What PCPs need to know about persistent COVID-19 symptoms

Emerging evidence suggests not all patients completely recover from COVID-19.

“We should recheck patients periodically to see how things are going,” Angelo Carfi, MD, of the geriatrics department at Agostino Gemelli University Hospital in Rome, told Healio Primary Care.

Carfi was lead author of a JAMA paper that assessed 143 patients from a single medical center in Italy after their recovery from COVID-19. The researchers found that 87.4% of the patients experienced at least one persistent symptom. These included cough, joint pain or a sore throat, but most frequently fatigue and dyspnea. In a study published in BJGP Open, persistent fatigue and dyspnea were also reported in a group of patients from England who recovered from COVID-19.

Healio Primary Care asked Peter Katona, MD, FACP, FIDSA, clinical professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and chair of the infection control working group at the UCLA, to discuss some other persistent symptoms associated with COVID-19 and possible reasons these symptoms do not resolve.

Q: What are some common persistent COVID-19 symptoms?

A: Generally speaking, persistent COVID-19 symptoms are those associated with the flu and COVID-19, such as fever, chills, muscle aches, cough, congestion, runny nose and headaches. Some patients have also reported a mental fog and symptoms with neurodegenerative components to them.

Q: What evidence do we have to suggest how long these symptoms could last ?

A: We do not know yet precisely how long these symptoms will last. We also do not know how many patients with COVID-19 are susceptible to experiencing symptoms again.

Q: What makes symptoms persistent when it comes to the coronavirus?

A: There are theories on why this is the case. We do know that COVID-19 is a disease that affects many parts of the body including direct infection and invasion of tissue. But it also is an autoimmune disease where the body starts attacking itself. It is also a cardiovascular disease that can cause blood clots. Any of these three diseases can have a persistent component.

Q: Is there anything different about persistent COVID-19 symptoms compared with persistent influenza symptoms ?

A: The impact of COVID-19 on the lungs is much more significant than the toll the flu takes on the lungs. The damage the flu does to the alveoli can be regenerated. COVID-19 does more irreparable harm but sometimes it is so mild, it takes being a marathon runner to recognize the damage to the lungs.

Q: What resources do you recommend PCPs use to stay up to date on the latest developments surrounding COVID-19?

A: The CDC is doing a good job. They have made some mistakes, but not all of them are the agency’s fault. I would also keep an eye on local health departments, since they often have directives that overlap into the clinical realm. A lot of hospitals are also having online forums for their clinicians, so PCPs should watch for those.

References :

• Carfi A, et al. JAMA. 2020;doi:10.1001/jama.2020.12603.
• Kingstone T, et al. BJGP Open. 2020;doi:10.3399/bjgpopen20X101143.