Long-Term Health Effects of COVID-19 in Tunisia, 2020-2021

Background: Some patients suffer from persistent symptoms following a COVID-19 infection, referred to as long COVID. The aims of the study were to estimate the prevalence of long COVID and study its determinants in Tunisia. Methods: We conducted a nationwide cross-sectional study among a representative sample of COVID-19 survivors residing in Tunisia between June and August 2022. We selected a random sample, stratified by age and region, among residents registered in the national surveillance database with a SARS-CoV-2 positive test taken from September 2020 to September 2021 (n = 479,743). The expected sample size was 384. We defined a patient with long COVID as having at least one self-reported symptom persisting for more than four weeks after the first confirmation of SARS-CoV-2 infection (RT-PCR or Ag-RDT) and not explained by an alternative diagnosis. Trained healthcare workers interviewed consenting respondents by phone using a structured questionnaire. We described continuous variables using median and interquartile range (IQR). We measured the prevalence of long COVID and its 95% confidence interval (95% CI). We estimated the association between explanatory variables (socio-demographic, lifestyle and comorbidities, SARS-CoV-2 history infection, COVID-19 vaccination status) and long COVID using a log-binomial model, reporting adjusted prevalence ratios (a-PR) and its 95% CI. Results: Of 1094 persons contacted, 416 were enrolled (response rate: 38%). Long-COVID prevalence was 64% (267/416); 95% CI [59-69%]. The sex ratio (M:F) was 0.72. Age ranged from 1 to 101 years, with a median of 41 years (IQR:31-55 years). The most common symptoms were fatigue (63%), myalgia/arthralgia (33%), and cognitive symptoms (52%). Median duration of long-COVID symptoms was 11 months (IQR: 3-14 months). In multivariate analysis, experiencing acute COVID-19 (a-PR = 1.5; 95% CI [1.0-2.1]), being a woman of childbearing age (a-PR = 1.2; 95% CI [1.0-1.4]) and residing in the central region (a-PR = 1.5; 95% CI [1.1-2.0]) were significantly associated with a higher prevalence of long COVID. Conclusions: Long COVID is prevalent in Tunisia affecting patients with multiple symptoms initially, those residing in the central region and young women. We recommend to enhance healthcare access and medical follow-up both during and after the infection, focusing on identified risk groups. We also recommend to conduct further research to optimize management of long-COVID patients.