COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings

Nehme, Mayssam; Braillard, Olivia; Alcoba, Gabriel; Perone, Sigiriya Aebischer; Courvoisier, Delphine S.; Chappuis, François; Guessous, Idris

doi:10.7326/m20-5926

Cited by 214 publications

(216 citation statements)

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“…For example, the ONS study based their estimates on a list of 12 symptoms included in the ONS infection survey 15 , with some of the common symptoms of Long Covid such as chest pain, palpitations and cognitive problems missing from that list. Other studies, some with a wider symptom list, estimate the prevalence of persisting symptoms to be higher at around one in three people for up to 18 weeks post infection 4,5,16 .…”

Section: Introductionmentioning

confidence: 99%

Characteristics of Long Covid: findings from a social media survey

Ziauddeen

Gurdasani

O’Hara³

et al. 2021

Preprint

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Many people are not recovering for months after being infected with SARS-CoV-2. Long Covid has emerged as a major public health concern that needs defining, quantifying, and describing. We aimed to explore the initial and ongoing symptoms of Long Covid following SARS-CoV-2 infection and describe its impact on daily life in people who were not admitted to hospital during the first two weeks of the illness. We co-produced a survey with people living with Long Covid. We collected the data through an online survey using convenience non-probability sampling, with the survey posted both specifically on Long Covid support groups and generally on social media. The criteria for inclusion were adults with lab-confirmed (PCR or antibody) or suspected COVID-19 managed in the community (non-hospitalised) in the first two weeks of illness. We used agglomerative hierarchical clustering to identify specific symptom clusters, and their demographic and functional correlates. We analysed data from 2550 participants with a median duration of illness of 7.7 months (interquartile range (IQR) 7.4-8.0). The mean age was 46.5 years (standard deviation 11 years) with 82.8% females and 79.9% of participants based in the UK. 89.5% described their health as good, very good or excellent before COVID-19. The most common initial symptoms that persisted were exhaustion, chest pressure/tightness, shortness of breath and headache. Cough, fever, and chills were common initial symptoms that became less prevalent later in the illness, whereas cognitive dysfunction and palpitations became more prevalent later in the illness. 26.5% reported lab-confirmation of infection. The biggest difference in ongoing symptoms between those who reported testing positive and those who did not was loss of smell/taste. Ongoing symptoms affected at least 3 organ systems in 83.5% of participants. Most participants described fluctuating (57.7%) or relapsing symptoms (17.6%). Physical activity, stress and sleep disturbance commonly triggered symptoms. A third (32%) reported they were unable to live alone without any assistance at six weeks from start of illness. 16.9% reported being unable to work solely due to COVID-19 illness. 66.4% reported taking time off sick (median of 60 days, IQR 20, 129). 37.0% reported loss of income due to illness, and 64.4% said they were unable to perform usual activities/duties. Acute systems clustered broadly into two groups: a majority cluster (n=2235, 88%) with cardiopulmonary predominant symptoms, and a minority cluster (n=305, 12%) with multisystem symptoms. Similarly, ongoing symptoms broadly clustered in two groups; a majority cluster (n=2243, 88.8%) exhibiting mainly cardiopulmonary, cognitive symptoms and exhaustion, and a minority cluster (n=283, 11.2%) exhibited more multisystem symptoms. Belonging to the more severe multisystem cluster was associated with more severe functional impact, lower income, younger age, being female, worse baseline health, and inadequate rest in the first two weeks of the illness, with no major differences in the cluster patterns when restricting analysis to the lab-confirmed subgroup. This is an exploratory survey of Long Covid characteristics. Whilst it is important to acknowledge that it is a non-representative population sample, it highlights the heterogeneity of persistent symptoms, and the significant functional impact of prolonged illness following confirmed or suspected SARS-CoV-2 infection. To study prevalence, predictors and prognosis, research is needed in a representative population sample using standardised case definitions (to include those not lab-confirmed in the first pandemic wave).

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Section: Introductionmentioning

confidence: 99%

Characteristics of Long Covid: findings from a social media survey

Ziauddeen

Gurdasani

O’Hara³

et al. 2021

Preprint

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“…Patients presenting to Area E were tested and then advised to self-isolate at home, where they received a follow-up telephone call from the dedicated COVICARE team [ 6 , 7 ] ( Fig 1 ). The COVICARE team, composed of primary care physicians and medical students communicated the test results and provided remote ambulatory follow-up to COVID-19 positive patients by phone or video consultations.…”

Section: Methodsmentioning

confidence: 99%

“…In addition, the COVICARE team performed a follow-up with all patients 30 days after diagnosis, collecting data on any additional consultations with their General Practitioner, COVID-19 related visits to Emergency Department or hospitalizations within 30 days [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

Novel outpatient management of mild to moderate COVID-19 spares hospital capacity and safeguards patient outcome: The Geneva PneumoCoV-Ambu study

et al. 2021

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Background Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2), the novel coronavirus that causes coronavirus disease (COVID-19), is creating an unprecedented burden on health care systems across the world due to its high rate of pneumonia-related hospitalizations. This study presents recommendations for the outpatient management of moderate SARS-CoV-2 pneumonia implemented at the Geneva University Hospital, Switzerland, from April 4 to June 30, 2020 and evaluated the impact of these recommendations on patient safety, patient satisfaction, and overall hospital capacity. Methods Recommendations for the outpatient management of moderate pneumonia implemented in the Geneva University Hospital (PneumoCoV-Ambu) between April 4 and June 30, 2020, were evaluated prospectively. The primary endpoint was hospitalization. Secondary endpoints were: severity of COVID-19 disease based on a 7-points ordinal scale assessed at 1 and 2 months following SARS-CoV-2 infection; patient satisfaction using a satisfaction survey and the analysis of number of beds and costs potentially averted. Results A total of 36 patients with COVID-19-related pneumonia were followed between April 4 and May 5, 2020. Five patients (14%) were hospitalized and none died over a median of 30 days follow-up. The majority of patients (n = 31; 86%) were satisfied with the ambulatory care they received. These novel recommendations for outpatient management resulted in sparing an estimated potential 124 hospital bed-nights and CHF 6’826 per capita averted hospitalization costs over the three months period. Conclusions Recommendations developed for the outpatient management of COVID-19-related pneumonia were able to spare hospital capacity without increasing adverse patient outcomes. Widely implementing such recommendations is crucial in preserving hospital capacity during this pandemic.

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“…3 Recent studies suggest that nearly a third of individuals having had SARS-CoV-2 infection, including those who are initially asymptomatic, go on to develop symptoms that appear to last for a yet undefined period of time. 1 These COVID-19 survivors report a wide range of long-lasting sequelae, 4 some of which are ongoing nine months after infection. 5 To date most of the research involving SARS-CoV-2 and its consequences has involved the 10% of individuals with severe illness that required hospitalization, [6][7][8] leaving a significant gap in our understanding of the health impacts of SARS-CoV-2 infection among the majority (90%) of persons who have been infected to date -those that did not require hospitalization.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Survivors’ Reports of the Timing, Duration, and Health Impacts of Post-Acute Sequelae of SARS-CoV-2 (PASC) Infection

Lambert

Corps²,

El-Azab

et al. 2021

Preprint

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IMPORTANCE: Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) is a major public health concern since studies suggest that 1 in 3 infected with SARS-CoV-2 may develop PASC, including those without initial symptoms or with mild COVID-19 disease.1, 2 OBJECTIVE: To evaluate the timing, duration, and health impacts of PASC reported by a large group of primarily non-hospitalized COVID-19 survivors. DESIGN, SETTING, AND PARTICIPANTS: A survey of 5,163 COVID-19 survivors reporting symptoms for more than 21 days following SARS-CoV-2 infection. Participants were recruited from Survivor Corps and other online COVID-19 survivor support groups. MAIN OUTCOMES AND MEASURES: Participants reported demographic information, as well as the timing, duration, health impacts, and other attributes of PASC. The temporal distribution of symptoms, including average time to symptom onset and duration of symptoms were determined, as well as the perceived distress and impact on ability to work. RESULTS: On average, participants reported 21.4 symptoms and the number of symptoms ranged from 1 to 93. The most common symptoms were fatigue (79.0%), headache (55.3%), shortness of breath (55.3%), difficulty concentrating (53.6%), cough (49.0%), changed sense of taste (44.9%), diarrhea (43.9%), and muscle or body aches (43.5%). The timing of symptom onset varied and is best described as happening in waves. The longest lasting symptoms on average for all participants (in days) were "frequently changing" symptoms (112.0), inability to exercise (106.5), fatigue (101.7), difficulty concentrating (101.1), memory problems (100.8), sadness (99.2), hormone imbalance (99.1), and shortness of breath (96.9). The symptoms that affected ability to work were changing symptoms, inability to concentrate, fatigue, and memory problems, among others. Symptoms causing the greatest level of distress (on scale of 1 "none" to 5 "a great deal") were extreme pressure at the base of the head (4.4), syncope (4.3), sharp or sudden chest pain (4.2), brain pressure (4.2), headache (4.2), persistent chest pain or pressure (4.1), and bone pain in extremities (4.1). CONCLUSIONS AND RELEVANCE: PASC is an emerging public health priority characterized by a wide range of changing symptoms and hindering survivors' ability to work. PASC has not been fully characterized and the trajectory of symptoms and long-term outcomes are unknown. There is no treatment for PASC, and survivors report distress in addition to a host of ongoing symptoms. Capturing patient reports of symptoms through open-ended inquiry is a critical first step in accurately and comprehensively characterizing PASC to ensure that medical treatments and symptom management strategies best meet the needs of patients and help mitigate health impacts of this new disease.

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COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings

Cited by 214 publications

References 5 publications

Characteristics of Long Covid: findings from a social media survey

Characteristics of Long Covid: findings from a social media survey

Novel outpatient management of mild to moderate COVID-19 spares hospital capacity and safeguards patient outcome: The Geneva PneumoCoV-Ambu study

COVID-19 Survivors’ Reports of the Timing, Duration, and Health Impacts of Post-Acute Sequelae of SARS-CoV-2 (PASC) Infection

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