Half of French COVID-19 survivors who were hospitalized (51.0%) had at least one COVID-related symptom at least 4 months later, according to a study published yesterday in JAMA.
The most commonly noted symptoms were fatigue (31.1%), cognitive conditions (20.7%), and shortness of breath (16.3%). Further clinical tests in a subset of 177 patients showed that 63.2% had abnormalities on lung computed tomography (CT) scan, but the researchers note that severe pulmonary after-effects were not common.
“Along with funding for research to better understand and treat long COVID, simultaneous investment in clinical infrastructure will be needed to support patients as they recover from this challenging disease,” writes Hallie Prescott, MD, MSc, of the University of Michigan, in an invited editorial.
For the study, 478 former COVID-19 patients in the Consultation Multi-Expertise de Bicetre Apres COVID-19 (COMEBAC) study completed a telephone survey 4 months after they were hospitalized in Paris in spring 2020. The patients were a median of 60.9 years old.
All intensive care unit (ICU) patients (142, 29.7%) and those who were still experiencing symptoms (152, 31.8%) were invited for a clinical assessment, of which 177 total accepted (median age, 56.9).
Long-term mental, cognitive effects
Back in January, CIDRAP News profiled several COVID-19 long-haulers, highlighting the “brain fog mystery,” which can include memory, attention, and multitasking issues, and this study also assessed cognitive decline. During the telephone survey, the researchers conducted a Q3PC cognitive questionnaire and found that, at least once a week, some experienced mental slowness (10.1%), concentration difficulties (10.0%), or memory problems (17.5%).
“The underlying mechanisms are unknown, but these symptoms might be the sequala of central nerve system injury by SARS-CoV-2, as occurs during other viral infections such as glandular fever,” write the researchers.
The clinical assessment included more questionnaires assessing both cognitive and mental health. The 20-item Multidimensional Fatigue Inventory questionnaire showed that the median mental fatigue score for 145 patients was 3.7 (1-5 scale, with 5 being the worst). Median score for reduced motivation was 4.5. Cognitive impairment was seen in 38.4% patients, mostly in those 75 and older.
The researchers note that while the 177-person cohort indicated that 31.4% of patients had anxiety and 20.6% had depression, in the ICU only about one in five had either (23.4% and 18.1%, respectively). Similarly, while only 7.4% of those who had been admitted to the ICU experienced post-traumatic symptoms, 14.2% of the overall subgroup did.
Fatigue, respiratory issues continue
The study also looked at physical symptoms that started during or after COVID-19 infection, both patient-reported (eg, fatigue) and medically quantified (eg, pulmonary function).
In the telephone survey, 31.1% respondents experienced fatigue, 16.3% had shortness of breath, and 12.1% had burning or prickling sensations in their limbs, all of which they did not have prior to COVID-19.
Clinical assessment revealed further symptoms for some patients, particularly with respiratory function. Shortness of breath was quantified as a 2 (median value) on the Modified Medical Research Council Dyspnea Scale, which indicates participants walked slower than others their age due to shortness of breath or required breaks. Persistent coughs were seen in 13.4% patients, and 20.9% had dysfunctional breathing as assessed by the Nijmegen score.
CT scans were performed on 171 patients and indicated abnormalities in 63.2%; of those patients, 75.5% had been intubated and 58.2% had not been. Most common were ground-glass opacities (42.4%), but fibrotic lesions showed up in 19.4% of scans and usually affected four lobes. The mean diffusing capacity for carbon monoxide for 152 participants was 87% predicted, with 21.7% of people achieving less than 70%.
While some patients received further heart (83) and kidney (95) tests, issues were not common. Among 51 intubated patients, 27.5% had muscular weakness consistent with ICU-related nervous system problems.
Overall, on the 36-item Short-Form Health Survey, which is scored on a range of 0 to 100, with higher being better, 130 participants had low median marks for “role limited owing to physical problems” (25), “vitality” (46.9), and “general health” (57.5).
Call for resources, research
“The exact rate of new symptoms remains unknown, as 43% of hospital survivors did not complete the telephone survey, and 40% of eligible telephone respondents declined in-person assessment,” writes Prescott in her editorial. “Regardless, the prevalence of symptoms will undoubtedly vary across settings and over time as treatment for COVID-19 and circumstances evolve.”
In a related call for action today, the American Academy of Physical Medicine and Rehabilitation (AAPMR) sent a letter to President Joe Biden and Congress asking for a national crisis action plan to address long-term health problems in COVID survivors.
The AAPMR recommends three major steps: (1) resources to build the necessary infrastructure, (2) equitable access to care for all patients, and (3) continued funding for research that advances medical understanding of long-haul COVID-19 symptoms.