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Randomized Controlled Trial
. 2024 Nov;89(5):106267.
doi: 10.1016/j.jinf.2024.106267. Epub 2024 Sep 6.

Antecedent and persistent symptoms in COVID-19 and other respiratory illnesses: Insights from prospectively collected data in the BRACE trial

Ellie McDonald  1 , Laure F Pittet  2 , Simone E Barry  3 , Marc Bonten  4 , John Campbell  5 , Julio Croda  6 , Mariana G Croda  7 , Margareth Pretti Dalcolmo  8 , Andrew Davidson  9 , Fernando F de Almeida E Val  10 , Glauce Dos Santos  11 , Kaya Gardiner  12 , Grace Gell  13 , Amanda Gwee  14 , Ann Krastev  15 , Marcus Vinícius Guimaraes Lacerda  16 , Michaela Lucas  17 , David J Lynn  18 , Laurens Manning  19 , Nick McPhate  20 , Kirsten P Perrett  21 , Jeffrey J Post  22 , Cristina Prat-Aymerich  23 , Lynne E Quinn  24 , Peter C Richmond  25 , Nicholas J Wood  26 , Nicole L Messina  27 , Nigel Curtis  28 ; BRACE Trial Consortium Group
Affiliations
Randomized Controlled Trial

Antecedent and persistent symptoms in COVID-19 and other respiratory illnesses: Insights from prospectively collected data in the BRACE trial

Ellie McDonald et al. J Infect. 2024 Nov.

Abstract

Background: Some individuals have a persistence of symptoms following both COVID-19 (post-acute COVID-19 syndrome; PACS) and other viral infections. This study used prospectively collected data from an international trial to compare symptoms following COVID-19 and non-COVID-19 respiratory illness, to identify factors associated with the risk of PACS, and to explore symptom patterns before and after COVID-19 and non-COVID-19 respiratory illnesses.

Methods: Data from a multicentre randomised controlled trial (BRACE trial) involving healthcare workers across four countries were analysed. Symptom data were prospectively collected over 12 months, allowing detailed characterisation of symptom patterns. Participants with COVID-19 and non-COVID-19 respiratory illness episodes were compared, focussing on symptom severity, duration (including PACS using NICE and WHO definitions), and pre-existing symptoms.

Findings: Compared to those with a non-COVID-19 illness, participants with COVID-19 had significantly more severe illness (OR 7·4, 95%CI 5·6-9·7). Symptom duration meeting PACS definitions occurred in a higher proportion of COVID-19 cases than non-COVID-19 respiratory controls using both the NICE definition (2·5% vs 0·5%, OR 6·6, 95%CI 2·4-18·3) and the WHO definition (8·8% vs 3·7%, OR 2·5, 95%CI 1·4-4·3). When considering only participants with COVID-19, age 40-59 years (aOR 2·8, 95%CI 1·3-6·2), chronic respiratory disease (aOR 5·5, 95%CI 1·3-23·1), and pre-existing symptoms (aOR 3·0, 95%CI 1·4-6·3) were associated with an increased risk of developing PACS. Symptoms associated with PACS were also reported by participants in the months preceding their COVID-19 or non-COVID-19 respiratory illnesses (32% fatigue and muscle ache, 11% intermittent cough and shortness of breath).

Interpretation: Healthcare workers with COVID-19 were more likely to have severe and longer-lasting symptoms than those with a non-COVID-19 respiratory illness, with a higher proportion meeting the WHO or NICE definitions of PACS. Age, chronic respiratory disease, and pre-existing symptoms increased the risk of developing PACS following COVID-19.

Keywords: Age; COVID-19; Chronic respiratory disease; Healthcare workers; Long COVID; Multicentre study; Non-COVID-19 respiratory illness; Persistent symptoms; Post-acute COVID-19 syndrome (PACS); Pre-existing symptoms; Prospective data; Symptom duration; Symptom patterns; Symptom severity.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Participant inclusion flowchart.
Fig. 2
Fig. 2
Stratification of the first and subsequent report of daily symptom data.
Fig. 3
Fig. 3
Total respiratory symptoms per participant over each period; non-COVID-19 respiratory controls compared to COVID-19 cases.
Fig. 4
Fig. 4
Total other symptoms per participant over each period; non-COVID-19 respiratory controls compared to COVID-19 cases.
Fig. 5
Fig. 5
Any respiratory symptom (days) before, during and after COVID-19 and non-COVID-19 illness.
Fig. 6
Fig. 6
Any other symptoms (days) before during and after COVID-19 and non-COVID-19 illness.
See this image and copyright information in PMC

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