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. 2025 May 5;20(5):e0321295.
doi: 10.1371/journal.pone.0321295. eCollection 2025.

Post-acute sequelae of COVID-19 in residents in long-term care homes: Examining symptoms and recovery over time

Gordana Rajlic  1 , Janice M Sorensen  1 , Benajir Shams  1 , Armin Mardani  1 , Ketki Merchant  1 , Akber Mithani  1   2
Affiliations

Post-acute sequelae of COVID-19 in residents in long-term care homes: Examining symptoms and recovery over time

Gordana Rajlic et al. PLoS One. .

Abstract

Background: Post-COVID-19 condition (PCC) has been studied extensively since the inception of the COVID-19 pandemic. In the population of long-term care (LTC) home residents, however, information about PCC and recovery after the acute phase of COVID-19 is lacking. This study contributes evidence about symptoms over time in 459 residents in nine Canadian LTC homes.

Methods: In a comprehensive retrospective chart review, we recorded medical symptoms in a 4-week period before contracting COVID-19 ("PRE-COVID") and during 24 weeks after contracting infection (a 4-week "ACUTE-COVID" period and five subsequent 4-week periods "POST1-5"). We investigated the number and type of symptoms over time, examined different "recovery trajectories", and compared the characteristics of residents across different trajectories.

Results: In the sample overall, the number of different symptoms increased from PRE-COVID to ACUTE-COVID (mean difference of 3 symptoms, p<.001), returning to the PRE-COVID level within the first two months post-infection. An individual-level examination revealed that after ACUTE-COVID about a quarter of residents did not return to their symptom baseline. There was no statistically significant difference in demographic characteristics or PRE-COVID comorbidities across different recovery trajectories. Comparing the group of residents that did not return to their symptom baseline and the group that did, the risk for not returning to baseline increased with the number of symptoms in ACUTE-COVID (adjusted for age, sex, and PRE-COVID comorbidities, exp[B]=1.15, 95% CI [1.05;1.25], p=.002). Additionally, there was a greater increase in the number of symptoms from PRE-COVID to ACUTE-COVID in the former group (significant interaction effect, p<.001). We present symptom types in each time-period.

Conclusions: Group-level results indicated that the number of symptoms after contracting COVID-19 fell to the pre-COVID level within the first two months post-infection. An examination of individual-level symptom trajectories contributed a more granular picture of recovery after infection and characteristics of residents across different trajectories.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Study design.
(a) Time periods in the study in which symptoms were recorded. (b) Trajectory T1. Not returning to baseline trajectory, defined as “greater number of symptoms in each period after ACUTE-COVID in comparison to PRE-COVID level (baseline), or returning to baseline in only one (any) out of the five POST periods”. (c) Trajectory T2. Returning to baseline trajectory, defined as “not exhibiting a greater number of symptoms as compared to baseline in any POST period, or returning to baseline within the first 3 months after contracting COVID (the latest in POST2)”.
Fig 2
Fig 2. Specific comorbidities at baseline.
Percentage of LTC residents diagnosed with specific diseases is presented (n = 459).
Fig 3
Fig 3. Number of symptoms over study periods.
The number of different symptoms over the time periods is presented for all residents with information about symptoms available (orange line, n = 433), along with the number of symptoms for residents classified into different post-acute recovery trajectories, as defined in Procedure – blue line for T1 trajectory (n = 109), green line for T2 (n = 207), and grey line for T3 (n = 107).
Fig 4
Fig 4. Types of symptoms over study period.
In the overall sample, percentage of residents experiencing the symptoms in each time-period is presented (valid n = 433).
See this image and copyright information in PMC

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