Women more at risk of post-Covid complications: Study

The prevalence of post-Covid complications was found to be 1.5 to 4 times higher in females than in males, according to a study.

According to the research, long-term complications in hospitalised patients and those needing intensive care were 2-3 times more likely than in non-hospitalised patients.

Patients hospitalised with Covid are at risk of diabetes, respiratory, and cardiovascular complications in the following weeks.

The findings were disclosed on Tuesday (21 March) during a dissemination seminar titled "Long-Term Sequelae of Covid- 19: A Longitudinal Follow-Up Study in Dhaka, Bangladesh," jointly organised by icddr,b and Bangabandhu Sheikh Mujib Medical University (BSMMU).

The seminar also presented a guideline titled "Long Covid Clinical Management Guideline for physicians".

The first of its kind in Asia, the study revealed that Covid-19 survivors carry a high burden of long-term effects of Covid-19 infection, often described as post-Covid-19 syndrome (PCS) or long Covid.

The study was funded by the United States Agency for International Development (USAID) Alliance for Combating TB (ACTB) in Bangladesh activity.

Chairman of the Department of Internal Medicine of BSMMU Professor Dr Shohael Mahmud Arafat, Professor of the Department of Cardiology Dr Chowdhury Meshkat Ahmed, and Dr Farzana Afroze, associate scientist, Nutrition and Clinical Service Division, icddr,b and the principal investigator of the study presented key findings at the event.

The findings, based on the first five months of participant follow-ups, were recently published in The Lancet Regional Health Southeast Asia.

The study was conducted at two Covid-19-designated hospitals in Dhaka, Bangladesh, between 15 December 2020 and 30 October 2021. The researchers recruited clinically recovered individuals older than 18 years with RT-PCR- confirmed Covid-19 who sought care from the study hospitals with or without hospitalisation.

The 362 enrolled participants were given comprehensive in-person follow-ups at one, three and five- month post-recovery intervals to evaluate the presence or trajectories of PCS symptoms which include neurological, cardiac, respiratory outcomes, and mental health.

The study revealed that Covid-19 survivors over the age of 60 are twice as likely to develop cardiovascular (hypertension, high pulse rate, edema), and neurological (peripheral neuropathy or numbness, tingling sensation, and pain in the hands and feet, taste, and smell abnormalities) complications when compared to the age group younger than 40 years.

Hospitalised survivors with pre-existing diabetes had a 9 to 11 times higher possibility of having uncontrolled blood sugar with regular medication and hence required the administration of insulin therapy more often compared to those who did not require hospitalisation.

The new occurrence of diabetes was 10 cases per 1,000 person- among hospitalised patients, compared to none in the non- hospitalised group. Similarly, the new occurrence of renal impairment (high creatinine and proteinuria) and the increased liver enzyme were considerably high among Covid-19 survivors.

Most complications decreased over time in both groups, however, shortness of breath, fast pulse rate, post-traumatic stress disorder, anxiety and depression did not decline significantly in the non- hospitalised group, even five months after recovery. The results highlight the need for continuous follow-up and care of Covid-19 survivors. Older and hospitalised patients should be routinely monitored for cardiovascular complications, given their increased risk. The novel incidence of diabetes mellitus among hospitalied Covid-19 survivors is also particularly concerning as it could be significantly adding to the diabetes burden in the country.

Dr Tahmeed Ahmed, executive director of icddr,b, stressed the importance of the study and said, "The findings bear immense importance in understanding the long-term effects of COVID-19 and address significant questions pertaining to prolonged complications associatede with it. However, it will only be beneficial if patients who have been hospitalised due to Covid-19 maintain regular monitoring of complications and address them accordingly."

Professor Dr Shohael Mahmud Arafat presented the clinical management guideline for Long-Covid for physicians, which was developed jointly by BSSMU and icddr,b. He noted the absence of a guideline causing challenges in treating and rehabilitating long COVID symptoms are often ambiguous. He hopes that the proposed guideline will help clinicians to identify, act and maximise patient rehabilitation.