Shortness of breath and fatigue most common in self-reported long-lasting COVID cases

The rapid outbreak of a new coronavirus, namely severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), caused the pandemic known as coronavirus disease 2019 (COVID-19). To date, this pandemic has claimed more than 6.1 million lives and massively affected the global economy. In response, researchers worked at an unprecedented pace to develop vaccines and therapies to contain the pandemic.

context

Recently, several studies have reported the long-term morbidity of COVID-19. These studies have also revealed its effects on society, the economy, and health care. Some of the symptoms that have persisted for an extended period in recovered COVID-19 patients are fatigue, shortness of breath, and reduced quality of life. Scientists have reported that these symptoms can persist for up to twelve months after COVID-19 illness. For example, a previous study reported that patients with pneumonia, who required hospitalization, suffered from prolonged fatigue, cough and dyspnea during their recovery period, which negatively affected the functioning of the healthcare system. Similarly, researchers have also reported that patients recovering from SARS-CoV-2 exhibit analogous ongoing morbidity with ongoing abnormal respiratory function.

There is an ongoing conflict between COVID-19 patients and clinicians over when a patient can be considered cured, i.e. once they present a negative COVID-PCR test and are discharged. hospital or when he has persistent symptoms and reduced functioning.

Study: Patient-reported respiratory outcome measures during recovery of adults hospitalized with COVID-19: a systematic review and meta-analysis. Image Credit: Kleber Cordeiro/Shutterstock

A new study

A new systematic review and meta-analysis published on the medRxiv* The preprint server focused on studying respiratory outcomes and functional recovery of patients eight weeks after hospitalization with COVID-19 disease.

In this study, scientists used patient-reported outcomes (PROMs) as measurement tools, where patients provided relevant information about their health, symptoms, quality of life, and day-to-day functioning. This information was extremely important in assessing their recovery pathways. In this systematic review, the researchers used databases, such as Embase, PubMed/MEDLINE, the Cochrane COVID-19 Studies Register, CINAHL and Google Scholar, to identify relevant articles and reviews.

Main conclusions

The authors observed that a third of recovered COVID-19 patients who required hospitalization continued to experience fatigue. Additionally, 32% of participants had an abnormal dyspnea score up to four months after hospital discharge, and quality of life was below the population average.

The researchers revealed that even after six months after discharge from hospital, many patients had to take persistent sick leave and had to change the scope of their work. Additionally, some patients were unable to begin work after being discharged from hospital and continuing to use primary and secondary health care facilities.

Similar to SARS-CoV-2, other respiratory infections have also shown prolonged respiratory and functional sequelae after discharge from hospital. For example, a systematic review of community-acquired pneumonia (CAP) found that 42% of patients suffered from fatigue and 39% from dyspnea six weeks after infection. However, in the case of COVID-19 patients, 36.6% of patients experienced fatigue and 28.8% experienced dyspnea, two to four months after discharge from hospital. Another coronavirus that has caused an outbreak in the past is SARS, and survivors experienced reduced exercise capacity for six months after discharge from hospital. They also suffered from long-term respiratory and psychological sequelae and poor health-related quality of life.

Compared to hospitalized seasonal flu survivors, recovered COVID-19 patients have persistent symptoms for a longer period of time and require more outpatient care. Interestingly, the majority of people infected with COVID-19 do not require hospitalization, but may have prolonged COVID-19 symptoms. Researchers estimated that 47% of women and 33% of men in the non-hospitalized COVID-19 group had more than one symptom, 117 days after SARS-CoV-2 infection.

The authors observed reinfection in 8% of women and 28% of men who recovered from COVID-19 infection. Additionally, they found that 61.7% of women and 66.4% of men had seen their GP six months after testing positive for SARS-CoV-2. Researchers observed increased use of healthcare facilities by recovered COVID-19 patients.

The scientists recommended allocating resources, which involve rehabilitation, psychological intervention and specialized management of physical health symptoms, for the management of recovering COVID-19 patients, regardless of their hospitalization status. Long-term respiratory and functional sequelae of COVID-19 have also been observed. Additionally, persistent gastrointestinal, neurological, mental health, cardiac, and metabolic disorders have been reported.

Strengths and limitations of the study

One of the main strengths of this study is its design, which used PROMs to analyze symptoms of long COVID in hospitalized patients discharged for more than 8 weeks. Another advantage of this study is that it was conducted according to PRISMA guidelines. Limitations include the inclusion of a large number of studies that followed varying methodologies to assess the long-term outcomes of COVID-19 in hospitalized patients. There is a strong possibility of biased results due to uncontrolled confounding factors and heterogeneity present in observational studies. Going forward, researchers should focus on standardizing PROMs and properly classifying COVID-19 severity to facilitate translational research.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be considered conclusive, guide clinical practice/health-related behaviors, or treated as established information.

About Mark A. Tomlin

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