Symptoms Compatible With Long Coronavirus Disease (COVID) in Healthcare Workers With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection-Results of a Prospective Multicenter Cohort

Carol Strahm; Marco Seneghini; Sabine Güsewell; Thomas Egger; Onicio Leal-Neto; Angela Brucher; Eva Lemmenmeier; Dorette Meier Kleeb; J Carsten Möller; Philip Rieder; Markus Ruetti; Remus Rutz; Hans Ruedi Schmid; Reto Stocker; Danielle Vuichard-Gysin; Benedikt Wiggli; Ulrike Besold; Stefan P Kuster; Allison McGeer; Lorenz Risch; Andrée Friedl; Matthias Schlegel; Dagmar Schmid; Pietro Vernazza; Christian R Kahlert; Philipp Kohler

doi:10.1093/cid/ciac054

Symptoms Compatible With Long Coronavirus Disease (COVID) in Healthcare Workers With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection-Results of a Prospective Multicenter Cohort

Clin Infect Dis. 2022 Aug 24;75(1):e1011-e1019. doi: 10.1093/cid/ciac054.

Authors

Carol Strahm¹, Marco Seneghini¹, Sabine Güsewell¹, Thomas Egger¹, Onicio Leal-Neto^{2

3}, Angela Brucher⁴, Eva Lemmenmeier⁵, Dorette Meier Kleeb⁶, J Carsten Möller⁷, Philip Rieder⁸, Markus Ruetti⁹, Remus Rutz¹, Hans Ruedi Schmid¹⁰, Reto Stocker⁸, Danielle Vuichard-Gysin¹¹, Benedikt Wiggli¹², Ulrike Besold¹³, Stefan P Kuster^{1

14}, Allison McGeer¹⁵, Lorenz Risch^{16

17

18}, Andrée Friedl¹², Matthias Schlegel¹, Dagmar Schmid¹⁹, Pietro Vernazza¹, Christian R Kahlert^{1

20}, Philipp Kohler¹

Affiliations

¹ Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
² Epitrack, Recife, Brazil.
³ Department of Economics, University of Zurich, Zurich, Switzerland.
⁴ Psychiatry Services of the Canton of St Gallen (South), St Gallen, Switzerland.
⁵ Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland.
⁶ Division of Occupational Health, Kantonsspital Baden, Baden, Switzerland.
⁷ Center for Neurological Rehabilitation, Zihlschlacht, Switzerland.
⁸ Hirslanden Clinic, Zurich, Switzerland.
⁹ Fuerstenland Toggenburg Hospital Group, Wil, Switzerland.
¹⁰ Central Laboratory, Kantonsspital Baden, Baden, Switzerland.
¹¹ Division of Infectious Diseases and Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen, Switzerland.
¹² Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland.
¹³ Geriatric Clinic St Gallen, St Gallen, Switzerland.
¹⁴ Federal Office of Public Health, Bern, Switzerland.
¹⁵ Sinai Health System, Toronto, Canada.
¹⁶ Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland.
¹⁷ Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein.
¹⁸ Center of Laboratory Medicine, Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland.
¹⁹ Clinic for Psychosomatic and Consultation Psychiatry, Cantonal Hospital St Gallen, St Gallen, Switzerland.
²⁰ Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.

Abstract

Background: The burden of long-term symptoms (ie, long COVID) in patients after mild COVID-19 is debated. Within a cohort of healthcare workers (HCWs), frequency and risk factors for symptoms compatible with long COVID are assessed.

Methods: Participants answered baseline (August/September 2020) and weekly questionnaires on SARS-CoV-2 nasopharyngeal swab (NPS) results and acute disease symptoms. In January 2021, SARS-CoV-2 serology was performed; in March, symptoms compatible with long COVID (including psychometric scores) were asked and compared between HCWs with positive NPS, seropositive HCWs without positive NPS (presumable asymptomatic/pauci-symptomatic infections), and negative controls. The effect of time since diagnosis and quantitative anti-spike protein antibodies (anti-S) was evaluated. Poisson regression was used to identify risk factors for symptom occurrence.

Results: Of 3334 HCWs (median, 41 years; 80% female), 556 (17%) had a positive NPS and 228 (7%) were only seropositive. HCWs with positive NPS more frequently reported ≥1 symptom compared with controls (73% vs 52%, P < .001); seropositive HCWs without positive NPS did not score higher than controls (58% vs 52%, P = .13), although impaired taste/olfaction (16% vs 6%, P < .001) and hair loss (17% vs 10%, P = .004) were more common. Exhaustion/burnout was reported by 24% of negative controls. Many symptoms remained elevated in those diagnosed >6 months ago; anti-S titers correlated with high symptom scores. Acute viral symptoms in weekly questionnaires best predicted long-COVID symptoms. Physical activity at baseline was negatively associated with neurocognitive impairment and fatigue scores.

Conclusions: Seropositive HCWs without positive NPS are only mildly affected by long COVID. Exhaustion/burnout is common, even in noninfected HCWs. Physical activity might be protective against neurocognitive impairment/fatigue symptoms after COVID-19.

Keywords: asymptomatic; healthcare workers; long COVID; risk factors; serology.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Asymptomatic Infections / epidemiology
COVID-19* / complications
COVID-19* / epidemiology
Fatigue
Female
Health Personnel
Humans
Male
Olfaction Disorders*
Post-Acute COVID-19 Syndrome
Prospective Studies
SARS-CoV-2