# Pulmonary manifestations of long COVID in Johannesburg, South Africa

## TL;DR

This study found that some people in South Africa still have lung issues up to two years after recovering from COVID-19, especially those who had severe cases.

## Contribution

This was one of the first comprehensive studies on long-term lung effects of long COVID in South Africa.

## Key findings

- 36 patients met inclusion criteria for long-term pulmonary evaluation, with 21.1% overall incidence of long COVID.
- Patients with severe prior infection had the highest long COVID incidence at 37.8%.
- HRCT scans showed probable/possible abnormalities in 7 patients, mostly those previously hospitalised.

## Abstract

There are few studies of long coronavirus disease (COVID) in low- and middle-income countries.

This study investigated long-term pulmonary manifestations of long COVID among adults in Johannesburg, South Africa.

This was a respiratory sub-study of a larger long COVID investigation. Cases with self-reported long COVID symptoms were recruited into four cohorts: prior asymptomatic infection, mild to moderate infection, hospitalised for severe infection and vaccinated prior to infection. Cases with respiratory comorbidity and/or well-characterised exposure to certain conditions (e.g. cigarette smoking) were excluded. Demographics, clinical features, spirometry, six-minute walk test (6MWT) and high-resolution computerised tomographic (HRCT) scan of the chest were recorded.

Of the 171 patients interviewed from the initial study, 36 with appropriate inclusion criteria were recruited a median of 2.1 years following their acute COVID-19 illness. Accordingly, the incidence of long COVID was 21.1% (36/171 patients) for the group as a whole and 5.9% (3/51), 25.0% (14/56), 37.8% (17/45) and 10.5% (2/19) for cohorts 1–4, respectively (p = 0.001). The major symptoms were tiredness and/or fatigue, shortness of breath and cough. Overall, 33 patients had abnormal 6MWT results, and 10 had abnormalities on spirometry; obstructive pattern in five, restrictive in three and mixed in two. Seven patients (six of whom were previously hospitalised) had probable/possible abnormalities compatible with long COVID on HRCT scan (p = 0.045).

This study documented respiratory abnormalities in patients as long as 2 years after prior SARS-CoV-2 infection, especially among those with severe prior infection.

This was among the first studies comprehensively documenting pulmonary abnormalities in patients with long COVID in South Africa.