**1. Introduction**

More than a year after reporting Coronavirus Disease-2019 (COVID-19) for the first time in China, the disease is unrelenting, with more than 147 million cases and 3.1 million deaths worldwide, as of 28 April 2021 [1]. Persistent/new symptoms following convalescence of the clinical disease and/or microbiological recovery have been observed in a large fraction of COVID-19 patients [2]. To date, there is no clear consensus on the definition of such a group of patients. Long COVID, long haul COVID, chronic COVID syndrome, post-COVID-19 syndrome, and post-acute COVID-19 are the different terminologies currently in use for the condition characterized by the persistence of symptoms beyond the acute phase of COVID-19 [3].

Post-COVID-19 patients continue to have persistent symptoms or may have new symptoms following apparent clinical recovery as a result of the consequences of organ damage during acute COVID-19 infection, neurobehavioral abnormalities due to the disease process or hospital admission and intensive care strategies. A perplexing finding noted by physicians in several parts of the world was the prevalence of long COVID unrelated to severity of illness of COVID-19, unlike other diseases, where rigorous intensive care strategies in severely ill patients were associated with long-term health implications in survivors [4].

**Citation:** Bastola, A.; Nepal, R.; Shrestha, B.; Maharjan, K.; Shrestha, S.; Chalise, B.S.; Neupane, J. Persistent Symptoms in Post-COVID-19 Patients Attending Follow-Up OPD at Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal. *Trop. Med. Infect. Dis.* **2021**, *6*, 113. https:// doi.org/10.3390/tropicalmed6030113

Academic Editors: Peter A. Leggat, John Frean and Lucille Blumberg

Received: 6 May 2021 Accepted: 18 June 2021 Published: 28 June 2021

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There have been unprecedented efforts from the scientific community worldwide for the diagnosis, treatment, and prevention of COVID-19; however, little has been done to address the potential long-term health implications for more than 95% COVID-19 patients who have recovered from this novel disease worldwide. Signs and symptoms that fail to return to a healthy baseline status beyond two weeks from the disease onset could be considered to a long-term effect of COVID-19 in apparently recovered post-COVID-19 patients [5]. This research aims to study persistent or new symptoms in post-COVID-19 patients presenting to a tertiary level infectious disease hospital in central Nepal.

#### **2. Materials and Methods**

#### *2.1. Study Design and Settings*

This was a descriptive, cross-sectional study conducted among post-COVID-19 patients who had presented to the follow-up outpatient department of a central level infectious disease governmen<sup>t</sup> hospital, Sukraraj Tropical and Infectious Disease Hospital (STIDH) in Kathmandu, the capital city of Nepal. All patients diagnosed with COVID-19 by positive real time polymerase chain reaction (RT-PCR) for SARS-CoV-2, at least two weeks prior to presentation, were included in our study. Data collection was done over the period of six weeks from 1 March 2021 to 14 April 2021. All patients who had been in home isolation or were discharged following hospital admission from STIDH or from any other hospital during their acute COVID-19 illness were included in this study.

### *2.2. Data Collection*

Data collection was done through a face-to-face interview by using a standardized structured questionnaire after consent for voluntary participation was obtained. History taking and relevant clinical examination were done by two experienced attending physicians. Patients were asked to answer Yes/No questions for the symptoms related to post-COVID pathology. Data related to course of COVID-19 illness and index admission were collected retrospectively from the patients, and by reviewing past medical records/discharge sheets brought by patients in the follow-up OPD. Cronbach's alpha was computed for reliability analysis of the questionnaire using responses from the first fifty consecutive participants. The value was calculated as 0.84 and found to be acceptable.

Patients were asked to report newly occurring or persistent symptoms, or any other symptom worse than before COVID-19 development. The symptoms that did not return to baseline and lasted for more than two weeks following diagnosis of COVID-19 were labeled as persistent symptoms and those symptoms that appeared after two weeks of diagnosis of COVID-19, and were not attributed to other diseases, were labeled as new symptoms in post-COVID-19 patients. Dyspnea/shortness of breath, fatigue, chest heaviness, cough, chest pain, palpitations, anosmia/hyposmia, ageusia/hypogeusia, decreased appetite, headache, and throat discomfort were the persistent symptoms reported by post-COVID-19 patients in our study. Likewise, insomnia, anxiety, hot flushes, parosmia, burning sensation along limbs, impaired concentration, and burning sensation in the perinostrillar area were the new symptoms reported by post-COVID-19 patients in our study. Level of dyspnea/shortness of breath were defined in terms of the Modified Medical Research Council (MMRC) dyspnea scale, where higher scores corresponded to increased level of dyspnea.

### *2.3. Data Analysis*

Data was entered in Microsoft Excel and then analyzed with a statistical package for social sciences (SPSS) version 25. Descriptive analyses were done using frequencies and percentages for categorical variables, and means and standard deviation for continuous variables. Bivariate analysis was done using Chi square and Fisher's exact test, where appropriate. *p* value < 0.05 was considered to be significant.
