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Persistent symptoms after apparent recovery from COVID-19

this image illustrates the electron microscopic appearance of the SARS-CoV-2 virus emerging from dying cells.
EM of sars-cov-2 budding from apoptotic (dying) cells–NIAID

This JAMANET article from July 9 describes a cohort of Italian patients who were examined a mean of 60 days after symptom onset. These patients were all hospitalized, for an average of two weeks, and 5% had “invasive ventilation” (mechanical, via intubation.) 22 of 179 potentially eligible patients (14 refused to participate) still had positive antigen tests– these patients had not recovered from acute infection after roughly two months.

Of 143 who had “virologic resolution” (negative antigen tests) only 18 (12.6%) were free of symptoms. Most commonly, patients had fatigue (53.1%) and dyspnea (43.4%).

Here is the results section:

From April 21 to May 29, 2020, 179 patients were potentially eligible for the follow-up post–acute care assessment; 14 individuals (8%) refused to participate and 22 had a positive test result. Thus, 143 patients were included. The mean age was 56.5 (SD, 14.6) years (range, 19-84 years), and 53 (37%) were women. During hospitalization, 72.7% of participants had evidence of interstitial pneumonia. The mean length of hospital stay was 13.5 (SD, 9.7) days; 21 patients (15%) received noninvasive ventilation and 7 patients (5%) received invasive ventilation. The characteristics of the study population are summarized in the Table.

Patients were assessed a mean of 60.3 (SD, 13.6) days after onset of the first COVID-19 symptom; at the time of the evaluation, only 18 (12.6%) were completely free of any COVID-19–related symptom, while 32% had 1 or 2 symptoms and 55% had 3 or more. None of the patients had fever or any signs or symptoms of acute illness. Worsened quality of life was observed among 44.1% of patients. The Figure shows that a high proportion of individuals still reported fatigue (53.1%), dyspnea (43.4%), joint pain, (27.3%) and chest pain (21.7%).

This article supports the anecdotes from many patients who say they have not recovered from their illnesses two months or more after falling sick. Based on the MRI findings of myocardial inflammation (see previous post) in 70% of patients after recovering from mild disease, we can guess that most of those with fatigue and dyspnea have heart problems due to COVID-19.

We do not know how long it will take these patients to recover completely. We only know that COVID-19 is far worse than influenza, both in mortality and in persistent morbidity. Most patients who survive are nearly fully recovered from influenza after two to three weeks– but two or three months seems to be a conservative estimate for recovery from this virus.

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