The association between commonly reported symptoms after SARS-CoV-2 infection and subjective well-being

In a recent study published in Epidemiology and infectionresearchers assessed the association between SWB (subjective well-being) and post-COVID-19 (coronavirus disease 2019) symptoms.

Background

Symptoms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have reportedly been persistent beyond the acute period of infection or occur in the post-acute phase after recovery. The global burden of post-acute health implications of SARS-CoV-2 infections could likely be enormous; however, the impact of post-acute Covid-19 symptoms on SWB is unclear.

About the study

In the current study, researchers determined the relationship between common post-COVID-19 symptoms and SWB to assess the effects of symptoms experienced beyond the acute phase of COVID-19 in the long term.

The team analyzed the documented symptoms and SWB of 2,295 people (576 of whom reported a history of SARS-CoV-2 infections) who were part of an ongoing longitudinal cohort study conducted in Israel. They estimated changes in SWB associated with documented symptoms after three to six months, after six to 12.0 months, and after 12 to 18 months after COVID-19 in people reporting previous SARS-CoV-2 infections. Participants were different at each follow-up assessment.

Participants were regularly (every three to four months) asked to answer questions regarding their physical, mental and psychosocial health and well-being using the ISARIC (International Consortium on Acute and Emerging Respiratory Infections) questionnaires . They documented symptoms experienced during the acute period of COVID-19 and in the seven days prior to filling out the survey.

The SWB division of the questionnaire was based on the WHO-5 (World Health Organization five-item wellness index). Participants were asked to complete the SWB division for the previous two weeks and provide NRS (Numerical Rating Scale) scores for fatigue experienced the previous day.

Invitations including survey links were sent via SMS (short message system) to all individuals who had a SARS-CoV-2 RT-PCR (reverse transcription polymerase chain reaction) test between July 2021 and April 2022 at any of the government hospitals in Israel, including Galilee Medical Center, Baruch Padeh Poriya Medical Center, and Ziv Medical Center.

The survey was available in four languages ​​commonly spoken in Israel: Arabic, Hebrew, Arabic, English and Russian. Participants were invited to participate at three time points: July 2021, November 2021, and March 2022. Generalized linear regression analysis was performed and data adjustments were made for key demographic factors.

Individuals documenting symptoms within 3.0 months or beyond 18 months of COVID-19 or those providing incomplete data were excluded from the analysis. Variables considered were participants’ gender, age, COVID-19 vaccination status, follow-up period, time to complete survey questionnaires, and symptoms documented when the questionnaires were completed.

Results

Out of 95,604 people invited, 6,500 people completed the questionnaires (seven percent). After excluding people with missing information and ineligible people, 2,295 people (2% of invitees) were considered for the final analysis. Among 2,295 participants, 57% (n=1,319) were female, 92% (n=2,112) had been vaccinated, and 75% (n=1,719) had no history of COVID-19.

Of 576 individuals previously infected with SARS-CoV-2, 32% (n=186) documented no COVID-19 symptoms when completing questionnaires, and 68% (n=390) documented ≥ 1.0 symptoms felt after -acute period when filling out the questionnaires. A median value of 260.0 days was obtained for the duration between COVID-19 and the completion of the questionnaires.

People with post-COVID-19 symptoms showed a higher likelihood of being unvaccinated and female. Among 526 participants with a history of COVID-19, the most commonly documented symptoms included fatigue (42%, n=243), muscle weakness (26%, n=153), muscle aches (23%, n= 134), sleep difficulty concentrating (21%, n=121), and difficulty concentrating/confusion (22%, n=126).

The SWB scores of people with a history of SARS-CoV-2 infections who had reported no symptoms in the post-COVID-19 period were identical to those of people without a history of COVID-19 (74% for two groups).

Compared to people who documented no symptoms, people documenting nonspecific symptoms such as difficulty sleeping, difficulty concentrating/confusion, and fatigue showed the most significant SWB reductions of 12, 12, and 8.0 pp (percentage points), respectively. The effect of individual post-acute symptoms of COVID-19 developed on SWB differed at each time point.

While fatigue resulted in a statistically nonsignificant eight-pp reduction in SWB among people documenting fatigue three to six months post-COVID-19, among people documenting fatigue over the 12- to 18-month period, reduction in fatigue-related SWB was significant (13 pp).

Concentration difficulties significantly reduced SWB scores when documented at three to six months or 12 to 18 months after infection. However, sleep difficulties significantly affected SWB at three to six months and six to 12 months, but not at 12 to 18 months after infection.

Musculoskeletal symptoms such as muscle pain and weakness showed no significant association with SWB at any time point except for a reduction in SWB in people documenting pain in the muscles during the follow-up period of six months to 12 months post-COVID -19. Among 553 people infected with SARS-CoV-2 with full NRS data, those documenting fatigue had significantly higher NRS scores (7.1, more fatigue) than those without (4.1) .

Conclusion

Overall, study results showed that post-acute symptoms of COVID-19 were associated with a significant reduction in SWB ≤ 18.0 months after initial infection.