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

Shelly Karuna(corresponding author)
,
Jorge A. Gallardo-Cartagena
,
Deborah Theodore
,
Portia Hunidzarira
,
Juan Montenegro-Idrogo
,
Jiani Hu

*Corresponding author for this work

Fred Hutchinson Cancer Research Center
,
Universidad Nacional Mayor de San Marcos
,
Columbia University Irving Medical Center
,
University of Zimbabwe
,
Medicina humana
,
Hutchinson Centre for Research in South Africa

Research Output:

Contribution to journal

Article

Peer-review

Open access

Publication Information

Output type

Research Output:

Contribution to journal

Article

Peer-review

Original language

English

Article number

06020

Journal (Volume, Issue Number)

Journal of global health (Volume 13)

Publication milestones

Published - 2023

Publication status

Published - 2023

ISSN

2047-2978

Publication IDs

Scopus: 85162798081
PubMed: 37352144

Abstract

Background 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. Methods 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. Results 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). Conclusions 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.

Funding Details

Acknowledgements: We would like to thank the participants, clinical trial site investigators and staff of the HVTN 405/ HPTN 1901 study, as well as the communities that supported them. We would also like to thank Surya Mony for regulatory support. Please see Online Supplementary Document for a list of clinical research site and investigator names. Ethics statement: Please see Online Supplementary Document for list of IRBs. Informed consent was obtained from all participants involved in the study. Data availability: All data will be provided upon request. Funding: This work was funded by NIAID/NIH UM1 AI068614-14 and UM1 AI068635. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Authorship contributions: SK, LC and SSL conceptualized the study and provided supervision. SSL, JH, MJ, VK, RDLG, CK and AT curated the data; SK, SSL, JH, MM and LC contributed to data visualization; SSL and JH formally analyzed the data and were responsible for the methodology and software used. SK, MJ, VK, MT and CK provided project administration. LC was responsible for funding acquisition; JGC, DT, PH, JMI, NE, PG, KG, LP and JH contributed resources. JGC, DT, PH, JMI, NE, PG and KG contributed investigation. SK, JGC, DT, PH, JMI, KG and SSL contributed to the original draft and SK, JGC, DT, PH, JMI, JH, MJ, MT, CK, LP, JH, MM, NE, PG, RM, LC, KG and SSL provided review and editing. SK, JGC, DT, PH, JMI, JH, MJ, VK, RDLG, CK, AT, LP, JH, LC, KG and SSL had full access to all the study data. SK and SSL had final responsibility for the decision to submit for publication. Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: PG reports funding from HVTN, consulting fees from Johnson & Johnson and DSMB activities. The other authors declare no conflicts of interest: KG, CK, JH, LP, MT, PH, RD, JGC, JM, LC, MJ, SL, VK, JH, MDM, SK, DT, NE, AT, RM. Additional material Online Supplementary Document 1 Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270-3. Medline:32015507 doi:10.1038/s41586-020-2012-7 2 Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020;92:1902-14. Medline:32293716 doi:10.1002/jmv.25884 3 Singhal S, Kumar P, Singh S, Saha S, Dey AB. Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis. BMC Geriatr. 2021;21:321. Medline:34011269 doi:10.1186/s12877-021-02261-3 4 Soltani S, Tabibzadeh A, Zakeri A, Zakeri AM, Latifi T, Shabani M, et al. COVID-19 associated central nervous system manifestations, mental and neurological symptoms: a systematic review and meta-analysis. Rev Neurosci. 2021;32:351-61. Medline:33618441 doi:10.1515/revneuro-2020-0108 5 Tariq R, Saha S, Furqan F, Hassett L, Pardi D, Khanna S. Prevalence and Mortality of COVID-19 Patients With Gas-trointestinal Symptoms: A Systematic Review and Meta-analysis. Mayo Clin Proc. 2020;95:1632-48. Medline:32753138 doi:10.1016/j.mayocp.2020.06.003 6 Shams S, Rathore SS, Anvekar P, Sondhi M, Kancherla N, Tousif S, et al. Maculopapular skin eruptions associated with Covid-19: A systematic review. Dermatol Ther. 2021;34:e14788. Medline:33481314 doi:10.1111/dth.14788 7 Shahjouei S, Tsivgoulis G, Farahmand G, Koza E, Mowla A, Vafaei Sadr A, et al. SARS-CoV-2 and Stroke Characteristics: A Report From the Multinational COVID-19 Stoke Study Group. Stroke. 2021;52:e117-30. Medline:33878892 doi:10.1161/ STROKEAHA.120.032927 8 Tu TM, Goh C, Tan YK, Leow AS, Pang YZ, Chien J, et al. Cerebral Venous Thrombosis in Patients with COVID-19 Infec-tion: a Case Series and Systematic Review. J Stroke Cerebrovasc Dis. 2020;29:105379. Medline:33254369 doi:10.1016/j. jstrokecerebrovasdis.2020.105379 During the first weeks of the pandemic, we initiated a prospective international cohort study at clinical research sites of the COVID-19 Prevention Network (CoVPN) in North and South America and sub-Saharan Africa funded by the National Institute of Allergy and Infectious Diseases (NIAID). We aimed to characterise the presentations of SARS-CoV-2 infection, including the clinical course of COVID-19, among convalescent individuals, measure adaptive immune responses to identify markers of COVID-19 disease severity and duration in a diverse population, and identify unique serologic reactivities that could differentiate SARS-CoV-2 infection from vaccination and provide a guidepost for characterising immune responses to candidate COVID-19 vaccines in early development at that time. Here we summarise our observations of the clinical course of COVID-19 over the first year post-diagnosis among study participants.

FundersFunding numbers

South America and sub-Saharan Africa

NIH

UM1 AI068635, UM1 AI068614-14

NIAID