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

• Published in: Journal of global health Vol. 13; p. 06020
• Main Authors: Karuna, Shelly, Gallardo-Cartagena, Jorge A, Theodore, Deborah, Hunidzarira, Portia, Montenegro-Idrogo, Juan, Hu, Jiani, Jones, Megan, Kim, Vicky, De La Grecca, Robert, Trahey, Meg, Karg, Carissa, Takalani, Azwi, Polakowski, Laura, Hutter, Julia, Miner, Maurine D, Erdmann, Nathan, Goepfert, Paul, Maboa, Rebone, Corey, Lawrence, Gill, Katherine, Li, Shuying Sue
• Format: Journal Article
• Language: English
• Published: Scotland Edinburgh University Global Health Society 23.06.2023; International Society of Global Health
• Subjects: Adolescent; Adult; Age; Asymptomatic; Body mass index; Botswana; Cohort analysis; COVID-19; COVID-19 - epidemiology; COVID-19 Testing; COVID-19 vaccines; Demographics; Disease; Ethnicity; Female; Global health; Hispanic Americans; Humans; Hypertension; Infections; Intubation; Male; Medical history; Middle Aged; Observational studies; Oxygen; Oxygen requirement; Pandemics; Post-Acute COVID-19 Syndrome; Quality of Life; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Young Adult; Botswana; South America; South Africa; United States > US; Peru; Africa
• ISSN: 2047-2978; 2047-2986
• DOI: 10.7189/jogh.13.06020

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. 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. 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). 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. Clinicaltrials.gov (#NCT04403880).