Abstract
Background
The burden and presentation of post-acute sequela of SARS-CoV-2 infection (PASC) are a developing major public health concern.
Objectives
To characterize the burden of PASC in community-dwelling individuals and understand the experiences of people living with PASC.
Methods
This mixed-methods study of COVID-19 positive community-dwelling persons involved surveys and in-depth interviews. Main outcome was self-report of possible PASC symptoms 3 weeks or longer after positive COVID-19 test. In-depth interviews were guided by a semi-structured interview guide with open-ended questions and probes based on emerging literature on PASC and the impact of COVID-19.
Results
With a survey response rate of 70%, 442 participants were included in this analysis, mean (SD) age 45.4 (16.2) years, 71% female, 12% Black/African American. Compared to those with no PASC symptoms, persons who reported PASC symptoms were more likely to be older (mean age: 46.5 vs. 42; p = 0.013), female (74.3% vs. 61.2%; p = 0.010), to have pre-existing conditions (49.6% vs. 34%; p = 0.005), and to have been hospitalized for COVID-19 (14.2% vs. 2.9%; p = 0.002). About 30% of the participants experienced severe fatigue; the proportion of persons reporting severe fatigue was 7-fold greater in those with PASC symptoms (Adjusted Prevalence Ratio [aPR] 6.73, 95%CI: 2.80–16.18). Persons with PASC symptoms were more likely to report poor quality of life (16% vs. 5%, p<0.001) and worse mental health functioning (Mean difference: -1.87 95%CI: -2.38, -1.37, p<0.001). Themes from in-depth interviews revealed PASC was experienced as debilitating.
Conclusions
In this study, the prevalence of PASC among community-dwelling adults was substantial. Participants reported considerable coping difficulties, restrictions in everyday activities, invisibility of symptoms and experiences, and impediments to getting and receiving PASC care.
Funder
National Heart, Lung, and Blood Institute
American Heart Association
National Institute on Minority Health and Health Disparities
National Institute of Nursing Research
Gordon and Betty Moore Foundation
National League for Nursing
National Institute of Allergy and Infectious Diseases
School of Nursing, Johns Hopkins University
Center for AIDS Research, Johns Hopkins University
P.E.O. International Peace Scholarship
Community Collaboration to Combat Coronavirus (C-Forward) - Provost Award - Johns Hopkins University COVID Community Research Initiative
Publisher
Public Library of Science (PLoS)
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