Long COVID and recovery from Long COVID: Quality of life impairments and subjective cognitive decline at a median of 2 years after initial infection

Abstract

Abstract Background:Quality of life (QoL) and cognition for those with Long COVID is not well-characterized, but existing research suggests impairments in both persist beyond 12 months after initial illness. Methods:In this cross-sectional study, 435 participants with SARS-CoV-2 infection, confirmed with laboratory test or physician diagnosis, between March 2020 and December 2021 completed self-report surveys between March 2022 and September 2022 (n=7305 sent surveys; response rate=6.0%). Multi-domain QoL and cognitive concerns were evaluated using PROMIS-29 and the Cognitive Change Index-12. Those not recovered from COVID-19 at time of survey (“Current Long COVID”; n=181) and those who recovered from COVID-19 in >3 months (“Recovered Long COVID”; n=34), were combined to form a Long COVID group (n=215) and were compared with those who recovered from COVID in ≤3 months (“Without Long COVID”; n=220). Results: Nearly half the participants (47.7%) were surveyed more than 2 years from initial infection (median=23.3 months; IQR=18.6, 26.7). The Long COVID group showed significantly greater proportion of moderate-to-severe impairment in all health domains assessed compared to those Without Long COVID (all p<0.05). The Recovered Long COVID group showed significantly lower prevalence of fatigue, pain, depression, and physical and social function impairment compared to those with Current Long COVID (all p<0.05). However, compared to patients Without Long COVID, the Recovered Long COVID group had greater prevalences of fatigue, pain (P≤0.06) and subjective cognitive decline (61.8% vs 29.1%; p<0.01). Multivariate relative risk (RR) regression indicated Long COVID risk was greater for older age groups (RR range 1.46-1.52; all p≤0.05), those without a bachelor’s degree (RR=1.33; 95% CI=1.03-1.71; p=0.03), and those with 3 or more comorbidities prior to SARS-CoV-2 infection (RR=1.45; 95% CI=1.11-1.90; p<0.01). Each additional symptom experienced during acute COVID-19 was associated with a 14% greater Long COVID risk (RR=1.14, 95% CI=1.10-1.18; p<0.01). Conclusions: Long COVID is associated with long-term cognitive complaints and diminished quality of life. Older age, not having a bachelor’s degree, and pre-existing comorbidities are risk factors for prolonged or non-recovery from COVID-19. Recovery from Long COVID was reported by a subset of those with Long COVID, though clinically significant cognitive complaints, fatigue, and pain persisted.