Chapter 4 106 Continuous variables presented as median (IQR) and compared using the Kruskal-Wallis test; categorical and binary variables presented as n(%) and compared using the Pearson χ2 test (or Fisher exact test if n<5). Clinical severity groups defined as: mild as having a RR<20/min and SpO2 on room air >94% at both D0 and D7; moderate disease as having a RR 20-30/min, SpO2 90-94% and/or receiving oxygen therapy at D0 or D7; severe disease as having a RR>30/min or SpO2 < 90% at D0 or D7; critical disease as requiring ICU admission. BMI=Body mass index; PCR=Polymerase Chain Reaction; PHSA=Public Health Service of Amsterdam; ICU= Intensive Care Unit; HR=heart rate; RR=respiratory rate. † Normal BMI group includes 3 individuals with BMI between 17.0 and 18.5 kg/m2. * Ethnic origin based on country of birth of participant and that of their parents. ‘Other’ ethnic origin includes: Europe, Russia, Australia, Canada, USA and New Zealand. ** COVID-related comorbidities are based on WHO Clinical Management Guidelines[18] and include: cardiovascular disease (including hypertension), chronic pulmonary disease (excluding asthma), renal disease, liver disease, cancer, immunosuppression (excluding HIV, including previous organ transplantation), previous psychiatric illness and dementia. ‡ SARS-CoV-2-specific antibodies were measured using the WANTAI SARS-CoV-2 Ab ELISA and a positive test result was defined according to the manufacturer’s instructions. ¶ Physical measurements at D0 and D7 study visits. Oxygen saturation measured on room air if possible or retrieved from ambulance records for hospitalised participants admitted on oxygen on day of enrolment. Physical measurements not displayed for individuals with critical disease due to unreliability of measurements at admission for critically-ill patients. Incidence proportions and severity of symptoms during the acute phase of infection Fatigue and cough were the most frequently reported symptoms overall and their incidence proportion during the acute phase did not differ between clinical severity groups (Supplementary Table S1). The incidence proportions of dyspnoea, headache and diarrhoea were significantly greater in those with severe/critical disease compared to those with mild or moderate disease during the acute phase of disease, whilst the opposite was true for loss of appetite, fever, rhinorrhoea and sore throat. Transition plots showed that although most participants transitioned to a lower level of severity over time for the more persistent symptoms (fatigue, dyspnoea, loss of smell and/or taste, and myalgia), some transitioned to a higher severity level over time (Supplementary Figures S3a-d). Time to recovery from symptoms Time to complete recovery was significantly longer in symptomatic participants with moderate and severe/critical disease than in those with mild COVID-19 (Figure 1). At least one ongoing symptom was reported at 12 weeks after illness onset, thus meeting NICE criteria for post-COVID syndrome, by 30.7% (95%CI=21.1%-40.9%) of participants with mild, 63.8% (95%CI=54.8-71.5%) with moderate and 86.7% (95%CI=76.5-92.7%) with severe/critical disease. Among participants with mild disease, median time to complete recovery was 63
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