Post-COVID-19 syndrome characteristics and risk factors:

Background,

There hasn’t been much research on the post-COVID syndrome (PCS) in low- and middle-income nations. We evaluated PCS prevalence, incidence rate, temporal evolution, and risk variables among COVID-19 survivors who were hospitalized (HS) and non-hospitalized (NHS).

Methods
At months 1, 3, and 5 following discharge from isolation, we conducted a prospective longitudinal study of COVID-19 survivors. Between December 2020 and October 2021, the study was carried out in two hospitals in Dhaka, Bangladesh, that were designated under COVID-19.

Findings
The trial included 362 people, and the median interval from the start of COVID-19 until enrollment was 57 days (IQR 41, 82). After taking into account potential confounders, it was found that, at enrollment, the HS were more likely than the non-hospitalized group to have one or more symptoms, peripheral neuropathy (PN), depression, anxiety disorder, poor quality of life, dyspnea, tachycardia, restrictive lung disease on spirometry, anemia, proteinuria, and the need for insulin therapy (95% CI > 1 for all). Although the majority of these results drastically changed over time in HS, PN changed in both groups. Diabetes had an incidence of 9.8/1000 person-months, and more HS patients than NHS patients now needed insulin therapy (a OR, 6.71; 95% CI, 2.87, 15.67). age, gender, comorbidities, smoking, hospitalization, and older age PCS was independently linked to and contact with COVID-19 patients.

Introduction:

Over six million people have died as a result of the novel coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease has proven to be the biggest challenge for public health services globally. To achieve herd immunity and control this pandemic threat, safe and effective SARS-CoV-2 vaccines with rapid vaccination coverage are needed. In February 2021, Pakistan launched its immunization campaign, immunizing seniors 70 and over as the second category after frontline healthcare professionals. The COVID-19 virus had a greater detrimental effect on people with comorbid conditions. Comorbidities increase both the chance of death and the severity of symptoms related to COVID-19, and this assertion has been verified by earlier published studies. The bulk of COVID-19-related deaths in patients with any comorbidity were reported to have happened previously by Guan et al. in China . “Multimorbidity” is the term used to describe the coexistence of multiple chronic health conditions. Multimorbidities increase the probability of hospitalization, according to numerous studies. According to a study done in a Scottish hospital, people with multimorbidities typically had poor COVID-19 prognoses or the worst clinical outcomes.

COVID-19 vaccines are essential for patients with chronic medical conditions in order to avoid severe COVID-19 infection and lower COVID-19-related hospitalizations. As a result, patients with severe comorbidities and immunocompromised state have been regarded as a group that requires too much priority for both the primary and booster doses of COVID-19

Despite a rise in the worldwide use of the COVID-19 vaccine, a notable fraction of the population still expresses vaccine reluctance, including this group. Vaccine hesitancy is defined as a “delay in acceptance or refusal of vaccination despite the availability of vaccination services” by the WHO’s Strategic Advisory Group of Experts (SAGE) on immunization. An internet-based survey that included patients with cancer, autoimmunity-related illnesses, and chronic lung diseases evaluated vaccine hesitancy and discovered that the most prevalent worries were related to the “newness of the vaccine,” “safety of the vaccine,” and “general mistrust of the development process of vaccines”. These worries are further amplified  by the rapid vaccination manufacture and the unknown genetic makeup of vaccines. The impact of the vaccine is another major worry among this people on underlying issues and how they affect the course of treatment. Additionally, there are more worries about vaccine safety in patients with multimorbidities due to the lack of data.

This cross-sectional study was carried out to provide actual information regarding the severity of the COVID-19 vaccine’s side effects in this medically vulnerable population in order to resolve the conflicting attitudes toward COVID-19 vaccines among people with pre-existing medical risk conditions. Therefore, the primary goal of this research is to examine and assess the severity and frequency of COVID-19 vaccine-related adverse effects in Pakistani individuals with and without specific pre-existing medical issues. Comparing the occurrence and severity of vaccine-related adverse events in patients with one condition versus those with multiple comorbidities is the secondary goal. This cross-sectional study was carried out to provide actual information regarding the severity of the COVID-19 vaccine’s side effects in this medically vulnerable population in order to resolve the conflicting attitudes toward COVID-19 vaccines among people with pre-existing medical risk conditions. Therefore, the primary goal of this research is to examine and assess the severity and frequency of COVID-19 vaccine-related adverse effects in Pakistani individuals with and without specific pre-existing medical issues. Comparing the occurrence and severity of vaccine-related adverse events in patients with one condition versus those with multiple comorbidities is the secondary goal.

By October 30, 2022, the COVID-19 pandemic had afflicted more than 627 million people worldwide including 60 million in South Asia (WHO).1 Even after healing from an acute infection, some people experience protracted illness, despite the fact that many people have quick recoveries.  It is still unclear how long after COVID-19 or “long COVID” or “post-COVID syndrome (PCS)” symptoms last. 6 Instead, “acute PCS”—which denotes symptoms that last between 4 and 12 weeks—and “chronic PCS”—which denotes symptoms that last longer than 12 weeks—have been classified as the sequelae of COVID-19. 7,8 Even though numerous studies have shown the PCS in broad strokes, it is unclear how the clinical repercussions may develop, especially in hospitalized (HS) and non-hospitalized survivors (NHS). PCS is frequently reported includes chest pain, joint pain, anosmia, ageusia, weariness, headache, and palpitations. 13 There are very few research on PCS from LMICs, despite the fact that people from low- and middle-income countries (LMICs) have also been severely impacted by the pandemic

Between 15 December 2020 and 30 October 2021, this prospective longitudinal study was carried out at two COVID-19 certified facilities in Dhaka, Bangladesh—the Bangabandhu Sheikh Mujib Medical University Hospital (BSMMU) and the Dhaka Hospital of icddr ,b. If a participant completed the requirements listed below, they were eligible for enrollment: more than 18 years old, COVID-19 verified by RT-PCR, and seeking care at the study hospitals with or without the need for hospitalization, 2) exhibiting significant symptom improvement for three days in a row with concurrent hospital discharge. NHS were accepted if their symptoms significantly improved after three days in a row and at least 10 days had passed since the COVID-19 infection began, as recommended by the WHO (end of isolation period)17. 3) living in Dhaka and willing to to return for other appointments. Participants having a history of mental illness or those who lived other than in Dhaka were not included. Within 4-6 weeks following patient discharge from the hospital or the conclusion of the isolation phase, all consecutive consenting patients were recruited. A thorough in-person follow up of COVID-19 survivors was to be conducted at 1, 3, and 5 months following clinical recovery (the baseline), according to the overall design. The icddr,b and BSMMU institutional review boards gave their approval to the study protocol. Written informed permission from participants was translated into the local tongue.

Procedure
In the appendix, follow-up visits and procedures are described in full. The new or persistent symptoms were noted on a symptom checklist. Each visit included a physical examination by trained professionals, including the 6-minute walk test (6MWT), to detect respiratory, cardiovascular, and neurological conditions. The appendix contains a description of the instruments used to detect peripheral neuropathy, dyspnea, weariness, functional restrictions of daily tasks, and psychological consequences. Participants with psychiatric results were subsequently assessed in a structured clinical interview by a psychiatrist. The follow-up examination included counseling and treatment for mental health as essential components. We identified new-onset diabetes using the diagnostic criteria established by the American Diabetes Association, and we included the need for insulin therapy as a sign of deteriorating glycemic control.

Laboratory evaluation
Following the recommendations of the American Thoracic Society, we tested the lung function using spirometry (Spirolab, Italy), and at the first and fifth months, we took a chest X-ray to rule out any moderate or severe disease. Only for HS, the cardiovascular consequences were assessed using an ECG and an echocardiography. During follow-up visits, blood and urine samples were taken for tests such as a glucometer’s random blood glucose (RBG), urine routine microscopy, serum creatinine, and complete blood count (CBC). Only at the 5-month visit, 20% of NHS patients and 30% of HS patients had thyroid function tests such as FT4, FT3, TSH, and C-peptide levels performed.

Results
We evaluated the eligibility of a total of 1981 confirmed COVID-19 patients that were listed in the registry of the icddr, b and BSMMU Dhaka Hospital (Fig. S1 in appendix). 362 of the 622 survivors who were requested to participate gave their permission and signed up for the study. At three and five months, 351 (97%) and 346 (95%) of the survivors had finished their follow-up appointments. After the 3-month visit, 1.1% of participants (3/242 of HS and 1/104 of NHS) re-infected with COVID-19; as a result, 342 participants made up the analyzable dataset during the 5-month visit. The estimates for the logit models used to compute the propensity scores are shown in Table S1 in the supplementary appendix (p. 8). For each baseline, adequate PS matching with a standardized mean difference of less than 10% was established.

Materials & Procedures
design of the study and participants
Between November 2021 and February 2022, we conducted a cross-sectional comparative study in Pakistan. Research Ethics Committee of Liaquat University of Medical and Health Sciences, REC# LUMHS/REC/159, approved the study. Beginning in December, an online poll was used to collect data through January 2022. Only 421 of the 472 respondents who completed the online survey passed the requirements for inclusion. The study’s population consisted of participants who were Pakistani nationals from various provinces. 

 Syphilis is frequently referred to as “the great masquerader,” as it can present with a wide variety of clinical symptoms and may mimic a multitude of other diseases, making diagnosis difficult. This was true long before the COVID-19 era. The COVID-19 vaccine damage syndromes will undoubtedly surpass syphilis, sarcoidosis, amyloidosis, and any other systemic condition and take the title of “the great masquerader,” without a shadow of a doubt.

The vast range of central nervous system and peripheral nervous system disorders that follow COVID-19 immunization are discussed by Chatterjee and Chakravarty in a recent edition of Current Neurology and Neuroscience Reports Each patient plays a game of Russian roulette to determine whether or not the nervous system will be hemodynamically showered with the harmful vaccination particles since the vaccines contain lipid nanoparticles laden with genetic material that codes for the harmful Spike protein.

The abstract of the authors states that COVID-19 vaccination is still our “sole weapon” against the disease as an illustration of how misinformed authors and editors have grown over studies on the vaccine. They will regret it in the future for their complete ignorance of the field of early SARS-CoV-2 treatment. What’s more alarming is that the authors claim that previous neurologic disorder is not a justification for delaying vaccination. As a senior academic doctor with extensive experience, I can confirm that the authors and editors who approved this publication exhibited poor medical judgment. Good doctors would never give a patient with a neurologic condition, such Guillain-Barre Syndrome or multiple sclerosis, a unique genetic biological product that is known to aggravate the patient’s impairment and increase the danger of death. When authors and historians read these lines again, they will feel regret and sympathy for the patients who had to endure this serious error in medical judgment. Visit your doctor and mention any neurological conditions you have that are new or have gotten worse after receiving the COVID-19 vaccine. Inform them that it wasn’t worthwhile. How about you .The vaccine’s hazards did not justify its ill-fated potential advantages for a curable upper respiratory infection.

Discussion
We discovered that the frequency and seriousness of the side effects brought on by COVID-19 vaccinations were not associated with pre-existing comorbidities. When compared to people without comorbidities, those who had comorbidities did not experience more severe side effects or had a higher likelihood of developing post-vaccination problems. In a survey from Pakistan, Beg et al. found that participants with comorbidities did not experience more vaccine-related side effects than those who had no history of such diseases [15]. Our cohort’s participants with pre-existing chronic diseases were older than the mean age determined by our study in around 70% of the cases. Participants in the survey done by Beg et al. were primarily older age groups.

Conclusions
The greater occurrence and severity of post-COVID-19 immunization side effects are not substantially correlated with a history of comorbidities, it may be said. Only one participant with pre-existing comorbidities reported any severe adverse events, and multimorbidity does not increase the severity of adverse events other than breathlessness and tachycardia. Individuals with multimorbidity are not at an increased risk to experience vaccine-related side effects. Given that it includes findings from individuals who are also coping with numerous chronic conditions, this study will aid in reducing vaccine hesitancy among this vulnerable segment of the population. To increase the likelihood that this population will accept subsequent immunization programs, further study should be done to evaluate vaccine reactogenicity in relation to the number of comorbidities.