Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the acute respiratory syndrome coronavirus-2 (SARS-CoV-2) [1]. The first known case was identified in Wuhan, China, in December 2019 [2]. The disease quickly spread worldwide, resulting in the COVID-19 pandemic. Symptoms of COVID-19 are variable, but often include fever, cough, headache, fatigue, loss of smell, and loss of taste [3]. Symptoms may begin one to fourteen days after exposure to the virus [4]. At least a third of infected individuals do not develop noticeable symptoms [5].

This study was targeted towards individuals who had contracted SARS-CoV-2 (i.e., received a positive test result following an RT-PCR or rapid antigen test for the SARS-CoV-2 virus) at any point since the onset of the COVID-19 pandemic. A questionnaire was presented orally to 121 patients at an urban tertiary care center in Bangalore, India, during the period of June 2022. All participants were approached at random and were spread across various medical departments, including but not limited to neurology/neurosurgery, endocrinology, cardiology, hematology, pulmonology, pediatrics, urology, psychiatry, physiotherapy, radiology, urgent care, and general medicine. Participation in the study was voluntary and all attempts were made to present questions and gather data in a neutral, unbiased manner. Additionally, all information was kept anonymous and participants were made aware of this prior to initiating data collection. 

Participants ranged in age from 21-65 years at the time of the study and were classified into the following age groups: “Young'' (<=35), “Middle-Aged” (36-50), and “Old” (>=50). Individuals reported having common respiratory symptoms (cough, cold, shortness of breath), non-respiratory symptoms (fever, fatigue, body-ache, headache, loss of taste/smell), gastrointestinal symptoms (diarrhea), and dermatological symptoms (skin rashes and inflammation). Out of 121 individuals, 87% reported being symptomatic and 51.24% had received one or more doses of the available COVID-19 vaccinations [6] prior to infection. 

A questionnaire consisting of a mixture of 24 subjective and objective questions was orally presented to each participant. As the goal of this study was to gather information on post-COVID symptoms and complications, and determine whether there were any correlations between, among other things, the presence of long-lasting negative (physical and psychological) health symptoms and prior inoculation with SARS-CoV-2 vaccinations, questions pertaining to the individuals’ lifestyles and prior health status were asked in order to account for confounding variables.

The data gathered through the questionnaire included the following attributes:

Age, gender, first positive test, vaccination status (yes/no, vaccine brand), symptomatic/asymptomatic, symptoms description, severity of illness (1-10), comorbidities, smoking habit (yes/no), visit to doctor (yes/no), doctor visit frequency, self-medicated (yes/no), duration of symptoms, long-term physical health changes (post recovery), post-COVID illnesses, common cold susceptibility (post recovery), pre-COVID fear of COVID, post-COVID Fear of COVID, Loss of Near and Dear to COVID (yes/no), Psychological Health Changes (post recovery).

Chi-squared test, Cramer’s V, and Cochran Mantel Haenszel test were used to study the association between various attributes. Ordinal logistic regression was used to determine the factors affecting severity of the disease.

Several attributes were assessed to determine the associations between various physiological parameters and the factors affecting severity of illness. The participants rated severity on a scale of 1-10, with 1 being “very mild” and 10 being “very severe”. For ease of analysis, the severity rating was classified into 3 groups: Mild (1-3), Moderate (4-6), and Severe (7-10).

Using Chi-squared test:

• Severity of illness was dependent on age and the strength of association was 0.2106, indicating low association between the attributes. 

• Severity of illness was dependent on being symptomatic/asymptomatic and the strength of the association was 0.7284, indicating strong association between the attributes. 

• Severity of illness was dependent on vaccination status and the strength of association was 0.4905, indicating moderate association between the attributes. 

• Severity of illness was independent of gender, smoking habit, and pre-COVID fear of COVID.

• Psychological health changes (anxiety, depression, nightmares) were independent of physical symptoms.

• Long-term physical health changes (fatigue, loss of taste/smell) and psychological health changes (anxiety, depression, and nightmares) were independent of age group. 

Using the Cochran Mantel Haenszel test, it was determined that age group, vaccine brand and severity of illness were independent of each other. Ordinal regression was used to determine the factors affecting severity of illness. 

• Age group had a significant effect on severity of illness. The odds of having a more severe illness experience were 1.35 times more for the Old age group in reference to the Middle-Aged age group and 0.67 times less for the Young age group in reference to the Middle-Aged age group. 

• Vaccination status had a significant effect on severity of illness. The odds of having a more severe illness experience were 1.06 times more for subjects vaccinated with Covishield and 6.95 times more for non-vaccinated subjects in reference to subjects vaccinated with Covaxin. 

• Gender had a significant effect on severity of illness. The odds of having a more severe illness experience were 0.74 times less for male subjects when compared to female subjects. 

This survey revealed that the long-term effects of COVID-19 might be more significant in elderly individuals and that unvaccinated individuals across age groups might be at an increased risk of having more severe illness experiences after contracting the SARS-CoV-2 virus.

Fig. 1: Distribution of reported illness severity (Mild, Moderate, Severe) across three different age groups (Young, Middle-Aged, Old). The vertical axis represents the number of individuals reporting a certain level of severity in each age group surveyed.

No funding sources.

 None declared.

 The study was approved by the Institutional Ethics Committee of Emory University.

1. Coronavirus disease (COVID-19). World Health Organization. Accessed September 04, 2022. https://www.who.int/health-topics/coronavirus#tab=tab_1

2. Yi-chi W, Ching-Sung C, Chan YJ. The Outbreak of COVID-19: An Overview. JCMA. 2020; 83(3):217-220. https://doi.org/10.1016/j.jcma.2020.02.009.

3. Raza, Syed Ahsan, et al. "Predictors of COVID-19 perceived susceptibility: insights from population-based self-reported survey during lockdown in the United States." Journal of Infection and Public Health 15.5 (2022): 508-514. https://doi.org/10.1016/j.jiph.2022.03.012 

4. Esakandari, Hanie, et al. "A comprehensive review of COVID-19 characteristics." Biological procedures online 22 (2020): 1-10. https://link.springer.com/article/10.1186/s12575-020-00128-2 

5. Johansson, Michael A., et al. "SARS-CoV-2 transmission from people without COVID-19 symptoms." JAMA network open 4.1 (2021): e2035057-e2035057. doi:10.1001/jamanetworkopen.2020.35057

6. Raina, Sunil Kumar, and Raman Kumar. "“Covishield and Covaxin”–India's contribution to global COVID-19 pandemic." Journal of Family Medicine and Primary Care 10.7 (2021): 2433-2435.DOI: 10.4103/jfmpc.jfmpc_174_21