Follow up for COVID-19 in Belfast City Hospital.

Abstract

Background: During the COVID-19 pandemic of Spring 2020, Belfast City Hospital functioned as Belfast's Nightingale facility. Evidence published during this time focused mainly on the acute management of the condition. Guidance on follow up and long-term management for patients recovering from COVID-19 was sparse. A specialist COVID-19 follow up service was devised in Belfast City Hospital led by a respiratory physician with physiotherapy and psychology input.

Methods: Data was collected on all patients admitted to Belfast Nightingale unit. Patients admitted to Intensive Care at any stage in their admission were followed up separately by Intensive Care. Initial consultation was via telephone call for all eligible patients six weeks post discharge, followed by face-to-face consultation for those with symptoms at next available appointment, and a further face-to-face consultation at twelve weeks post hospital discharge. Patients were seen by respiratory physician, physiotherapy and psychology at each appointment. All patients who had initial changes on chest radiograph had 12 week follow up radiograph requested as per British Thoracic Society guidelines.

Results: 29 patients were followed up after hospitalisation with COVID-19. Of these, 10 were brought for face-to-face consultations. Patients at clinic were all functionally independent with a median Medical Research Council dyspnoea score of 2 and a subjective assessment of their current health of median 50, on a visual analogue scale 0-100. Fatigue was common with all patients. Depression, anxiety and post-traumatic stress disorder were all reported from psychological review. Chest radiograph showed signs of improvement in 100% of clinic attendees. 90% of patients seen in clinic had normal or chronic obstructive patterns on spirometry, with one patient having a reduced transfer factor.

Conclusion: Majority of patients did not require face-to-face review and were recovering well. Of the 10 patients seen in the respiratory led clinic, the main issues reported were fatigue and psychological issues. Respiratory symptoms were significantly improving in 9 out of the 10 patients seen. All patients have been introduced to psychology service whilst at clinic and will continue to receive necessary support.