Nearly a third of patients with asymptomatic COVID-19 showed symptoms of post-acute sequelae of SARS-CoV-2 (PASC), according to a study published in Journal of General Internal Medicine.
Patients who have recovered from COVID-19 frequently report symptoms of PASC such as fatigue, shortness of breath, and loss of smell. Previous studies describing PASC have focused on adult hospitalized patients or patients with mild COVID-19 who were treated on an outpatient basis for up to 9 months after infection. Cohorts of patients with PASC included small proportions of individuals from minority groups. This is the first study to examine the association between race, social vulnerability, and insurance status with the development of PASC, according to the researchers.
They analyzed data for 1,038 participants (aged 60 years; interquartile range [IQR], from 37 to 83 years old; 42% Latino, 30% White) in the UCLA Mobile Health Surveillance Program. Patients completed follow-up surveys at 30, 60, or 90 days after hospital discharge or outpatient diagnosis. Eighty percent of patients were followed up after their illness.
PASC was reported by 29.8% of patients after at least 60 days of acute illness (30.8% of hospitalized patients, 26.5% of high-risk outpatients).
Within 30 days, the most common symptoms were fatigue (73.2%), shortness of breath (63.6%), fever and chills (51.5%), and muscle aches (50.6%). At 60 days, fatigue (31.4%), shortness of breath (13.9%), loss of taste or smell (9.8%).
Fatigue was the most common symptom among hospitalized and outpatient patients. About 15% of hospitalized patients experienced shortness of breath, and about 16% of outpatients experienced a loss of taste or smell.
PASC patients in outpatient care were more likely to be younger, white, female, and commercially insured. Hospitalized patients were more likely to report symptoms of PASC if they were women. Patients with a history of organ transplantation were less likely to develop PASC.
Hospitalized with COVID-19 (OR, 1.49 95% CI 1.04-2.14), with diabetes (odds ratio) [OR], 1.39; A 95% CI, 1.02-1.88) and a higher BMI (OR, 1.02; 95% CI, 1.0002-1.04) were associated with the development of PASC. Patients with Medicaid (OR, 0.49; 95% CI, 0.31–0.77) or history of organ transplantation (OR, 0.44; 95% CI, 0.26–9.76) were less likely to develop PASC.
The researchers said the lack of association of age or race with developing PASC may be influenced by access to the same health system with standardized follow-up, the importance of risk factors for developing COVID-19 compared to recovery from COVID-19, or the difference in symptoms and outlook across demographic groups and the ability of tools to detect For PASC to recognize these differences. The difference in symptoms between hospitalized patients and treated outpatients is likely due to differences in clinical phenotypes, according to the researchers.
Study limitations included potential self-report bias, referral bias, survival bias, assessment of a limited number of PASC symptoms, lack of a control group of patients with persistent symptoms after hospital admission not associated with COVID, and limited knowledge of pre-existing conditions.
The researchers concluded that, “Understanding the prolonged effects of COVID will allow for more effective education among patients and providers, and allow for the use of appropriate healthcare resources in the assessment and treatment of PASC.”
Yoo SM, Liu TC, Motwani Y et al. Factors associated with acute post-SARS-CoV-2 (PASC) sequelae after symptomatic diagnosis of COVID-19 in inpatients and outpatients in a diverse group. J General Apprentice Med. Published online April 7, 2022. doi: 10.1007/s11606-022-07523-3