Post-COVID symptom profiles and duration in a global convalescent COVID-19 observational cohort: Correlations with demographics, medical history, acute COVID-19 severity and global region

Abstract

Background: Post-COVID conditions are characterised by persistent symptoms that negatively impact quality of life after SARS-CoV-2 diagnosis. While post-COVID risk factors and symptoms have been extensively described in localised regions, especially in the global north, post-COVID conditions remain poorly understood globally. The global, observational cohort study HVTN 405/HPTN 1901 characterises the convalescent course of SARS-CoV-2 infection among adults in North and South America and Africa.

Methods: We categorised the cohort by infection severity (asymptomatic, symptomatic, no oxygen requirement (NOR), non-invasive oxygen requirement (NIOR), invasive oxygen requirement (IOR)). We applied a regression model to assess correlations of demographics, co-morbidities, disease severity, and concomitant medications with COVID-19 symptom persistence and duration across global regions.

Results: We enrolled 759 participants from Botswana, Malawi, South Africa, Zambia, Zimbabwe, Peru, and the USA a median of 51 (interquartile range (IQR) = 35-66) days post-diagnosis, from May 2020 to March 2021. 53.8% were female, 69.8% were 18-55 years old (median (md) = 44 years old, IQR = 33-58). Comorbidities included obesity (42.8%), hypertension (24%), diabetes (14%), human immunodeficiency virus (HIV) infection (11.6%) and lung disease (7.5%). 76.2% were symptomatic (NOR = 47.4%; NIOR = 22.9%; IOR = 5.8%). Median COVID-19 duration among symptomatic participants was 20 days (IQR = 11-35); 43.4% reported symptoms after COVID-19 resolution, 33.6% reported symptoms ≥30 days, 9.9% reported symptoms ≥60 days. Symptom duration correlated with disease severity (P < 0.001, NIOR vs NOR; P = 0.003, IOR vs NOR), lung disease (P = 0.001), race (P < 0.05, non-Hispanic Black vs White), and global region (P < 0.001). Prolonged viral shedding correlated with persistent abdominal pain (odds ratio (OR) = 5.51, P < 0.05) and persistent diarrhoea (OR = 6.64, P < 0.01).

Conclusions: Post-COVID duration varied with infection severity, race, lung disease, and region. Better understanding post-COVID conditions, including regionally-diverse symptom profiles, may improve clinical assessment and management globally.

Registration: Clinicaltrials.gov (#NCT04403880).

Figure 1

Clinical profiles by region and symptom severity. Panel A. Proportion of participants with each symptom, by region and symptom severity. Panel B. Rates of persistence of COVID-19 symptoms after acute COVID-19 resolution, by region and symptom severity. Each plot shows proportion or rate of response, from 0% (middle of pie chart) to 100% (outer ring of pie chart). NOR – no oxygen requirement, NIOR – non-invasive oxygen requirement, IOR – infection requiring invasive oxygen, RSA – Republic of South Africa.

Figure 2

Kaplan-Meier (K-M) curves of symptom duration and the comparison of restricted mean duration. Panel A. Between severity groups. Panel B. Between regions. NOR – no oxygen requirement, NIOR – non-invasive oxygen requirement, IOR – infection requiring invasive oxygen, RSA – Republic of South Africa.

Figure 3

Correlation of prolonged viral shedding with duration and persistence of gastrointestinal symptoms. GIT – gastrointestinal tract, OR – odds ratio, GMR – geometric mean ratio.