Three-month Follow-up Study of Survivors of Coronavirus Disease 2019 after Discharge

Abstract

Background: Most patients including health care workers (HCWs) survived the coronavirus disease 2019 (COVID-19), however, knowledge about the sequelae of COVID-19 after discharge remains limited.

Methods: A prospectively observational 3-month follow-up study evaluated symptoms, dynamic changes of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) IgG and IgM, lung function, and high resolution computed tomography (HRCT) of survivors of COVID-19 after discharge at Wuhan Union Hospital, China.

Results: Seventy-six survivors (55 females) with a mean age of 41.3 ± 13.8 years were enrolled, and 65 (86%) were HCWs. A total of 69 (91%) patients had returned to their original work at 3-months after discharge. Most of the survivors had symptoms including fever, sputum production, fatigue, diarrhea, dyspnea, cough, chest tightness on exertion and palpitations in the three months after discharge. The serum troponin-I levels during the acute illness showed high correlation with the symptom of fatigue after hospital discharge (r = 0.782; P = 0.008) and lymphopenia was correlated with the symptoms of chest tightness and palpitations on exertion of patients after hospital discharge (r = -.285, P = 0.027; r = -.363, P = 0.004, respectively). The mean values of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity and diffusion capacity were all normal (> 80% predicted) and lung HRCTs returned to normal in most of the patients (82%), however, 42% of survivors had mild pulmonary function abnormalities at 3-months after discharge. SARS-CoV-2 IgG turned negative in 11% (6 of 57 patients), 8% (4 of 52 patients) and 13% (7 of 55 patients), and SARS-CoV-2 IgM turned negative in 72% (41 of 57 patients), 85% (44 of 52 patients) and 87% (48 of 55 patients) at 1-month, 2-months and 3-months after discharge, respectively.

Conclusion: Infection by SARS-CoV-2 caused some mild impairments of survivors within the first three months of their discharge and the duration of SARS-CoV-2 antibody was limited, which indicates the necessity of long-term follow-up of survivors of COVID-19.

Keywords: COVID-19; Follow-up; Lung Function; SARS-CoV-2 Antibody.

Fig. 1. Enrolment of patients and follow-up at 3 months after hospital discharge.

COVID-19 = coronavirus disease 2019, SARS-CoV-2 = severe acute respiratory syndrome-coronavirus-2.

Fig. 2. HRCT scan of a 32-year-old patient with coronavirus disease 2019 obtained from January 31, 2020 to June 9, 2020 (the patient discharged on March 13, 2020). (A) Axial HRCT image shows bilateral, multifocal GGO that was predominantly located in the subpleural area. (B) Axial HRCT image shows bilateral, extensive area of consolidations that was distributed in the middle and outer zones. Air bronchograms have been seen. (C) Axial HRCT image shows that the consolidations became resolved and there was left pneumothorax. (D) Axial lung computed tomography image shows bilateral patchy areas of GGO with evidence of fibrosis. The area of consolidations continued to reduce. (E) Axial HRCT image shows that consolidations almost disappeared. The density and area of GGO were reduced, while fibrotic changes increased. (F) Axial HRCT image shows that GGO and fibrosis in bilateral lung lobes continued to resolve and gradually reduced.

HRCT = high-resolution computed tomography, GGO = ground glass opacity.