Emerging evidence is showing that COVID-19 symptoms may still persist even after recovery.

Coronavirus disease 2019 (COVID-19) is a pandemic that continuously presents with new scientific information. Symptoms generally appear 2-14 days after exposure to the virus and may include fever or chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.1 Evidence suggests that older adults and individuals with underlying health conditions are at higher risk of developing severe COVID-19.1

There is limited evidence regarding lasting COVID-19 symptoms after the infection is gone. However, there have been reports of individuals still experiencing symptoms months after the infection, including continued loss of taste or smell, tachycardia, chest pain, shortness of breath, extreme fatigue, cognitive problems, and recurring fevers.2 

Study Findings and Implications
One study conducted in Italy assessed for persistent symptoms in patients who were discharged from the hospital after recovery from COVID-19.3 The Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, Italy established a post-acute outpatient service for individuals discharged from the hospital after recovery from COVID-19. Patients who were discharged had no fever for 3 consecutive days, improvement in other symptoms, and 2 negative test results for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2)—the virus that causes COVID-19—24 hours apart. Additionally, these patients received follow-up care through a comprehensive health assessment of detailed medical history and a physical examination with information documented electronically.3 

Patients were asked retrospectively, through a questionnaire, about symptoms during their COVID-19 infection and whether they persisted at the time of their outpatient visit.3 The EuroQol visual analog scaled was used to score patients’ quality of life from 0 (worst imaginable health) to 100 (best imaginable health) before COVID-19 and at the time of their outpatient consult. 

There were 143 patients included in the study with an average age of 56.5 years, and 37% were women. Patients were evaluated at their outpatient appointment on average 60 days after the onset of their first COVID-19 symptom. The study revealed that 87.4% of patients who had recovered from COVID-19 still reported persistence of at least 1 symptom, especially fatigue and shortness of breath.3 At the time of their outpatient assessment, only 12.6% of patients were completely free of any COVID-19 symptom, 32% had 1 or 2 symptoms, and 55% had 3 or more symptoms. There were 44.1% of patients that experienced worsened quality of life. Many patients still reported fatigue (53.1%), shortness of breath (43.4%), joint pain (27.3%), and chest pain (21.7%).3

This study provides important insight into the possible longer road to recovery in COVID-19 patients after the infection is gone. Patients should still be monitored closely after being discharged from the hospital through follow-up appointments and phone calls to check on their symptoms and overall quality of life. Pharmacists can also play an important role in the follow-up process for COVID-19 patients. Study limitations include that there were a small number of study participants, lack of information on symptom history prior to COVID-19 illness, and limited details of symptom severity.3 Further studies are needed to assess for persistent COVID-19 symptoms after recovery.     


REFERENCES
  1. CDC. Coronavirus disease 2019 (COVID-19) frequently asked questions. https://www.cdc.gov/coronavirus/2019-ncov/faq.html. Updated July 3, 2020. Accessed July 10, 2020.
  2. AHA. Months after infection, many COVID-19 patients can’t shake illness. https://www.heart.org/en/news/2020/07/06/months-after-infection-many-covid-19-patients-cant-shake-illness. Published July 6, 2020. Accessed July 10, 2020.
  3. Carfi A, Bernabei R, Landi F.  Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020. doi: 10.1001/jama.2020.12603. Online ahead of print.