The major findings of this prospective cohort study are the followings: i) even in patients with non-severe COVID-19, total resolution of symptoms takes time: approximately 50% of patients had not returned to their baseline health status 6 weeks after their COVID-19, and only 55% of those who practiced sports before were able to resume their sport activities; ii) the primary complaints, at 6 weeks, included dyspnea, weight loss, sleep disorders, and anxiety; iii) even among patients most affected by post-COVID symptoms, physical examination was unremarkable, while LFT and chest CT scan were normal in most cases.
Little is known about the persistence of disabling symptoms following COVID-19. A post-acute outpatient service for individuals discharged from hospital after recovery from COVID-19 in Italy found that only 18/143 patients (12.6%) were completely free of COVID-19–related symptoms at 60 days. Fatigue, dyspnea, pain, and lack of appetite, were reported by > 50% of patients (2). Similar findings were reported from Ireland, where 52.3% of patients (67/128) reported persistent fatigue 10 weeks after COVID-19, and this was not associated with severity during the acute COVID-19 (3). A multicenter study from Egypt found higher prevalence of fatigue in patients who recovered from COVID-19 (209/287, 72.8%) (4). To our knowledge, our study is the first to provide systematic investigations in patients most disabled by respiratory symptoms: All of them (23/23) had normal physical examination, no new findings on chest CT-scan, and no or limited abnormalities on LFT.
The optimal management of patients with persistent symptoms after the acute phase of COVID-19 remains unknown. A Post-COVID-19 Functional Status (PCFS) scale has been proposed to evaluate the entire range of functional limitations, including in lifestyle, sports and social activities (7). Others advocated for an interdisciplinary approach, through a post-COVID outpatient unit, to implement comprehensive and individualized care for these patients (6,8,9).
Our study has limitations. First, our web-based questionnaire was deliberately short, to ensure a high proportion of answers: hence, it was not powered to detect all post-COVID symptoms. Second, we only collected data at 6 weeks, so that we have no information beyond this time point. Additional studies are requested to estimate symptoms duration, as this is one of the main concerns for patients. Third, investigations were restricted to patients most disabled, and were limited to non-contrast chest CT scan and LFT. However, in our experience, other investigations, including contrast-enhanced CT scan, echocardiography, and tests for inflammatory or auto-immune disorders, provide no additional information about the pathophysiology of persistent symptoms.
In conclusion, this prospective cohort study confirms the high prevalence of persistent symptoms even after non-severe COVID-19. Long-term follow-up with multidisciplinary management is requested to assist patients throughout this difficult recovery time.