Background

Post COVID-19 condition (PCC), as defined by WHO, refers to a wide range of new, returning, or ongoing health problems in people who have had COVID-19, and it represents a rapidly emerging public health priority. We aimed to establish how this developing condition has affected patients in South Africa and which population groups are at risk.

Methods

In this prospective cohort study, we used the DATCOV national hospital surveillance system to identify participants aged 18 years or older who had been hospitalised with laboratory-confirmed SARS-CoV-2 infection in South Africa. Participants underwent telephone follow-up assessment at 1 month and 3 months after hospital discharge. Participants were assessed using a standardised questionnaire for the evaluation of symptoms, functional status, health-related quality of life, and occupational status. We used negative binomial regression models to determine factors associated with PCC.

Findings

Of 241 159 COVID-19 admissions reported to DATCOV between Dec 1, 2020, and Aug 23, 2021, 8309 were randomly selected for enrolment. Of the 3094 patients that we were able to contact, 2410 (77·9%) consented to participate in the study at 1 month after discharge. Of these, 1873 (77·7%) were followed up at 3 months after hospital discharge. Participants had a median age of 52 years (IQR 41–62) and 960 (51·3%) were women. At 3 months of follow-up, 1249 (66·7%) of 1873 participants reported new or persistent COVID-19-related symptoms, compared with 1978 (82·1%) of 2410 at 1 month after hospital discharge. The most common symptoms reported at 3 months were fatigue (50·3%), shortness of breath (23·4%), confusion or lack of concentration (17·5%), headaches (13·8%), and problems seeing or blurred vision (10·1%). On multivariable analysis, the factors associated with persistent symptoms after acute COVID-19 were being female (adjusted incident rate ratio 1·20, 95% CI 1·04–1·38) and admission to an intensive care unit (1·17, 1·01–1·37).

Interpretation

Most participants in this cohort of individuals previously hospitalised with COVID-19 reported persistent symptoms 3 months after hospital discharge and a significant impact of PCC on their functional and occupational status. The large burden of PCC symptoms identified in this study emphasises the need for a national health strategy. This should include the development of clinical guidelines and training of health-care workers for identifying, assessing, and caring for patients affected by PCC; establishment of multidisciplinary health services; and provision of information and support to people who have PCC.

Funding

Bill & Melinda Gates Foundation, UK Foreign, Commonwealth & Development Office, and Wellcome.

中文翻译：

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南非因 SARS-CoV-2 住院 3 个月后的 COVID-19 后状况：一项前瞻性队列研究

 背景

根据 WHO 的定义，COVID-19 后病症 (PCC) 是指感染过 COVID-19 的人出现的一系列新的、复发的或持续存在的健康问题，它代表了一个迅速出现的公共卫生优先事项。我们的目的是确定这种正在发展的疾病如何影响南非的患者以及哪些人群面临风险。

 方法

在这项前瞻性队列研究中，我们使用 DATCOV 国家医院监测系统来识别在南非因实验室确诊的 SARS-CoV-2 感染而住院的 18 岁或以上的参与者。参与者在出院后1个月和3个月接受电话随访评估。使用标准化问卷对参与者进行评估，以评估症状、功能状态、健康相关的生活质量和职业状态。我们使用负二项式回归模型来确定与 PCC 相关的因素。

 发现

在 2020 年 12 月 1 日至 2021 年 8 月 23 日期间向 DATCOV 报告的 241 159 例 COVID-19 入院病例中，随机选择了 8309 例进行注册。在我们能够联系到的 3094 名患者中，2410 名 (77·9%) 同意在出院后 1 个月参加该研究。其中，1873 例（77·7%）在出院后 3 个月进行了随访。参与者的中位年龄为 52 岁 (IQR 41–62)，其中 960 名 (51·3%) 为女性。在 3 个月的随访中，1873 名参与者中有 1249 名 (66·7%) 报告了新的或持续的 COVID-19 相关症状，而出院 1 个月时，2410 名参与者中有 1978 名 (82·1%) 报告了新的或持续的 COVID-19 相关症状。 3 个月时报告的最常见症状是疲劳 (50·3%)、呼吸急促 (23·4%)、意识模糊或注意力不集中 (17·5%)、头痛 (13·8%) 和视力问题或视力模糊（10·1%）。在多变量分析中，与急性 COVID-19 后持续症状相关的因素是女性（调整后的发病率比 1·20，95% CI 1·04–1·38）和入住重症监护室（1·17， 1·01–1·37）。

 解释

该队列中之前因 COVID-19 住院的患者中的大多数参与者在出院 3 个月后报告了持续症状，并且 PCC 对他们的功能和职业状态产生了重大影响。本研究中发现的 PCC 症状的巨大负担强调了制定国家健康战略的必要性。这应包括制定临床指南和培训医护人员来识别、评估和护理 PCC 患者；建立多学科卫生服务机构；向 PCC 患者提供信息和支持。

 资金

比尔及梅琳达·盖茨基金会、英国外交、联邦与发展办公室和惠康。