Elke Wynberg

Evolution of COVID-19 symptoms during the first 12 months after illness onset 4 109 (aHR 0.78, 95%CI=0.68-0.89). Number of comorbidities at illness onset was significantly associated with recovery from fatigue, where those with one comorbidity recovered twice as slowly as those without comorbidities (aHR 0.51, 95%CI=0.34-0.76). When we replaced total number of comorbidities with the presence of each of CVD, CLD, or DM in the multivariable models for each of these symptoms, no statistically significant effect on time to recovery was detected for any of these specific comorbidities. DISCUSSION To our knowledge, this study is one of the first to report detailed longitudinal data on the evolution of COVID-19 symptoms in a cohort of individuals with mild to critical disease up to one year after illness onset. Despite an overall improvement in severity of the most persistent COVID-19 symptoms during the acute phase of disease, approximately onethird of the mild group, nearly two-thirds of the moderate group and more than four-fifths of patients with severe/critical disease met NICE criteria for post-COVID syndrome. Even at one year after illness onset, one in six of those with mild disease and approximately half of participants with moderate or severe/critical disease experienced at least one ongoing symptom. Female sex and obesity at illness onset were important determinants of slow recovery from symptoms. Since the start of the COVID-19 pandemic, avoiding the immediate consequences of hospitalisation and mortality has been the primary goal of each public health strategy. Longer term sequelae of COVID-19 have received relatively little attention, especially among non-hospitalised patients. In our study, as many as one in three participants with mild COVID-19 still reported symptoms 12 weeks after illness onset. Indeed, the proportion of participants meeting the NICE definition of post-COVID syndrome in our cohort (60.2% overall) was comparable to other prospective cohort studies[7, 8, 20], but higher than estimates by the UK Office for National Statistics and among healthcare workers [21, 22]. Although this could be partly explained by the fact that our analysis was limited to symptomatic participants, the consequences of these proportions when extrapolated to a global level are likely to be substantial. It is therefore clear that responding to this emerging public health crisis requires urgent attention. Although patient advocacy groups have helped in making post-COVID syndrome a research priority[23], studies to date have differed in study population, follow-up time and symptoms evaluated [15], making it difficult to synthesize all available evidence. Moreover, the symptom profiles that falls under post-COVID syndrome are diverse [24],

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