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2023 HSR&D/QUERI National Conference Abstract

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1018 — Burden of post-acute sequelae of SARS CoV-2 infection (PASC) in Veterans seen at a large, inner-city VA Medical Center

Lead/Presenter: Howard Gordon,  COIN - Hines
All Authors: Gordon HS (Jesse Brown VAMC, Center of Innovation for Complex Chronic Healthcare, and University of Illinois at Chicago), Gardner J (Jesse Brown VA Medical Center, Chicago IL) Brown G (Jesse Brown VA Medical Center, Chicago IL) Vargas-Correa J (Jesse Brown VA Medical Center, Chicago IL) Rubinstein I (Jesse Brown VA Medical Center and University of Illinois at Chicago, Chicago IL)

Objectives:
After contracting acute SARS-CoV-2 illness, some patients experience a plethora of physical and mental health manifestations that last four or more weeks, the Post-Acute Sequelae of SARS CoV-2 infection (PASC). We sought to determine the burden of PASC among Veterans with prior PCR-positive COVID-19 infection seen at a large, inner-city VAMC.

Methods:
In early 2022, we mailed surveys to Veterans who had tested positive for SARS-CoV-2, at our site, and had survived at least 30-days after diagnosis (N = 1,849). Respondents indicated symptoms they experienced during their acute COVID-19 illness and if they were still experiencing symptoms. Demographic and clinical characteristics were obtained through medical record linkage. Frequency of initial COVID-19 symptoms and long-lasting symptoms were reported. Chi-square tests were used to compare differences between COVID-19 initial and on-going symptoms by race and age. Written responses to an open-ended question about experiences with COVID-19 were analyzed with qualitative content analysis.

Results:
A total of 211 surveys were completed and returned between February and July 2022, with a response rate of 13.2%. Survey respondents had mean age 65.7 years (SD 12) and were 93.8% male (N = 197), 54% Black (N = 114), 13.2% Latinx (N = 27), 71.6% had a high school education or higher (N = 151), 69.1% (N = 143) lived with at least one other person, and 53.5% (N = 93) did not report trouble affording basic needs such as food and utilities. The most frequent reported symptoms upon initial diagnosis of COVID-19 was fatigue (73.9%), body aches (72.9%), loss of appetite (70.7%), shortness of breath (65.1%), and cough (57.3%). Survey respondents experienced a mean of four (SD 4.1) PASC symptoms. The most frequent on-going symptoms reported were fatigue (41.9%), trouble sleeping or staying asleep (40.5%), mental fog (36.7%), shortness of breath (32.2%), and body aches (28.4%). There were no statistically significant differences between initial symptoms, on-going symptoms, and race. When asked about on-going symptoms, those 65 years and older were more likely to report trouble sleeping (p = 0.029) and mental fog (p = 0.01). These older Veterans were twice or more likely to seek care for their PASC symptoms compared to younger patients (p = 0.02). Older Veterans experienced more symptoms when initially diagnosed with COVID-19 in comparison to younger Veterans (p = 0.002). We collected 95 (45%) responses to an open-ended question about experiences with COVID-19 and 30 Veterans provided accounts of severe illness that included descriptions of perceived near death experiences and prolonged hospital stays. Also, 12 Veteran respondents described difficulty with PASC, including ongoing respiratory, GI, neurological and cognitive symptoms.

Implications:
Though these findings are limited by the low response rate, they indicate a substantial burden of PASC in this inner-city Veteran population. On average, survey respondents continued to experience 4 symptoms long after acute COVID-19 illness. Older Veterans were more likely to report persistent sleep problems and mental fog compared to their younger counterparts.

Impacts:
These findings suggest that PASC is prevalent among inner-city Veterans. We posit that assessment of PASC burden by age, race, sex, and other clinical characteristics could inform the need for dedicated PASC clinics in Veterans Health Administration.