Patients With Uncomplicated Coronavirus Disease 2019 (COVID-19) Have Long-Term Persistent Symptoms and Functional Impairment Similar to Patients with Severe COVID-19: A Cautionary Tale During a Global Pandemic

Jacobson, Karen; Rao, M. V. S. Kameshwar; Bonilla, Hector; Subramanian, Aruna; Hack, Isabelle; Madrigal, Martina; Singh, Upinder; Jagannathan, Prasanna; Grant, Philip

doi:10.1093/cid/ciab103

Cited by 155 publications

(177 citation statements)

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“…A total of 29 published studies [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] and five medRxiv preprints [44] , [45] , [46] , [47] , [48] were initially included in the review/meta-analysis ( Figure 1 ) . One preprint [44] was excluded because the same study has been posteriorly published in a peer-reviewed journal [30] .…”

Section: Resultsmentioning

confidence: 99%

“…Of the twenty-one studies [ 15 , 16 , 18 , [22] , [23] , [24] , [25] , 27 , 29 , [32] , [33] , [34] , [35] , [36] , [37] , [40] , [41] , [42] , [43] , 46 , 47 ] investigating the presence of post-COVID-19 symptoms in hospitalized patients, four analyzed symptoms 30 days after hospital discharge [ 15 , 33 , 41 , 43 ], nine showed a follow-up period of 60 days [ 15 , 18 , 24 , 27 , 29 , 36 , 37 , 42 , 47 ], whereas ten reported symptoms ≥90 days after discharge [ 16 , 22 , 23 , 25 , 26 , [33] , [34] , [35] , 40 , 46 ]. Overall, hospitalized COVID-19 patients were assessed a mean of 83.6±48.4 after hospital discharge.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, hospitalized COVID-19 patients were assessed a mean of 83.6±48.4 after hospital discharge. Among twelve studies [ 17 , [19] , [20] , [21] , 26 , 28 , 30 , 31 , 38 , 39 , 45 , 48 ] with non-hospitalized patients, four studies evaluated post-COVID-19 symptoms 30 days after onset [ 19 , 31 , 38 , 45 ] two had a follow-up of 60 days [ 30 , 45 ], whereas seven analyzed symptoms after ≥90 days [ 17 , 20 , 21 , 26 , 28 , 45 , 48 ]. The sample of non-hospitalized patients was assessed a mean of 73.9±46.4 days after onset of symptoms.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis

Fernández‐de‐las‐Peñas

Palacios‐Ceña

Gómez‐Mayordomo

et al. 2021

European Journal of Internal Medicine

413

300

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Background : Single studies support the presence of several post-COVID-19 symptoms; however, no meta-analysis differentiating hospitalized and non-hospitalized patients has been published to date. This meta-analysis analyzes the prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized patients recovered from COVID-19 . Methods : MEDLINE, CINAHL, PubMed, EMBASE, and Web of Science databases, as well as medRxiv and bioRxiv preprint servers were searched up to March 15, 2021. Peer-reviewed studies or preprints reporting data on post-COVID-19 symptoms collected by personal, telephonic or electronic interview were included. Methodological quality of the studies was assessed using the Newcastle-Ottawa Scale. We used a random-effects models for meta-analytical pooled prevalence of each post-COVID-19 symptom, and I² statistics for heterogeneity. Data synthesis was categorized at 30days, 60days, and ≥90 days after . Results : From 15,577 studies identified, 29 peer-reviewed studies and 4 preprints met inclusion criteria. The sample included 15,244 hospitalized and 9,011 non-hospitalized patients. The methodological quality of most studies was fair. The results showed that 63.2%, 71.9% and 45.9% of the sample exhibited ≥one post-COVID-19 symptom at 30, 60, or ≥90days after onset/hospitalization. Fatigue and dyspnea were the most prevalent symptoms with a pooled prevalence ranging from 35% to 60% depending on the follow-up. Other post-COVID-19 symptoms included cough (20-25%), anosmia (10-20%), ageusia (15-20%) or joint pain (15-20%). Time trend analysis revealed a decreased prevalence 30days after with an increase after 60days . Conclusion : This meta-analysis shows that post-COVID-19 symptoms are present in more than 60% of patients infected by SARS-CoV‑2. Fatigue and dyspnea were the most prevalent post-COVID-19 symptoms, particularly 60 and ≥90 days after.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis

Fernández‐de‐las‐Peñas

Palacios‐Ceña

Gómez‐Mayordomo

et al. 2021

European Journal of Internal Medicine

413

300

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“…It is still debated whether long-time persistence of symptoms in patients hospitalized for COVID-19 is pathogenically similar to that observed in ICU patients admitted for other diseases or is specifically related to SARS-CoV-2 infection. The latter hypothesis is supported by the high prevalence of persistent symptoms even in outpatients with nonsevere COVID-19 [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

et al. 2021

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Purpose Few data are currently available on persistent symptoms and late organ damage in patients who have suffered from COVID-19. This prospective study aimed to evaluate the results of a follow-up program for patients discharged from a nonintensive COVID-19 ward. Methods 3–6 months after hospital discharge, 59 of 105 COVID-19 patients (31 males, aged 68.2 ± 12.8 years) were recruited in the study. Forty-six patients were excluded because of nontraceability, refusal, or inability to provide informed consent. The follow-up consisted of anamnesis (including a structured questionnaire), physical examination, blood tests, ECG, lower limb compression venous ultrasound (US), thoracic US, and spirometry with diffusion lung capacity for carbon monoxide (DLCO). Results 22% of patients reported no residual symptoms, 28.8% 1 or 2 symptoms and 49.2% 3 or more symptoms. The most frequently symptoms were fatigue, exertional dyspnea, insomnia, and anxiety. Among the inflammatory and coagulation parameters, only the median value of fibrinogen was slightly above normal. A deep vein thrombosis was detected in 1 patient (1.7%). Thoracic US detected mild pulmonary changes in 15 patients (25.4%), 10 of which reported exertional dyspnea. DLCO was mildly or moderately reduced in 19 patients (37.2%), 13 of which complained of exertional dyspnea. Conclusion These results highlight that a substantial percentage of COVID-19 patients (77.8%) continue to complain of symptoms 3–6 months after hospital discharge. Exertional dyspnea was significantly associated with the persistence of lung US abnormalities and diffusing capacity alterations. Extended follow-up is required to assess the long-term evolution of postacute sequelae of COVID-19.

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“…It will only be through population-based probability samples that researchers can be confident that their study populations are representative of the relevant targets. For this reason, the percentage of study participants with persistent symptoms that we and others [9,[49][50][51] calculate cannot be interpreted as meaningful population-level prevalence estimates. The threat of selection bias in the initial selection of participants also extends to our follow-up.…”

Section: There Are Multiple Mechanisms That Might Contribute To Pascmentioning

confidence: 91%

Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection/COVID-19

Peluso

Kelly

et al. 2021

Preprint

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BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic continues and millions remain vulnerable to infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), attention has turned to characterizing post-acute sequelae of SARS-CoV-2 infection (PASC). METHODS: From April 21 to December 31, 2020, we assembled a cohort of consecutive volunteers who a) had documented history of SARS-CoV-2 RNA-positivity; b) were ≥ 2 weeks past onset of COVID-19 symptoms or, if asymptomatic, first test for SARS-CoV-2; and c) were able to travel to our site in San Francisco. Participants learned about the study by being identified on medical center-based registries and being notified or by responding to advertisements. At 4-month intervals, we asked participants about physical symptoms that were new or worse compared to the period prior to COVID-19, mental health symptoms and quality of life. We described 4 time periods: 1) acute illness (0-3 weeks), 2) early recovery (3-10 weeks), 3) late recovery 1 (12-20 weeks), and 4) late recovery 2 (28-36 weeks). Blood and oral specimens were collected at each visit. RESULTS: We have, to date, enrolled 179 adults. During acute SARS-CoV-2 infection, 10 had been asymptomatic, 125 symptomatic but not hospitalized, and 44 symptomatic and hospitalized. In the acute phase, the most common symptoms were fatigue, fever, myalgia, cough and anosmia/dysgeusia. During the post-acute phase, fatigue, shortness of breath, concentration problems, headaches, trouble sleeping and anosmia/dysgeusia were the most commonly reported symptoms, but a variety of others were endorsed by at least some participants. Some experienced symptoms of depression, anxiety, and post-traumatic stress, as well as difficulties with ambulation and performance of usual activities. The median visual analogue scale value rating of general health was lower at 4 and 8 months (80, interquartile range [IQR]: 70-90; and 80, IQR 75-90) compared to prior to COVID-19 (85; IQR 75-90). Biospecimens were collected at nearly 600 participant-visits. CONCLUSION: Among a cohort of participants enrolled in the post-acute phase of SARS-CoV-2 infection, we found many with persistent physical symptoms through 8 months following onset of COVID-19 with an impact on self-rated overall health. The presence of participants with and without symptoms and ample biological specimens will facilitate study of PASC pathogenesis. Similar evaluations in a population-representative sample will be needed to estimate the population-level prevalence of PASC.

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Patients With Uncomplicated Coronavirus Disease 2019 (COVID-19) Have Long-Term Persistent Symptoms and Functional Impairment Similar to Patients with Severe COVID-19: A Cautionary Tale During a Global Pandemic

Cited by 155 publications

References 10 publications

Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis

Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis

COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge

Rapid implementation of a cohort for the study of post-acute sequelae of SARS-CoV-2 infection/COVID-19

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