Estimating the Burden of Long COVID in the Canton of Zurich: Implications for Healthcare Service Planning
Dominik Menges, Tala Ballouz, Alexia Anagnostopoulos, Hélène E. Aschmann, Anja Domenghino, Jan S. Fehr, Milo A. Puhan
Background: As of January 2021, more than 500'000 individuals have been diagnosed with SARS-CoV-2 in Switzerland and up to 1.5 million are estimated to have been infected. In addition to the acute healthcare burden of COVID-19, evidence is emerging on individuals experiencing protracted symptoms and complications after infection, such as fatigue as well as respiratory, neurological, cognitive and mental health issues. It is yet unclear how many persons are affected by Long COVID and what the needs of those suffering from Long COVID are as well as what the implications are for the Swiss healthcare system. Our study aimed to assess the prevalence of Long COVID among SARS-CoV-2 infected individuals in the Canton of Zurich to identify needs for healthcare planning in Switzerland.
Methods: In the population-based Zurich SARS-CoV-2 Cohort study, we invited all contactable adults with PCR-confirmed SARS-CoV-2 infection between 27.02. and 05.08.2020 in the Canton of Zurich. We surveyed participants on their acute illness as well as their symptoms and health status at approximately 6 months after infection. We descriptively analyzed the proportion of individuals whose health status is still impaired, as well as Fatigue Assessment Scale (FAS), Depression and Anxiety Symptom Scale (DASS-21) and mMRC dyspnea scale scores at 6 months after diagnosis.
Results: We enrolled 437 SARS-CoV-2 infected individuals. Median age of participants was 48 years and 51% were female. Symptoms at diagnosis were reported by 90% of participants, of which 16%, 40%, 30% and 13% reported mild, moderate, severe and very severe symptoms, respectively. 20% of participants were hospitalized within two weeks of the infection. At 6 months, 26% reported not having returned to their normal health state; 31% among males and 21% among females. Furthermore, 23% among the non-hospitalized and 39% among the hospitalized reported not having fully recovered. Half of the participants reported at least one general practitioner visit post-infection. 54% of participants had fatigue in the FAS, and 26% and 32% had DASS-21 scores indicating depression and anxiety, respectively. One fourth had grade 1 dyspnea or higher based on mMRC scores.
Discussion: Our results show that a relevant proportion of individuals suffer from longer-term consequences after SARS-CoV-2 infection. The proportion of individuals with Long COVID may be overestimated due to underdetection of mild cases during the first wave. But a relevant absolute number of affected individuals, ranging up to several hundred thousand persons in Switzerland is to be expected, who suffer from mild to severe symptoms months after the infection. Our findings indicate that a wide range of healthcare services and integrative approaches will be required to support the recovery of these individuals. Alongside measures to mitigate the spread of SARS-CoV-2, the early planning of resources and tailored services for those suffering from Long COVID will be crucial for reduce the burden from Long COVID.