A cohort study of post-COVID-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalized and nonhospitalized participants

Waasila Jassat; Caroline Mudara; Caroline Vika; Richard Welch; Tracy Arendse; Murray Dryden; Lucille Blumberg; Natalie Mayet; Stefano Tempia; Arifa Parker; Jeremy Nel; Rubeshan Perumal; Michelle J Groome; Francesca Conradie; Norbert Ndjeka; Louise Sigfrid; Laura Merson; Cheryl Cohen

doi:10.1016/j.ijid.2022.12.036

A cohort study of post-COVID-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalized and nonhospitalized participants

Int J Infect Dis. 2023 Mar:128:102-111. doi: 10.1016/j.ijid.2022.12.036. Epub 2022 Dec 29.

Authors

Waasila Jassat¹, Caroline Mudara², Caroline Vika², Richard Welch³, Tracy Arendse³, Murray Dryden², Lucille Blumberg³, Natalie Mayet², Stefano Tempia⁴, Arifa Parker⁵, Jeremy Nel⁶, Rubeshan Perumal⁷, Michelle J Groome⁸, Francesca Conradie⁹, Norbert Ndjeka¹⁰, Louise Sigfrid¹¹, Laura Merson¹¹, Cheryl Cohen⁴

Affiliations

¹ National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; Right to Care, Centurion, South Africa. Electronic address: [email protected].
² National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa.
³ National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; Right to Care, Centurion, South Africa.
⁴ National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Divisions of General Medicine and Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
⁶ Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa.
⁷ Division of Pulmonology and Critical Care, Department of Medicine, University of KwaZulu-Natal, Berea, Durban, South Africa; South African Medical Research Council-CAPRISA HIV/TB Pathogenesis and Treatment Research Unit, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.
⁸ National Institute for Communicable Disease, Division of the National Health Laboratory Services, Johannesburg, South Africa; School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
⁹ Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
¹⁰ Drug-Resistant TB, TB & HIV Directorate, National Department of Health, Pretoria, South Africa and University of KwaZulu-Natal, Durban, South Africa.
¹¹ International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom.

Abstract

Objectives: The study aimed to describe the prevalence of and risk factors for post-COVID-19 condition (PCC).

Methods: This was a prospective, longitudinal observational cohort study. Hospitalized and nonhospitalized adults were randomly selected to undergo telephone assessment at 1, 3, and 6 months. Participants were assessed using a standardized questionnaire for the evaluation of symptoms and health-related quality of life. We used negative binomial regression models to determine factors associated with the presence of ≥1 symptoms at 6 months.

Results: A total of 46.7% of hospitalized and 18.5% of nonhospitalized participants experienced ≥1 symptoms at 6 months (P ≤0.001). Among hospitalized people living with HIV, 40.4% had persistent symptoms compared with 47.1% among participants without HIV (P = 0.108). The risk factors for PCC included older age, female sex, non-Black race, presence of a comorbidity, greater number of acute COVID-19 symptoms, hospitalization/COVID-19 severity, and wave period (lower risk of persistent symptoms for the Omicron compared with the Beta wave). There were no associations between self-reported vaccination status with persistent symptoms.

Conclusion: The study revealed a high prevalence of persistent symptoms among South African participants at 6 months but decreased risk for PCC among participants infected during the Omicron BA.1 wave. These findings have serious implications for countries with resource-constrained health care systems.

Keywords: Long COVID; Omicron; Post-COVID-19 condition; Risk factors; Variants.

Publication types

Observational Study

MeSH terms

Adult
COVID-19*
Cohort Studies
Female
Follow-Up Studies
HIV Infections*
Humans
Prospective Studies
Quality of Life
South Africa

Grants and funding

WT_/Wellcome Trust/United Kingdom