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Covid-19: Symptoms are common after acute phase of disease, Italian study shows

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2804 (Published 10 July 2020) Cite this as: BMJ 2020;370:m2804

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  1. Jacqui Wise
  1. London, UK

Almost nine out of 10 patients discharged from a Rome hospital after recovery from covid-19 were still experiencing at least one symptom two months later, a study shows.

Fatigue and shortness of breath were the most common symptoms reported in the study of 143 patients.1 More than half of patients were still experiencing three or more symptoms.

The research, published as a letter in JAMA, is further evidence of a “long tail” of covid-19 related illness. On 5 July health and social care secretary Matt Hancock announced the launch of a study into the long term health effects of covid-19 on hospitalised patients in the UK. The post-hospitalisation covid-19 study aims to recruit 10 000 patients who have been hospitalised with covid-19 and will track them over a year.2

In the waning phase of the pandemic in Italy, beginning on 21 April, the Fondazione Policlinico Universitario Agostino Gemelli hospital established a post-acute outpatient service for patients discharged from the hospital after recovering from covid-19. The mean age of the patients was 56.5 years and 63% were men. They had been in hospital for an average of 13.5 days and 72% had evidence of interstitial pneumonia. Some 15% of patients had received non-invasive ventilation and 5% had received invasive ventilation.

The patients were only included in the study if they had a negative transcriptase polymerase chain reaction test for SARS-CoV-2, indicating they were not in the acute phase of the illness.

When patients were assessed a mean of 60 days after onset of the first covid-19 symptoms, only 18 (12.6%) were completely free of any covid-19 related symptom, while 32% had one or two symptoms, and 55% had three or more. None of the patients had fever or any signs or symptoms of acute illness. Worsened quality of life was reported by 44% of patients. A high proportion of patients still reported fatigue (53%), dyspnea (43%), joint pain (27%), and chest pain (22%).

The study has limitations as it is based on a single centre with a relatively small number of patients and without a control group of patients discharged for other reasons. There is also a lack of information on symptom history before acute covid-19 illness and no information on symptom severity. Furthermore, the study authors point out that patients with community acquired pneumonia can also have persistent symptoms.

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