This rural community-based study explored preexisting functional impairments among COVID-19 survivors and correlated them with long-term COVID-19 symptoms. This study employed computer-assisted personal interviews (CAPIs) for questionnaire administration among participants selected from the rural predominant district of Jhajjar in Haryana, India, to determine the prevalence of LCSs and its determinants among individuals with prior COVID-19 infection.
One of the important metrics for gauging the pandemic potential of any new coronavirus variant is R0. Consistent with reports of greater mortality in the second wave than in the first wave due to the delta variant, studies have reported that R0 was 1.22 times greater in the second wave than in the first wave, leading to more cases in urban and densely populated areas.(19) However, rural areas receive millions of migrant workers fleeing cities, and agriculture is an essential activity exempt from lockdown, causing a relatively high prevalence in rural areas. (20)(21) For example, a serosurvey of SARS-CoV-2 IgG immunoglobulin among the rural population of South India, a marker of chronic infection, reported an adjusted seroprevalence of 8.5%. (21) The current study also showed that the self-reported COVID-19 prevalence was 6.2%. Given the high prevalence of PCS in rural areas, it is important to know about PCS and LCS. Moreover, lingering COVID-19 symptoms after the pandemic can result in a poor economically productive life as well as a poor quality of life, especially in places with fewer healthcare facilities available. Therefore, it is critical to investigate post-pandemic health issues in rural settings by focusing on LCSs.
The present study showed that the prevalence of LCSs was 22.9%. An umbrella review estimated that the prevalence of persistent post-COVID-19 symptoms ranged from 7.5–41% in nonhospitalized adults, 2.3%-53% in mixed adult samples, 37.6% in hospitalized adults, and 2%-3.5% in primarily nonhospitalized children.(18) Previous community-based studies from rural India reported a prevalence of persistent COVID-19 symptoms of 17.5%, while hospital-based studies from northern India reported a prevalence of 16.7%. (22)(23)
Univariable and multivariable analyses were used to assess the impact of sociodemographic variables on LCSs and revealed that female sex, older age, and lower education were risk factors for LCSs. Numerous studies have reported that female sex, older age, and obesity are predictors of LCS. (8)(7)(24) A study among infected healthcare workers from Malaysia revealed that females and older individuals were more likely to have post-COVID-19 syndrome.(25) The current study also reported an association between age and sex with LCSs; however, this association was not statistically significant for all age groups. The reason could be the smaller number of participants in the age categories and a rural-based study.
Another online study on 315 COVID-19-recovered individuals from India reported that persistent muscle pain and weakness waxed and waned throughout the first year after recovery.(26) The current study also revealed that weakness, weight loss, memory problems, and headaches were the most common persistent symptoms after COVID-19. In a previous study by the same authors, a total of 257 COVID-19-recovered healthcare workers reported weakness (204, 79.4%), weight loss (46, 17.9%), memory problems (36, 14.0%), and headache (70, 27.2%) as common PCS symptoms.(14)
Among the six functional difficulties studied, problems in seeing, hygiene, and remembering were more likely to be reported by those exposed to COVID-19. A previous registry-based nationwide study from Norway reported a greater risk of memory disturbance among participants exposed to COVID-19.(27) The accessibility challenges of rural areas are well documented, and providing universal health coverage to vulnerable rural populations requires innovative interventions. One such model was piloted in Germany by a mobile health clinic for post-COVID-19 syndrome patients, which reported better and timely provision of interdisciplinary care to these patients, despite substantial organizational challenges.(28)
The current study has several limitations. First, the LCS was based on self-reports, and recall or social desirability biases may have led to over- or underestimation of prevalence. Second, the cross-sectional design limits the determination of the causality of risk factors, and only associations can be ascertained. However, the strength of the study lies in its community-based design in a rural setting, with a rigorous sampling methodology and estimation of LCSs along with their determinants.