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. 2021 Jun 23;11(1):13153.
doi: 10.1038/s41598-021-92045-x.

Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients

Sofie Bliddal #  1   2 , Karina Banasik #  3 , Ole Birger Pedersen  4 , Janna Nissen  5 , Lisa Cantwell  3 , Michael Schwinn  5 , Morten Tulstrup  6   7 , David Westergaard  3   8   9   10 , Henrik Ullum  11   12 , Søren Brunak  3 , Niels Tommerup  13 , Bjarke Feenstra  14 , Frank Geller  14 , Sisse Rye Ostrowski  5   12 , Kirsten Grønbæk  6   7   12 , Claus Henrik Nielsen  2   12 , Susanne Dam Nielsen  12   15 , Ulla Feldt-Rasmussen  16   17
Affiliations

Acute and persistent symptoms in non-hospitalized PCR-confirmed COVID-19 patients

Sofie Bliddal et al. Sci Rep. .

Abstract

Reports of persistent symptoms after hospitalization with COVID-19 have raised concern of a "long COVID" syndrome. This study aimed at determining the prevalence of and risk factors for acute and persistent symptoms in non-hospitalized patients with polymerase chain reaction (PCR) confirmed COVID-19. We conducted a cohort study of non-hospitalized participants identified via the Danish Civil Registration System with a SARS-CoV-2-positive PCR-test and available biobank samples. Participants received a digital questionnaire on demographics and COVID-19-related symptoms. Persistent symptoms: symptoms > 4 weeks (in sensitivity analyses > 12 weeks). We included 445 participants, of whom 34% were asymptomatic. Most common acute symptoms were fatigue, headache, and sneezing, while fatigue and reduced smell and taste were most severe. Persistent symptoms, most commonly fatigue and memory and concentration difficulties, were reported by 36% of 198 symptomatic participants with follow-up > 4 weeks. Risk factors for persistent symptoms included female sex (women 44% vs. men 24%, odds ratio 2.7, 95% CI 1.4-5.1, p = 0.003) and BMI (odds ratio 1.1, 95% CI 1.0-1.2, p = 0.001). In conclusion, among non-hospitalized PCR-confirmed COVID-19 patients one third were asymptomatic while one third of symptomatic participants had persistent symptoms illustrating the heterogeneity of disease presentation. These findings should be considered in health care planning and policy making related to COVID-19.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Flowchart of inclusion process. Inclusion process of Danes with PCR-confirmed SARS-CoV-2 in study of symptoms among non-hospitalized patients. e-Boks secure digital postbox used by 92% of Danes, PCR polymerase chain reaction, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2.
Figure 2
Figure 2
Symptom presentation and severity during acute COVID-19 in non-hospitalized patients. Symptom pattern and severity reported in relation to the acute phase of COVID-19 by non-hospitalized participants with a SARS-CoV-2-positive PCR test. Only participants with symptom start between 28 days before and 14 days after the PCR-test were included. (a) All symptomatic participants (n = 238). (b) Symptomatic participants without comorbidities (n = 105), and (c) symptomatic participants with self-reported comorbidities (n = 106) Twenty seven participants did not answer the questions on comorbidity. PCR polymerase chain reaction, SARS-CoV-2 severe acute respiratory syndrome coronavirus 2.
Figure 3
Figure 3
Persistent symptoms in COVID-19 at 4 and 12 weeks. Persistent symptoms after COVID-19. In dark blue, persistent symptoms for more than 4 weeks in the 198 non-hospitalized participants with symptoms and a follow-up time of more than 4 weeks and, in light blue, persistent symptoms for more than 12 weeks in the 129 non-hospitalized participants with symptoms and a follow-up time of more than 12 weeks.
Figure 4
Figure 4
Acute symptoms and symptoms > 4 weeks in non-hospitalized men and women with COVID-19. The percentage of acute (panel to the left) symptoms and symptoms > 4 weeks (panel to the right) in non-hospitalized COVID-19 participants according to sex. Acute symptoms were reported by 148 women and 90 men of which 4 weeks of follow-up was available in 126 women and 72.
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