from models adjusted for age, sex, initial hospitalization and symptom severity.

Fig 3. Associations for healthcare service utilization at six to eight months after SARS-CoV-2 infection.

Fig 3 shows associations for having at least one further healthcare contact after initial COVID-19, based on multivariable logistic regression models adjusted for age, sex, initial hospitalization, and initial symptom severity.