Title : Post COVID-19 syndrome in Honduras: systems affected and its association with severity of first COVID-19 episode
Abstract:
Introduction: COVID-19 was an amplifier of global vulnerabilities such as climate change, poverty/social exclusion, curative health systems, poor surveillance capacity and a silent pandemic of chronic diseases. By the middle 2020, several studies described the so-called long COVID syndrome as an emerging and prevalent syndrome. Post-COVID-19 syndrome (PCS) refers to a range of lingering symptoms that persist after the acute phase of COVID-19 infection has resolved; some individuals experience symptoms that can last for months and may have a significant impact on their daily lives.
Objective. The purpose of the study is to estimate the prevalence of PCS, systems affected, symptoms, duration and association with severity of first COVID-19 episode among ambulatory patients in Honduras.
Methods: Last-year medical students from the Faculty of Medical Sciences (UNITEC), during 2022-2023, were assigned by the Ministry of Health to primary health clinics (PHC). They interviewed a convenience sample of adults that consecutively attended PHC. The protocol was approved by UNITEC’s Bioethical Committee. Only subjects diagnosed with COVID-19, usually by a RT-PCR test, during years 2020-2021 were included. Date of first COVID-19 episode was established and a 12-week-period after the first COVID-19 symptom appeared was estimated; then, subjects were asked for the presence and duration of PCS’ symptoms by body organ and systems.
Results: A total of 2967 participated, 59.6% female, 20.3% 51+ years of age, 71.6% overweight-obese, 17.4% hypertension and 12.2% diabetes mellitus. For first COVID-19 episode: 29.6% asymptomatic, 60.8% mild disease, 6.6% hospitalized, 2.0% severe disease and 0.4% admitted to intensive care unit. PCS’ prevalence was 51.5% (95% CI: 49.7%-53.3%). Among the 1528 persons with PCS, systems affected were: Respiratoy (68.6%), Neurological (68.1%), Systemic (65.1%), Psychiatry (33.0%), Cardiological (31.7%), Cognitive (30.1%) and Gastrointestinal (20.6%). With regard to SPC’s symptoms: 55.8% had 1-3, 24.2% had 4-6, 14.9% had 7-9 and 10.4% had 10+ symptoms. A total of 143 (9.3%) had persistent PCS’ symptoms (≥ 24 months duration). For subjects with Mild-Asymptomatic disease, 9.9% had ≥ 7 PCS’ symptoms and 3.9% had persistent PCS compared with 43.0% and 14.1%, respectively, among persons that reported Hospitalized-Severe disease (p<0.001). Mean symptom’s duration (months) was also higher for each system evaluated for persons that reported Hospitalized-Severe disease (p<0.001).
Discussion: There are still many PCS’ unanswered questions and areas of controversy that require further research and discussion. There is ongoing debate about definition and diagnostic criteria for PCS. The wide range of symptoms reported by individuals has led to discussions about whether it represents a single syndrome or a collection of related conditions. Conclusion: PCS’ prevalence was 51.5% (95% CI: 49.7%-53.3%); systems most affected were Respiratoy, Neurological and Systemic; 9.3% had persistent PCS; subjects who reported Hospitalized-Severe disease had more symptoms, persistent symptomatology and higher mean duration of symptoms.
