Post-acute sequelae of COVID-19 in residents in long-term care homes: Examining symptoms and recovery over time

TL;DR

This study examines how residents in long-term care homes experience and recover from symptoms after contracting COVID-19.

Contribution

The study provides new insights into individual recovery trajectories of post-acute COVID-19 symptoms in long-term care residents.

Findings

The number of symptoms increased during acute infection but returned to baseline for most residents within two months.

About a quarter of residents did not return to their pre-COVID symptom baseline.

Higher symptom count during acute infection increased the risk of not recovering to baseline.

Abstract

Post-COVID-19 condition (PCC) has been studied extensively since the inception of the COVID-19 pandemic. In the population of long-term care (LTC) home residents, however, information about PCC and recovery after the acute phase of COVID-19 is lacking. This study contributes evidence about symptoms over time in 459 residents in nine Canadian LTC homes.

In a comprehensive retrospective chart review, we recorded medical symptoms in a 4-week period before contracting COVID-19 (“PRE-COVID”) and during 24 weeks after contracting infection (a 4-week “ACUTE-COVID” period and five subsequent 4-week periods “POST1–5”). We investigated the number and type of symptoms over time, examined different “recovery trajectories”, and compared the characteristics of residents across different trajectories.

In the sample overall, the number of different symptoms increased from PRE-COVID to ACUTE-COVID (mean difference of 3 symptoms, p<.001), returning to the PRE-COVID level within the first two months post-infection. An individual-level examination revealed that after ACUTE-COVID about a quarter of residents did not return to their symptom baseline. There was no statistically significant difference in demographic characteristics or PRE-COVID comorbidities across different recovery trajectories. Comparing the group of residents that did not return to their symptom baseline and the group that did, the risk for not returning to baseline increased with the number of symptoms in ACUTE-COVID (adjusted for age, sex, and PRE-COVID comorbidities, exp[B]=1.15, 95% CI [1.05;1.25], p=.002). Additionally, there was a greater increase in the number of symptoms from PRE-COVID to ACUTE-COVID in the former group (significant interaction effect, p<.001). We present symptom types in each time-period.

Group-level results indicated that the number of symptoms after contracting COVID-19 fell to the pre-COVID level within the first two months post-infection. An examination of individual-level symptom trajectories contributed a more granular picture of recovery after infection and characteristics of residents across different trajectories.

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