Persistent COVID, After Two Years of Overcoming the Acute Infection by SARS-Cov-2, Havana, Cuba, 2022

Research Article

Austin J Pulm Respir Med. 2023; 10(1): 1098.

Persistent COVID, After Two Years of Overcoming the Acute Infection by SARS-Cov-2, Havana, Cuba, 2022

Yudelmis Álvarez Gavilán1*; Hilda Roblejo Balbuena2; Iris A Rojas Betancourt3; Maidalys Bravo Ramírez4; Beatriz Marcheco Teruel5; Amanda Alonso Valle6; María de los A González Torres7; Luis Carlos Silva8; Nayade Pereira Roche9; Francisco Sotomayor Lugo10; Giselle Monzón Benítez11

1Degree in Biological Sciences, MCs in Medical Genetics, Professor and Assistant Researcher at the University of Medical Sciences of Havana, National Center of Medical Genetics, Cuba

2Doctor of Medicine, PhD in Medical Sciences, II Degree Specialist in Clinical Genetics, Master of Science in Comprehensive Child Care, Professor and Assistant Researcher, National Center for Medical Genetics, Havana Cuba

3D in Medicine, 2nd degree Specialist in Clinical Genetics, Professor and Assistant Researcher at the University of Medical Sciences of Havana, National Center of Medical Genetics, Cuba

4Dr in Medicine, 1st degree Specialist in Clinical Genetics, Assistant Professor of the University of Medical Sciences of Havana, National Center of Medical Genetics, Cuba

5Doctor of Medicine, Second Degree Specialist in Clinical Genetics, Doctor of Medical Sciences, Associate Professor. Senior Researcher, National Center for Medical Genetics, Havana, Cuba

6Dr in Medicine, 4th year resident of the Clinical Genetics specialty, Cuba

7Computer Science Engineer, Associate Researcher at the National Center for Medical Genetics, Havana, Cuba

8DrC, Graduate in Mathematics, Professor and Senior Researcher, ENSAP, Cuba

9Doctor of Medicine, Second Degree Specialist in Clinical Biochemistry, Master of Science in Atherosclerosis, Assistant Professor, Associate Researcher, National Center for Medical Genetics, Havana, Cuba

10Doctor of Medicine, First Degree Specialist in Clinical Genetics, Assistant Professor, National Center for Medical Genetics, Havana, Cuba

11Doctor of Medicine, First Degree Specialist in Clinical Genetics, Assistant Professor, National Center for Medical Genetics, Havana, Cuba

*Corresponding author: Yudelmis álvarez Gavilán Degree in Biological Sciences, MCs in Medical Genetics, Professor and Assistant Researcher at the University of Medical Sciences of Havana, National Center of Medical Genetics, Cuba. Email: yudelmisml@gmail.com

Received: May 24, 2023 Accepted: June 19, 2023 Published: June 26, 2023

Summary

Introduction: Persistent COVID is considered the lack of return to a usual state of health after an acute illness due to COVID-19. Objective: To describe the presence of symptoms of Persistent COVID in affected patients two years after the infection was overcome.

Methods: A prospective cohort study was carried out in 138 patients residing in Havana and Artemisa, who suffered from COVID-19 (44 mild, 87 moderate, 5 severe, 2 critical) in the period from March to June 2020, first Pandemic outbreak in Cuba. From July 2020 to July 2022, five interviews were conducted with the participants (3, 7, 12, 18, and 24 months) to determine the presence of reported symptoms of Persistent COVID.

Results: 62% of the patients suffered Persistent COVID four weeks after their clinical discharge. The most reported persistent symptoms were: respiratory distress (82.6%), muscle weakness (78.2%), headache (73.9%), fatigue (65.2%), and anosmia (52.2%). One year later, only 23.2% of the cases maintained persistent COVID. At 18 months, this persistence in 8% of the cases was the majority among severe and critical. Two years after suffering from the disease, the percentage of those affected remained the same as at 18 months, with a slight improvement in some patients. Persistent COVID was more frequent in people with comorbidities and over 40 years of age.

Conclusions: The presence of Persistent COVID is not exclusive to symptomatic patients for acute infection. The severity of persistent symptoms and their duration show a proportional relationship with severity, which points to a more severe and prolonged Persistent COVID the more severe the acute phase of the disease was suffered.

Keywords: COVID-19; Coronavirus; Symptoms; Sequelae; Convalescence

Introduction

More than two years after the notification of the first cases of COVID-19 (joint report by the WHO and the Government of China in February 2020), [1] it is considered that more than 8 million people have died and more than 90% of those infected have passed the acute phase of the infection. The latter may suffer from post-COVID-19 conditions made up of a wide range of health problems, which comprise a multi-organ symptom complex that affects patients who have suffered from COVID-19 and who remain symptomatic after the acute phase of the disease [2]. This entity, called post-acute COVID, long-term COVID, persistent COVID, or chronic COVID, is failure to return to a usual state of health after an acute illness from COVID-19, which may include the development of new, recurrent symptoms or ongoing, four to eight weeks after first being infected with the SarsCov-2 virus [3]. The maintenance of fluctuating symptoms of the disease for months could have a significant physical, occupational and emotional repercussion [4].

Three theories have been formulated to explain the pathogenesis of persistent COVID manifestations: the permanence of the virus in immunologically privileged sites such as the central nervous system, the aberrant immune response, and autoimmune phenomena secondary to infection [5]. Respiratory difficulty, cardiovascular, neurological, muscular, gastrointestinal and renal affections are reported as the main persistent symptoms [5-8]. Today, knowledge in this regard is limited. It is unfortunate that this persistent COVID issue does not receive enough media coverage. In most research scenarios, the health conditions of people after having suffered the disease are ignored. This fact confers special interest to the present investigation, which aims to describe the presence of persistent COVID symptoms in affected patients two years after the acute phase of the disease has passed.

Methods

As part of the research project Genetic risk factors associated with the clinical severity of COVID 19 in Cuban patients, from the National Center for Medical Genetics, an observational, longitudinal, prospective, cohort study was carried out in July 2020 to July 2022, in six municipalities of Havana and in the Province of Artemisa, Cuba. The selection of the study areas was in correspondence with the possibility of the researchers to follow up the participants over time, in the midst of a complex epidemiological situation, with movement restrictions and social isolation measures. Of the 439 Cuban patients who tested positive for the SARS-CoV-2 virus by PCR, between March 11 and June 11, 2020, in the municipalities of La Lisa, Marianao, Habana Vieja, Cotorro, Regla and San Miguel del Padrón in Havana, together with those affected from the Artemisa Province, those people over 18 years of age, with a clinical discharge date prior to June 11, 2020, were intentionally selected, not probabilistically. Those who were not fit, either physically or mentally, to give their testimony about the symptoms they exhibited at the time of the investigation. The study sample was made up of 138 patients.

In order to consider the participants in this study discharged, the provisions of version 1.5 of the National Action Protocol for COVID-19 were taken into account, which establishes: once the patient was PCR negative and passed the acute phase of the disease, with the guarantee of its follow-up in the health area, a clinical discharge with surveillance for 14 days at home is decided [9].

Patients who consented to participate in research underwent five interviews as part of the follow-up designed to explore the persistence of reported symptoms of COVID-19. These interviews were planned in homogeneous periods for each participant according to the date on which the acute phase of the disease was overcome in correspondence with their clinical discharge: first interview between two and six weeks after clinical discharge, second interview seven months later, third interview one year later, the fourth interview at 18 months and the last interview two years after clinical discharge. It is important to clarify that even when no symptoms of persistent COVID were reported in a previous interview; all the participants were interviewed on all five occasions, taking into account the description in the literature of fluctuating symptoms.

The exit criteria were established: the recurrence of the positive PCR to Sars- CoV-2 in the study period, death, change of residence, leaving the country, or any other event that made it difficult to question the participants, as well as the presence of any other disease that could bias the self-assessment of the state of health, taking into account that the research is based on symptoms reported by the patients themselves.

The information obtained was tabulated and processed in an Excel spreadsheet, to carry out the corresponding statistical analysis through the use of summary measures (absolute frequency and relative frequency) of the descriptive statistics. The formula Χ²C=Σ(Fo – Fe)2/Fe was used to calculate the Chi Square, and the Chi Square calculator for the calculation of p whose interpretation allows us to estimate the probability that two variables are dependent or not, for p values less than or greater than 0.05.

Sociodemographic variables such as age (according to age groups) and sex (Female and Male) were studied; variables of clinical interest that included Personal Pathological History (Diabetes mellitus, High blood pressure, Obesity, Heart disease, Asthma, Immunodeficiencies, Chronic Kidney Disease, Neuropsychiatric disorders, others), COVID-19 symptoms (dry cough, fever, diarrhea, fatigue, smell disturbances, taste disturbances, insomnia, irritability, anxiety, difficulty breathing, sore throat, headache, skin lesions, hair loss, complications (pneumonia, respiratory distress, cardiac arrhythmias, kidney failure, venous or arterial thrombosis , acute myocardial infarction, decompensation of a chronic disease suffered) and the duration of the symptoms from clinical discharge to the time of each interview.

During the first outbreak of COVID-19 in Cuba, all patients diagnosed with positive PCR were admitted to hospitals or isolation centers, which allowed grouping the participants according to the classification referred to in the medical history consulted according to the severity with which they suffered the disease in, mild (mild or asymptomatic symptoms), moderate (those who were treated in wards and did not present complications), severe (those who presented complications, were reported as serious and were in the Intensive Care Unit, ICU) and critical (those who who were reported as critical and were in the ICU).

Follow-up for Persistent COVID performed on each participant was possible for two years, stopping once the convalescents received their first dose of the COVID-19 vaccine. Recent articles propose a possible relationship between autoimmunity, the presence of antibodies against SARS-CoV-2, and the expression of Persistent COVID-19, so vaccination could bias the results [3].

Ethical Aspects

The project to which this study belongs was approved by the MINSAP Innovation Committee. For its realization, the approval of the Research Ethics Committee and the Scientific Council of the National Center of Medical Genetics of Cuba was obtained. The principles of the Declaration of Helsinki on research involving human subjects were complied with [10].

Results

Of the 138 patients that made up the study sample, 44 suffered from the acute phase of COVID-19 with mild or asymptomatic symptoms, 87 moderate, 5 severe and 2 critical, distributed in the six municipalities studied in Havana and in the Artemisa Province (Table 1).