# Clinical characterization of acute COVID-19 and Post-COVID-19 Conditions 3 months following infection: A cohort study among Indigenous adults and children in the Southwestern United States

## TL;DR

This study examines the long-term health effects of COVID-19 in Indigenous communities in the Southwest US, finding that many experience lingering symptoms three months after infection.

## Contribution

The study provides the first detailed clinical characterization of Post-COVID-19 Conditions in Indigenous adults and children.

## Key findings

- 39.8% of adults and 15.9% of children had symptoms consistent with Post-COVID-19 Conditions three months after infection.
- Older age and hospitalization increased PCC risk, while vaccination decreased it in multivariable analysis.
- Fatigue, cough, headache, runny nose, and myalgia were commonly reported PCC symptoms.

## Abstract

Long-term effects of COVID-19 on multiple organ systems have been reported. Indigenous persons experienced disproportionate morbidity and mortality from COVID-19; however, Post-COVID-19 Conditions (PCC) have not been well described in this population. We conducted a longitudinal cohort study among Indigenous persons living in the Navajo Nation or White Mountain Apache Tribal lands in the Southwest United States who tested positive for SARS-CoV-2 between February 1, 2021 and August 31, 2022. Participants were enrolled during their acute illness and followed for three months. PCC was defined as the presence of any self-reported symptom and/or any sequelae or new condition recorded in the electronic health record at the 3-month visit. Risk factors for PCC were evaluated using Poisson regression with robust standard errors. The analysis included 258 adults and 84 children. Most participants (98.4% of adults, 90.5% of children) experienced a mild, symptomatic acute illness. Over half of adults (57.8%) and a third (39.3%) of children experienced six or more symptoms during the acute illness. Three months post-acute COVID-19, 39.8% of adults and 15.9% of children had symptoms consistent with PCC. Commonly reported symptoms were fatigue/tiredness, cough, headache, runny nose, and myalgia. Among adults enrolled during Omicron predominance, older age and hospitalization for COVID-19 were significantly associated with an increased risk of PCC, and COVID-19 vaccination was significantly associated with a decreased risk of PCC in univariable analysis. In a multivariable analysis, COVID-19 vaccination (risk ratio: 0.56; 95% confidence interval: 0.34, 0.90) remained significantly associated with a decreased risk of PCC. In this cohort of Indigenous persons in the Southwest US, PCC at three months post-acute COVID-19 illness were common, including among individuals with mild acute illness. While the absence of a control group is a limitation, these findings highlight the potential ongoing healthcare needs related to PCC in Indigenous populations.