DISCUSSION
As of July 2021, more than 182 million confirmed COVID-19 cases worldwide have been reported.25 Individuals experienced long COVID symptoms had a decline in quality of life after COVID-19 illness.26,27 Therefore, understanding effects of long COVID symptoms in life is essential both an individual and populational level.
This study fills an important knowledge gap in measuring the impact of pandemic on COVID-19 quality of life in terms of long COVID.
In this study, it was determined that the impact of the pandemic on the COVID-19 quality of life was high (median score 3.0), and health perception was moderate (median score 40.0) among participants. This finding was expected and suggests that  long COVID symptoms deteriorates quality of life and health perception. This study supports evidence from previous observation.11
It has been reported that the prevalence of persistent symptoms in COVID-19 disease is more common in individuals over the age of 40 and the quality of life decreases with aging.28 This previous finding broadly supports the current study that the impact of the pandemic on the COVID-19 quality of life increased with aging. A possible explanation for this might be that relationship between aging and existing chronic disease.
This present study observed that the greatest impact of the pandemic on the COVID-19 quality of life were seen in individuals with less than high school education. As the level of education increased, the impact of the pandemic on the quality of life decreased. Of course, the positive effect of higher education level on the health and well-being is undeniable.
In the study, respondents were asked to explain whether they were suffering from existing chronic conditions (such as diabetes, heart disease, respiratory disease) before the infected with COVID-19. Approximately 40% of the participants stated that they suffered from any chronic disease. The greater impact of the pandemic on COVID-19 quality of life is particularly evident in those with existing chronic diseases. The combination of comorbid conditions with COVID-19 disease, may slow recovery time, decrease quality of life and are not surprising results. Indeed, it has been reported that the existing chronic diseases were highly predictive in the quality of life of long COVID-19 survivors.29
Previous studies have often focused on quality of life in hospitalized patients due to ongoing persistent symptoms after being discharged that may lead to delay in regaining previous health.30,31In the present study, consistent with the literature, the impact of the pandemic on the COVID-19 quality of life was quite evident in hospitalized individuals. In COVID-19 disease, individuals with severe disease are hospitalized. Disease severity may be affected by underlying comorbidities and advanced age. The current result highlights the need for a long-term follow-up clinical care and rehabilitation programs for hospitalized patients.
More than one symptom combination appear in the long COVID picture commonly.16 In this study, as the combination of symptoms increased, a significant increase was observed in the impact of the pandemic on the COVID-19 quality of life. Also this study supports evidence from previous observations that fatigue was the most commonly reported symptom.11,31,32 Long COVID-19 includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (12 weeks or more).33 The most important clinically relevant finding was that symptoms lasted 1-3 months in about half of the participants and long duration of symptoms increased the impact of the pandemic on covıd-19 quality of life. The observed increase could be attributed to combination of symptoms. The longer the symptoms last, the greater the impact of the pandemic on COVID-19 quality of life.
Although the relationship between suffering from long-term COVID symptoms and how long ago individuals were infected is unknown, it is clear that, time since first infected significantly related with quality of life in this study. Quality of life worsens when persistent symptoms are prolonged.11 Perceived health was negatively correlated with COV19-QoL. As the perception of health increased, the impact of the pandemic on the quality of life decreased.