Abstract / Summary
Recovery following acute COVID-19 varies widely, yet early recovery patterns remain understudied in Africa. Given the high burden of post-infection morbidity in resource-limited settings, there is a need to characterize recovery trajectories and identify those at risk for delayed recovery. We enrolled 151 adults between July 2021 and July 2022 with confirmed SARS-CoV-2 infection from healthcare facilities in Uganda and followed them for 12 weeks. Outcomes included pulmonary function, exercise capacity, symptom burden, and mental health, and were analyzed descriptively and using mixed-effects models. Participants with severe acute COVID-19 had the greatest impairments during recovery. At 12 weeks, forced expiratory volume in 1 second (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO), and six-minute walk distance remained lower in severe versus mild cases (mean (SD): 98.45 (22.22) vs 105.26 (12.29); 78.99 (18.83) vs 107.72 (20.44); 409.28 (71.18) vs 506.82 (70.87)), consistent with adjusted models showing lower FEV1 (β = -13.10, 95% CI: -24.13, -2.07), DLCO (β = -40.75, 95% CI: -53.84, -27.66), and six-minute walk distance (β = -95.87, 95% CI: -136.66, -55.08). Continued COVID-19 and mental health symptoms were reported across all groups; mild cases had worse mental health scores (23.19 (12.65) vs 16.95 (13.98)), while severe cases had a broader range of persistent symptoms, including fatigue, breathlessness, and cognitive complaints. In this longitudinal study in Uganda, COVID-19 was associated with persistent physiological and psychosocial impacts, particularly among those with severe illness. Initial severity may help identify individuals at risk for delayed recovery and guide targeted post-COVID care in resource-limited settings.