The Prevalence of COVID-19 Fog and the Impact on Quality of Life After SARS-CoV-2 Infection (QoL-COVID): A Cross Sectional Study
Keywords:COVID-19, Mental Fatigue, Mental Status and Dementia Tests, Patient Reported Outcome Measures, Quality of Life, SARS-CoV-2
Introduction: Coronavirus has an impact on both the physical and mental health of individuals. The literature regarding the patient’s health status post-SARS-CoV-2 is still scarce with limited data on the prevalence of residual symptoms and quality of life (QoL) after the infection. The aim of this study was to understand the impact of SARS-CoV-2 on patient QoL, and remaining symptoms.
Methods: Single center cross-sectional study of patients who had been admitted to our COVID-19 ward between March 2020 and March 2021. By applying a QoL questionnaire (EQ-5D-5L) we assessed the overall sample, at three time points and in different groups of patients: those admitted to the intensive care unit (ICU) and the elderly.
Results: A total of 125 participants were included in our study. Most patients who were admitted had a severe course of disease (51%), with 22% of admissions to the ICU, with 8% requiring prone ventilation, 10% experiencing thrombotic complications and 18% of nosocomial infections throughout the admission. As for persistent symptoms related with COVID-19 fog, the most frequent were fatigue (57%), memory loss (52%) and insomnia (50%). Regarding QoL, the average decrease was 0.08 ± 0.2 in the index and 8.7 ± 19 in the Visual Analogue Scale (VAS). The QoL index decrease correlated with age, chronic obstructive pulmonary disease, asthma and heart failure, and all persistent symptoms, significantly. QoL VAS correlated significantly with fatigue, mood changes, difficulty concentrating and memory loss. The decrease in QoL and the persistent symptoms remained overall stable over the three time points. The ICU group showed no statistically significant difference in QoL, but the most frequently persistent symptoms were mood changes and attention disturbances. However, the elderly experienced a worsening in QoL expressed by index (0.69 ± 0.3 vs 0.8 ± 0.2, p-value = 0.01).
Conclusion: A decrease in QoL was observed following SARS-CoV-2 infection, correlating with both chronic conditions and persistent symptoms. The lack of difference through time points of both QoL and persistent symptoms suggests a long-standing effect.
Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. The cytokine release syndrome (CRS) of severe COVID-19 and Interleukin-6 receptor (IL-6R) antagonist tocilizumab may be the key to reduce the mortality. Int J Antimicrob Agents. 2020;55:105954. DOI: https://doi.org/10.1016/j.ijantimicag.2020.105954
Direcção-Geral da Saúde. Situação epidemiológica em Portugal distribuição dos casos em internamento. 2021. [cited 2021 Jul 23]. Available from: https://covid19.min-saude.pt/wp-content/uploads/2022/03/507_DGS_boletim_20210722_pdf-396kb.pdf.
Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81:e4–6. DOI: https://doi.org/10.1016/j.jinf.2020.08.029
Ferreira LN, Pereira LN, da Fé Brás M, Ilchuk K. Quality of life under the COVID-19 quarantine. Qual Life Res. 2021;30:1389-405. DOI: https://doi.org/10.1007/s11136-020-02724-x
Garratt AM, Ghanima W, Einvik G, Stavem K. Quality of life after COVID-19 without hospitalisation: good overall, but reduced in some dimensions. J Inf. 2021;82:186-230. DOI: https://doi.org/10.1016/j.jinf.2021.01.002
Taboada M, Moreno E, Cariñena A, Rey T, Pita-Romero R, Leal S, et al. Quality of life, functional status, and persistent symptoms after intensive care of COVID-19 patients. Br J Anaesth. 2021;126:e110-3. DOI: https://doi.org/10.1016/j.bja.2020.12.007
Todt BC, Szlejf C, Duim E, Linhares AO, Kogiso D, Varela G, et al. Clinical outcomes and quality of life of COVID-19 survivors: a follow-up of 3 months post hospital discharge. Respir Med. 2021;184:106453. DOI: https://doi.org/10.1016/j.rmed.2021.106453
Ma YF, Li W, Deng HB, Wang L, Wang Y, Wang PH, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020;275:145–8. DOI: https://doi.org/10.1016/j.jad.2020.06.033
Lim SL, Woo KL, Lim E, Ng F, Chan MY, Gandhi M. Impact of COVID-19 on health-related quality of life in patients with cardiovascular disease: a multiethnic Asian study. Health Qual Life Outcomes. 2020;18:1–7. DOI: https://doi.org/10.1186/s12955-020-01640-5
Fernandes J, Fontes L, Coimbra I, Paiva JA. Health-related quality of life in survivors of severe COVID-19 of a university hospital in northern Portugal. Acta Med Port. 2021;34:601–7. DOI: https://doi.org/10.20344/amp.16277
Kumar S. Understanding the long-term health effects of COVID-19. EClinicalMedicine. 2020;26:100586. DOI: https://doi.org/10.1016/j.eclinm.2020.100586
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220–32. DOI: https://doi.org/10.1016/S0140-6736(20)32656-8
Xiong Q, Xu M, Li J, Liu Y, Zhang J, Xu Y, et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect. 2021;27:89–95. DOI: https://doi.org/10.1016/j.cmi.2020.09.023
Siette J, Dodds L, Seaman K, Wuthrich V, Johnco C, Earl J, et al. The impact of COVID-19 on the quality of life of older adults receiving community-based aged care. Australas J Ageing. 2021;40:84–9. DOI: https://doi.org/10.1111/ajag.12924
Marzo RR, Khanal P, Ahmad A, Rathore FA, Chauhan S, Singh A, et al. Quality of life of the elderly during the COVID-19 pandemic in Asian countries: a cross-sectional study across six countries. Life. 2022;12:365. DOI: https://doi.org/10.3390/life12030365
EuroQol Research Foundation. EQ-5D-5L user guide v3.0. The Netherlands: EuroQol Research Foundation; 2021.
Ferreira PL, Antunes P, Ferreira LN, Pereira LN, Ramos-Goñi JM. A hybrid modelling approach for eliciting health state preferences: the Portuguese EQ-5D-5L value set. Qual Life Res. 2019;28:3163–75. DOI: https://doi.org/10.1007/s11136-019-02226-5
Direção-Geral da Saúde. Norma nº 004/2020 de 23/03/2020 atualizada a 21/04/2022. Abordagem das pessoas com suspeita ou confirmação de COVID-19. Lisboa: DGS; 2022.
Huang Z, Kämpfen F. Assessing (and addressing) reporting heterogeneity in Visual Analogue Scales (VAS) with an application to gender difference in quality of life. Population Center Working Papers (PSC/PARC). 2019.[cited 2022 Sep 8]. Available from: https://repository.upenn.edu/psc_publications/26.
Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr. 2021;21:199. DOI: https://doi.org/10.1186/s12877-021-02140-x
How to Cite
Copyright (c) 2023 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.