Post–COVID-19 Syndrome (Long Haul Syndrome): Description of a Multidisciplinary Clinic at Mayo Clinic and Characteristics of the Initial Patient Cohort

Abstract

Objective To describe characteristics of a series of patients reporting prolonged symptoms after an infection with COVID-19. Methods This study describes the multidisciplinary COVID-19 Activity Rehabilitation Program (CARP), established at Mayo Clinic to evaluate and treat post-COVID-19 syndrome (PCS) patients, and reports the clinical characteristics of the first 100 patients receiving evaluation and management during the timeframe of June 1, 2020 and December 31, 2020. Results The cohort consisted of 100 patients (mean age 45 years, 68% women, BMI 30.2, presenting a mean of 93 days after infection). Common pre-existing conditions were respiratory (23%) and mental health, including depression and/or anxiety (34%.) The majority (75%) had not been hospitalized for COVID-19. Common presenting symptoms ware fatigue (80%), respiratory complaints (59%), and neurologic complaints (59%) followed by subjective cognitive impairment, sleep disturbance, and mental health symptoms. More than one-third of the patients (34%) reported difficulties with performing basic activities of daily living. Only 1 in 3 patients had returned to unrestricted work duty at the time of the analysis. For most patients, laboratory and imaging studies were normal or non-diagnostic despite debilitating symptoms. Most patients required physical therapy, occupational therapy, or brain rehabilitation. Face-to-face and virtual care delivery modalities were feasible. Conclusion Many of the patients did not experience COVID-19-related symptoms that were severe enough to require hospitalization, were younger than 65 years of age, more likely to be female, and most had no pre-existing comorbidities prior to SARS-CoV-2 infection. Symptoms including mood disorders, fatigue, and perceived cognitive impairment resulted in severe negative impacts on resumption of functional and occupational activities in patients experiencing prolonged effects.

Prospective cohort study of workers diagnosed with COVID-19 and subsequent unemployment

“…A recent longitudinal prospective cohort study of post-COVID-19 patients found that 30% had at least one symptom persisting for nine months or longer. 5 The sequelae of COVID-19 are referred to as “post-COVID syndrome” or “COVID long haul syndrome.” 6 However, in our analysis, the relationship between being diagnosed with COVID-19 and unemployment remained significant even after adjusting for self-rated health; thus, poor health may not be the reason for unemployment.…”

Factors associated with persistence of symptoms 1 year after COVID-19: A longitudinal, prospective phone-based interview follow-up cohort study

“…Given the clinical context of the COVID-19 pandemic, with a greater prevalence of patients >65 years particularly among those requiring hospitalization, assessment of frailty status could be implemented prior to discharge and in early follow-up, to identify those individuals at higher risk of long-term persisting symptoms and, possibly, of incident disability. As a case in point, patients discharged with COVID-19 with symptoms including mood disorders, fatigue, and perceived cognitive impairment at 3 months had more difficulties on resumption of functional and occupational activities [25] . Thus, assessment of functional status could be a proxy to further clinical and social evaluation.…”

‘I Live a Kind of Shadow Life’: Individual Experiences of COVID-19 Recovery and the Impact on Physical Activity Levels

“…Following recovery from the acute infection with SARS-CoV-2, many individuals have experienced a range of persistent symptoms of varied frequency and severity. Recovery is seldom linear and is, instead, characterised by recurrent exacerbations of new and existing symptoms, primarily shortness of breath and fatigue [ 15 ]. Participants in the present study reported that the burden of managing the ongoing effects of COVID-19 has a profound impact on all aspects of their life, including work, leisure, and ADL.…”