Persistent symptoms after acute COVID-19 infection: importance of follow-up

To the Editor:

Since its beginning at the end of 2019, and given its rapid spread, the SARS-CoV-2 infection has become a health emergency in the form of a worldwide pandemic. There are numerous publications about the signs and symptoms of acute SARS-CoV-2 infection, with fever, cough, dyspnoea, musculoskeletal involvement (myalgias, arthralgias), diarrhoea, anosmia and dysgeusia being the most commonly described manifestations¹. However, there are few data on the persistence of the symptoms in subjects who have overcome the infection. Our objective is to evaluate the persistence of symptoms in patients who have required hospital admission due to COVID-19 infection and who are undergoing follow-up in specialist consultations.

A retrospective and descriptive cohort study of 118 patients admitted to a hospital ward of the Virgen de las Nieves hospital in Granada from 13th March to 15th May 2020, all of them with confirmed SARS-CoV-2 infection by PCR and/or serology, with unconfirmed suspects being excluded. Signs and symptoms of onset presentation were described and later, in the specialist consultation, they were asked again about their persistence or disappearance and a physical examination was carried out including height and weight measurements.

Of the patients included, 55.9% were male, with a mean age of 60.16 years (SD: 15.08). The BMI was 29.7 kg/m² (SD: 5.79), with 41% of patients with obesity and 37.3% with overweight, according to the BMI values (overweight, BMI > 25.0 to 29.9 kg/m²; obesity, BMI > 30.0 kg/m²).

Regarding cardiovascular risk factors, the most common associated pathologies were arterial hypertension (50%), hypercholesterolemia (28%) and type 2 diabetes mellitus (22%). Other associated comorbidities were: asthma (14.4%), sleep apnoea-hypopnea syndrome (8.5%), chronic obstructive pulmonary disease (6%), ischemic heart disease (6%), and chronic kidney disease (6%). The mean stay in the hospital ward was 11.25 days (SD: 8.5), with 7.6% requiring intensive care and 4.2% invasive mechanical ventilation. 3.4% required non-invasive mechanical ventilation. Regarding radiological findings, 94% had radiographic abnormalities during admission, with a prevalence of bilateral multilobe involvement in 68.6%.

The re-evaluation in the specialist consultation was carried out after a mean of 50.8 days (SD: 6.02) following hospital discharge.

The symptoms at admission and during the acute phase were highly variable, with only 5% of the total being asymptomatic. According to frequency, the signs and symptoms were: fever (84.7%), cough (65.3%), dyspnoea (61%), diarrhoea (50.8%), ageusia (50.8%), myalgia (49, 2%), anosmia (42.4%), chest pain (34.7%), headache (34%) and expectoration (13.6%).

At the follow-up visit, when asked about the symptoms present at the onset, 62.5% of patients reported persistence of symptoms: dyspnoea (31.4%), asthenia (30.5%), myalgia (13%), cough (5%), anosmia (1.7%) and ageusia (1%).

In 28%, two or more of the symptoms specified above persisted.

Our study showed that 62.5% of patients hospitalized for COVID-19 infection report persistence of some symptom after a mean period of time from discharge of 50 days, with dyspnoea and asthenia being, by far, the most common. These results agree with those published by Carfì et al.², where these two symptoms were confirmed as those that persisted the most.

There are limitations in our study, such as the evaluation of only hospitalized patients and the size of the sample. Furthermore, it is unknown whether some of these symptoms were present prior to SARS-CoV-2 infection in some cases.

However, the importance of clinical follow-up of these patients after the acute phase is highlighted, with the aim of monitoring the persistence, improvement, or worsening of the above-mentioned signs and symptoms.

More studies are needed to evaluate the mid- and long-term clinical course of these patients after their acute infection.