Prevalence and characteristics of post-acute sequelae of COVID-19 in recovered patients

Zuri Dale^1*Sherrie Flynt Wallington^2,3,4Michelle Penn -Marshall¹

• ¹Texas Southern University, Houston, United States
• ²The George Washington University School of Nursing, Ashburn, United States
• ³The George Washington University Milken Institute School of Public Health, Washington, United States
• ⁴GW Cancer Center, Washington, United States

ABSTRACT Introduction: Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection, has emerged as a major public health concern following the COVID-19 pandemic. Although initially perceived as a respiratory illness, growing biomedical evidence confirms that COVID-19 affects multiple organ systems. This study aimed to explore the clinical manifestations, risk factors, and long-term outcomes associated with long COVID and to identify patients at highest risk. The research also contributes to the ongoing discourse on establishing a unified definition of long COVID. Methods: A secondary analysis of a cross-sectional, community-based study was conducted using data from 168 households, representing a weighted total of 14,769 households in Third Ward, Houston, Texas. Data were collected via interviewer-administered surveys and included variables on demographics, pre-existing comorbidities, COVID-19 symptom severity, and post-acute symptom persistence. Symptom variables were recoded as binary indicators, and weighted logistic regression models were applied to identify associations between acute phase characteristics and the development of long COVID. Results: Risk factors significantly associated with long COVID included symptom severity during acute infection (OR = 29.58, 95% CI [1.38, 632.53]), heart disease (OR = 6.00, 95% CI [1.15, 31.28]), asthma (OR = 3.49, 95% CI [1.05, 11.59]), and poor physical health (OR = 4.20, 95% CI [1.12, 15.75]). Acute symptoms predictive of long COVID included anxiety (OR = 22.94, 95% CI [2.01, 262.31]), chest pain (OR = 7.15, 95% CI [1.13, 45.23]), constipation (OR = 16.81, 95% CI [1.33, 213.23]), heart palpitations (OR = 6.59, 95% CI [1.08, 40.18]), and shortness of breath (OR = 4.97, 95% CI [1.16, 21.36]). No statistically significant associations were found between long COVID and race, education, or income. Conclusion: The findings underscore the multisystemic nature of long COVID, characterized by a diverse range of symptoms including fatigue, cognitive impairment, shortness of breath, and neuropsychiatric issues such as depression. While clinical factors are critical in understanding long COVID, the results also suggest that addressing associated health outcomes requires broader consideration of social determinants of health.