A RETROSPECTIVE OBSERVATIONAL STUDY TO ASSESS THE CLINICAL MANIFESTATIONS AND FUNCTIONING STATUS AMONG COVID-19 SURVIVORS WITH AND WITHOUT POST-COVID SYNDROME

A RETROSPECTIVE OBSERVATIONAL STUDY TO ASSESS THE CLINICAL MANIFESTATIONS AND FUNCTIONING STATUS AMONG COVID-19 SURVIVORS WITH AND WITHOUT POST-COVID SYNDROME

N. Senthil Kumar *, Deborah Rose, M. K. Amrutha, Samuel Babu, Naivin D. Almeda and R. Dileep

JKKMMRF’s Annai JKK Sampoorani Ammal College of Pharmacy, Komarapalayam, Tamil Nadu, India.

ABSTRACT: Post-COVID syndrome is defined as COVID-19 associated illness that extends for more than three weeks from the onset of symptoms, and chronic COVID-19 is an illness that extends beyond 12 weeks from the onset of symptoms. An online survey was conducted where 400 Covid-19 infected, participated from various areas of India. Among 400, 58% (232) had complaints of persistence of Covid symptoms. The most common long-term clinical manifestations identified based on this study include fatigue, cough, shortness of breath, and myalgia. Patients who exhibit symptoms such as fatigue, cough, and shortness of breath early in their condition are more prone to developing post-COVID syndrome. The results show that long-term clinical manifestations after mild and moderate COVID-19 are common and lead to limitations of activities and participation. However, in most cases, they are not severe and do not lead to frequent or serious issues with quality of life or workability. Thus, early rehabilitation is needed during the acute phase of illness, including mobilization, psychological support, and respiratory rehabilitation.

Keywords: Post covid syndrome, Fatigue, Cough, Functioning status, Rehabilitation

INTRODUCTION: Chronic or long-haul COVID are the other names used to describe the sequel of COVID-19 ^{1, 2}. The pathophysiologic mechanisms of acute COVID-19 include direct viral toxicity, endothelial damage, and microvascular injury; immune system dysregulation and stimulation of a hyper-inflammatory state; hypercoagulability with in-situ thrombosis and macrothrombosis and maladaptation of the angiotensin-converting enzyme (ACE2) pathway 2 ³. Disability-adjusted life years are increasing and the survivors experience long-lasting psychological, medical and economical consequences. The health consequences of COVID-19 remain urgent even despite vaccination efforts ⁴.

Persistent medical problems reported after acute COVID-19 can include a wide range of symptoms and are linked to residual inflammation during the convalescent phase, organ damage, non-specific effects from prolonged ventilation such as post-intensive care syndrome, prolonged hospitalization, social isolation, or impact on underlying medical conditions ^{5, 6}. The study's objective is to assess the participants with and without post covid syndrome based on CDC (Center for Disease Control and Prevention) guidelines. Understanding various clinical manifestations during covid and post covid period.

To assess the functioning status using Post Covid Functioning Status (PCFS) scale. The "Post-COVID-19 Functional Status (PCFS) Scale" was proposed by Klok and colleagues as a patient-reported outcome measure for measuring COVID-19 side effects and their impact on functional status. Before and after discharge from the hospital, the PCFS Scale can be used to measure functional status. The scale was designed to cover the complete range of functional constraints, from 0 (no functional limitations) to 4 (severe functional limitations) and 5 (extreme functional limitations or death) ⁷.

MATERIALS AND METHODS:

Study Type: This is a Retrospective observational study

Study site: The study is conducted in various areas of India

Study duration: The study is conducted for 6 months

Study Population: 400

Data Collection: Data collection is done through online google forms.

The institutional ethics committee permission was taken to conduct this study (Date of approval 12/02/2022) (EC/PHARM.D/2022-06).

Study Criteria:

Inclusion Criteria:

• People infected with Covid-19 disease.
• With and without the persistence of symptoms after covid-19 infection.
• People who are vaccinated.
• Pregnant women.

Exclusion Criteria:

• People who are not willing to participate in the study.
• Age less than 18 years.

Study Procedure:

Questionnaire: An Online based survey was done with a help of a questionnaire form created with the help of the WHO Case Report Form (CRF) for Post COVID condition (Post COVID-19 CRF) and Post Covid Functioning Status (PCFS) scale send through social platforms.

Participants and Data Collection: The study is organized through an online google form. The link which proceeds to the questionnaire is prepared and shared through various social media like WhatsApp, email, Telegram, etc., and the email id of the participants after informing the objectives and confidentiality to the participants. Informed consent is obtained from the individuals who marked the Yes option for the section detailing the consent. 400 participants Covid infected participants responded to the google form.

Data Entry: The data was properly coded and entered in Microsoft Excel.

RESULTS:

FIG. 1: GENDER-WISE DISTRIBUTION (N=400)

TABLE 1: AGE-CATEGORY-WISE DISTRIBUTION (N=400)

TABLE 2: OCCUPATION STATUS-BASED DISTRIBUTION N=400)

TABLE 3: METHODS USED FOR DIAGNOSIS OF COVID INFECTION (N=400)

FIG. 2: WHO SEVERITY-BASED CLASSIFICATION (N=400)

FIG. 3: CLASSIFICATION OF PARTICIPANTS WITH AND WITHOUT POST-COVID SYNDROME (N=400)

TABLE 4: CLINICAL MANIFESTATIONS EXPERIENCED DURING AND AFTER COVID-19 INFECTION (N=400)

FIG. 4: CLINICAL MANIFESTATIONS AMONG PARTICIPANTS WITH POST-COVID SYNDROME (n=232)

FIG. 5: CLASSIFICATION BASED ON POST-COVID FUNCTIONING STATUS SCALE (N=400)

DISCUSSION: A total of 400 participated, including 181 (45.25%) males and 219 (54.75%) females as shown in Fig. 1. Table 1 shows mean age of 31.2 ± 12.0 years and includes 267 (66.75%) in the category 18-33 years, 91 (22.75%) in the category 34-49 years, 35 (8.75%) in the category 50-65 years and 7 (1.75%) in the category above 65 years. Table 2 shows a majority of participants 188 (47%) are employed and 135 (33.75%) are students in the survey. Various methods were used for the diagnosis of Covid-19 and including 200 (50%) PCR tests, 178 (45%) Antigen tests, 8 (2%) Antibody tests and 14 (4%) confirmed by Spirometry or chest radiology shown in Table 3.

Fig. 2 shows WHO severity-based classification according to the supportive measures received and includes 371 (92.75%) Category A (Mild/ Moderate) who did not receive oxygen therapy, 27 (6.75%) Category B (Severe) who received oxygen therapy and 2 (0.5%) Category C (Critical) who received ventilator administration. In a similar study done by Anjana, et al. 109 (70.8%) were reported as Category A, 43 (29.2%) were reported as Category B and Two patients had significant symptoms reported as Category C⁸.

Fig. 3 shows the persistence of symptoms beyond 4 weeks after infection was present in 232(58%) participants and was absent in 168(42%) participants 400. For defining post-COVID-19 symptom persistence, Centers for Disease Control and Prevention (CDC) guidelines were used. A similar study done by Lemhofer et al. Sums up the number of symptoms, 226 participants (61.9%) of the total sample reported long-term symptoms ⁹. In all, 38.1% of cases did not report any long-term symptoms. Another study was done by Mahmud R, et al. involving 355 patients; the incidence of post-COVID-19 syndrome was 46%.

Table 4 shows that the most common symptoms present during and after Covid 19 infection among 400 subjects are General -373(93%), 169(42%); Respiratory -247(62%), 110(27.5%); Musculoskel et al -198(49.5%), 86(22%) respectively. Fig. 4 shows the most common clinical manifestations experienced after covid-19 infection was fatigue 151(65%), Cough 68(29%) followed by Cold 66(28.4%) and Dyspnoea 64(27%). A study done by Binu Areekal et al. showed similar results where the most common manifestations identified were fatigue in 109 (32.5%) of 355 participants ¹⁰. A study done by Mahmud R et al. shows similar results where persistent cough (8.5%) and post-exertional dyspnoea (7%) among 355 participants ¹¹. Both psychological and neurological manifestations were common, with depression and anxiety in 50(21%) and sleep disturbances found in 43(18%). The most common clinical manifestation related to musculoskeletal was Muscle pain 57(24%). The most common post-COVID manifestations in the cohort study done by Shivdas Naik were myalgia (134, 10.9%) ¹².

Fig. 5 shows that among 400 participants, 161(40.25%) had no limitations in the daily routine and no symptoms, pain, or anxiety experienced, 108(27%) had Little limitations and can perform all the daily activities but still had symptoms like pain, depression or anxiety, 79(19.75%) had limitations in daily routine due to symptoms like pain, depression or anxiety but can perform all activities without any assistance, 41(10.25%) had difficulty in daily routine-not able to perform usual activities due to symptoms like pain, depression or anxiety but take care without any assistance and 11 (2.75%) had severe difficulty in daily routine- Not able to take care and dependent on others due to symptoms like pain, depression or anxiety.

CONCLUSION: Patients with COVID-19 require long-term monitoring and management of their post-COVID symptoms, even after recovering. The most common long-term clinical manifestations identified based on this study include fatigue, cough, cold, dyspnoea, and myalgia. The results show that long-term clinical manifestations after mild and moderate COVID-19 are common and lead to limitations in activities and participation.

However, in most cases, they are not severe and do not lead to frequent or serious issues with the quality of life or workability. A complete rehabilitation program for a great population in post-COVID conditions is required. Early rehabilitation is needed during the acute phase of the illness. It must be personalized particularly for patients with comorbidities, advanced age, obesity, multiple diseases and complications of single or multiple organs.

Rehabilitation programs include mobilization and psychological support to restore fitness and reduce anxiety and depression. The respiratory rehabilitation program includes respiratory muscle training, coughing exercises, stretching exercises, and home exercises comprising 2 sessions per week for 6 weeks, once a day for 10 minutes. Digital health interventions-telehealth can help provide self-monitoring tools, exercise protocols, and psychological support.

ACKNOWLEDGEMENT: Nothing to disclosure.

CONFLICTS OF INTEREST: The author declares no conflicts of interest.

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    How to cite this article:

    Hussain M and Srinivas GD: A retrospective observational study to assess the clinical manifestations and functioning status among Covid-19 survivors with and without post-covid syndrome. Int J Pharm Sci & Res 2023; 14(8): 3972-77. doi: 10.13040/IJPSR.0975-8232.14(8).3972-77.

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