Long Covid is an emerging public health public problem; the ligering symptoms after Covid-19 infection can last weeks to months. At present, no pharmacologic agent has been know that effectively reduces or abolishes the symptoms of long COVID. The aim of this study was to describe the long term health of patients with confirmed COVID-19 who have discharged from QingHai fourth people’s hospital (QingHai, China) and investigate clinical characteristic of long Covid syndrome by using questionnaires and case review in 1000 discharged adult patients and 156 discharged pediatric patients. In addition to describing therapeutic strategies, this study explores the potential effect of highland plants on the treatment of long Covid syndrome and is innovative in that it opens up new possibilities for future research and clinical practice.

Keywords: Long Covid-19; Plateau; Clinical characteristic; Fatigue; Plateau Plants; Treatment strategies.

At least 65 million individuals around the world have long COVID, based on a conservative estimated incidence of 10% of infected people and more than 651 million documented COVID-19 cases worldwide [1]. By December 8th 2023, more than 772 million individuals were infected with over 6.98 million deaths worldwide. According to World Health Organization (WHO) [2]. COVID-19 still deserves our attention and research. SARS-COV-2 has been evolving quickly in past three years, and multiple variants have gained increased abilities to infect patients or evade the protection by vaccination [3]. So long COVID will remain a global challenge to health care system and economy [4,5]. After the acute phase of a SARS-COV-2 infection, a proportion of those infected show persistent somatic symptoms over weeks, months and even years, including general tiredness, muscle pain, difficulties when breathing, chest pain [6]. This post COVID-19 condition is termed” long COVID” [7-9]. Many patients experiencing dozens of symptoms across multiple organ systems [10-12]. There are currently no validated effectively treatments. WHO has made a clinical case definition to the public in delineating long COVID,” post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-COV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis [13,14]. The National Institute for Health and Care Excellence (NICE) defined post COVID-19 syndrome as “signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis”. Additionally, symptoms appearing during a timeframe of four to twelve week post COVID-19 onset are regarded as ongoing symptomatic COVID-19 [15,16]. We designed a follow-up questionnaire for post-COVID-19 syndrome in individuals discharged from the Fourth people’s Hospital of QingHai Province. The study included 100 discharged adults and 86 discharged children October 23, 2022 and January 11, 2023. The aim is to explore differences in post-COVID-19 syndrome among patients of different age groups, providing a more comprehensive understanding of the clinical manifestations of post-COVID-19 syndrome in the QingHai region. QingHai is located on an elevated plateau, has an average altitude of more than 3,000 meters and has climate characteristics of low oxygen, dryness and strong ultraviolet rays [17-21]. Which have a unique impact on the lives and health of residents. Our study compared symptom presentations of long-term COVID-19 recoverers in Qinghai Plateau with those in low-altitude regions to understand high-altitude COVID-19 characteristics [22-24]. Additionally, we explored the therapeutic potential of plateau plants in long COVID-19 treatment.

Study design and patients

For this retrospective study, we enrolled 1000 discharged adults and 156 discharged children from the Fourth People of QingHai province from October 23, 2022 and January 11, 2023. The time since discharge from the hospital of all subjects was more than 1 months. The discharge criteria for all survivor also followed the World Health Organization interim guidance. The selected survivors were enrolled onto a telephone follow-up study primarily to observe their clinical sequelae in early recovery from COVID-19. This study was approved by the ethics commissions of the Fourth People of QingHai province. Oral consent was obtained from patients.

Data collection

The demographic, clinical and treatment were obtained from patients’ medical records. Survivors were systematically contacted by three experienced clinicians via mobile Phone, and the detailed reported symptoms related to the key points we were assessing were recorded. Median values were compared by Mann-Whiney test.

Statistical analysis

Categorical variables were described as proportions and percentages, and continuous variables were described using median and range (min-max) values. Statistical analyses were done using the Graphpad Prism software, version 8.02. For unadjusted comparisons a two-sided α of less than 0.05 was considered statistically significant.

Demographics and characteristics

The median (IQR) age of the 1000 Covid-19 adults survivors was 44.0 years, ranging from 18 to 76 years, 560 patients (56%) were female. The median (IQR) age of the 156 COVID-19 children survivors was 4.0 years, ranging from 1 to 17 years, and 73 patients (47%) were female. Their age distribution, clinical symptoms and treatment time are shown in Table 1. The sex ratio, age distribution between two cohorts showed no significant difference (P>0.05).

Characteristics of clinical sequelae

On the basis of follow-up results, compared to the COVID-19 children survivors, cough, fatigue, myalgia, loss of olfactory and gustatory function, throat pain, chest pain, dyspnea, depresdepression, memory loss, anxiety, dizziness, cardiovascular-related symptoms were significantly higher in COVID-19 adults survivors (all P<0.05) (Table 1).

Treatment

All adults patients and children patients received antiviral Treatment. Within the adults COVID-19 patients cohort, 32% underwent Oxygen therapy, while 1% received antibiotic treatment. Conversly, among pediatric patients, 5.1% underwent oxygen therapy, with 0.6% receiving antibiotic treatment (Table 2).

Post-COVID-19 patients experiencing COVID symptoms (fatigue, headache, cough, loss of smell and taste, hair loss, muscle pain, depression, heart discomfort, and anxiety) within one month of discharge, they were randomly divided into two groups: a treatment group and a control group. The treatment group was given oral liquid preparations of Rhodiola and sea buckthorn. Follow-ups were conducted one month later (Table 3).

Table 3 shows Significant relief of fatigue, headache, respiration insufficiency, loss of smell and taste, cough, hair loss, pain in joints, muscles, cognitive functions (attention, memory), mood disorders (anxiety, and depression) and physical activity over time of treatment and the follow-up period was observed in treatment group of patient. In particular, the number of patients with symptoms of fatigue and mood disorders was less in the treat group than in the control group.

Table 1: Treatment in 1000 adult patients and 156 child patients with Covid-19.

Table 2: Treatment in 1000 adult paitients and 156 child patients with Covid-19.

Table 3: Duration (days) of symptoms from the day of randomization and the significance of the difference between treatment group and control group.

In QingHai province, Adults survivors of COVID-19 are significantly more likely to develop clinical sequelae 1 month after discharge from the hospital than children survivors. Fatigue symptoms, in particular, are notably pronounced. This conclusion aligns with the findings of many research studies [25,26]. Of the adults COVID-19 survivors experiencing fatigue symptoms, we found that the median age was 56 years, higher than that of who did not experience fatigue symptoms (P<0.05) this finding suggests that age plays a crucial role in fatigue symptoms among long COVID-19.

A study found that among adult COVID-19 survivors discharged from RenMin Hospital of WuHan University three months, 28.3% experienced fatigue symptoms [27]. The incidence is significantly higher than that of fatigue symptom in QingHai province. It indicates that at high-altitude, the proportion of fatigue syndrome is lower compared to low altitude. In our study, we found plateau plants such as Rhodiola and sea buckthorn in the treatment strategy for COVID syndrome is significant relief of fatigue, headache, respiration insufficiency, loss of smell and taste, cough, hair loss, pain in joints, muscles, cognitive functions (attention, memory) mood disorders (anxiety, and depression) and physical activity over time of treatment and the follow-up period was observed in treatment group of patient. The use of plateau plants in treating fatigue syndrome related to COVID-19 in plateau may be a promising therapeutic approach. Plateau plants often possess adaptations to high-altitude, and their bioactive components may positively impact alleviating fatigue symptoms [28,29].

Firstly, some plateau plants such as Rhodiola, saffron, and sea buckthorn are found to contain abundant alkaloids, flavonoids, and other compounds, which have antioxidative, anti-inflammatory, and immune-regulating effects [30,31]. By consuming extracts of these plants, it is hoped to alleviate oxidative stress to some extent, reduce inflammation levels, and enhance immune system activity.

Secondly, some plateau plants have traditionally been used to improve the body’s tolerance to hypoxia [32-36]. These plants may help improve oxygen supply to patients, alleviate symptoms such as difficulty breathing, and thus have a positive impact on fatigue.

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