Infectious Disease
Post-COVID syndrome 24 months after a SARS-CoV-2 infection in adults of the general population: cohort study from South of Germany Dietrich Rothenbacher* Dietrich Rothenbacher Raphael S. Peter Alexandra Nieters Lisamaria Eble Hans-Georg Kräusslich Stefan O. Brockmann Siri Göpel Jürgen M. Steinacker Dietrich Rothenbacher Winfried V. Kern for the EPILOC Phase 3a Study Group
Besides morbidity and mortality in the acute phase of SARS-CoV-2 infection, considerable post-acute health problems are reported. This study aimed to describe post-acute sequelae up to two years after acute SARS-CoV-2 infection in a population-based sample of previously SARS-CoV-2 infected adults and to evaluate factors for persistence or improvement of the post-acute syndrome (PCS).
Analyses were done in a population-based, observational study including adults aged 18-65 years with positive SARS-CoV-2 polymerase chain reaction tested between October 2020 and April 2021 in defined geographic regions in the South of Germany and had to be notified to the regional public health authorities. Possible participants were contacted 6-12 months after the acute infection (baseline) and followed-up after two years (median 23.9 months) by a standardized questionnaire. PCS was defined as health or working capacity recovered ≤80% (compared to pre-infection) and any post-infection symptom with impairment moderate to strong. Prevalence of symptom clusters and results of adjusted logistic regression analyses for changes in PCS from baseline to follow-up were estimated.
Overall, n=6631 subjects (mean age 45.8 years, 60.9% females) were included in this analysis. Prevalence of symptom clusters at follow-up was 22.2% for fatigue, 17.6% for neurocognitive impairment, 17.2% for symptoms of anxiety or depression, 14.1% for musculoskeletal pain, and 13.8% for chest symptoms. Predictors of improvement of PCS-cases (n=514 improved, prevalence of PCS at baseline 29.9% and at follow-up 31.3%, respectively) were age (OR 0.79 per 10 years (95% CI 0.72; 0,87)), smoking at baseline (OR 0.60 (95% CI 0.40; 0.90)), treatment of acute infection (OR 0.73 (95% CI 0.58; 0.92)), and obesity (OR 0.71 (0.54; 0.92)) among others.
Even two years after acute infection, a considerable burden of PCS is present. An unhealthy lifestyle (smoking, obesity) is associated with persistence of PCS.