One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals

Abstract

Background: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors.

Objective: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative.

Methods: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date.

Results: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history.

Conclusion: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Keywords: SARS; epidemiology; functional impairment; infectious diseases; inflammation; internal medicine; persistent symptoms; post-COVID.

Fig. 1

Flowchart.

Fig. 2

Associations between laboratory‐confirmed SARS‐CoV‐2 infection and the persistence of symptoms and functional impairment at 1 year stratified by sex, age categories, and pre‐existing medical conditions (n = 1245). The persistence of symptoms was defined as the presence of any one symptom within the 2 weeks before the questionnaire. Functional impairment was assessed using the Sheehan Disability Scale [33]. Odds ratios were adjusted for time from infection, age, sex, education, profession, working in healthcare setting, smoking, physical activity, COVID‐19 vaccination status, symptoms at presentation, hospitalization, and the following comorbidities present prior to testing: overweight or obese, hypertension, respiratory disease, cardiovascular disease, diabetes, immunosuppression, hypothyroidism, anemia, migraine, tension headache, sleeping disorder, anxiety, depression, any psychiatric condition, irritable bowel syndrome, chronic pain syndrome, and chronic fatigue. aOR, adjusted odds ratio; CI, confidence interval; OR, odds ratio.