Half of recovered COVID-19 patients reported at least one symptom after four months

The effects of COVID-19 vary widely, from asymptomatic individuals to patients who develop severe acute respiratory distress syndrome, with possible damage to almost all organs and systems, were published at the start of the pandemic. However, the possible long-term consequences of COVID-19 have become of growing concern.

Although long-term sequelae of individual organ damage have been reported, there have been few comprehensive assessments of the long-term consequences of COVID-19. In addition, most of the studies included patients who decided to actively participate in the follow-up.

The objective of a study, published in the specialized journal JAMA, by a group of specialists from the Bicêtre hospital in France was systematically assess, four months after discharge, the clinical status of survivors of the COVID-19 disease requiring hospitalization.

This was an uncontrolled prospective cohort study. COVID-19 survivors who had been hospitalized at a university hospital in France, who underwent a telephone assessment four months after discharge.

Patients with relevant symptoms and all those hospitalized in an intensive care unit (ICU) were invited for further evaluation during an outpatient visit.

Therefore, 51% reported at least one symptom that did not exist before the illness. The most common symptoms were fatigue, cognitive problems, and newly onset dyspnea.

The legacies of COVID-19

Among patients who returned for further evaluation, CT scans frequently revealed persistent lung abnormalities as well as pulmonary fibrotic lesions in a minority of patients. Persistent cardiac dysfunction and renal failure were rare. Almost all of the patients had a positive anti-SARS-CoV-2 serology.

“There have been significant concerns about the respiratory sequelae of COVID-19 -Explain Luc Morin, lead author of the research. However, severe pulmonary sequelae were rare in the patients we saw, although all had severe or very severe COVID-19.“.

The results of the pulmonary CT scan, performed in all symptomatic and intensive care patients, were abnormal in most of them, but the most frequent lesions were subtle opacities of ground glass, confirming the previous results. Fibrotic lesions from the initial severe inflammation were only present in 19% of patients. Fibrotic changes affected less than 25% of the lung parenchyma in all patients and occurred almost exclusively in ICU patients..

Although serious pulmonary sequelae are rare, New onset dyspnea was reported in 16% of patients. If this is confirmed in other studies and found to be persistent, it could be clinically important, given the large number of critically ill COVID-19 patients around the world.

Additionally, although parenchymal sequelae were the most common finding, respiratory dysfunction was confirmed by the hyperventilation challenge test in 12% of patients, a finding that was not previously described. “Dysfunctional breathing is most likely not specific to COVID-19 -explains the specialist-. However, this could be the sequel to the dissociation between dyspnea and the severity of hypoxemia described in patients with acute COVID-19.

In this studio, cognitive problems were common: 21% of patients referred at least one, and deterioration was confirmed in 38% of patients. The underlying mechanisms are unknown, but these symptoms could be a consequence of damage to the central nervous system by SARS-CoV-2, as occurs in other viral infections such as glandular fever.

Psychological testing was only performed on patients who returned for an outpatient assessment, making it difficult to determine the true prevalence of these findings. Symptoms of anxiety were found in 31% of patients and depression in 21%. On the contrary, the prevalence of psychological symptoms in ICU patients, systematically evaluated in outpatient clinics, was significant. These appear to have been less frequent in ICU patients than in the general population assessed.

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