The prevalence of post COVID-19 condition (PCC) and a simple risk scoring tool for PCC screening on Bonaire, Caribbean Netherlands: a retrospective cohort study

ABSTRACT Aim To assess the prevalence of post COVID-19 condition (PCC) on Bonaire and develop a practical risk scoring tool for PCC screening, using easily obtainable characteristics. Methods A retrospective cohort study of symptomatic SARS-CoV-2 cases were randomly sampled from Bonaire’s case-registry and telephone interviewed between 15-November-2021 and 4-December-2021. PCC patients had a PCR-positive SARS-CoV-2 test (1-March-2020 and 1-October-2021) and self-attributed at least one symptom lasting over four weeks to their infection. Multivariate logistic regression was used to derive a risk formula to develop a practical risk scoring tool. Results Out of 414 cases, 160 (39%) were PCC patients. Fifty-three patients were unrecovered (median illness duration 250 days (IQR 34)). Of recovered patients, 35% experienced symptoms for at least 3 months after disease onset. PCC prevalence was highest among females (38%), 40-59 year-olds (40%), morbidly obese (31%) and hospitalized patients (80%). A PCC risk scoring tool using age, sex, presence of comorbidities, and acute phase hospitalization or GP visit had an area-under-the-curve (AUC) of 0.68 (95%CI 0.63-0.74). Adding smoking, alcohol use, BMI, education level, and number of acute phase symptoms increased the AUC to 0.79 (95%CI 0.74-0.83). Subgroup analyses of non-hospitalized patients (n=362) resulted in similar AUCs. Conclusion Thee estimated prevalence of PCC on Bonaire was 39%. Moreover, easily obtainable patient characteristics can be used to build a risk scoring tool for PCC with acceptable discriminatory power. After external validation, this tool could aid the development of healthcare interventions in low resource settings to identify patients at risk for PCC. Key messages: What is already known on this topic: An increasing number of studies show that varying proportions of COVID-19 patients are left with prolonged health issues, including persistence of symptoms such as fatigue, shortness of breath, loss of muscle strength, and concentration issues following the acute phase of COVID-19. Prevalence of this recently recognized medical syndrome, ‘long-COVID’ or ‘post COVID-19 condition (PCC)’, ranges between 37-49% in the European Netherlands, though there are no reports of PCC prevalence in the Caribbean Netherlands to date. What this study adds: We designed the first retrospective cohort study estimating the prevalence and characteristics of PCC on Bonaire, Caribbean Netherlands and devised a simple risk scoring formula to calculate PCC risk. We found a PCC prevalence of 39% on Bonaire and describe a proof-of-concept risk scoring tool with good discriminatory performance. How this study might affect research, practice or policy: Our study estimates PCC prevalence and describes disease and patient characteristics for Bonaire. This is the first study providing these insights in the Caribbean; a region that has been underrepresented in PCC research. Furthermore, our study highlights the added benefit of registering sufficient patient characteristics at the time of consultation for acute COVID-19 disease, for improved PCC screening later on. After external validation of our proof-of-concept study, this risk scoring tool could aid the development of primary care and public health interventions and health communication strategies in low resource settings for the identification of patients at risk for PCC.