COVID-19 waves have been characterized by different clinical manifestations, decrease of functional abilities and presence of psychological symptoms. The aims of this study were to investigate differences in physical and psychological symptoms during the three Italian waves of the coronavirus pandemic. Patients undergoing a functional, cardiological and pneumological check-up follow-up 2-3 months after recovery from COVID-19 were consecutively recruited to participate in the study completing also a quanti-qualitative questionnaire about anxiety, depression, PTSD symptoms and resources.

104 patients were recruited: 44 (mean age 63.0±12.4 years, 27.3% female) and 60 (mean age 65.7±9.2 years, 25% female) during the first and second/third pandemic waves, respectively. Physical comorbidities [cardiopathy (p=.011), dyslipidemia (p=.024) and diabetes (p=.01)] and NIV treatment ((p=.001) were higher in the second/third waves compared to the first one, while no significant differences were found in anxious (6.2±5.45) and depressive (5.7±5.4) symptoms, that were significantly higher than normal; was significantly more present in the second/third wave group (p=.001). PTSD symptoms were reported by the 56.3% of patients. Family, social support, and a positive mindset were described as resources to cope with the COVID-19 burden. Negative affects arose during outbreaks (panic) and the disease (fear), while positive affect (joy) characterized only the follow-up period.

Conclusion: This study shows how psychological symptoms varied during the pandemic waves and highlights the importance of protective factors to balance the distressed psychological state.