Residual Symptom Burden in Adult COVID-19 Survivors at One, Three, and Six Months After COVID-19 Illness

Abstract

Rationale: Recent reports suggest that many patients diagnosed with COVID-19 will experience protracted symptoms. As part of a COVID-19 Recovery Engagement program, we aimed to 1) elucidate the type and trajectory of protracted symptoms after COVID-19 diagnosis and 2) compare symptom prevalence and severity at 1, 3 and 6 months after COVID-19 diagnosis. Methods: This is a prospective observational study of adults diagnosed with COVID-19 at Montefiore Medical Center from March 2020 to December 2020. We identified patients with a positive SARS-CoV-2 result who were recently treated in outpatient, Emergency Department, or hospital settings within the medical center. Patients were contacted for consent via telephone at 1, 3, and 6 months after diagnosis and asked to complete 1) a modified revised Edmonton Symptom Assessment (mrESAS), which assessed 13 symptoms on a scale of 0-10 and 2) three additional questions that asked patients to compare their physical, emotional and cognitive health status to their pre-COVID health state. We used chart review to gather additional data for each of the patients, including demographics, past medical history, and course of COVID-19 illness.Results: We enrolled 141 patients (mean (standard deviation (SD) age 49.5(16.9)], with 29 in the 1-month cohort, 22 in 3-month cohort, and 90 in 6-month cohort;46/141 (32.6%) were hospitalized. In patients in the 1-month cohort, there was a high (≥ 25% of patients) prevalence of 7/13 symptoms: pain (31%), fatigue (31%), sleepiness (30.3%), nausea (30.3%), change in taste (31%), breathlessness (27.6%) and anxiety (37.9%). In general, prevalence of symptoms was lower in patients at 3- month and 6-months after discharge. We found a higher prevalence of nausea and change of taste symptoms in the 1-month group compared with the 3- and 6-month group (10% at 1-month reported nausea vs 1.8% in 3- and 6-month cohorts, p= 0.026;31% at 1-month reported change in taste vs. 10.7 in the 3- and 6-month groups, p=0.006 for change of taste). Furthermore, in the 6-month cohort, 24.4%, 25.6% and 30% reported being worse than pre-COVID in their physical, emotional and cognitive health status, respectively. Conclusion: Patients at 1-month post-COVID experience more nausea and taste change than patients called at later time points after diagnosis. Even at 6 months after COVID diagnosis, over one-fourth of all patients still consider themselves to have worse health status than before their illness. COVID-19 survivors have a significant risk of residual symptoms for months after diagnosis.