AUTHOR: Wendy S. Armstrong, MD reviewing
NEJM Journal Watch
Of patients hospitalized with COVID-19, 87% had persistent symptoms more than 2 months after onset of disease, despite resolution of viral infection.
Anecdotal reports of prolonged symptomatic recovery after COVID-19 are increasing in the popular press. Now, investigators in Italy report outcomes of 143 patients previously hospitalized for COVID-19, 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 hospitalization was 13.5 days. During hospitalization,73% had evidence of interstitial pneumonia, 15% required noninvasive ventilation, and 5% received mechanical ventilation. For this study, participants were virus-free by polymerase chain reaction testing and met World Health Organization criteria for ending quarantine (isolation).
On physical examination and history taking, only 13% of participants reported being symptom-free; 55% had 3 or more symptoms and the remainder had 1 or 2 symptoms. The most common symptoms were fatigue in 53%, dyspnea in 43%, joint pain in 27%, and chest pain in 22%. Compared with their pre-COVID-19 quality of life, 44% reported that their quality of life was ≥10 points lower on a scale of 0 (worst health) to 100 (best health).
The U.S. President has described COVID-19 as “totally harmless” 99% of the time. I suspect this is the first of many reports to suggest that such characterizations are far from true and that survival and recovery are not synonymous. Longitudinal data are 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 postacute interdisciplinary clinics are needed to follow-up on these phenomena further.