Abstract

Background

Long Covid is a recently emerged public health phenomenon that occurs after recovering from the coronavirus, and it requires proper definition and description. Our objective is to investigate the symptoms of Long Covid and the factors that contribute to its development.

Methods

From June 2022 to September 2022, we gathered self-reported data via a survey that we distributed and published. We used convenience non-probability sampling to enroll adults who had contracted the coronavirus. We conducted univariate comparisons between those who had developed Long COVID and those who had not, in order to identify particular clusters of symptoms and the underlying factors that contribute to the development of this syndrome.

Results

We conducted an analysis of data collected from 1018 participants residing in Algeria. The average age of the participants was 40 years, and 67.58% of them were female.

Prior to contracting COVID-19, 81.53% of the participants described their health as being excellent. The most common initial symptoms that persisted included exhaustion, fever, headache, loss of taste or smell, cough, aches and pains, sore throat, chest pain, difficulty breathing or shortness of breath, nausea, and diarrhea. As the disease progressed, symptoms such as depression, forgetfulness, white tongue, and palpitations became more common. 18.66% of sparticipants reported having a severe infection, and 36.73% experienced persistent symptoms even after recovery. The ongoing symptoms were broadly grouped into two categories; the majority of the participants exhibited psychiatric, cardiopulmonary, and fatigue symptoms, while the minority group experienced more multisystem symptoms such as gastrointestinal issues. The appearance of these symptoms was associated with several factors such as age, psychological state, severity of the corona infection, chronic diseases, and gender (specifically being female).

Conclusions

This survey aimed to explore the characteristics of Long COVID. Although the sample of participants is not representative of the general population, it sheds light on the diversity of persistent symptoms and the considerable impact of prolonged illness following confirmed or suspected SARS-CoV-2 infection. In order to gain a deeper understanding of this syndrome, extensive and comprehensive research that covers a wide range of factors is necessary.

Data Availability: The survey data is available on request, please email .

Introduction

Coronavirus disease (COVID-19) is a contagious illness caused by the SARS-CoV-2 virus. This virus was first reported in Wuhan, China in December 2019 and has since spread to all countries worldwide. As with all viruses, it multiplies in the host organism and may undergo genetic modifications or mutations, resulting in the emergence of new variants.

Months after infection, some individuals may experience changes in their health condition, including the persistence of somatic symptoms or the onset of new symptoms. These ongoing health problems have been referred to by various terms such as post-COVID-19 syndrome, post-COVID conditions, long COVID-19, and post-acute sequelae of SARS-CoV-2 infection (PASC). However, the definition and diagnosis of long COVID remain unclear as it has been linked to over 200 symptoms, ranging from mild to debilitating, and may last for months or years, with the tendency to reappear.

Estimates of its prevalence vary from 5 to 50%. The aim of this study is to:

Methods

The survey was conducted on Facebook, particularly in groups with over 40,000 individuals who have been affected by Long COVID. We were determined to gather reliable and accurate data. The survey was made available online in Google Forms format and was open for completion for around two months, from July 1st to September 7th, 2022. The survey was solely offered in Arabic since we aimed to collect data from the Arab world, which has been experiencing a lack of accessibility, and the answers were later translated into English.

The social media post provided brief information about the study, eligibility requirements, and a link to the questionnaire. Once the link was clicked, participants were directed to the questions page about Corona. If the individual answered the last question saying that they experienced symptoms after recovery, they were directed to a second page specifically about long-term Corona. By responding “yes” to the consent question, participants gave their consent.

The data is unbiased, credible, and in line with the ROCCC criteria. Personal information was not collected to ensure privacy protection.

Eligibility criteria

The survey was designed to include individuals who were at least 18 years old. To ensure that only eligible participants took part, two screening questions were added to the survey: “What is your age?” and “Did you experience symptoms after recovering from the Corona virus?”.

If a participant answered “no” to the first question, they would not be able to move to the page containing questions about the Corona virus infection. Similarly, if a participant answered “no” to the second question, they would be unable to proceed to the next page of the survey.

The survey aimed to provide an opportunity for individuals with the syndrome to participate in the research and share information about their condition. This was necessary because there is a lack of knowledge about this syndrome in Algeria and few studies have been conducted on it. Many individuals who suffer from the syndrome are often perceived as having mental health issues and may be referred to a psychiatrist.

Questionnaire components

The survey was created in collaboration with individuals who are experiencing Long COVID. The questionnaire was designed to be concise and included essential questions.

The questions covered demographic information, such as age, gender, the wave of Corona that the participant was infected with, the symptoms experienced, severity of infection, their psychological state, whether they smoke, have chronic diseases or cysts, and whether they have symptoms after recovery.

If the participant answered “yes” to the last question, they were directed to the second page, which contained questions about the symptoms of the syndrome they experienced, whether the symptoms disappeared when they resumed their normal activities, psychological state, the tests they underwent, and the results of those tests.

The survey also asked about their vaccination status, exercise routine, and the date of recovery from the syndrome.

Statistical analysis

The data was downloaded from Google Forms and analyzed using statistical tools like QlikSense, RStudio, and Tableau.

To determine Long COVID cases for the analysis, we defined a minimum illness duration of four weeks. We generated graphs to compare the severity of COVID infection based on factors like age, gender, chronic diseases, and psychological status.

Additionally, we compared cases with and without the Long COVID syndrome to identify the factors that contribute to its development.

Clustering

We analyzed symptom clusters based on the symptoms reported in the first two weeks of illness as well as ongoing symptoms. We used bar plots to display the prevalence of symptoms in a specific order and classified them based on the body system they affected, such as the nervous system or respiratory system, to determine which system the virus impacted the most.

Additionally, we examined demographic and social factors associated with persistent symptoms, including age, gender, smoking habits, mental health, chronic diseases, and healthy nutrition with exercising. We also investigated whether vaccination provided protection against Long COVID by creating bar plots that categorized the number of people infected with the syndrome based on whether they were vaccinated before infection, after infection, or not at all.

We further categorized the symptoms as either psychological or physical based on whether they disappeared when ignoring them or practicing daily life and based on the results of medical examinations.

Results

A survey was completed by a total of 1018 participants, revealing that almost 4 out of 10 people (36.73%) had Long COVID syndrome with a median duration of illness between 6 to 12 months.

The mean age of individuals who had contracted COVID-19 was 40 years, with 67.58% of them being female. On the other hand, the median age of individuals with Long COVID was between 21 to 35 years, with 69.36% of them being female.

Previous health

The majority of participants, specifically 81.53%, reported being in good health prior to contracting COVID-19. Whereas only a small proportionn 18.47%, reported having poor health prior to infection and suffering from chronic conditions like asthma, hypertension, hypothyroidism, or Polycystic ovaries.

Course of illness

The initial symptoms that persisted the most were exhaustion (81.1%), fever (68.7%), headache (64.1%), loss of taste or smell (60.6%), cough (49.6%), aches and pains (40.9%), sore throat (40.2%), chest pain (29.7%), difficulty breathing or shortness of breath (26%), nausea (24.3%), and diarrhea (20.9%).

Some participants also reported less common symptoms like red or irritated eyes (8.5%), loss of speech or mobility or confusion (7%), rash on the skin or discoloration of fingers or toes (2.3%), joint pain, numbness, depression, anorexia, reduction of blood pressure, dizziness, insomnia, body weight, unconsciousness, weight loss, and palpitations.

Symptoms like depression, forgetfulness, and palpitations became more prevalent later in the disease.

After recovering from the infection, certain symptoms such as fatigue and headache persisted for an extended duration, and new symptoms emerged that were not present during the infection.

The chart below compares persistent and new symptoms after recovery.

The table below shows the Long COVID symptoms mentioned by the participants.

Hair and skin Sleep Reproductive health
- Hair loss. -Insomnia. - Prostate enlargement.
- Itchy skin.
Pain Circulation Eyes
- Muscle pain. - Bradycardia. - Blurry vision and a fly in both eyes.
- Chest pain. - Chest pain. - Misty eyes and flying flies.
- Pain in the lower legs and a feeling of sharp nails in the legs when stepping on them. - Tachycardia from the simplest effort.
Breathing Ear, nose and throat Mental health and wellbeing
- Almost constant Shortness of breath. - Bad smell and taste of eggs and chicken. -Anorexia.
- Rapid breathing, especially upon exertion. - Cough. - Anxiety.
- Shortness of breath increases in cold weather and decreases in warm weather. - Decreased sense of smell. - Depression.
- Shortness of breath when showering or touching water. - Dry mouth and throat. - Difficulty of focusing.
- Sleep apnea. - Ear pain. - Lack of feeling and knowing the time and place for intermittent periods in the first months.
- Hearing impairment. - Muscle spasms when thinking or focusing.
- Hoarseness. - Obsessive-compulsive disorder.
- Loss of sense of smell or taste. - Tension.
- Parosmia. - Too much forgetfulness.
- Phlegm.
- Smelling a strange smell like cigarettes and burning things that makes breathing becomes too difficult.
- Throat pain.
- White tongue with cracks.
Fatigue Stomach and digestion Other symptoms
- Difficulty walking. - Constipation. - Allergy.
- Exhaustion. - Diarrhea. - Anemia.
- Fatigue in the legs. - GERD. - Arthritis.
- General fatigue. - Nausea. - Bleeding.
- Lack of feeling in the feet and hands and constant numbness. - Stomach and colon dysfunction. - Burning sensation.
- Numbness in the extremities. - Weight loss. - Diabetes.
- Feeling of heaviness in the neck and face when bending over.
- Fever.
- Flatulence.
- High blood sugar level.
- High cholesterol.
- Hypertension.
- Low Blood pressure.
- Low blood sugar level.
- Nerves infection.
- Thyroid hormone changes.
- Vertigo.

The persistent symptoms had a significant impact on the nervous, circulatory, and respiratory systems. According to the participants’ reports, all of them experienced at least one symptom that affected their nervous system.

Additionally, other symptoms affected the musculature (60.97%), respiratory system (36.23%), circulatory system (23.03%), ligamentous apparatus (17.41%), and digestive system (12.07%). The remaining symptoms had a lower percentage.

Factors that affect the severity of COVID-19 infection

A total of 25 symptoms were used to cluster COVID-19 symptoms, while 68 symptoms were used for ongoing symptoms. Several factors contributed to the severity of COVID-19. Through the survey, we identified some of them:

Age:

After analyzing the data, we found out that 24% to 53% of young people are more likely to have a mild to moderate infection, while only 19% of them experience severe symptoms. In contrast, only 10% of the elderly experience mild symptoms, and their average severity of infection is up to 24%.

Having chronic diseases

Chronic diseases increase the severity of symptoms when infected with the virus. When comparing the severity of infection between people with chronic diseases and those without, we found out that 27.65% of individuals with chronic conditions such as asthma, hypothyroidism, PCOS, heart disease, etc., 27.68% experienced a severe infection, while 48.40% experienced moderate symptoms.

Psychological state

Comparing the severity of COVID-19 infection with the psychological state of individuals revealed that 53.98% of those with good psychological health experienced mild symptoms, and only 8.89% with severe infection.

However, only 9.22% of those with bad psychological health experienced mild symptoms, and up to 42.71% with severe infection.

Factors Contributing to Long COVID Syndrome

There are several factors that contribute to 36.73% of people experiencing Long COVID. The findings indicate that anyone can develop Long COVID, regardless of the severity of their initial infection. However, the chances of developing it increase with the severity of the infection, with estimates of 17.43% for mild, 39.92% for moderate, and 61.57% for severe cases. Consequently, the more severe the infection, the more likely it is that symptoms will persist after recovery.

When comparing the number of people who developed Long COVID in relation to chronic diseases, psychological health, and gender, we found out that 24.33% of those with Long COVID had chronic conditions such as asthma, hypertension, polycystic ovaries, and hypothyroidism. Additionally, 77% had bad or rather bad psychological health, and 74.86% were female.

Medical examinations such as ECG, brain MRI, chest x-ray, gastrointestinal examinations, and blood tests were performed on 73.79% % of the patients, with 69.52% of the results indicating no abnormalities. However, 30.47% of the results confirmed the existence of conditions such as POTS syndrome, spots in the lungs, lung defects, pericardial effusion, severe iron deficiency, ulcers, IBS, gallstones, polyps, diabetes, and cholesterol.

Discussion

The results of the survey show that Long Covid is a serious illness that affects multiple systems in the body for a significant number of people who have contracted it. Various factors contribute to the development of this syndrome. One of the key factors is the severity of the original COVID-19 infection. There is a clear correlation between the severity of the infection and the likelihood of experiencing Long Covid. The survey estimates that the incidence of Long Covid is around 17.43% for those with mild infections and 61.57% for those with severe infections. This means that the more severe the original infection was, the more likely it is that the symptoms of Long Covid will persist even after recovery.

Regarding chronic diseases, the survey results indicate that 79.12% of people with chronic conditions such as asthma, hypothyroidism, PCOS, and heart disease, who had Long Covid, had moderate to severe infections. This means that individuals with chronic diseases are more susceptible to Long Covid, particularly if their psychological state is poor, as this may prolong the symptoms’ duration.

It’s important to note that not all chronic diseases cause this syndrome. Only a few persons with diabetes reported having Long Covid, and several studies have shown that diabetes does not cause this syndrome. However, having diabetes with another chronic condition may increase the risk of developing Long Covid.

The survey results also indicate that asthma, hypertension, polycystic ovaries, and hypothyroidism are the most common chronic diseases that cause this syndrome.

The psychological condition of individuals during their Long Covid infection affects the severity of symptoms and the time it takes to recover. The survey results revealed that individuals who had poor mental health during their COVID-19 infection were more likely to experience Long Covid. In addition, those with worse psychological states had longer-lasting symptoms, with some lasting for two years or more.

Gender also appears to be a factor in Long Covid. According to the survey, 40.69% of female participants reported suffering from the syndrome, while only 28.48% of male participants reported suffering from it. Women may be more susceptible to infection than men due to differences in immunity and body structure. However, the exact causes are not yet known, and one possibility is that the higher incidence of semi-chronic diseases such as Polycystic ovaries in women may play a role.

The nature of Long Covid syndrome’s symptoms

Out of the participants who developed Long COVID, 73.79% underwent medical examinations such as ECG, brain MRI, chest x-ray, gastrointestinal examination, and blood tests. Of these examinations, 69.52% showed no abnormalities, while 30.47% revealed various conditions such as Pots syndrome, spots in the lungs, lung defects, pericardial effusion, severe iron deficiency, ulcers, IBS, calculi biliaires, polyps, diabetes, and cholesterol.

For 76.81% of participants, their symptoms did not decrease or disappear when they engaged in daily activities or tried to distract themselves, this means that not all cases of Long COVID are psychological in nature. The severity of their symptoms remained constant, increased in cold weather, and decreased in high temperature.

Moreover, 79.94% of participants reported that their symptoms worsened when their psychological state deteriorated, such as in cases of anger or tension. This suggests that psychological state can influence the severity of symptoms, but it does not necessarily mean that all symptoms are psychological in nature.

Conclusions

Long COVID is a debilitating illness that affects multiple body systems and is linked to age, gender, the severity of COVID-19 infection, chronic diseases, and psychological health. The symptoms can be both physical and psychological.

The duration of recovery from the symptoms is dependent on the underlying factors causing them. While some symptoms may subside within three months, others may persist for two years or more.

To prevent or quickly recover from the symptoms of Long COVID, the following measures are recommended:

Limitations

This survey was conducted through social media and is non-representative, meaning that the sample was not randomly drawn from the population of interest and therefore cannot be used to determine the prevalence of Long COVID in the wider population. The survey was kept brief and accurate to ensure reliable responses.

The sampling method used was appropriate for non-probability sampling, and the participants were primarily female and from Algeria. As a result, the findings cannot be generalized to other populations or groups that were not represented in the survey.

It is also possible that there are individuals who are infected with COVID-19 and experiencing symptoms of Long COVID but are unaware of it or attribute their symptoms to psychological factors. Further research is needed to gain a better understanding of this syndrome.

Acknowledgments

We would like to express our gratitude to all the participants who took the time to complete the survey and provided us with valuable insights. We also extend our heartfelt thanks to those who helped us publish the survey and ensured that the responses were accurate.