Informing the management of the post-COVID condition: insights from the Western Australian experience comparing those who tested positive and negative to early COVID-19 strains
Kristen Grove A , Vinicius Cavalheri B C , HuiJun Chih D E , Varsha Natarajan F , Meg Harrold A C , Sheeraz Mohd G , Elizabeth Hurn H , Lisa Van der Lee C F H , Andrew Maiorana C I , Jessica Tearne J , Carol Watson A , Jane Pearce E K , Angela Jacques C L , Ann White E , Caitlin Vicary F , Caroline Roffman A C , Emma-Leigh Synnott M , Ian Suttie N , Ivan Lin O P , Jade Larsson A , Louise Naylor Q , Linda Woodhouse R S , Mercedes Elliott F , Paul Gittings F , Peta Winship F , Robyn Timms F , Sheldon Wulff A , Tracy Hebden-Todd H and Dale W. Edgar F L T U *A
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Abstract
This study aimed to compare the relative physical recovery and symptoms after SARS-CoV-2 infection between groups confirmed positive or negative to early strains of COVID-19.
A prospective, longitudinal cohort study compared outcomes of metropolitan adults polymerase chain reaction-tested for COVID-19 between March and November 2020 in Western Australia. Control matching was attempted: inpatients (gender, age) and ambulatory clinic (gender, age, asthma, chronic pulmonary disease). One-year follow-up involved three repeated measures: physical function (grip strength and 1-min sit-to-stand) and patient-reported outcomes (Fatigue Severity Scale, modified Medical Research Council dyspnoea scale and Euroqol-5D-5L).
Three hundred and forty-four participants were recruited (154 COVID+, age 54 ± 18 years, 75 females [49%]); 190 COVID−, age 52 ± 16 years, 67 females [35%]) prior to national vaccination roll-out. No between-group differences in physical function measures were evident at any time point. Fatigue (OR 6.62, 95% CI 2.74–15.97) and dyspnoea (OR 2.21, 95% CI 1.14–4.30) were higher in the COVID+ group at second assessment (T2). On Euroqol-5D-5L, no between-group differences were evident in the physical function domains of self-care, mobility or usual activities at any time point. However, COVID+ participants were less likely to report an absence of anxiety or depression symptoms at T2 (OR 0.41, 95% CI 0.19–0.89).
Neither statistical nor clinically meaningful differences in physical function were evident between COVID+ and COVID− participants to 12-months after acute illness. Symptoms of fatigue, dyspnoea, anxiety or depression were more prevalent in the COVID+ group til ~8 months after illness with between-group differences no longer evident at 1 year.
Keywords: anxiety, control group, COVID-19 virus infection, depression, dyspnoea, fatigue, pain, primary care, quality of life.
References
1 Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med 2021; 27(4): 601-15.
| Crossref | Google Scholar | PubMed |
3 Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397(10270): 220-32.
| Crossref | Google Scholar | PubMed |
4 Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group.. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; 324(6): 603-5.
| Crossref | Google Scholar | PubMed |
5 The Writing Committee for the COMEBAC Study Group.. Four-Month Clinical Status of a Cohort of Patients After Hospitalization for COVID-19. JAMA 2021; 325(15): 1525-34.
| Crossref | Google Scholar | PubMed |
6 World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO; 2021. Available at https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1 [cited 12 February 2024].
7 Butler M. National Post-Acute Sequelae of COVID-19 (PASC) Plan. Canberra: Australian Government; 2024. Available at https://www.health.gov.au/resources/publications/national-post-acute-sequelae-of-covid-19-plan?language=en
8 Office for National Statistics. Prevalence of Ongoing Symptoms Following Coronavirus (COVID-19) Infection in the UK: 30 March 2023. London: ONS; 2023. Available at https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/30march2023 [cited 12 Feburary 2024].
9 Ledford H. How common is long COVID? Why studies give different answers. Nature 2022; 606: 852-3.
| Crossref | Google Scholar | PubMed |
10 Australian Institute of Health and Welfare. Long COVID in Australia - a review of the literature. Canberra: AIHW; 2022. Available at https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary [updated 16 December 2022]
11 Beauchamp M, Kirkwood R, Duong M, Ho T, Raina P, Kruisselbrink R, et al. Long-Term Functional Limitations and Predictors of Recovery after COVID-19: A Multicenter Prospective Cohort Study. Am J Med 2024;
| Crossref | Google Scholar | PubMed |
12 Naik H, Wilton J, Tran KC, Janjua NZ, Levin A, Zhang W. Long-term Health-related Quality of Life in Working-age COVID-19 Survivors: A Cross-sectional Study. Am J Med 2024;
| Crossref | Google Scholar | PubMed |
13 Munblit D, Nicholson TR, Needham DM, Seylanova N, Parr C, Chen J, et al. Studying the post-COVID-19 condition: research challenges, strategies, and importance of Core Outcome Set development. BMC Med 2022; 20(1): 50.
| Crossref | Google Scholar | PubMed |
14 Brown M, Gerrard J, McKinlay L, Marquess J, Sparrow T, Andrews R. Ongoing symptoms and functional impairment 12 weeks after testing positive for SARSCoV-2 or influenza in Australia: an observational cohort study. BMJ Public Health 2023; 1(1): e000060.
| Crossref | Google Scholar |
16 O’Mahoney LL, Routen A, Gillies C, Ekezie W, Welford A, Zhang A, et al. The prevalence and long-term health effects of Long Covid among hospitalised and non-hospitalised populations: a systematic review and meta-analysis. EClinicalMedicine 2023; 55: 101762.
| Crossref | Google Scholar | PubMed |
17 Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep 2021; 11(1): 16144.
| Crossref | Google Scholar | PubMed |
18 Bliddal S, Banasik K, Pedersen OB, Nissen J, Cantwell L, Schwinn M, et al. Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients. Sci Rep 2021; 11(1): 13153.
| Crossref | Google Scholar | PubMed |
19 Australian Institute of Health and Welfare. Long COVID in Australia – a review of the literature. Canberra: Australian Government; 2022. Available at https://www.aihw.gov.au/reports/covid-19/long-covid-in-australia-a-review-of-the-literature/summary
21 Edgar DW, Gittings P, van der Lee L, Naylor L, Maiorana A, Jacques A, et al. Life AfTER covid-19 (LATER-19): a protocol for a prospective, longitudinal, cohort study of symptoms, physical function and psychological outcomes in the context of a pandemic. Tasman Med J 2021; 3(1): 1-10.
| Google Scholar |
22 Shah W, Hillman T, Playford ED, Hishmeh L. Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ 2021; 372: n136.
| Crossref | Google Scholar | PubMed |
23 Duddy C, Powell T, Kirk-Wade E, Brione P, Hobson F, Long R. House of Commons Library briefing paper: Number 9112, 29 February 2024: Coronavirus: Long COVID. 2024. Available at https://commonslibrary.parliament.uk/research-briefings/cbp-9112/
24 Grove K, Harrold M, Mohd S, Natarajan V, Hurn E, Pearce J, et al. Research lessons during the COVID-19 pandemic: collecting longitudinal physical and mental health outcomes. Arch Public Health 2022; 80(1): 14.
| Crossref | Google Scholar | PubMed |
25 Grove K, Edgar DW, Chih H, Harrold M, Natarajan V, Mohd S, et al. Greater In-Hospital Care and Early Rehabilitation Needs in People with COVID-19 Compared with Those without COVID-19. J Clin Med 2022; 11(13): 3602.
| Crossref | Google Scholar | PubMed |
26 Sigfrid L, Cevik M, Jesudason E, Lim WS, Rello J, Amuasi J, et al. What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol. BMJ Open 2021; 11(3): e043887.
| Crossref | Google Scholar | PubMed |
27 O’Toole Á, Scher E, Underwood A, Jackson B, Hill V, McCrone JT, et al. Assignment of epidemiological lineages in an emerging pandemic using the pangolin tool. Virus Evol 2021; 7(2): veab064.
| Crossref | Google Scholar | PubMed |
28 Hutchinson D, Williams H, Stone H. COVID-19 Variants of Concern in Australia, September 2020-April 2021. J Global Biosecur 2021; 3(1):.
| Crossref | Google Scholar |
30 Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body composition, and mortality. Int J Epidemiol 2007; 36(1): 228-35.
| Crossref | Google Scholar | PubMed |
31 Rantanen T, Volpato S, Ferrucci L, Heikkinen E, Fried LP, Guralnik JM. Handgrip strength and cause-specific and total mortality in older disabled women: exploring the mechanism. J Am Geriatr Soc 2003; 51(5): 636-41.
| Crossref | Google Scholar | PubMed |
32 Syddall H, Cooper C, Martin F, Briggs R, Aihie Sayer A. Is grip strength a useful single marker of frailty? Age Ageing 2003; 32(6): 650-6.
| Crossref | Google Scholar | PubMed |
33 Bohannon RW. Minimal clinically important difference for grip strength: a systematic review. J Phys Ther Sci 2019; 31(1): 75-8.
| Crossref | Google Scholar | PubMed |
34 Crook S, Büsching G, Schultz K, Lehbert N, Jelusic D, Keusch S, et al. A multicentre validation of the 1-min sit-to-stand test in patients with COPD. Eur Respir J 2017; 49(3): 1601871.
| Crossref | Google Scholar | PubMed |
35 Chorin F, Cornu C, Beaune B, Frère J, Rahmani A. Sit to stand in elderly fallers vs non-fallers: new insights from force platform and electromyography data. Aging Clin Exp Res 2016; 28(5): 871-9.
| Crossref | Google Scholar | PubMed |
36 Puhan MA, Siebeling L, Zoller M, Muggensturm P, ter Riet G. Simple functional performance tests and mortality in COPD. Eur Respir J 2013; 42(4): 956-63.
| Crossref | Google Scholar | PubMed |
37 Zanini A, Aiello M, Cherubino F, Zampogna E, Azzola A, Chetta A, et al. The one repetition maximum test and the sit-to-stand test in the assessment of a specific pulmonary rehabilitation program on peripheral muscle strength in COPD patients. Int J Chron Obstruct Pulmon Dis 2015; 10: 2423-30.
| Crossref | Google Scholar | PubMed |
38 Briand J, Behal H, Chenivesse C, Wémeau-Stervinou L, Wallaert B. The 1-minute sit-to-stand test to detect exercise-induced oxygen desaturation in patients with interstitial lung disease. Ther Adv Respir Dis 2018; 12: 1753466618793028.
| Crossref | Google Scholar | PubMed |
39 Gruet M, Peyré-Tartaruga LA, Mely L, Vallier JM. The 1-Minute Sit-to-Stand Test in Adults With Cystic Fibrosis: Correlations With Cardiopulmonary Exercise Test, 6-Minute Walk Test, and Quadriceps Strength. Respir Care 2016; 61(12): 1620-8.
| Crossref | Google Scholar | PubMed |
40 Bohannon RW, Crouch R. 1-Minute Sit-to-Stand Test: SYSTEMATIC REVIEW OF PROCEDURES, PERFORMANCE, AND CLINIMETRIC PROPERTIES. J Cardiopulm Rehabil Prev 2019; 39(1): 2-8.
| Crossref | Google Scholar | PubMed |
41 Vaidya T, de Bisschop C, Beaumont M, Ouksel H, Jean V, Dessables F, et al. Is the 1-minute sit-to-stand test a good tool for the evaluation of the impact of pulmonary rehabilitation? Determination of the minimal important difference in COPD. Int J Chron Obstruct Pulmon Dis 2016; 11: 2609-16.
| Crossref | Google Scholar | PubMed |
42 Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB. Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population. J Hand Surg Eur Vol 2009; 34(1): 76-84.
| Crossref | Google Scholar | PubMed |
43 Strassmann A, Steurer-Stey C, Lana KD, Zoller M, Turk AJ, Suter P, et al. Population-based reference values for the 1-min sit-to-stand test. Int J Public Health 2013; 58(6): 949-53.
| Crossref | Google Scholar | PubMed |
44 Valko PO, Bassetti CL, Bloch KE, Held U, Baumann CR. Validation of the fatigue severity scale in a Swiss cohort. Sleep 2008; 31(11): 1601-7.
| Crossref | Google Scholar | PubMed |
45 Impellizzeri FM, Agosti F, De Col A, Sartorio A. Psychometric properties of the Fatigue Severity Scale in obese patients. Health Qual Life Outcomes 2013; 11: 32.
| Crossref | Google Scholar | PubMed |
46 Learmonth YC, Dlugonski D, Pilutti LA, Sandroff BM, Klaren R, Motl RW. Psychometric properties of the Fatigue Severity Scale and the Modified Fatigue Impact Scale. J Neurol Sci 2013; 331(1-2): 102-7.
| Crossref | Google Scholar | PubMed |
47 Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999; 54(7): 581-6.
| Crossref | Google Scholar | PubMed |
48 Poulos LM, Ampon RD, Currow DC, Marks GB, Toelle BG, Reddel HK. Prevalence and burden of breathlessness in Australian adults: The National Breathlessness Survey-a cross-sectional web-based population survey. Respirology 2021; 26(8): 768-75.
| Crossref | Google Scholar | PubMed |
49 McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Health-related quality of life measured using the EQ-5D-5L: South Australian population norms. Health Qual Life Outcomes 2016; 14(1): 133.
| Crossref | Google Scholar | PubMed |
50 Department of Health. COVID-19 update – 1 April 2020. Government of Western Australia; 2020. Available at https://ww2.health.wa.gov.au/Media-releases/2020/COVID19-update-1-April-2020 [cited 2024 February 12].
51 Newman M. Chronic fatigue syndrome and long covid: moving beyond the controversy. BMJ 2021; 373: n1559.
| Crossref | Google Scholar | PubMed |
52 Stavem K, Ghanima W, Olsen MK, Gilboe HM, Einvik G. Prevalence and Determinants of Fatigue after COVID-19 in Non-Hospitalized Subjects: A Population-Based Study. Int J Environ Res Public Health 2021; 18(4): 2030.
| Crossref | Google Scholar | PubMed |
53 Seessle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A, et al. Persistent Symptoms in Adult Patients 1 Year After Coronavirus Disease 2019 (COVID-19): A Prospective Cohort Study. Clin Infect Dis 2022; 74(7): 1191-8.
| Crossref | Google Scholar | PubMed |
54 Hastie CE, Lowe DJ, McAuley A, Winter AJ, Mills NL, Black C, et al. Outcomes among confirmed cases and a matched comparison group in the Long-COVID in Scotland study. Nat Commun 2022; 13(1): 5663.
| Crossref | Google Scholar | PubMed |
55 Han Q, Zheng B, Daines L, Sheikh A. Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms. Pathogens 2022; 11(2): 269.
| Crossref | Google Scholar | PubMed |
56 van Kessel SAM, Olde Hartman TC, Lucassen P, van Jaarsveld CHM. Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review. Fam Pract 2022; 39(1): 159-67.
| Crossref | Google Scholar | PubMed |
57 Raman B, Cassar MP, Tunnicliffe EM, Filippini N, Griffanti L, Alfaro-Almagro F, et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine 2021; 31: 100683.
| Crossref | Google Scholar | PubMed |
58 Tan S, Pryor AJG, Melville GW, Fischer O, Hewitt L, Davis KJ. The lingering symptoms of post-COVID-19 condition (long-COVID): a prospective cohort study. Intern Med J 2024; 54(2): 224-33.
| Crossref | Google Scholar | PubMed |
59 Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, et al. The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study. Crit Care 2021; 25(1): 382.
| Crossref | Google Scholar | PubMed |
60 Malik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Post-acute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)-A systematic review and meta-analysis. J Med Virol 2022; 94(1): 253-62.
| Crossref | Google Scholar | PubMed |
61 Watanabe A, Iwagami M, Yasuhara J, Takagi H, Kuno T. Protective effect of COVID-19 vaccination against long COVID syndrome: A systematic review and meta-analysis. Vaccine 2023; 41(11): 1783-90.
| Crossref | Google Scholar | PubMed |
62 Holmes E, Wist J, Masuda R, Lodge S, Nitschke P, Kimhofer T, et al. Incomplete Systemic Recovery and Metabolic Phenoreversion in Post-Acute-Phase Nonhospitalized COVID-19 Patients: Implications for Assessment of Post-Acute COVID-19 Syndrome. J Proteome Res 2021; 20(6): 3315-29.
| Crossref | Google Scholar | PubMed |
63 Lawler NG, Gray N, Kimhofer T, Boughton B, Gay M, Yang R, et al. Systemic Perturbations in Amine and Kynurenine Metabolism Associated with Acute SARS-CoV-2 Infection and Inflammatory Cytokine Responses. J Proteome Res 2021; 20(5): 2796-811.
| Crossref | Google Scholar | PubMed |
64 Attwell K, Carlson S, Tchilingirian J, Harper T, McKenzie L, Roberts L, et al. Coronavax: preparing community and government for COVID-19 vaccination: a research protocol for a mixed methods social research project. BMJ Open 2021; 11(6): e049356.
| Crossref | Google Scholar | PubMed |
65 Roberts L, McKenzie L, Carlson SJ, Tomkinson S, Attwell K. Reopening to the world: how safety, normality and trust in government shape young adults’ COVID-19 vaccine intentions. Aust J Polit Sci 2022; 58(1): 105-23.
| Crossref | Google Scholar |
66 Menges D, Ballouz T, Anagnostopoulos A, Aschmann HE, Domenghino A, Fehr JS, et al. Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study. PLoS One 2021; 16(7): e0254523.
| Crossref | Google Scholar | PubMed |
67 Burrell AJ, Pellegrini B, Salimi F, Begum H, Broadley T, Campbell LT, et al. Outcomes for patients with COVID-19 admitted to Australian intensive care units during the first four months of the pandemic. Med J Aust 2021; 214(1): 23-30.
| Crossref | Google Scholar | PubMed |
68 Hodgson CL, Higgins AM, Bailey MJ, Mather AM, Beach L, Bellomo R, et al. Comparison of 6-Month Outcomes of Survivors of COVID-19 versus Non-COVID-19 Critical Illness. Am J Respir Crit Care Med 2022; 205: 1159-68.
| Crossref | Google Scholar | PubMed |
69 Logue JK, Franko NM, McCulloch DJ, McDonald D, Magedson A, Wolf CR, et al. Sequelae in Adults at 6 Months After COVID-19 Infection. JAMA Netw Open 2021; 4(2): e210830.
| Crossref | Google Scholar | PubMed |
70 Haslam A, Prasad V. Comparability of Control and Comparison Groups in Studies Assessing Long COVID. Am J Med 2023;
| Crossref | Google Scholar | PubMed |
71 Jiang J, Akhlaghi H, Haywood D, Morrissey B, Parnis S. Mental health consequences of COVID-19 suppression strategies in Victoria, Australia: a narrative review. J Int Med Res 2022; 50(11): 3000605221134466.
| Crossref | Google Scholar | PubMed |
72 Fang Z, Ahrnsbrak R, Rekito A. Evidence Mounts That About 7% of US Adults Have Had Long COVID. JAMA 2024; 332: 5-6.
| Crossref | Google Scholar | PubMed |
73 Australian Bureau of Statistics. Chronic Obstructive Pulmonary Disease. Canberra: ABS; 2022. Available at https://www.abs.gov.au/statistics/health/health-conditions-and-risks/chronic-obstructive-pulmonary-disease/latest-release [cited 12 February 2024].
74 Lee J, Nguyen HQ, Jarrett ME, Mitchell PH, Pike KC, Fan VS. Effect of symptoms on physical performance in COPD. Heart Lung 2018; 47(2): 149-56.
| Crossref | Google Scholar | PubMed |
75 Clark LA, Reed R, Corazzini KN, Zhu S, Renn C, Jennifer Klinedinst N. COPD-Related Fatigue: A Scoping Review. Clin Nurs Res 2023; 32(5): 914-28.
| Crossref | Google Scholar | PubMed |
76 Martínez-Gestoso S, García-Sanz MT, Carreira JM, Salgado FJ, Calvo-Álvarez U, Doval-Oubiña L, et al. Impact of anxiety and depression on the prognosis of copd exacerbations. BMC Pulm Med 2022; 22(1): 169.
| Crossref | Google Scholar | PubMed |
77 Jarjour N, Lathrop JA, Meller TE, Roberts KS, Sopczak JM, Van Genderen KJ, et al. The 10% rule: grip strength and hand dominance in a factory population. Work 1997; 8(1): 83-91.
| Crossref | Google Scholar | PubMed |
78 Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther 1989; 43(7): 444-7.
| Crossref | Google Scholar | PubMed |
79 Canas LS, Molteni E, Deng J, Sudre CH, Murray B, Kerfoot E, et al. Profiling post-COVID-19 condition across different variants of SARS-CoV-2: a prospective longitudinal study in unvaccinated wild-type, unvaccinated alpha-variant, and vaccinated delta-variant populations. Lancet Digit Health 2023; 5(7): e421-34.
| Crossref | Google Scholar | PubMed |
80 Du M, Ma Y, Deng J, Liu M, Liu J. Comparison of Long COVID-19 Caused by Different SARS-CoV-2 Strains: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022; 19(23): 16010.
| Crossref | Google Scholar | PubMed |
81 Byambasuren O, Stehlik P, Clark J, Alcorn K, Glasziou P. Effect of covid-19 vaccination on long covid: systematic review. BMJ Med 2023; 2(1): e000385.
| Crossref | Google Scholar | PubMed |