Estimating the burden of post-COVID-19 syndrome in a population-based cohort study of SARS-CoV-2 infected individuals: Implications for healthcare service planning

Menges, D.; Ballouz, T.; Anagnostopoulos, A.; Aschmann, H. E.; Domenghino, A.; Fehr, J. S.; Puhan, M. A.

Objective To assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterise their healthcare utilisation. Design Population-based prospective cohort study. Setting Zurich SARS-CoV-2 Cohort, Zurich, Switzerland. Participants 431 adults from the general population with PCR-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020. Main outcome measures We assessed the proportion of individuals reporting not having fully recovered since SARS-CoV-2 infection, the proportion reporting fatigue (assessed by Fatigue Assessment Scale), dyspnoea (assessed by mMRC dyspnoea scale) or depression (assessed by DASS-21) at six to eight months after diagnosis. We further evaluated the proportion of individuals with at least one healthcare contact since their acute illness. Multivariable logistic regression models were used to assess factors associated with the main outcomes. Results Symptoms were present in 385 (89%) participants at diagnosis and 81 (19%) were initially hospitalised. At six to eight months, 111 (26%) reported not having fully recovered. 233 (55%) participants reported symptoms of fatigue, 96 (25%) had at least grade 1 dyspnoea, and 111 (26%) had DASS-21 scores indicating symptoms of depression. 170 (40%) participants reported at least one general practitioner visit related to COVID-19 after acute illness, and 10% (8/81) of initially hospitalised individuals were rehospitalised. Individuals that have not fully recovered or suffer from fatigue, dyspnoea or depression were more likely to have further healthcare contacts. However, a third of individuals (37/111) that have not fully recovered did not seek further care. Conclusion In our population-based study, a relevant proportion of individuals suffered from longer-term consequences after SARS-CoV-2 infection. Our findings indicate that a considerable number of individuals affected by post-COVID-19 syndrome is to be expected, and that a wide range of additional healthcare services and integrative approaches will be required to support the recovery of these individuals. Thus, the timely planning of resources and services for post-COVID-19 care will be necessary alongside public health measures to mitigate the effects of the pandemic. Registration ISRCTN14990068