gms | German Medical Science

Introduction: We previously described a considerable burden of self-reported post-acute symptom clusters, notably fatigue, neurocognitive impairment, chest symptoms, smell or taste disorders, and anxiety or depression among others, six to 12 months after acute SARS-CoV-2 infection in 18-65-year-old adults after the index infection [1]. We now re-assessed their health status 24 months after infection.

Methods: Participants of the EPILOC (Epidemiology of Long Covid) baseline survey (Aug.-Sep. 2021, six to 12 months after confirmed SARS-CoV-2 infection) were contacted again in Nov. 2023 (Follow-up). At baseline, they were asked to answer a standardised questionnaire on socio-demographics and lifestyle factors. A comprehensive list of possible Covid-related symptoms was included at both time points. We calculated the prevalences of specific symptom clusters at both time points as well as the prevalences of new onset of symptoms clusters or resolving of symptom clusters. We used generalized linear models to identify predictors of new onset or resolving of symptom clusters.

Results: Overall, n=6632 subjects (mean age 46.6 years, 60.9% females) were included in this analysis. At baseline (median time since infection 8.7 months) and follow-up (median 23.9 months after infection) we found the following prevalences (follow-up in brackets): fatigue 23.8% (22.0%), neurocognitive impairment 15.8% (17.3%), chest symptoms 14.4% (13.7%), smell or taste disorder 12.0% (7.5%), anxiety or depression 11.7% (17.0%), and musculoskeletal pain 9.0% (13.8%). However, symptom clusters were not as stable as suggested by these point prevalences, e.g. fatigue symptoms resolved in 9.8% of participants but newly developed in 8.0% of participants.

Consistent predictors for the onset of new symptom clusters were female sex (RRs between 1.23 and 1.54) and treatment of the acute infection (RRs between 1.48 and 1.83). Obesity, a history of cardiovascular diseases, and mental disorders were predictors for the onset of some, but not all, symptom clusters. Higher education was a statistically significant predictor for resolving of all symptom clusters, as was the treatment of the acute infection (RRs between 0.81 and 0.90). Interestingly, additional SARS-CoV-2 infection (mainly with the Omicron variant) was only predictive for the onset of chest symptoms (RR=1.22, 95%-CI 1.04 to 1.43), including shortness of breath, chest pain and wheezing.

Conclusions: Even two years after acute infection with SARS-CoV-2 wild-type or early variants, a considerable burden of symptoms remains.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.