“… 14 Many reports have now described post-COVID symptoms and show that cough can persist for weeks and months after SARS-CoV-2 infection in some patients, with differing severity of acute symptoms ( figure 1 , table 1 ). 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Figure 1 Follow-up studies reporting persistent cough in patients with post-COVID syndrome Studies sorted by follow-up duration in ascending order from left to right. Follow-up duration ranges from 6 weeks to 6 months.…”
Section: Cough In the Post-covid Syndromementioning
confidence: 99%
“…Data were retrieved from available publications, including peer-reviewed papers and preprints. 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Detailed characteristics of each study are summarised in table 1 . Some studies did not report acute cough data.…”
Section: Cough In the Post-covid Syndromementioning
confidence: 99%
“…24 , 25 In a pooled analysis, we found that the estimated prevalence of persistent cough was 18% (95% CI 12–24%; I 2 =93%) in 14 studies of hospitalised patients (follow-up duration ranged from 6 weeks to 4 months; figure 2 ). 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 However, prevalence varied widely between studies, and is presumably dependent on patient characteristics, treatment, follow-up duration, and outcome definition. Figure 2 Prevalence of post-COVID cough in 14 studies of patients who required hospitalisation Follow-up duration ranges from 6 weeks to 4 months.…”
Section: Cough In the Post-covid Syndromementioning
confidence: 99%
“…Detailed characteristics of included studies are summarised in table 1 . 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 We conducted a random-effects meta-analysis to estimate the pooled prevalence and standard errors for post-COVID-cough in previously hospitalised patients, and quantified the degree of heterogeneity between studies using the I 2 in the MetaXL 5.3 software (EpiGear International Pty, Sunrise Beach, QLD, Australia). …”
Section: Cough In the Post-covid Syndromementioning
Cough is one of the most common presenting symptoms of COVID-19, along with fever and loss of taste and smell. Cough can persist for weeks or months after SARS-CoV-2 infection, often accompanied by chronic fatigue, cognitive impairment, dyspnoea, or pain—a collection of long-term effects referred to as the post-COVID syndrome or long COVID. We hypothesise that the pathways of neurotropism, neuroinflammation, and neuroimmunomodulation through the vagal sensory nerves, which are implicated in SARS-CoV-2 infection, lead to a cough hypersensitivity state. The post-COVID syndrome might also result from neuroinflammatory events in the brain. We highlight gaps in understanding of the mechanisms of acute and chronic COVID-19-associated cough and post-COVID syndrome, consider potential ways to reduce the effect of COVID-19 by controlling cough, and suggest future directions for research and clinical practice. Although neuromodulators such as gabapentin or opioids might be considered for acute and chronic COVID-19 cough, we discuss the possible mechanisms of COVID-19-associated cough and the promise of new anti-inflammatories or neuromodulators that might successfully target both the cough of COVID-19 and the post-COVID syndrome.
“… 14 Many reports have now described post-COVID symptoms and show that cough can persist for weeks and months after SARS-CoV-2 infection in some patients, with differing severity of acute symptoms ( figure 1 , table 1 ). 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 Figure 1 Follow-up studies reporting persistent cough in patients with post-COVID syndrome Studies sorted by follow-up duration in ascending order from left to right. Follow-up duration ranges from 6 weeks to 6 months.…”
Section: Cough In the Post-covid Syndromementioning
confidence: 99%
“…Data were retrieved from available publications, including peer-reviewed papers and preprints. 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Detailed characteristics of each study are summarised in table 1 . Some studies did not report acute cough data.…”
Section: Cough In the Post-covid Syndromementioning
confidence: 99%
“…24 , 25 In a pooled analysis, we found that the estimated prevalence of persistent cough was 18% (95% CI 12–24%; I 2 =93%) in 14 studies of hospitalised patients (follow-up duration ranged from 6 weeks to 4 months; figure 2 ). 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 However, prevalence varied widely between studies, and is presumably dependent on patient characteristics, treatment, follow-up duration, and outcome definition. Figure 2 Prevalence of post-COVID cough in 14 studies of patients who required hospitalisation Follow-up duration ranges from 6 weeks to 4 months.…”
Section: Cough In the Post-covid Syndromementioning
confidence: 99%
“…Detailed characteristics of included studies are summarised in table 1 . 9 , 10 , 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 We conducted a random-effects meta-analysis to estimate the pooled prevalence and standard errors for post-COVID-cough in previously hospitalised patients, and quantified the degree of heterogeneity between studies using the I 2 in the MetaXL 5.3 software (EpiGear International Pty, Sunrise Beach, QLD, Australia). …”
Section: Cough In the Post-covid Syndromementioning
Cough is one of the most common presenting symptoms of COVID-19, along with fever and loss of taste and smell. Cough can persist for weeks or months after SARS-CoV-2 infection, often accompanied by chronic fatigue, cognitive impairment, dyspnoea, or pain—a collection of long-term effects referred to as the post-COVID syndrome or long COVID. We hypothesise that the pathways of neurotropism, neuroinflammation, and neuroimmunomodulation through the vagal sensory nerves, which are implicated in SARS-CoV-2 infection, lead to a cough hypersensitivity state. The post-COVID syndrome might also result from neuroinflammatory events in the brain. We highlight gaps in understanding of the mechanisms of acute and chronic COVID-19-associated cough and post-COVID syndrome, consider potential ways to reduce the effect of COVID-19 by controlling cough, and suggest future directions for research and clinical practice. Although neuromodulators such as gabapentin or opioids might be considered for acute and chronic COVID-19 cough, we discuss the possible mechanisms of COVID-19-associated cough and the promise of new anti-inflammatories or neuromodulators that might successfully target both the cough of COVID-19 and the post-COVID syndrome.
“…84 However symptom duration, patient populations, and length of follow-up are highly variable between studies, with reported rates of full recovery between 13% and 86% at follow-up ranging from 30 to 186 days ( Table 2 ). 71 – 73 , 75 , 78 , 83 , 85 – 103 …”
Coronavirus disease 2019 (COVID-19) is a viral infection which can cause a variety of respiratory, gastrointestinal, and vascular symptoms. The acute illness phase generally lasts no more than 2–3 weeks. However, there is increasing evidence that a proportion of COVID-19 patients experience a prolonged convalescence and continue to have symptoms lasting several months after the initial infection. A variety of chronic symptoms have been reported including fatigue, dyspnea, myalgia, exercise intolerance, sleep disturbances, difficulty concentrating, anxiety, fever, headache, malaise, and vertigo. These symptoms are similar to those seen in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a chronic multi-system illness characterized by profound fatigue, sleep disturbances, neurocognitive changes, orthostatic intolerance, and post-exertional malaise. ME/CFS symptoms are exacerbated by exercise or stress and occur in the absence of any significant clinical or laboratory findings. The pathology of ME/CFS is not known: it is thought to be multifactorial, resulting from the dysregulation of multiple systems in response to a particular trigger. Although not exclusively considered a post-infectious entity, ME/CFS has been associated with several infectious agents including Epstein–Barr Virus, Q fever, influenza, and other coronaviruses. There are important similarities between post-acute COVID-19 symptoms and ME/CFS. However, there is currently insufficient evidence to establish COVID-19 as an infectious trigger for ME/CFS. Further research is required to determine the natural history of this condition, as well as to define risk factors, prevalence, and possible interventional strategies.
BackgroundThe prevalence and prognosis of post-acute stage SARS-CoV-2 infection fatigue symptoms remain largely unknown.AimsWe performed a systematic review to evaluate the prevalence of fatigue in post-recovery from SARS-CoV-2 infection.MethodMedline, Embase, PsycINFO, CINAHL, Web of Science, Scopus, trial registries, Cochrane Central Register of Controlled Trials and Google Scholar were searched for studies on fatigue in samples that recovered from PCR diagnosed COVID-19. Meta-analyses were conducted separately for each recruitment setting.ResultsWe identified 39 studies with 8825 patients that recovered from COVID-19. Post-COVID-19 patients self-report of fatigue was higher compared to healthy controls (RR = 3.688, 95%CI [2.502, 5.436], p < 0.001). Over 50% of patients discharged from inpatient care reported symptoms of fatigue during the first (ER = 0.517, 95%CI [0.278, 0.749]) and second month following recovery (ER = 0.527, 95%CI [0.337, 0.709]). 10% of the community patients reported fatigue in the first month post-recovery. Patient setting moderated the association between COVID-19 recovery and fatigue symptoms (R2 = 0.12, p < 0.001). Female gender was associated with greater self-report of fatigue (OR =1.782, 95%CI [1.531, 2.870]). Patients recruited through social media had fatigue above 90% across multiple time points. Fatigue was highest in studies from Europe.ConclusionFatigue is a symptom associated with functional challenges which could have economic and social impacts. Developing long-term planning for fatigue management amongst patients beyond acute stages of SARS-CoV-2 infection is essential to optimizing patient care and public health outcomes.
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