Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19

Abstract

Introduction: The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.

Methods: Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.

Results: Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).

Conclusion: Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Keywords: COVID-19; descriptive study; epidemiology; health policy.

Figure 1

Flow chart of follow-up of the enrolled participants. *n=number of participants for whom an attempt to contact was made.

Figure 2

Symptom profile of participants post-discharge.

Figure 3

Symptoms and post-discharge mortality within 30 days of discharge among patients discharged from hospital, admitted across three waves of COVID-19. *Denominator=participants alive at 30-day follow-up. ^#Denominator=participants whose calls were responded to (dead+alive).

Figure 4

Evidence-based framework for holistic management of COVID-19 sequelae. Grass roots-level workers sensitised with the health needs of post-COVID-19 patients. Post COVID OPD at Primary health centre (PHC)/ Community health centre (CHC)/ district hospitals at specified time and days with multiple virtual linkages. CAD, coronary artery disease; OPD, outpatient department.