Persistent Symptoms in Patients After Acute COVID-19

Quick Takes

  • Patients with even milder forms of COVID-19 have persistent symptoms of fatigue and dyspnea up to 60 days post-infection.
  • Understanding the recovery of COVID-19 patients and possible long-lasting effects will define how care should be provided post-discharge.

Study Questions:

What symptoms persist in patients recovering from coronavirus disease 2019 (COVID-19)?

Methods:

Patients who had been hospitalized for COVID-19 and met World Health Organization (WHO) criteria for discontinuation of quarantine (no fever for 3 consecutive days, improvement in other symptoms, and two negative test results for severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] 24 hours apart) were invited to follow-up at a post-acute care clinic in Rome, Italy. Standardized questionnaires were used to assess symptoms. Patients were asked to retrospectively recount the presence or absence of symptoms during the acute phase of COVID-19 and whether each symptom persisted at the time of the visit.

Results:

A total of 143 patients were included, of whom 37% were women and 5% had received mechanical ventilation during their hospitalization. The mean age was 56 years. Patients were assessed at a mean duration of 60 days after the onset of the first COVID-19 symptoms. Only 18 (12.6%) were completely free of any COVID-19–related symptom, while 32% had one or two symptoms and 55% had ≥3. None of the patients had fever or any signs or symptoms of acute illness. The most frequently reported symptoms were fatigue and dyspnea. Close to half of the patients reported a worse quality of life.

Conclusions:

Patients recovering from COVID-19 have persistent symptoms up to 60 days post-infection.

Perspective:

Little is known about the post-discharge course of patients with COVID-19 and long-term complications. This single-center study suggests that symptoms related to COVID-19 can be protracted. The long-term impact of COVID-19 is underestimated in this study, as the median age of the patients is lower than what is typical for hospitalized COVID-19 patients, and few had severe respiratory failure requiring mechanical ventilation. Whether the persistent fatigue and dyspnea are related to pulmonary or nonpulmonary issues such as arrhythmias or heart failure is unknown. Systematic evaluation of recovering patients post-COVID-19 is needed to better understand their health care needs.

Clinical Topics: Heart Failure and Cardiomyopathies, Prevention

Keywords: Acute Disease, Coronavirus, COVID-19, Dyspnea, Fatigue, Fever, Primary Prevention, Quality of Life, Quarantine, Respiration, Artificial, severe acute respiratory syndrome coronavirus 2, Subacute Care, Symptom Assessment, Ventilators, Mechanical


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