Post-COVID symptoms reported at asynchronous virtual review and stratified follow-up after COVID-19 pneumonia

Abstract

Background: The COVID-19 pandemic has strained healthcare systems and how best to address post-COVID health needs is uncertain. Here we describe the post-COVID symptoms of 675 patients followed up using a virtual review pathway, stratified by severity of acute COVID infection.

Methods: COVID-19 survivors completed an online/telephone questionnaire of symptoms after 12+ weeks and a chest X-ray. Dependent on findings at virtual review, patients were provided information leaflets, attended for investigations and/or were reviewed face-to-face. Outcomes were compared between patients following high-risk and low-risk admissions for COVID pneumonia, and community referrals.

Results: Patients reviewed after hospitalisation for COVID pneumonia had a median of two ongoing physical health symptoms post-COVID. The most common was fatigue (50.3% of high-risk patients). Symptom burden did not vary significantly by severity of hospitalised COVID pneumonia but was highest in community referrals. Symptoms suggestive of depression, anxiety and post-traumatic stress disorder were common (depression occurred in 24.9% of high-risk patients). Asynchronous virtual review facilitated triage of patients at highest need of face-to-face review.

Conclusion: Many patients continue to have a significant burden of post-COVID symptoms irrespective of severity of initial pneumonia. How best to assess and manage long COVID will be of major importance over the next few years.

Keywords: breathlessness; depression; follow-up; long COVID; sequalae.

Fig 1.

Physical health symptoms reported on the Amplitude questionnaire by patients at post-COVID review. (a) ‘high-risk’ admissions, (b) ‘low-risk’ admissions, (c) ‘community’. Plot colours: pale pink if the symptom is ‘getting better’; dark pink if the symptom is ‘staying the same’; dark red if symptom is ‘getting worse’. MSK = musculoskeletal muscle or joint pains; GI = gastrointestinal complaints of diarrhoea or abdominal pains.

Fig 2.

Clinical interventions following asynchronous Virtual Review. (a) Examples of frequency of provision of different health advice information leaflets sent to patients in different groups. Dark purple: discharged high-risk inpatients. RCOT = Royal College of Occupational Therapists. (b) All patients were sent information leaflets on mental health recovery following COVID pneumonia and a proportion more specific advice on how to access help for possible depression, anxiety or post-traumatic stress disorder based on their PHQ-2, GAD-2 and TSQ scores. (c) Proportion of patients in each group triaged to face-to-face review or telephone review after virtual clinic review of Amplitude questionnaire and chest X-ray.

Fig 3.

Factors affecting post-COVID symptom burden in patients following admission for COVID pneumonia. Violin with box-and-whisker plots of symptom scores (number of physical health symptoms reported) in patients grouped by (a) high- vs low-risk admission, (b) long (≥7 days) vs short (<7) admissions, (c) gender and (d) ethnicity. P values for Mann-Whitney U tests.