Persistent poor health after COVID-19 appears unrelated to initial severity of infection
Persistent poor health following COVID-19 does not appear to be associated with severity of initial infection, researchers reported in the Annals of the American Thoracic Society.
“We found that fatigue, ill-health and breathlessness were all common following COVID-19,” Liam Townsend, MD, research fellow in the department of clinical medicine at Trinity Translational Medicine Institute at Trinity College and specialist registrar in the department of infectious diseases at St. James Hospital, Dublin, said in a press release from the American Thoracic Society. “However, these symptoms appeared to be unrelated to the severity of initial infection or any single measurement at the time of an outpatient appointment.”
The researchers performed a cross-sectional study to analyze measures of recovery for 153 patients who were followed in an outpatient clinic a median of 75 days after their initial COVID-19 diagnoses in March to May. All participants underwent chest radiography and a 6-minute walk test. Researchers assessed fatigue and subjective return to health and measured C-reactive protein, interkeukin-6, soluble CD25 and D-dimer in each participant.
Infection severity was classified as not requiring hospital admission, requiring hospital admission or requiring ICU care. Nearly half (n = 74) of the patients required hospital admission during acute infection (mean age, 40.2 years; 72.2% women), 55 required hospital admission (mean age, 56.4 years; 47.3% women) and 19 required ICU care (mean age, 54.5 years; 26.3% women).
The results suggest that COVID-19 does not cause significant fibrosis. Lung scarring was seen on CT scans of only 4% of participants, following X-ray detection of earlier abnormalities in a larger group, according to the release.
Median 6-minute walk test distance was 460 m, and reduced distance was associated with frailty and length of inpatient stay, according to the results.
Sixty-two percent of patients reported feeling that they had not returned to full health and 47% were classified as having fatigue. Patients who felt they had to exert themselves during moderate exercise also reported they felt fatigued and in poor health, according to the release.
“We were surprised by our findings,” Townsend said in the release. “We expected a greater number of abnormal chest X-rays. We also expected the measures of ongoing ill-health and abnormal findings to be related to severity of initial infection, which was not the case.”
The researchers said these results highlight the importance of follow-up for all patients diagnosed with COVID-19, regardless of severity of initial infection.
“This study highlights the persistence of ill health following SARS-CoV-2 infection that presents a serious burden to quality of life,” the researchers wrote. “The lack of association with infection severity highlights that this may be an issue for a large number of patients, and this should be used to inform management strategies for convalescent patients.”