Patients with COVID-19 who develop severe and critical symptoms that require hospitalization may recover from the disease, but some of these individuals continue to face clinical manifestations and psychological disorders after recovery. Remote, over-the-phone follow-up through simple communication between patients and health care providers can help manage improved patients (12). The present study was aimed at following up the clinical course of patients with COVID-19 between February 2022 and July 2022 in the city of Sabzevar,Iran. A self-report method was adopted to collect the necessary data. This study explored the relationship between vaccination and the improvement of clinical symptoms in 2 follow-up stages (4 and 12 weeks after discharge).
The results of the present study showed that more than 80% of patients attained full recovery 12 weeks after discharge. In a cohort study, Huang et al. (2021) followed up patients recovered from COVID-19 and found that 76% of them reported clinical symptoms of fatigue or muscle weakness at least 6 months after discharge (13). Similar to the present study, in China, Zhao et al(2020). and Liang et al(2020). followed up patents 3 months after discharge (14, 15).
Also, the results of the present study showed COVID-19 is associated with persistent symptoms, such that some assessed patients had not recovered completely even 3 months after discharge. Liang et al. (2020) in China reported the recovery rate after 3 months was 90.1% (14), which is 10.7% higher than the rate observed in the present study. The reason for this variation could be related to the difference in methodology (self-report versus paraclinical).
The results of several studies substantiate that older adults, men, people of black color, obese people, smokers, patients with diabetic, cardiovascular, or renal diseases, as well as those with hypertension are at higher risk of being hospitalized due to COVID-19 (16–19). This is in agreement with the results of the present study in that we found underlying diseases and old age, followed by addiction and smoking, are the most frequent risk factors for hospitalization.
In the present study, the most common initial symptoms in hospitalized patients were pulmonary involvement, fever and chills, body pain, and shortness of breath, whereas other studies have reported fever and cough to be the most common complaints (20). This variation be due to the difference in guidelines adopted by different countries according to their available resources or due to different strains of COVID-19.Due to different strains of COVID-19 could not be compared in the present study because we did not have access to data from the reference laboratory so as to determine the common strain of COVID-19.
Because a considerable portion of severe cases of COVID-19 occur for older adults with underlying diseases, the safety profile is especially important when administering medications for this group of people. In this context, most countries have deployed the potential of herbal and traditional medicine in dealing with the pandemic.
The systematic review by Phuc Hung (2021) demonstrated that integrating traditional Chinese medicine with Western medicine improved symptoms in patients with COVID-19 (21). In the present study, the patients had frequently taken complementary and traditional medications before hospitalization. Likewise, studies conducted in Vietnam suggest that half of the assessed population had used herbal medications to treat COVID-19 (19). In the present study, too, the recommendations of traditional medicine were frequently observed by patients in the 2 follow-up stages (4 and 12 weeks). Traditional herbal medications are popular and enjoy strong social support in Iran. Although late, the national guidelines in this country (Version 11, released in December 2021) incorporated preventive recommendations and complementary treatments of traditional medicine to diagnose and treat COVID-19 via outpatient and inpatient services (22).
Men and illiterate people had the highest frequency among patients with COVID-19. Consistent with the results of the present study, many researchers have highlighted that men are more susceptible to severe infection with COVID-19, and they have confirmed the role of literacy in preventing and curbing this disease (23–27).
Several studies have stressed the positive role of family support in caring for patients during a pandemic as well as in promoting and improving their health during hospital stay and after discharge (28, 29). Family-based management has been suggested as one of the effective strategies for risk perception (30). In the present study, over 90% of patients were cared for by family members, which implies the proper conditions of family emotional ties in the studied population.
CDC(Centers for Disease Control and Prevention ) studies suggest that receiving an updated dose of the COVID-19 vaccine protects against serious diseases, hospitalization, and death (31). Heftdal et al. (2022) investigated the relationship between the incidence of COVID-19 and positive PCR in Denmark, and showed that people who received 2 doses of COVID-19 vaccine were at lower risk of infection after 8 months of follow-up (32). In line with this study, the results of the present study showed a significant relationship between vaccination and the recovery rate at the 12-week follow-up.
One of the limitations of the present study is not using diagnostic tests and radiological images to confirm patients’ recovery and, instead, relying on patients’ self-report as a reference for their recovery.