12 Jan Ill-Health Common After COVID-19 But Surprisingly Unrelated to Initial Infection Severity
MedicalResearch.com Interview with:
Dr. Liam Townsend, PhD
Department of Infectious Diseases
St. James’s Hospital and Department of Clinical Medicine
Trinity Translational Medicine Institute
Trinity College, Dublin, Ireland
MedicalResearch.com: What is the background for this study?
Response: Much is known about the clinical characteristics and pathological features of acute SARS-CoV-2 infection, but there is relatively little known about post-COVID recovery. This has come under increasing scrutiny in light of reports that patients suffer persistent symptoms beyond resolution of initial infection, known as long COVID. We set out to assess patients in our post-COVID clinic for ongoing ill-health, with particular focus on fatigue and breathlessness. Given that COVID-19 primarily affects the respiratory system, we also evaluated respiratory recovery. Patients underwent chest radiography and six-minute-walk testing, as well as routine blood tests including inflammatory markers and D-dimers. We included both patients who were admitted during their acute infection as well as those managed in the community in order to capture the full spectrum of disease.
MedicalResearch.com: What are the main findings? Are there any markers that suggest a higher risk of persistent post-Covid symptoms?
Response: We assessed 153 patients, of whom 74 had required admission during initial infection, at a median of 75 days post-infection. We found persistent ill-health was common in those attending our clinic, with 62% reporting that they did not feel back to full health. Almost half (47%) met the case definition for fatigue, as assessed by the Chalder Fatigue Scale. Patients also reported moderate breathlessness on six-minute-walk-test, with a median modified Borg score of 3. Reassuringly, we saw persistent abnormal chest x-rays in only 4% of patients, and the median distance covered during walk test was 460m, which approaches the normal range for healthy populations. Furthermore, there were only two patients that experienced oxygen desaturation to less than 90% during walk test.
We investigated the potential predictors and associations of breathless, distance covered and abnormal chest x-ray using a multivariate regression analysis model. Interestingly, we found that severity of initial infection, as defined by requirement for admission to hospital, peak CRP and peak oxygen requirement, was not associated with severity of self-reported symptoms. Thus, there were no features from initial infection identified that could predict persistence of symptoms beyond initial infection.
MedicalResearch.com: What should readers take away from your report?
Response: This study highlights several important points:
- Ill-health, fatigue and breathlessness are common in the aftermath of SARS-CoV-2 infection
- These appear unrelated to initial severity of infection. This has implications for the potential number of patients who may be affected, as well as increased burden on the healthcare system
- We show reassuringly low rates of abnormal chest x-rays as well as reassuring objective six-minute-walk test results, suggesting that clinically significant pulmonary damage is uncommon.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We would suggest that future studies on the aftermath of COVID-19 include patients across the spectrum of disease severity, rather than focusing only on those who required hospitalization. The range and frequency of post-COVID symptoms are being emerging in the literature, and there is a need for mechanistic studies to understand the underlying pathology.
We have no disclosures to declare.
Liam Townsend, Joanne Dowds, Kate O’Brien, Grainne Sheill, Adam H Dyer, Brendan O’Kelly, John P. Hynes, Aoife Mooney, Jean Dunne, Cliona Ni Cheallaigh, Cliona O’Farrelly, Nollaig M Bourke, Niall Conlon, Ignacio Martin-Loeches, Colm Bergin, Parthiban Nadarajan, Ciaran Bannan. Persistent Poor Health Post-COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity. Annals of the American Thoracic Society, 2021; DOI: 10.1513/AnnalsATS.202009-1175OC
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