Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

Abstract

BackgroundMany patients with COVID-19 do not require hospitalisation, let alone have undergone COVID-19 testing. There is anecdotal evidence that patients with “mild” COVID-19 may complain about persistent symptoms, even weeks after the infection. This suggests that symptoms during the infection may not resolve spontaneously. The objective of this study was to assess whether multiple relevant symptoms recover following the onset of symptoms in hospitalised and non-hospitalised patients with COVID-19.Methods2113 members of two Facebook groups for coronavirus patients with persistent complaints in The Netherlands and Belgium, and from a panel of people who registered at a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, date of symptoms onset, COVID-19 diagnosis, healthcare utilisation, and the presence of 29 symptoms at the time of the onset of symptoms (retrospectively) and at follow-up (79±17 days after symptoms onset).Results112 hospitalised patients and 2001 non-hospitalised patients (confirmed COVID-19, n=345; symptom-based COVID-19, n=882; and suspected COVID-19, n=774) were analysed. The median number of symptoms during the infection reduced significantly over time (14 (11–17) versus6 (4–9), p<0.001). Fatigue and dyspnoea were the most prevalent symptoms during the infection and at follow-up (fatigue: 95% versus 87%; dyspnoea: 90% versus 71%).ConclusionIn previously hospitalised and non-hospitalised patients with confirmed or suspected COVID-19, multiple symptoms are present about 3 months after symptoms onset. This suggests the presence of a “post-COVID-19 syndrome” and highlights the unmet healthcare needs in a subgroup of patients with “mild” or “severe” COVID-19.

Quality of life after COVID-19 without hospitalisation: Good overall, but reduced in some dimensions

“…There is some evidence for prolonged fatigue for non-hospitalised patients in the months after being diagnosed with COVID-19. 3 The current study not only shows that other aspects of health are also affected in these subjects, but compared to the general population, social functioning and general health were the most affected, as shown by z-scores. Moreover, differences from RAND-36 population norms were most apparent for dimensions associated with aspects of mental health, which in addition to social functioning, included role-limitations due to emotional problems and emotional well-being.…”

“… 1 There is less evidence for the non-hospitalised, but breathlessness and fatigue is common after several months. 3 , 4…”

Long-term neurological manifestations of COVID-19: prevalence and predictive factors

“…These findings extend recent studies which have argued for a high prevalence of Post-COVID clinical manifestation and claimed that long term consequences of COVID-19 involve both central and peripheral nervous systems 1,2,10,11 . In particular, Goertz and coauthors 5 (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

“…Clinical findings on previously hospitalised and non-hospitalised patients with COVID19 reported the persistence of multiple symptoms, particularly fatigue and dyspnoea 4 . Accordingly, some authors have suggested the so called, but not yet defined, "post-COVID-19 syndrome" based on symptoms reported after three months of SARS-CoV-2 infection 5 . Few follow up studies, however, have investigated patients discharged from hospital after recovery from COVID-19 and no data about persistent neurological manifestations are available yet.…”

Generic and Respiratory-Specific Quality of Life in Non-Hospitalized Patients with COVID-19

“…Even though both validated and standardized generic and respiratory-specific quality of life questionnaires exist, the question remains which instrument is more adequate in patients with a new disease such as COVID- 19. As pulmonary function may be impaired [8,9] and dyspnea is one of the most prevalent symptoms in patients with COVID-19 [3], it seems reasonable to hypothesize that the impact on respiratory-specific quality of life, which not only focuses on the state of the airways but also on the patients' functional needs, is very prominent in these patients. Therefore, our objective was to assess respiratory-specific quality of life in addition to generic quality of life in non-hospitalized patients with COVID-19.…”