Wendy Armstrong in the Journal of the American Medical Association of July revealed that 87% of patients hospitalised with COVID-19 had persistent symptoms more than two months after the onset of the disease despite resolution of viral infection.

Investigators in Italy reported outcomes of 143 patients previously hospitalised for COVID-19 and evaluated a mean of 60 days after symptom onset and 36 days after hospital discharge. This observational cohort had a mean age of 56.5 years, 37% were women, and the mean length of hospitalisation was 13.5 days.

During hospitalisation, 73% had evidence of interstitial pneumonia, 15% required non-invasive ventilation, and 5% received mechanical ventilation. For this study, participants were virus-free by PCR testing and met the WHO criteria for ending quarantine.

Physical examination and history taking revealed only 13% of participants reported being symptom free. 55% had three or more symptoms and the remainder had one or two symptoms.

The most common symptoms were:

  • Fatigue in 53%
  • Dyspnoea in 43%
  • Joint pain in 27%
  • Chest pain in 22%

Compared with their pre-COVID-19 quality of life, 44% reported that their quality of life was greater than or equal to 10 points lower on a scale of 0-100 with 0 being worst health, 100 being best health.

Characterisations such as reported by President Trump are far from true and that survival and recovery are not synonymous. Longitudinal data is needed to fully understand how long symptoms persist and how many become permanent.

Whether any effective therapies exist for COVID-19 sequelae is equally unclear. Long term post-acute interdisciplinary clinics are needed to follow up on these phenomena further.

Dr Paul Ettlinger
The London General Practice

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