Breathlessness and fatigue most common in self reported long-COVID

By Dr. Priyom Bose, Ph.D.Mar 24 2022Reviewed by Emily Henderson, B.Sc.

The rapid outbreak of a novel 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 has massively affected the world’s economy. In response, researchers have been working at an unprecedented pace to develop vaccines and therapeutics to contain the pandemic.

Background

Recently, several studies have reported the long-term morbidity of COVID-19. These studies have also revealed its effects on society, the economy, and healthcare. Some of the symptoms that persisted for a prolonged period in COVID-19 recovered patients are fatigue, shortness of breath, and reduced quality of life. Scientists reported that these symptoms could persist for up to twelve months post COVID-19 illness. For example, a previous study indicated that patients with pneumonia, who required hospitalization, experienced prolonged fatigue, cough, and dyspnoea during their recovery period, which adversely affected the functioning of the healthcare system. Similarly, researchers also reported that SARS-CoV-2 convalescent patients experience analogous ongoing morbidity with continual abnormal respiratory function. 

There is an ongoing conflict between COVID-19 patients and clinicians on when a patient can be considered recovered, i.e., once they exhibit negative COVID-PCR test and are discharged from hospital or when they show persistent symptoms and reduced functioning.

Study: Patient-reported respiratory outcome measures in the recovery of adults hospitalised with COVID-19: A systematic review and meta-analysis. Image Credit: Kleber Cordeiro / Shutterstock

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

A New Study

A new systematic review and meta-analysis posted to the medRxiv* preprint server has focussed on investigating the respiratory outcomes and functional recovery of patients eight weeks post-hospitalization with COVID-19 disease.

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

Key Findings

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

Researchers revealed that even after six months post-hospital discharge, many patients had to take persisting sick leave from work and had to modify the scope of work. In addition, some patients could not start working after being released from the hospital and continued use of primary and secondary healthcare facilities.

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

Compared to hospitalized seasonal influenza survivors, COVID-19 recovered patients experience persistent symptoms for a more extended period and require more outpatient care. Interestingly, the majority of COVID-19 infected individuals do not require hospitalization but might experience long-COVID symptoms. Researchers estimated that 47% of females and 33% of men in the non-hospitalized COVID-19 group exhibit more than one symptom, 117 days post SARS-CoV-2 infection.

The authors observed reinfection in 8% of females and 28% of males who recovered from COVID-19 infection. In addition, they found 61.7% of females and 66.4% of males visited their general physician six months after testing positive for SARS-CoV-2. Researchers observed an increased utilization of healthcare facilities by COVID-19 recovered patients.

Scientists recommended allocating resources, which involve rehabilitation, psychological intervention, and specialty management of physical health symptoms, for managing COVID-19 convalescent 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 were reported. 

Strengths and Limitations of the Study

One of the key strengths of this study is its study design, which used PROMs for analyzing long-COVID symptoms in hospitalized patients discharged for more than 8 weeks. Another advantage of this study is that it was conducted as per the PRISMA guidelines. The limitations include the inclusion of a large number of studies that followed varied methodologies to evaluate long-term COVID-19 outcomes in hospitalized patients. There is a high possibility of biased results due to uncontrolled confounders and heterogeneity present in observational studies. In the future, researchers should focus on standardizing PROMs and properly classifying COVID-19 severity to aid translative research. 

*Important notice: medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.