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Article ; Online: COVID-19: Evaluation and Care of Patients With Persistent Symptoms Following Acute SARS-CoV-2 Infection.

Laine, Christine / Cotton, Deborah

2021 Volume 174, Issue 8, Page(s) 1159–1160

MeSH term(s)	COVID-19/complications ; COVID-19/therapy ; Humans ; SARS-CoV-2
Language	English
Publishing date	2021-06-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M21-2342
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Article ; Online: Emerging trends in management of long COVID with a focus on pulmonary rehabilitation: A review.

Li, Allison Y / Li, Willis X / Li, Jinghong

The clinical respiratory journal

2024 Volume 18, Issue 5, Page(s) e13777

Abstract: ... with persistent symptoms following SARS-Cov-2 infection. The symptoms include fatigue, dyspnoea, cognitive ... medical evaluation by multidisciplinary team and assessment of persistent symptoms with scoring systems ... in development. Treatment strategies are symptom-focused, encompassing multidisciplinary care, rehabilitation and ...

Abstract	Long COVID, or post-acute sequelae of COVID-19 (PASC), represents a complex condition with persistent symptoms following SARS-Cov-2 infection. The symptoms include fatigue, dyspnoea, cognitive impairment, decreased quality of life in variable levels of severity. Potential mechanisms behind long COVID include vascular damage, immune dysregulation and viral persistence. Diagnosing long COVID involves medical evaluation by multidisciplinary team and assessment of persistent symptoms with scoring systems in development. Treatment strategies are symptom-focused, encompassing multidisciplinary care, rehabilitation and tailored exercise programmes. Pulmonary rehabilitation, an effective and critical component of long COVID management, has shown promise, particularly for patients with respiratory symptoms such as dyspnoea. These programmes, which combine exercise, breathing techniques, education and psychological support, improve symptoms, quality of life and overall recovery. Innovative technologies, such as telemedicine, wearable devices, telerehabilitation, are transforming long COVID management. Telemedicine facilitates consultations and interventions, eliminating healthcare access barriers. Wearable devices enable remote and continuous monitoring of patients during their rehabilitation activities. Telerehabilitation has proven to be safe and feasible and to have high potential for COVID-19 recovery. This review provides a concise overview of long COVID, encompassing its definition, prevalence, mechanisms, clinical manifestations, diagnosis and management approaches. It emphasizes the significance of multidisciplinary approach in diagnosis and treatment of long COVID, with focus on pulmonary rehabilitation and innovative technology advances to effectively address the management of long COVID.
MeSH term(s)	Humans ; COVID-19/epidemiology ; COVID-19/rehabilitation ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; Quality of Life ; Telemedicine/trends ; Dyspnea/etiology ; Dyspnea/rehabilitation ; Exercise Therapy/methods ; Critical Illness
Language	English
Publishing date	2024-05-22
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2442214-9
ISSN	1752-699X ; 1752-6981
ISSN (online)	1752-699X
ISSN	1752-6981
DOI	10.1111/crj.13777
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Article ; Online: Italian good practice recommendations on management of persons with Long-COVID.

Giuliano, Marina / Tiple, Dorina / Agostoni, Piergiuseppe / Armocida, Benedetta / Biardi, Ludovico / Bonfigli, Anna Rita / Campana, Andrea / Ciardi, Maria / Di Marco, Fabiano / Floridia, Marco / Gnerre, Paola / Grassi, Tiziana / Grattagliano, Ignazio / Kruger, Paola / Leonardi, Matilde / Liguori, Rocco / Pagani, Elisabetta / Perger, Elisa / Pricci, Flavia /

Ruggeri, Marinella / Silenzi, Andrea / Spannella, Francesco / Tascini, Carlo / Teté, Giulia / Tosato, Matteo / Vecchi, Simona / Villa, Marika / Onder, Graziano

Frontiers in public health

2023 Volume 11, Page(s) 1122141

Abstract: A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or ... the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 ... in standardizing the care provided to Long-COVID patients. ...

Abstract	A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and care of Long-COVID were implemented. However, the activity of these clinical centers is highly heterogeneous, with wide variation in the type of services provided, specialistic expertise and, ultimately, in the clinical care provided. Recommendations for a uniform management of Long-COVID were therefore needed. Professionals from different disciplines (including general practitioners, specialists in respiratory diseases, infectious diseases, internal medicine, geriatrics, cardiology, neurology, pediatrics, and odontostomatology) were invited to participate, together with a patient representative, in a multidisciplinary Panel appointed to draft Good Practices on clinical management of Long-COVID. The Panel, after extensive literature review, issued recommendations on 3 thematic areas: access to Long-COVID services, clinical evaluation, and organization of the services. The Panel highlighted the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 infection, and agreed that a multidisciplinary service, one-stop clinic approach could avoid multiple referrals and reduce the number of appointments. In areas where multidisciplinary services are not available, services may be provided through integrated and coordinated primary, community, rehabilitation and mental health services. Management should be adapted according to the patient's needs and should promptly address possible life-threatening complications. The present recommendations could provide guidance and support in standardizing the care provided to Long-COVID patients.
MeSH term(s)	Humans ; Child ; Post-Acute COVID-19 Syndrome ; COVID-19/epidemiology ; COVID-19/therapy ; SARS-CoV-2 ; Geriatrics ; Health Services Accessibility
Language	English
Publishing date	2023-04-20
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1122141
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Article ; Online: Incidence and risk factors of post COVID-19 syndrome: a Tunisian cohort study.

Zemni, Imen / Gara, Amel / Bennasrallah, Cyrine / Ezzar, Salma / Kacem, Meriem / Chokri, Roua / Maatouk, Amani / Abroug, Hela / Dhouib, Wafa / Fredj, Manel Ben / Bouanene, Ines / Belguith, Asma Sriha

BMC infectious diseases

2024 Volume 24, Issue 1, Page(s) 461

Abstract: Background: It has become increasingly clear that SARS-CoV-2 infection can lead to persistent ... CI 95% [1.28 - 1.67]) and patients having receive two or more doses of vaccine prior to COVID-19 ... and increasing the burden on the healthcare system. This phenomenon, known as post COVID-19 syndrome ...

Abstract	Background: It has become increasingly clear that SARS-CoV-2 infection can lead to persistent physical and mental health problems lasting weeks or months, requiring prolonged periods of clinical care and increasing the burden on the healthcare system. This phenomenon, known as post COVID-19 syndrome (PCS), is a relatively new condition, its incidence is still unclear and differs between studies. Objectives: In this cohort study, we aimed to estimate the incidence of PCS and to identify its risk factors in the Tunisian population. Methods: This is a prospective cohort study that enrolled patients diagnosed with COVID-19 from the triage unit of the University Hospital of Monastir, Tunisia. between April 2021 and June 2022. Patients were contacted by phone for a follow-up evaluation of PCS 12- weeks after the diagnosis date. Results: A total of 1451 individuals diagnosed with COVID-19 during the study period, responded to the follow-up evaluation after 3 months. The incidence of PCS was found to be 44.03% (95% CI [41.47; 46.58]), with fatigue being the most common symptom (21.5%), followed by cognitive impairment (10.3%), including memory loss and difficulty concentrating. Multivariate analysis revealed that the main associated factors to PCS were female gender (RR = 1.54; CI95% [1.30 - 1.82]), pre-existing comorbidities (RR = 1.30; CI95% [1.10 - 1.52]), duration of acute COVID-19 illness (days) (RR = 1.02; CI95% [1.01 - 1.03]), hospitalization (RR = 1.27; CI95% [1.05 - 1.53]), number of COVID-19 episodes (RR = 1.46; CI 95% [1.28 - 1.67]) and patients having receive two or more doses of vaccine prior to COVID-19 infection (RR = 0.82; CI95% [0.70 - 0.96]). Conclusion: Our study allowed to estimate the incidence and identify risk factors of PCS. Recognizing these factors could help to better understand the underlying mechanisms and guide interventions for prevention and management of this condition.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Male ; Female ; Incidence ; Risk Factors ; Middle Aged ; Tunisia/epidemiology ; Prospective Studies ; Adult ; Post-Acute COVID-19 Syndrome ; SARS-CoV-2 ; Aged ; Cohort Studies ; Fatigue/epidemiology ; Young Adult ; Cognitive Dysfunction/epidemiology
Language	English
Publishing date	2024-05-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08949-8
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Article ; Online: Italian good practice recommendations on management of persons with Long-COVID

Marina Giuliano / Dorina Tiple / Piergiuseppe Agostoni / Benedetta Armocida / Ludovico Biardi / Anna Rita Bonfigli / Andrea Campana / Maria Ciardi / Fabiano Di Marco / Marco Floridia / Paola Gnerre / Tiziana Grassi / Ignazio Grattagliano / Paola Kruger / Matilde Leonardi / Rocco Liguori / Elisabetta Pagani / Elisa Perger / Flavia Pricci /

Marinella Ruggeri / Andrea Silenzi / Francesco Spannella / Carlo Tascini / Giulia Teté / Matteo Tosato / Simona Vecchi / Marika Villa / Graziano Onder

Frontiers in Public Health, Vol

2023 Volume 11

Abstract	A significant number of people, following acute SARS-CoV-2 infection, report persistent symptoms or new symptoms that are sustained over time, often affecting different body systems. This condition, commonly referred to as Long-COVID, requires a complex clinical management. In Italy new health facilities specifically dedicated to the diagnosis and care of Long-COVID were implemented. However, the activity of these clinical centers is highly heterogeneous, with wide variation in the type of services provided, specialistic expertise and, ultimately, in the clinical care provided. Recommendations for a uniform management of Long-COVID were therefore needed. Professionals from different disciplines (including general practitioners, specialists in respiratory diseases, infectious diseases, internal medicine, geriatrics, cardiology, neurology, pediatrics, and odontostomatology) were invited to participate, together with a patient representative, in a multidisciplinary Panel appointed to draft Good Practices on clinical management of Long-COVID. The Panel, after extensive literature review, issued recommendations on 3 thematic areas: access to Long-COVID services, clinical evaluation, and organization of the services. The Panel highlighted the importance of providing integrated multidisciplinary care in the management of patients after SARS-CoV-2 infection, and agreed that a multidisciplinary service, one-stop clinic approach could avoid multiple referrals and reduce the number of appointments. In areas where multidisciplinary services are not available, services may be provided through integrated and coordinated primary, community, rehabilitation and mental health services. Management should be adapted according to the patient’s needs and should promptly address possible life-threatening complications. The present recommendations could provide guidance and support in standardizing the care provided to Long-COVID patients.
Keywords	COVID-19 ; Long COVID ; good clinical practices (GCP) ; Italy ; health care systems ; guideline ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-04-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Alteration of Inflammatory Parameters and Psychological Post-Traumatic Syndrome in Long-COVID Patients.

Clemente, Irma / Sinatti, Gaia / Cirella, Antonio / Santini, Silvano Junior / Balsano, Clara

International journal of environmental research and public health

2022 Volume 19, Issue 12

Abstract: ... recovered from SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (long-COVID patients ... or respiratory disease and a negative history of SARS-CoV-2 infection, whereas the long-COVID ... We highlighted that beyond the first three months after contagion, patients recovered from SARS-CoV-2 infection ...

Abstract	The aim of our study is to evaluate the correlation between the psychological status of patients recovered from SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection (long-COVID patients) and their inflammatory status. Three months after hospital discharge, ninety-three patients were recruited and categorized into two distinct populations: control and long-COVID (COrona VIrus Disease) group. Patients belonging to the control group presented with an entering diagnosis of cardiovascular, metabolic, or respiratory disease and a negative history of SARS-CoV-2 infection, whereas the long-COVID population presented with a severe SARS-CoV-2 infection treated in the sub-intensive Care Unit. Psychological evaluation was performed through the administration of the Symptom Checklist-90 (SCL90) and LDH (Lactate dehydrogenase), ferritin, CRPhs (C-high sensitivity Reactive Protein), NLR (Neutrophil-to-lymphocyte ratio), PLR (Platelet-to-lymphocyte ratio), and SII (systemic immune-inflammation index) were investigated. We highlighted that beyond the first three months after contagion, patients recovered from SARS-CoV-2 infection are characterized by the persistence of a systemic inflammatory state and are at high risk for developing somatization, depression, anxiety, and sleep disturbances. Interestingly, ferritin value was strongly correlated with sleep disorders (p < 0.05). Our study emphasizes how COVID-19 strategies for risk stratification, prognosis, and therapy management of patients should be implemented with a psychological follow-up.
MeSH term(s)	Anxiety/epidemiology ; Anxiety/etiology ; C-Reactive Protein/analysis ; COVID-19/complications ; Ferritins ; Humans ; L-Lactate Dehydrogenase ; SARS-CoV-2 ; Sleep Wake Disorders ; Post-Acute COVID-19 Syndrome
Chemical Substances	C-Reactive Protein (9007-41-4) ; Ferritins (9007-73-2) ; L-Lactate Dehydrogenase (EC 1.1.1.27)
Language	English
Publishing date	2022-06-09
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph19127103
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Article ; Online: Post-COVID-19 condition 3 months after hospitalisation with SARS-CoV-2 in South Africa: a prospective cohort study.

Dryden, Murray / Mudara, Caroline / Vika, Caroline / Blumberg, Lucille / Mayet, Natalie / Cohen, Cheryl / Tempia, Stefano / Parker, Arifa / Nel, Jeremy / Perumal, Rubeshan / Groome, Michelle J / Conradie, Francesca / Ndjeka, Norbert / Sigfrid, Louise / Merson, Laura / Jassat, Waasila

The Lancet. Global health

2022 Volume 10, Issue 9, Page(s) e1247–e1256

Abstract: ... the factors associated with persistent symptoms after acute COVID-19 were being female (adjusted incident rate ... persistent symptoms 3 months after hospital discharge and a significant impact of PCC on their functional and ... hospitalised with laboratory-confirmed SARS-CoV-2 infection in South Africa. Participants underwent telephone follow-up ...

Abstract	Background: Post COVID-19 condition (PCC), as defined by WHO, refers to a wide range of new, returning, or ongoing health problems in people who have had COVID-19, and it represents a rapidly emerging public health priority. We aimed to establish how this developing condition has affected patients in South Africa and which population groups are at risk. Methods: In this prospective cohort study, we used the DATCOV national hospital surveillance system to identify participants aged 18 years or older who had been hospitalised with laboratory-confirmed SARS-CoV-2 infection in South Africa. Participants underwent telephone follow-up assessment at 1 month and 3 months after hospital discharge. Participants were assessed using a standardised questionnaire for the evaluation of symptoms, functional status, health-related quality of life, and occupational status. We used negative binomial regression models to determine factors associated with PCC. Findings: Of 241 159 COVID-19 admissions reported to DATCOV between Dec 1, 2020, and Aug 23, 2021, 8309 were randomly selected for enrolment. Of the 3094 patients that we were able to contact, 2410 (77·9%) consented to participate in the study at 1 month after discharge. Of these, 1873 (77·7%) were followed up at 3 months after hospital discharge. Participants had a median age of 52 years (IQR 41-62) and 960 (51·3%) were women. At 3 months of follow-up, 1249 (66·7%) of 1873 participants reported new or persistent COVID-19-related symptoms, compared with 1978 (82·1%) of 2410 at 1 month after hospital discharge. The most common symptoms reported at 3 months were fatigue (50·3%), shortness of breath (23·4%), confusion or lack of concentration (17·5%), headaches (13·8%), and problems seeing or blurred vision (10·1%). On multivariable analysis, the factors associated with persistent symptoms after acute COVID-19 were being female (adjusted incident rate ratio 1·20, 95% CI 1·04-1·38) and admission to an intensive care unit (1·17, 1·01-1·37). Interpretation: Most participants in this cohort of individuals previously hospitalised with COVID-19 reported persistent symptoms 3 months after hospital discharge and a significant impact of PCC on their functional and occupational status. The large burden of PCC symptoms identified in this study emphasises the need for a national health strategy. This should include the development of clinical guidelines and training of health-care workers for identifying, assessing, and caring for patients affected by PCC; establishment of multidisciplinary health services; and provision of information and support to people who have PCC. Funding: Bill & Melinda Gates Foundation, UK Foreign, Commonwealth & Development Office, and Wellcome.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Cohort Studies ; Female ; Hospitalization ; Humans ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; SARS-CoV-2 ; South Africa/epidemiology
Language	English
Publishing date	2022-04-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(22)00286-8
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Article ; Online: Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients.

Kersten, Johannes / Wolf, Alexander / Hoyo, Luis / Hüll, Elina / Tadic, Marijana / Andreß, Stefanie / d'Almeida, Sascha / Scharnbeck, Dominik / Roder, Eva / Beschoner, Petra / Rottbauer, Wolfgang / Buckert, Dominik

Scientific reports

2022 Volume 12, Issue 1, Page(s) 8801

Abstract: ... with persistent long COVID symptoms three months after acute infection we assessed physical and mental health ... After acute infection with the SARS-CoV-2 virus, a considerable number of patients remains ... mental burden of symptoms of long COVID patients to the findings of a somatic evaluation. In patients ...

Abstract	After acute infection with the SARS-CoV-2 virus, a considerable number of patients remains symptomatic with pathological changes in various organ systems. This study aimed to relate the physical and mental burden of symptoms of long COVID patients to the findings of a somatic evaluation. In patients with persistent long COVID symptoms three months after acute infection we assessed physical and mental health status using the SF-36 questionnaire. The cohort was dichotomised by the results (upper two quartiles vs. lower to quartiles) and compared with regard to transthoracic echocardiography, body plethysmography (including diffusion capacity), capillary blood gas analysis and 6-min walk test (6-MWT). From February 22 to September 13, 2021, 463 patients were prospectively examined, of which 367 completed the SF-36 questionnaire. A positive correlation between initial disease severity (need for hospitalization, intensive care medicine) and resulting symptom burden at follow-up could be demonstrated. Patients with impaired subjective physical and mental status were significantly more likely to be women. There was a significant correlation between symptom severity and reduced exercise tolerance in the 6-MWT (495.6 ± 83.7 m vs 549.7 ± 71.6 m, p < 0.001) and diffusion capacity for carbon monoxide (85.6 ± 14.3% of target vs 94.5 ± 14.4, p < 0.001). In long COVID patients, initial disease severity is correlated with symptom burden after at least 3 months of follow-up. Highly symptomatic long COVID patients show impaired diffusion capacity and 6-MWT despite average or mildly affected mechanical lung parameters. It must be further differentiated whether this corresponds to a transient functional impairment or whether it is a matter of defined organ damage.
MeSH term(s)	COVID-19/complications ; Exercise Tolerance ; Female ; Humans ; Lung ; Male ; SARS-CoV-2
Language	English
Publishing date	2022-05-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-12839-5
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Article ; Online: Persisting chemosensory impairments in 366 healthcare workers following COVID-19: an 11-month follow-up.

Bussiere, Nicholas / Mei, Jie / Levesque-Boissonneault, Cindy / Blais, Mathieu / Carazo, Sara / Gros-Louis, Francois / Laforce, Robert / De Serres, Gaston / Dupre, Nicolas / Frasnelli, Johannes

Chemical senses

2022 Volume 47

Abstract: Olfactory and gustatory dysfunctions (OD, GD) are prevalent symptoms following COVID-19 and persist ... in a third of COVID-19 patients 11 months after COVID-19. OD appears to be a common symptom of post-COVID-19 ... questionnaire assessing chemosensory function to healthcare workers with a RT-PCR-confirmed SARS-CoV-2 infection ...

Abstract	Olfactory and gustatory dysfunctions (OD, GD) are prevalent symptoms following COVID-19 and persist in 6%-44% of individuals post-infection. As only few reports have described their prognosis after 6 months, our main objective was to assess the prevalence of OD and GD 11-month post-COVID-19. We also aimed to determine intraclass correlation coefficients (ICC) of chemosensory self-ratings for the follow-up of chemosensory sensitivity. We designed an observational study and distributed an online questionnaire assessing chemosensory function to healthcare workers with a RT-PCR-confirmed SARS-CoV-2 infection 5- and 11-month post-COVID-19. Specifically, we assessed olfaction, gustation, and trigeminal sensitivity (10-point visual analog scale) and function (4-point Likert scale). We further measured clinically relevant OD using the Chemosensory Perception Test, a psychophysical test designed to provide a reliable remote olfactory evaluation. We included a total of 366 participants (mean [SD] age of 44.8 (11.7) years old). They completed the last online questionnaire 10.6 months (0.7) after the onset of COVID-19 symptoms. Of all participants, 307 (83.9%) and 301 (82.2%) individuals retrospectively reported lower olfactory or gustatory sensitivity during the acute phase of COVID-19. At the time of evaluation, 184 (50.3%) and 163 (44.5%) indicated reduced chemosensory sensitivity, 32.2% reported impairment of olfactory function while 24.9% exhibited clinically relevant OD. Olfactory sensitivity had a high test-retest reliability (ICC: 0.818; 95% CI: 0.760-0.860). This study suggests that chemosensory dysfunctions persist in a third of COVID-19 patients 11 months after COVID-19. OD appears to be a common symptom of post-COVID-19 important to consider when treating patients.
MeSH term(s)	Adult ; COVID-19/epidemiology ; Follow-Up Studies ; Health Personnel ; Humans ; Middle Aged ; Olfaction Disorders/diagnosis ; Olfaction Disorders/epidemiology ; Olfaction Disorders/etiology ; Reproducibility of Results ; Retrospective Studies ; SARS-CoV-2 ; Taste Disorders/diagnosis ; Taste Disorders/epidemiology ; Taste Disorders/etiology
Language	English
Publishing date	2022-05-17
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	754122-3
ISSN	1464-3553 ; 0379-864X
ISSN (online)	1464-3553
ISSN	0379-864X
DOI	10.1093/chemse/bjac010
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Article: The MedConnect Program: Symptomatology, Return Visits, and Hospitalization of COVID-19 Outpatients Following Discharge From the Emergency Department.

Bayly, Bryana L / Kercheval, Jacquelyn B / Cranford, James A / Girgla, Taania / Adapa, Arjun R / Busschots, Ginette V / Li, Katheen Y / Perry, Marcia / Fung, Christopher M / Greineder, Colin F / Losman, Eve D

Cureus

2022 Volume 14, Issue 7, Page(s) e26771

Abstract: ... with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the high rates of morbidity and mortality among these patients have ... for worsening COVID-19 symptoms. Established risk factors for severe disease and self-reported persistence ... admitted, 16 (9%) for worsening COVID-19 symptoms. Age, male sex, comorbid illnesses, and self-reported ...

Abstract	Background and objective Although hospitalization is required for only a minority of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the high rates of morbidity and mortality among these patients have led researchers to focus on the predictors of admission and adverse outcomes in the inpatient population. However, there is scarce data on the clinical trajectory of individuals symptomatic enough to present for emergency care, but not sick enough to be admitted. In light of this, we aimed to examine the symptomatology, emergency department (ED) revisits, and hospitalization of coronavirus disease 2019 (COVID-19) outpatients after discharge from the ED. Methods Adult patients with COVID-19 infection were prospectively enrolled after discharge from the ED between May and December 2020. Patients were followed up longitudinally for 14 days via phone interviews designed to provide support and information and to track symptomatology, ED revisits, and hospitalization. Results A volunteer, medical student-run program enrolled 199 COVID-19 patients discharged from the ED during the first nine months of the pandemic. Of the 176 patients (88.4%) who completed the 14-day protocol, 29 (16.5%) had a second ED visit and 17 (9.6%) were admitted, 16 (9%) for worsening COVID-19 symptoms. Age, male sex, comorbid illnesses, and self-reported dyspnea, diarrhea, chills, and fever were associated with hospital admission for patients with a subsequent ED visit. For those who did not require admission, symptoms generally improved following ED discharge. Age >65 years and a history of cardiovascular disease (CVD) were associated with a longer duration of cough, but generally, patient characteristics and comorbidities did not significantly affect the overall number or duration of symptoms. Conclusions Nearly one in five patients discharged from the ED with COVID-19 infection had a second ED evaluation during a 14-day follow-up period, despite regular phone interactions aimed at providing support and information. More than half of them required admission for worsening COVID-19 symptoms. Established risk factors for severe disease and self-reported persistence of certain symptoms were associated with hospital admission, while those who did not require hospitalization had a steady improvement in symptoms over the 14-day period.
Language	English
Publishing date	2022-07-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.26771
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