Clinical Characteristics and Factors Associated with Long COVID in Zambia, August 2020 to January 2023

Abstract

ABSTRACTBackgroundSeveral seroprevalence studies in Africa documented the extent of spread of SARS-CoV-2, yet there is limited data on signs, symptoms and conditions that continue or develop after acute COVID-19 infection (long COVID). We sought to examine patient characteristics at post-acute COVID-19 (PAC-19) clinics in Zambia and assess factors associated with long COVID at first visit to a PAC-19 clinic and longitudinally among a cohort of patients.MethodsLong COVID was defined, initially in the Zambia PAC-19 clinical guidelines, as new, relapsing or persistent symptoms lasting >4 weeks after an initial SARS-CoV-2 infection. Severe illness was defined as COVID-19 episode that required supplemental oxygen therapy, intensive care unit stay or treatment with steroids/remdesivir. We fitted logistic regression models with cross-sectional and longitudinal data and considered statistical significance at p<0.05.ResultsIn total, 1,359 patients attended PAC-19 clinics and had data abstracted from Aug-2020 to Jan-2023; 548 (40.3%) patients with ≥2 visits were included in the longitudinal analysis. Patients’ median age was 53 (interquartile range [IQR]: 41-63) years, 919 (67.6%) were hospitalized for acute COVID-19, and of whom 686 (74.6%) had severe illness. Patients with hospital length of stay ≥15 days (adjusted odds ratio [aOR]: 5.50; 95% confidence interval [95% CI]: 3.06-10.3), severe illness (aOR: 3.23; 95% CI: 1.68-6.75), and comorbidities (aOR:1.51; 95% CI: 1.04-2.22) had significantly higher odds of long COVID. Longitudinally, long COVID prevalence significantly (p<0.001) declined from 75.4% at the first PAC-19 visit to 26.0% by the fifth visit. The median follow-up time was 7 (IQR: 4-12) weeks.ConclusionLong COVID symptoms were common among patient presenting for care in PAC-19 clinics in Zambia, but most recovered within ∼2 months. Despite potentially substantial morbidity due to long COVID, few patients overall with COVID-19 attended a PAC-19 clinic. Scaling up PAC-19 services and integrating into routine clinical care could improve access by patients.