High burden of persistent symptoms seen in patients after COVID-19 recovery

1. Patients reported a high burden of persistent symptoms more than six weeks after recovery from coronavirus disease 2019 (COVID-19).

2. Despite the high burden of symptoms, antibody levels were variable across patients and no specific cause of post-COVID sequalae was delineated.

Evidence Rating Level: 1 (Excellent)

Study Rundown: With more than 500 million COVID-19 cases worldwide, a significant number of those infected have reported symptoms that persist even after recovering from their acute illness. However, previous studies of post-acute sequelae have been primarily based on questionnaire data and retrospective analysis of electronic medical records. Therefore, there is a gap in knowledge as to understanding the long-term medical and mental health consequences of COVID-19. This includes characterizing the risk factors, clinical findings, and laboratory findings in affected patients. The present study found that patients with mild to moderate COVID-19 experienced a high burden of persistent symptoms following recovery. Though, there were no objective medical abnormalities noted on diagnostic evaluation that explained ongoing symptoms. This study was limited by study participants not having a severe form of COVID-19 that required hospitalization and did not capture any post-acute sequelae that resolved before enrollment in the study. Nevertheless, these study’s findings are significant, as they demonstrate that COVID-19 can cause persistent post-acute sequelae even in mild to moderate cases after recovery.

Click to read the study in AIM

Relevant Reading: Understanding and Improving Recovery From COVID-19

In-Depth [longitudinal cohort study]: This is a longitudinal cohort study conducted at the National Institutes of Health Clinical Center in Maryland, with patients recruited from within a 100-mile radius of Bethesda, Maryland. Patients who had laboratory-confirmed SARS-CoV-2 infection were eligible if they were at least six weeks past onset of COVID-19 symptoms, had no fever within seven days of enrollment and did not have worsening respiratory symptoms. Patients with no history of COVID-19 were enrolled as a control group. Both groups were enrolled over the same period and same geographic area. The primary outcome included symptoms consistent with post-acute sequelae of COVID-19 infection and antibody levels as well as mental and physical health data. Outcomes in the primary analysis were assessed via unadjusted comparisons and adjusted comparisons with multivariate linear regression. Based on the analysis, symptoms that correlated with post-acute sequelae of COVID-19 were reported in 55% of the patients in the COVID-19 group and in 13% of the control patients. There was a higher risk for post-acute sequelae in women and those with a history of anxiety disorder. Additionally, patients who reported any post-acute sequelae also reported lower quality of life. However, abnormal findings on physical exam or diagnostic lab testing were not seen and there was no correlation between persistent viral infection, autoimmunity, or abnormal immune activation in patients experiencing post-acute sequelae. Overall, this study demonstrates that there is a high burden of persistent post-acute symptoms after COVID-19 recovery, but that there was no specific pathophysiologic mechanism discerned.

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