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Preplanned Studies: The Long-Term Impacts of COVID-19 on Physical and Psychological Health — Beijing Municipality, China, December 2022–April 2023

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  • Summary

    What is already known about this topic?

    Reports detailing the clinical presentation of coronavirus disease 2019 (COVID-19) are extensive in China. However, data remains limited regarding the long-term effects of the 2022 outbreak on the community and healthcare workers (HCWs).

    What is added by this report?

    In the follow-up study conducted with 1,069 community members and 3,309 HCWs infected with COVID-19, we observed that five months post-outbreak, 39.2% of community members and 28.7% of HCWs reported experiencing at least one symptom. The symptoms most frequently reported included fatigue or muscle weakness, insomnia, cognitive dysfunction, hair loss, joint or muscle pain, and persistent cough. HCWs tended to experience fewer long-term physical consequences and their symptoms had an expedited recovery time compared to the community members. Nevertheless, HCWs displayed a higher prevalence of moderate to severe depression and anxiety.

    What are the implications for public health practice?

    The establishment of a public healthcare system dedicated to continual monitoring, prevention, and clinical treatment of persistent COVID-19 symptoms is imperative.

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  • Funding: This study was funded by National Natural Science Foundation of China (82288102), and Chinese Academy of Engineering (2022-XBZD-16)
  • [1] Leung K, Lau EHY, Wong CKH, Leung GM, Wu JT. Estimating the transmission dynamics of SARS-CoV-2 Omicron BF.7 in Beijing after adjustment of the zero-COVID policy in November–December 2022. Nat Med 2023;29(3):579-82. http://dx.doi.org/10.1038/S41591-023-02212-Y.http://dx.doi.org/10.1038/S41591-023-02212-Y
    [2] Srikanth S, Boulos JR, Dover T, Boccuto L, Dean D. Identification and diagnosis of long COVID-19: a scoping review. Prog Biophys Mol Biol 2023;182:1 − 7. http://dx.doi.org/10.1016/j.pbiomolbio.2023.04.008CrossRef
    [3] Shabnam S, Razieh C, Dambha-Miller H, Yates T, Gillies C, Chudasama YV, et al. Socioeconomic inequalities of long COVID: a retrospective population-based cohort study in the United Kingdom. J Roy Soc Med 2023;116(8):263 − 73. http://dx.doi.org/10.1177/01410768231168377CrossRef
    [4] Zhao YM, Shi L, Jiang ZD, Zeng N, Mei H, Lu Y, et al. The phenotype and prediction of long-term physical, mental and cognitive COVID-19 sequelae 20 months after recovery, a community-based cohort study in China. Mol Psychiatry 2023;28(4):1793 − 801. http://dx.doi.org/10.1038/s41380-023-01951-1CrossRef
    [5] Zhang CM, Guo T, Zhang L, Gu AQ, Ye J, Lin M, et al. The infection of healthcare workers and the reinfection of patients by omicron variant — Jiangsu Province, China, December 2022 to January 2023. China CDC Wkly 2023;5(18):402 − 6. http://dx.doi.org/10.46234/ccdcw2023.074CrossRef
    [6] Wanga V, Chevinsky JR, Dimitrov LV, Gerdes ME, Whitfield GP, Bonacci RA, et al. Long-term symptoms among adults tested for SARS-CoV-2 — United States, January 2020–April 2021. MMWR Morb Mortal Wkly Rep 2021;70(36):1235 − 41. http://dx.doi.org/10.15585/mmwr.mm7036a1CrossRef
    [7] Raveendran AV. Long COVID-19: challenges in the diagnosis and proposed diagnostic criteria. Diabetes Metab Syndr: Chin Res Rev 2021;15(1):145 − 6. http://dx.doi.org/10.1016/j.dsx.2020.12.025CrossRef
    [8] Cabrera Martimbianco AL, Pacheco RL, Bagattini ÂM, Riera R. Frequency, signs and symptoms, and criteria adopted for long COVID-19: a systematic review. Int J Clin Pract 2021;75(10):e14357. http://dx.doi.org/10.1111/IJCP.14357CrossRef
    [9] Huang CL, Huang LX, Wang YM, Li X, Ren LL, Gu XY, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2023;401(10393):e21 − 33. http://dx.doi.org/10.1016/S0140-6736(23)00810-3CrossRef
    [10] Long COVID or post-COVID conditions. 2023. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/. [2023-07-28].https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/
  • FIGURE 1.  Duration of recovery for the community population and HCWs — Beijing Municipality, China, December 2022–April 2023. (A) The overall recovery duration among HCWs and the general population. (B) The median recovery duration for each symptom was also determined.

    Note: The adjusted P-value was calculated using Cox regression, taking into account confounding variables such as age, gender distribution, history of any disease, and vaccination status. Recovery time, measured in days, was compared between these groups using Kaplan-Meier analysis in panel A.

    Abbreviation: HCWs=healthcare workers; IQR=interquartile range.

    FIGURE 2.  Comparison of psychological consequences among the general population and HCWs during the first and second follow-up periods — Beijing Municipality, China, December 2022–April 2023.

    Note: The scores for stress, depression, and anxiety from both groups were evaluated at the first and second follow-ups and are represented as points in the associated figure. Furthermore, the prevalence of moderate to severe stress, depression, and anxiety in the observed sample was computed and illustrated as bars in the same figure. The comparative analysis between the community and HCW cohorts was executed using log-binomial regression. Potential confounders, which include age, gender proportions, medical history, and vaccination status, were accounted for in the analysis. It should be noted that “1ST” and “2ND” refer to the initial and subsequent follow-ups, respectively.

    Abbreviation: HCWs=healthcare workers; ad-P=adjusted-P.

    TABLE 1.  Basic demographic characteristics of the community population and HCWs — Beijing Municipality, China, December 2022–April 2023.

    Characteristics of participantsCommunity (N=1,069)HCW (N=3,309)P
    Age (mean±SD)41.67±17.4337.40±9.800.003
    Gender, n (%)
    Male388 (36.3)903 (27.3)<0.001
    Female681 (63.7)2,406 (72.7)
    History of disease, n (%)
    Hypertension175 (16.4)273 (8.3)<0.001
    Diabetes88 (8.2)109 (3.3)<0.001
    Hyperlipidemia142 (13.3)305 (9.2)<0.001
    Respiratory disease47 (4.4)76 (2.3)<0.001
    Cardiovascular disease55 (5.1)16 (0.5)<0.001
    Kidney disease12 (1.1)26 (0.8)0.302
    Digestive system diseases56 (5.2)90 (2.7)<0.001
    Immune system diseases10 (0.9)38 (1.1)0.561
    Reproductive system diseases44 (4.1)121 (3.7)0.493
    Any396 (37.0)845 (25.5)<0.001
    Vaccination, n (%)
    Inactivated vaccine952 (89.1)2,922 (88.3)0.504
    Adenovirus injection vaccine32 (3.0)1,281 (38.7)<0.001
    Adenovirus inhalation vaccine18 (1.7)165 (5.0)<0.001
    mRNA vaccine3 (0.3)192 (5.8)<0.001
    Recombinant protein vaccine10 (0.9)187 (5.7)<0.001
    Any990 (92.6)3,171 (95.8)<0.001
    Abbreviation: SD=standard deviation; HCW=healthcare worker.
    Download: CSV

    TABLE 2.  Acute and chronic symptoms reported at each follow-up among the community population and HCWs — Beijing Municipality, China, December 2022–April 2023, n (%).

    SymptomsAcute symptomsFirst follow-upSecond follow-up
    CommunityHCWPCommunityHCWPCommunityHCWP
    (N=1,069)(N=3,309)N=1,069(N=3,309)(N=1,069)(N=3,309)
    Anyone of the following symptoms
     No50 (4.7)99 (3.0)0.011580 (54.3)1,953 (59.0)<0.001650 (60.8)2,359 (71.3)<0.001
     Yes1,019 (95.3)3,210 (97.0)489 (45.7)1,134 (34.3)419 (39.2)950 (28.7)
    Fatigue/tired or weakness716 (67.0)2,555 (77.2)<0.001308 (28.8)744 (22.5)<0.001205 (19.2)603 (18.2)0.513
    Smell disorder306 (28.6)1,267 (38.3)<0.00151 (4.8)94 (2.8)<0.00129 (2.7)73 (2.2)0.402
    Hypogeusia345 (32.3)1,372 (41.5)<0.00151 (4.8)73 (2.2)<0.00131 (2.9)62 (1.9)0.057
    Shortness of breath or breathlessness162 (15.2)734 (22.2)<0.00137 (3.5)106 (3.2)<0.00141 (3.8)77 (2.3)0.011
    Cough645 (60.3)2,679 (81.0)<0.001107 (10.0)218 (6.6)<0.00155 (5.1)165 (5.0)0.900
    Headache384 (35.9)1,529 (46.2)<0.00149 (4.6)129 (3.9)<0.00137 (3.5)109 (3.3)0.868
    Problems sleeping280 (26.2)1,099 (33.2)<0.001123 (11.5)351 (10.6)<0.001107 (10.0)256 (7.7)0.023
    Joint or muscle pain498 (46.6)1,886 (57.0)<0.00178 (7.3)170 (5.1)<0.00154 (5.1)147 (4.4)0.457
    Cognitive dysfunction261 (24.4)1,095 (33.1)<0.001109 (10.2)409 (12.4)<0.00196 (9.0)313 (9.5)0.684
    Chest pain153 (14.3)671 (20.3)<0.00136 (3.4)99 (3.0)<0.00140 (3.7)81 (2.4)0.033
    Change in mood80 (7.5)373 (11.3)0.00129 (2.7)107 (3.2)<0.00133 (3.1)103 (3.1)>0.999
    Decreased interest98 (9.2)424 (12.8)0.00227 (2.5)96 (2.9)<0.00126 (2.4)84 (2.5)0.936
    Stomach pain110 (10.3)473 (14.3)0.00131 (2.9)77 (2.3)<0.00140 (3.7)63 (1.9)0.001
    Hair loss103 (9.6)415 (12.5)0.01245 (4.2)215 (6.5)<0.00161 (5.7)201 (6.1)0.714
    Diarrhea111 (10.4)612 (18.5)<0.00116 (1.5)38 (1.1)<0.00113 (1.2)37 (1.1)0.923
    Sore throat394 (36.9)1,888 (57.1)<0.00153 (5.0)132 (4.0)<0.00141 (3.8)116 (3.5)0.682
    Fever596 (55.8)2,252 (68.1)<0.00126 (2.4)66 (2.0)<0.00110 (0.9)50 (1.5)0.209
    Chilliness225 (21.0)1,105 (33.4)<0.00130 (2.8)61 (1.8)<0.00130 (2.8)51 (1.5)0.011
    Palpitations172 (16.1)829 (25.1)<0.00153 (5.0)212 (6.4)<0.00141 (3.8)139 (4.2)0.664
    Nausea/vomiting104 (9.7)506 (15.3)<0.00113 (1.2)26 (0.8)<0.0019 (0.8)26 (0.8)>0.999
    Postexertional malaise117 (10.9)775 (23.4)<0.00152 (4.9)180 (5.4)<0.00145 (4.2)130 (3.9)0.751
    Abbreviation: HCW=healthcare worker.
    Download: CSV

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The Long-Term Impacts of COVID-19 on Physical and Psychological Health — Beijing Municipality, China, December 2022–April 2023

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Summary

What is already known about this topic?

Reports detailing the clinical presentation of coronavirus disease 2019 (COVID-19) are extensive in China. However, data remains limited regarding the long-term effects of the 2022 outbreak on the community and healthcare workers (HCWs).

What is added by this report?

In the follow-up study conducted with 1,069 community members and 3,309 HCWs infected with COVID-19, we observed that five months post-outbreak, 39.2% of community members and 28.7% of HCWs reported experiencing at least one symptom. The symptoms most frequently reported included fatigue or muscle weakness, insomnia, cognitive dysfunction, hair loss, joint or muscle pain, and persistent cough. HCWs tended to experience fewer long-term physical consequences and their symptoms had an expedited recovery time compared to the community members. Nevertheless, HCWs displayed a higher prevalence of moderate to severe depression and anxiety.

What are the implications for public health practice?

The establishment of a public healthcare system dedicated to continual monitoring, prevention, and clinical treatment of persistent COVID-19 symptoms is imperative.

  • 1. Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
  • 2. State Key Laboratory of Female Fertility Promotion, Beijing, China
  • 3. National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
  • 4. Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
  • 5. Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
  • 6. Personnel Department, Peking University Third Hospital, Beijing, China
  • 7. Office of Hospital Management, Peking University Health Science Center, Beijing, China
  • 8. The Second Outpatient Department of Peking University Third Hospital, Beijing, China
  • 9. Capital Airport sub-district DongPingLi Community Health Center, Beijing, China
  • 10. Zizhuyuan Community Service Station in Haidian District, Beijing, China
  • 11. Beijing Advanced Innovation Center for Genomics, Beijing, China
  • 12. Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
  • Corresponding authors:

    Huiqing Wang, w_huiqing@sina.com

    Yuanyuan Wang, yyuanwang@163.com

    Jie Qiao, jie.qiao@263.net

  • Funding: This study was funded by National Natural Science Foundation of China (82288102), and Chinese Academy of Engineering (2022-XBZD-16)
  • Online Date: October 06 2023
    Issue Date: October 06 2023
    doi: 10.46234/ccdcw2023.170
  • Following the relaxation of lockdown measures in China on November 11, 2022, there was a rapid uptick in coronavirus disease 2019 (COVID-19) cases from November to December 2022. By January 31, 2023, Beijing observed a cumulative infection rate of 92.3% (1). The urgent necessity now pertains to the evaluation of the short-term and long-term impacts of COVID-19 on the Chinese population. Long COVID-19, classified by the World Health Organization (WHO) as the persistence of symptoms for 12 weeks post-infection, is alarming in various countries (2). However, it remains inadequately explored in China’s context, especially pertaining to the 2022 outbreak (3). Beyond the physical implications, the psychological ramifications of COVID-19 are increasingly concerning. Factors such as the stress associated with medical care, extensive hospital stays, social isolation, and stigma substantially contribute to prolonged mental health issues, including depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) (4). Furthermore, research accentuates the varying duration and severity of COVID-19 symptoms across different populations. Healthcare workers (HCWs) appear to be particularly susceptible (5). Thus, this research aims to conduct a comprehensive examination of the long-term physical and psychological symptoms among the community and HCWs, aiming to enhance epidemic prevention policies and health care support in the post-COVID-19 era.

    In this research, two cohorts were established in January 2023: a HCW cohort comprised of 6,237 participants from Peking University Third Hospital (PUTH), a tertiary institution in Beijing Municipality, and a community-based cohort with 2,011 participants. The latter was enlisted from four Beijing communities, including 528 civilians from PUTH’s Second Outpatient Department in the Haidian District, 574 from the Dongpingli Community in the Chaoyang District, 360 from the Zizhuyuan Community in the Haidian District, and 549 teachers and students associated with Peking University Health Science Center. A digital survey was employed to collect participants’ demographics and COVID-19 infection details such as infection date, onset symptoms within two weeks, duration of symptoms, treatment received, and vaccination status (68). Infection was diagnosed based on a positive result from either an antigen test or a nucleic acid test. Two follow-up periods were conducted: the first from March 1 to 10, 2023 (approximately three months post-outbreak), and the second from April 20 to 30, 2023 (roughly five months post-outbreak). During each follow-up, participants filled out an online questionnaire, detailing symptoms they experienced within the preceding week and the duration of symptoms. Furthermore, the Depression Anxiety and Stress Scale (DASS-21) was utilized to evaluate participants’ mental health condition. By the end of the study, 4,229 HCWs and 1,287 community members had successfully completed the entire process, of which 3,309 HCWs and 1,069 community individuals, who had contracted the virus, were included in the final analysis.

    The statistical analysis was executed with the use of R software (version 4.1.0, R core team, Vienna, Austria). We represent qualitative data as frequencies (percentages), which have been compared via the chi-square test or Fisher’s exact test. The measurement of recovery time was conducted in days and juxtaposed between groups utilizing Kaplan-Meier analysis. To control for potential confounders, such as age, sex, history of illness, and vaccination status, Cox regression analysis was carried out. The DASS-21 was deployed to compute scores for stress, depression, and anxiety, which were then compared between groups using the Mann-Whitney nonparametric test. Log-binomial regression was additionally used to control confounders. A P-value of less than 0.05 was deemed statistically significant.

    Among 4,229 HCWs, 3,309 (78.2%) were infected with COVID-19. Within the broader community sample of 1,287 individuals, 1,069 (83.1%) were infected (Table 1). The average ages for the infected persons were 37.4±9.8 years for HCWs, and 41.7±17.4 years for the community cohort, respectively. Preexisting medical conditions were reported in 25.5% of the HCWs and 37.0% of the community cohort. Regarding COVID-19 vaccination, 95.8% of HCWs and 92.6% of the community cohort had received the vaccine. Furthermore, 38.7% of HCWs had been administered the adenovirus-based vaccine.

    Characteristics of participantsCommunity (N=1,069)HCW (N=3,309)P
    Age (mean±SD)41.67±17.4337.40±9.800.003
    Gender, n (%)
    Male388 (36.3)903 (27.3)<0.001
    Female681 (63.7)2,406 (72.7)
    History of disease, n (%)
    Hypertension175 (16.4)273 (8.3)<0.001
    Diabetes88 (8.2)109 (3.3)<0.001
    Hyperlipidemia142 (13.3)305 (9.2)<0.001
    Respiratory disease47 (4.4)76 (2.3)<0.001
    Cardiovascular disease55 (5.1)16 (0.5)<0.001
    Kidney disease12 (1.1)26 (0.8)0.302
    Digestive system diseases56 (5.2)90 (2.7)<0.001
    Immune system diseases10 (0.9)38 (1.1)0.561
    Reproductive system diseases44 (4.1)121 (3.7)0.493
    Any396 (37.0)845 (25.5)<0.001
    Vaccination, n (%)
    Inactivated vaccine952 (89.1)2,922 (88.3)0.504
    Adenovirus injection vaccine32 (3.0)1,281 (38.7)<0.001
    Adenovirus inhalation vaccine18 (1.7)165 (5.0)<0.001
    mRNA vaccine3 (0.3)192 (5.8)<0.001
    Recombinant protein vaccine10 (0.9)187 (5.7)<0.001
    Any990 (92.6)3,171 (95.8)<0.001
    Abbreviation: SD=standard deviation; HCW=healthcare worker.

    Table 1.  Basic demographic characteristics of the community population and HCWs — Beijing Municipality, China, December 2022–April 2023.

    As depicted in Table 2, a significant majority of both the community population (95.3%) and HCWs (97.0%) reported experiencing at least one acute symptom. Interestingly, HCWs exhibited higher rates of acute symptoms as compared to the community population overall. A notable decrease in symptom occurrence was observed between the first and second follow-ups: by the 3-month mark, 54.3% of the community population and 59.0% of HCWs reported an absence of symptoms. This increased to 60.8% and 71.3% respectively, five months post COVID-19 infection. At the final follow-up session, the most frequently reported symptoms among both groups were fatigue or weakness (19.2% community vs. 18.2% HCWs), sleep disruptions (10.0% vs. 7.7%), cognitive dysfunction (9.0% vs. 9.5%), hair loss (5.7% vs. 6.1%), musculoskeletal discomfort (5.1% vs. 4.4%), and persistent cough (5.1% vs. 5.0%). Interestingly, five months post COVID-19 onset, HCWs had a lower symptom prevalence compared to the community population, with the exceptions of cognitive dysfunction and diminished interest.

    SymptomsAcute symptomsFirst follow-upSecond follow-up
    CommunityHCWPCommunityHCWPCommunityHCWP
    (N=1,069)(N=3,309)N=1,069(N=3,309)(N=1,069)(N=3,309)
    Anyone of the following symptoms
     No50 (4.7)99 (3.0)0.011580 (54.3)1,953 (59.0)<0.001650 (60.8)2,359 (71.3)<0.001
     Yes1,019 (95.3)3,210 (97.0)489 (45.7)1,134 (34.3)419 (39.2)950 (28.7)
    Fatigue/tired or weakness716 (67.0)2,555 (77.2)<0.001308 (28.8)744 (22.5)<0.001205 (19.2)603 (18.2)0.513
    Smell disorder306 (28.6)1,267 (38.3)<0.00151 (4.8)94 (2.8)<0.00129 (2.7)73 (2.2)0.402
    Hypogeusia345 (32.3)1,372 (41.5)<0.00151 (4.8)73 (2.2)<0.00131 (2.9)62 (1.9)0.057
    Shortness of breath or breathlessness162 (15.2)734 (22.2)<0.00137 (3.5)106 (3.2)<0.00141 (3.8)77 (2.3)0.011
    Cough645 (60.3)2,679 (81.0)<0.001107 (10.0)218 (6.6)<0.00155 (5.1)165 (5.0)0.900
    Headache384 (35.9)1,529 (46.2)<0.00149 (4.6)129 (3.9)<0.00137 (3.5)109 (3.3)0.868
    Problems sleeping280 (26.2)1,099 (33.2)<0.001123 (11.5)351 (10.6)<0.001107 (10.0)256 (7.7)0.023
    Joint or muscle pain498 (46.6)1,886 (57.0)<0.00178 (7.3)170 (5.1)<0.00154 (5.1)147 (4.4)0.457
    Cognitive dysfunction261 (24.4)1,095 (33.1)<0.001109 (10.2)409 (12.4)<0.00196 (9.0)313 (9.5)0.684
    Chest pain153 (14.3)671 (20.3)<0.00136 (3.4)99 (3.0)<0.00140 (3.7)81 (2.4)0.033
    Change in mood80 (7.5)373 (11.3)0.00129 (2.7)107 (3.2)<0.00133 (3.1)103 (3.1)>0.999
    Decreased interest98 (9.2)424 (12.8)0.00227 (2.5)96 (2.9)<0.00126 (2.4)84 (2.5)0.936
    Stomach pain110 (10.3)473 (14.3)0.00131 (2.9)77 (2.3)<0.00140 (3.7)63 (1.9)0.001
    Hair loss103 (9.6)415 (12.5)0.01245 (4.2)215 (6.5)<0.00161 (5.7)201 (6.1)0.714
    Diarrhea111 (10.4)612 (18.5)<0.00116 (1.5)38 (1.1)<0.00113 (1.2)37 (1.1)0.923
    Sore throat394 (36.9)1,888 (57.1)<0.00153 (5.0)132 (4.0)<0.00141 (3.8)116 (3.5)0.682
    Fever596 (55.8)2,252 (68.1)<0.00126 (2.4)66 (2.0)<0.00110 (0.9)50 (1.5)0.209
    Chilliness225 (21.0)1,105 (33.4)<0.00130 (2.8)61 (1.8)<0.00130 (2.8)51 (1.5)0.011
    Palpitations172 (16.1)829 (25.1)<0.00153 (5.0)212 (6.4)<0.00141 (3.8)139 (4.2)0.664
    Nausea/vomiting104 (9.7)506 (15.3)<0.00113 (1.2)26 (0.8)<0.0019 (0.8)26 (0.8)>0.999
    Postexertional malaise117 (10.9)775 (23.4)<0.00152 (4.9)180 (5.4)<0.00145 (4.2)130 (3.9)0.751
    Abbreviation: HCW=healthcare worker.

    Table 2.  Acute and chronic symptoms reported at each follow-up among the community population and HCWs — Beijing Municipality, China, December 2022–April 2023, n (%).

    Figure 1 demonstrates that among HCWs, the median recovery period amounted to 41 days. This duration is notably shorter than the median recovery span of 62 days observed within the broader community. The latter group reported prolonged recovery times relating to symptoms such as breathlessness, cognitive dysfunction, chest discomfort, reduced interest, hair loss, and palpitations, with the median recovery terms being equal to or surpassing 60 days. Conversely, HCWs exhibited prolonged symptoms such as reduced interest, hair loss, mood changes, palpitations, breathlessness, and chest discomfort. It’s worth noting that, except for mood changes that took longer to resolve, HCWs generally reported faster symptom resolution in comparison to the community cohort.

    Figure 1. 

    Duration of recovery for the community population and HCWs — Beijing Municipality, China, December 2022–April 2023. (A) The overall recovery duration among HCWs and the general population. (B) The median recovery duration for each symptom was also determined.

    Note: The adjusted P-value was calculated using Cox regression, taking into account confounding variables such as age, gender distribution, history of any disease, and vaccination status. Recovery time, measured in days, was compared between these groups using Kaplan-Meier analysis in panel A.

    Abbreviation: HCWs=healthcare workers; IQR=interquartile range.

    Psychological symptom scores, including those indicating stress, depression, and anxiety, demonstrated a decreasing trend following infection with COVID-19. Importantly, during the final follow-up, both the numerical scores and the percentage of individuals displaying moderate to severe depression (15.5% vs. 9.4%, adjusted P<0.001) and anxiety (21.7% vs. 17.4%, adjusted P=0.025) were observably greater among HCWs compared to the general population (Figure 2).

    Figure 2. 

    Comparison of psychological consequences among the general population and HCWs during the first and second follow-up periods — Beijing Municipality, China, December 2022–April 2023.

    Note: The scores for stress, depression, and anxiety from both groups were evaluated at the first and second follow-ups and are represented as points in the associated figure. Furthermore, the prevalence of moderate to severe stress, depression, and anxiety in the observed sample was computed and illustrated as bars in the same figure. The comparative analysis between the community and HCW cohorts was executed using log-binomial regression. Potential confounders, which include age, gender proportions, medical history, and vaccination status, were accounted for in the analysis. It should be noted that “1ST” and “2ND” refer to the initial and subsequent follow-ups, respectively.

    Abbreviation: HCWs=healthcare workers; ad-P=adjusted-P.

  • In December 2022, China revamped its policies on epidemic prevention and control due to a peak in a COVID-19 outbreak. “Long COVID-19” is rising as a significant public health crisis. Subsequently, a cohort of HCWs and a separate cohort representative of the general community were established and tracked in Beijing from November 2022 through April 2023. The research findings showed that five months post-outbreak, 39.2% of the general community and 28.7% of HCWs experienced at least one symptom. Furthermore, the median recovery durations documented were 62 days for HCWs and 41 days for the general community, respectively.

    The present study has unveiled common enduring physical symptoms amongst COVID-19 patients, which include fatigue or weakness, insomnia, cognitive impairment, alopecia, musculoskeletal pain, and a persistent cough. Similar observations have emerged from numerous studies conducted in various Chinese metropolises such as Shanghai, Beijing, and Guangzhou, where fatigue, a lingering cough, cognitive focus challenges, and anxiety have been identified as chronic symptoms (4,9). Additionally, the CDC’s findings from the USA corroborate this data, noting that long-haul COVID patients typically report fatigue, cognitive difficulties, sleep disturbances, alterations in olfaction or taste, depression or anxiety, as well as digestive and other systemic symptoms (10). Such unanimous findings indicate the urgency of creating a comprehensive public health infrastructure for the continuous monitoring, prevention, and treatment of prolonged manifestations of COVID-19. Special emphasis must be placed on strategic interventions for symptoms like dyspnea, cognitive impairment, thoracic pain, mood alterations, hair loss, and sleep disorders, owing to their stubbornly prolonged recovery periods. Such endeavors will serve to augment the well-being and health outcomes of those affected by COVID-19.

    HCWs face an elevated risk of contracting COVID-19 because of their constant, close contact with potentially infected individuals or critically ill patients within healthcare settings (5). Our study identified a higher prevalence of acute symptoms at the onset of COVID-19 among HCWs compared to the general population. Remarkably, HCWs demonstrated lower rates of long-term symptoms and a shorter recovery period. This phenomenon may be attributed to HCWs’ comprehensive understanding of the disease and their convenient access to medical support.

    COVID-19 patients may endure various psychological issues due to multiple factors such as the viral infection’s direct effects, corticosteroid therapy, social isolation, and stigma. Around five months following the onset of COVID-19, an estimated 21.7% of HCWs and 17.4% of the general population reported suffering from moderate to severe anxiety. Additionally, 15.8% of HCWs and 9.4% of community members experienced depression, underscoring the necessity for heightened concern for the mental health of individuals afflicted with COVID-19. Depression and anxiety scores were noticeably higher among HCWs when compared to the general population. Literature consistently indicates that HCWs bear a higher risk of psychological distress during the COVID-19 pandemic, derived from the heavy workload and the exposure to patient suffering. Our research underscores the pressing need to prioritize the mental well-being of hospital HCWs and establish initiatives to safeguard their well-being both in the present and moving forward.

    This study bears certain constraints that warrant acknowledgement. First, the HCW cohort is sourced from a singular facility in a Chinese tertiary hospital, positioning the study’s representations of all HCWs in China as potentially incomplete. Additional research in hospitals varying in both size and location is necessitated. Second, this research gathered symptoms and recovery period data through self-reported online questionnaires, inherently exposing the study to potential ascertainment bias due to individual recall processes and judgment. Finally, the focus of our study was to primarily provide a comprehensive review of the long-term effects on both the community population and HCWs. Consequently, these distinct groups may carry inherent differences, and as such, some potential confounding factors may not be adequately considered in comparing community and hospital-based participants.

    This research represents a concurrent evaluation of two cohorts with the broadest period of follow-up subsequent to the most substantial and recent outbreak of COVID-19 in China. The data suggests that among recovered COVID-19 patients, prevalent symptoms include fatigue or muscle weakness, sleep difficulties, and psychological complications. Notably, while HCWs initially presented with a higher prevalence of acute symptoms, their physical symptom recovery trajectory surpassed that of the general community population. However, HCWs experienced significant psychological distress. The findings from our comprehensive study offer critical insights into future directions for improving long-term healthcare system development in the context of the post-COVID-19 pandemic era.

  • No conflicts of interest.

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