Clinical Characteristics and Factors Associated with Long COVID in Zambia, August 2020 to January 2023

IntroductionA number of seroprevalence studies in Zambia document the extent of spread of SARS-CoV-2, yet few have examined signs, symptoms and conditions that continue or develop after acute COVID-19 infection (long COVID). This is an important gap given the estimated prevalence of long COVID in other countries. We sought to examine characteristics of post-acute COVID-19 (PAC-19) clinics patients in Zambia and assess factors associated with long COVID at first visit to a PAC-19 clinic and longitudinally among a cohort of patients. MethodsLong COVID was defined, initially in the Zambia PAC-19 clinical guidelines, as new, relapsing, or persistent symptoms lasting >4 weeks after an initial SARS-CoV-2 infection. Severe COVID-19 was defined as COVID-19 episode that required supplemental oxygen therapy, intensive care unit stay or treatment with steroids/remdesivir. We performed a cross-sectional and longitudinal analysis of PAC-19 clinic patients from August 2020 to January 2023 using logistic and mixed effects regression models and considered statistical significance at p<0.05. ResultsIn total, 1,359 patients attended PAC-19 clinics of whom 548 (40.3%) with [&ge;]2 visits were included in the longitudinal analysis. Patients median age was 53 (interquartile range [IQR]: 41-63) years, 919 (67.6%) were hospitalized for acute COVID-19, and of whom 686 (74.6%) had severe COVID-19. Patients with hospital length of stay [&ge;]15 days (adjusted odds ratio [aOR]: 5.37; 95% confidence interval [95% CI]: 2.99-10.0), severe illness (aOR: 3.22; 95% CI: 1.68-6.73), and comorbidities (aOR:1.50; 95% CI: 1.02-2.21) had significantly higher likelihood of long COVID. Longitudinally, long COVID prevalence significantly (p<0.001) declined from 75.4% at the first PAC-19 visit to 26.0% by the fifth visit. The median follow-up time was 7 (IQR: 4-12) weeks. ConclusionLong COVID symptoms were common among patient presenting for care in PAC-19 clinics in Zambia, but most recovered within [~]2 months. Despite potentially substantial morbidity due to long COVID, few patients overall with COVID-19 attended a PAC-19 clinic. Scaling up PAC-19 services and integrating into routine clinical care could improve access by patients.