Short-term post-COVID-19 symptoms in 21,012 patients: a cross-sectional study

Abstract

Objectives: This study aimed to clarify the short-term symptoms, duration, and influencing factors in people recovering from coronavirus disease 2019 (COVID-19) after China’s dynamic zero-COVID-19 policy was implemented in December 2022.

Methods: We included data from a large-scale on-line survey conducted in China between January 14 and February 1, 2023. Participants were individuals of all ages. Chi-squared tests and multivariate logistic regression analyses were performed to identify factors associated with different symptoms.

Results: Overall, 21,012 patients from seven regions of China were included in this study (female: 71.22%). For most patients, the period from symptom onset to a negative nucleic acid test result was ≤10 days (72.33%). The distribution of symptoms varied at different times, with respiratory (1-4 weeks) and psychocardiology (5-8 weeks) symptoms being the most common. Multivariate analysis identified male sex, no comorbidity, and living in northeast and northwest China (compared with central China) as independent factors associated with a lower risk of symptoms, while age (41-60 years) was a possible risk factor (compared with 18-40 years).

Conclusions: Short-term respiratory and psychocardiology symptoms were the most common after COVID-19 recovery. Sex, age, geographical region, and comorbidities were potential influencing factors for the development of short-term symptoms.

Keywords

China / COVID-19 / Influencing factors / Negative nucleic acid test / Short-term symptoms

Conflict of interest statement

Junhua Zhang is editorial board members of this journal. Xinyao Jin is responsible editorial coordinator of this journal. The other authors declare no conflict of interest.

Funding

This research was funded by the Young Scientists Fund of the National Natural Science Foundation of China under 82305433, 82305437.

Author contributions

Junhua Zhang and Lujia Cao had full access to all of the study data and took responsibility for the integrity of the data and the accuracy of the data analysis. Junhua Zhang and Jingqing Hu contributed to the study concept, design, and study supervision. Wenliang Lyu, Li Liu, Wei Liu, Zhimin Yang, Yan Shi, Shuguang Yu, Candong Li, and Ming Yang contributed to the acquisition of data. Lujia Cao contributed to the analysis and interpretation of the data. Lujia Cao, Xiaolei Wu, Chenyao Zhang, and Chuanchi Wang contributed to the preparation of figures and drafting of the manuscript. All authors contributed to critical revision of the manuscript for important intellectual content, administrative, technical, or material support. Lujia Cao and Xiaolei Wu contributed to statistical analysis. Junhua Zhang contributed to funding acquisition.

Ethical approval of studies and informed consent

The study obtained approval from the Tianjin University of Traditional Chinese Medicine provided institutional review board approval (approval number: TJUTCM-EC20230002) and was conducted in accordance with the principles of the Helsinki Declaration. Before the commencement of the study, participants provided informed consent by signing a consent form.

Acknowledgments

We thank all the patients who participated in the study.

Data availability

Data are available from the data custodians on reasonable request when necessary. Approvals are in place.

References

[1] Luo X, Ni X, Lin J, et al. The add-on effect of Chinese herbal medicine on COVID-19: a systematic review and meta-analysis. Phytomedicine 2021; 85:153282.

[2] Zhou L, Wu Z, Li Z, et al. One hundred days of coronavirus disease 2019 prevention and control in China. Clin Infect Dis 2021; 72(2):332-339.

[3] Moeti M, Gao GF, Herrman H. Global pandemic perspectives: public health, mental health, and lessons for the future. Lancet 2022; 400(10353):e3-e7.

[4] Liu J, Liu M, Liang W. The dynamic COVID-zero strategy in China. China CDC Wkly 2022; 4(4):74-75.

[5] Pan Y, Wang L, Feng Z, et al. Characterisation of SARS-CoV-2 variants in Beijing during 2022: an epidemiological and phylogenetic analysis. Lancet 2023; 401(10377):664-672.

[6] Groff D, Sun A, Ssentongo AE, et al. Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: a systematic review. JAMA Netw Open 2021; 4(10):e2128568.

[7] NIHR. Living with COVID-19. A dynamic review of the evidence around ongoing COVID-19 symptoms (often called long COVID). 2020;2023(04.27).

[8] CDC. Post-COVID conditions: information for healthcare providers. 2022;2023(2023/4/27).

[9] Datta SD, Talwar A, Lee JT. A Proposed framework and timeline of the spectrum of disease due to SARS-CoV-2 infection: illness beyond acute infection and public health implications. JAMA 2020; 324(22):2251-2252.

[10] CACM. Expert consensus on the treatment of traditional Chinese medicine for common symptoms of post COVID-19 short-term condition (2023/5/13).

[11] Aranha C, Patel V, Bhor V, et al. Cycle threshold values in RT-PCR to determine dynamics of SARS-CoV-2 viral load: an approach to reduce the isolation period for COVID-19 patients. J Med Virol 2021; 93(12):6794-6797.

[12] Abrahim SA, Tessema M, Defar A, et al. Time to recovery and its predictors among adults hospitalized with COVID- 19: a prospective cohort study in Ethiopia. PLoS One 2020; 15(12):e0244269.

[13] Voinsky I, Baristaite G, Gurwitz D. Effects of age and sex on recovery from COVID-19: analysis of 5769 Israeli patients. J Infect 2020; 81(2):e102-e103.

[14] Young BE, Ong S, Kalimuddin S, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 2020; 323(15):1488-1494.

[15] Niu J, Rodriguez JA, Sareli C, et al. COVID-19 infection among first responders in Broward County, Florida, March-April 2020. J Public Health (Oxf) 2021; 43(3):450-454.

[16] Fernandes Q, Inchakalody VP, Merhi M, et al. Emerging COVID- 19 variants and their impact on SARS-CoV-2 diagnosis, therapeutics and vaccines. Ann Med 2022; 54(1):524-540.

[17] Coronavirus disease (COVID-19): how is it transmitted? Apr 27, 2023.

[18] Ledford H. How severe are Omicron infections? Nature 2021; 600(7890):577-578.

[19] Burki TK. Omicron variant and booster COVID-19 vaccines. Lancet Respir Med 2022; 10(2):e17.

[20] Fan Y, Li X, Zhang L, et al. SARS-CoV-2 Omicron variant: recent progress and future perspectives. Signal Transduct Target Ther 2022; 7(1):141.

[21] Nyberg T, Ferguson NM, Nash SG, et al. Comparative analysis of the risks of hospitalisation and death associated with SARSCoV- 2 omicron (B.1.1.529) and delta (B.1.617.2) variants in England: a cohort study. Lancet 2022; 399(10332):1303-1312.

[22] Zhou Y, Yan X, Ma F, et al. Effects of moxibustion for COVID- 19 convalescence: a protocol for systematic review and meta-analysis. Medicine (Baltim) 2021; 100(14):e25389.

[23] Luo ZH, Wang KX, Zhang YL, et al. Thumb-tack needles based on “Biaoben acupoint compatibility” for sequela of COVID-19 during recovery period. Zhongguo Zhen Jiu 2022; 42(3):281-286.

[24] Gu M, Liu J, Shi NN, et al. Analysis of property and efficacy of traditional Chinese medicine in staging prevention and treatment of coronavirus disease 2019. Zhongguo Zhong Yao Za Zhi 2020; 45(6):1253-1258.

[25] Pang WT, Jin XY, Pang B, et al. Analysis on pattern of prescriptions and syndromes of traditional Chinese medicine for prevention and treatment of COVID-19. Zhongguo Zhong Yao Za Zhi 2020; 45(6):1242-1247.

[26] Yin L, Gao Y, Li Z, et al. Analysis of Chinese herbal formulae recommended for COVID-19 in different schemes in China: a data mining approach. Comb Chem High Throughput Screen 2021; 24(7):957-967.

[27] Tian J, Sun D, Xie Y, et al. Network pharmacology-based study of the molecular mechanisms of Qixuekang in treating COVID-19 during the recovery period. Int J Clin Exp Pathol 2020; 13(10):2677-2690.

[28] Su KL, Xiong XJ. Treatment strategy and thought on classical herbal formulae for coronavirus disease 2019. Zhongguo Zhong Yao Za Zhi 2021; 46(2):494-503.

[29] Takayama S, Namiki T, Odaguchi H, et al. Prevention and recovery of COVID-19 patients with kampo medicine: review of case reports and ongoing clinical trials. Front Pharmacol 2021; 12:656246.

[30] Li T, Zhao M, Zhu MJ, et al. Xuanfei Baidu decoction, a Chinese herbal medicine for coronavirus disease 2019 (COVID-19): a randomized clinical trial. Acupunct Herb Med. 2023; 3(3):207-212.

[31] Montani D, Savale L, Noel N, et al. Post-acute COVID-19 syndrome. Eur Respir Rev 2022; 31(163):210185.

[32] Jacobs LG, Gourna PE, Lesky-Di BD, et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS One 2020; 15(12):e0243882.

[33] Carfi A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324(6):603-605.

[34] Sun LL, Wang J, Wang YS, et al. Symptomatic features and prognosis of 932 hospitalized patients with coronavirus disease 2019 in Wuhan. J Dig Dis 2021; 22(5):271-281.

[35] Ettman CK, Abdalla SM, Cohen GH, et al. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open 2020; 3(9):e2019686.

[36] Lyu M, Xiao GX, Wang SM, et al. “Three medicines and three formulas” in COVID-19: From bench to bedside. Acupunct Herb Med. 2023; 3(4):309-322.

[37] Gallo G, Calvez V, Savoia C. Hypertension and COVID-19:current evidence and perspectives. High Blood Press Cardiovasc Prev 2022; 29(2):115-123.

[38] Ahmad MJ, Ahmed S, Shinde M, et al. The impact of COVID-19 on comorbidities: a review of recent updates for combating it. Saudi J Biol Sci 2022; 29(5):3586-3599.

[39] Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol 2022; 10(5):311-321.