Abstract

Background: Risks of Ongoing Symptomatic COVID-19 (OSC) and Post-acute COVID-19 Syndrome (PCS), following COVID-19 infection, are not well documented. Our study evaluated those risks based on patient and COVID-19 Signs and Symptoms (CSS).

Methods: Patients with COVID-19 (first date=index) from April 1, 2020, to June 30, 2021, and ≥ 6 months of continuous enrollment pre- and post-index, in IBM® MarketScan® Commercial and Medicare Supplemental databases, were identified and stratified by severity during the disease’s acute phase, using mild, moderate and Severe/Critical (SC) algorithms defined by the Janssen COVID-19 vaccine Phase 3 Trial. Variables included demographics, comorbidities, and individual CSS. Patients with OSC (COVID-19 disease duration >4 weeks) or PCS (COVID-19 disease duration >12 weeks) were identified. Logistic regression analyses were conducted to identify risk factors for PCS across all COVID-19 patients and within each severity group.

Results: 383,883 patients (160,326 mild (DoD: 18.8 days (standard deviation (SD): 15.3)); 189,240 moderate (DoD: 27.9 days (SD: 30.8)); 34,317 SC cases (DoD: 60.7 days (SD: 67.0)))were included. The percentage of patients with OSC and PCS in the mild, moderate and severe cohort was as follows: 11.8% and 0.6%, 25.2% and 3.6%, and 41.4% and 19.5%, respectively. Patients with PCS, suffered mostly from continued shortness of breath and malaise (24% and 16%, respectively). In the overall COVID-19 population, the main risk factors for PCS was severity at time of acute disease (OR for PCS in severe vs. mild population: 3.113, (95%CI: 2.336-4.149), OR for PCS in moderate vs. mild population: 1.911 (95%CI: 1.838-1.988)); CSS associated with increased risk of PCS, included somnolence: OR: 1.911 (95%CI: 1.838-1.988) and thrombosis: OR: 1.787 (95%CI: 1.717-1.860).

Conclusions: PCS affected nearly one in 5 patients with severe or critical COVID-19 at time of acute infection.

Keywords: COVID-19; Signs and symptoms; Disease predictors