Follow-Up of Hospitalized Adults with Post-Acute COVID-19 Syndrome

Abstract

More reports are surfacing about the occurrence of post-acute COVID-19 syndrome. However, there is limited data on the long-term symptom persistence and mental health of critical and noncritical COVID-19 patients. Understanding these long-term effects can help healthcare workers provide better and targeted care for their patients. This prospective follow-up survey included 35 patients who were diagnosed with COVID-19 and managed at our academic hospital from March 25,2020 to November 3, 2020. The survey evaluated for persistent post-acute COVID-19 symptoms and COVID-19 related mental health issues or stigma. Demographics, inflammatory markers, diagnostics, and therapy given were also recorded and descriptive analysis performed. In this study, patients were diagnosed 40 to 264 days prior to analysis. Patients comprised of 46.2% females, average of 4 comorbidities, and median age of 64 years old. Over a third of patients were tested in the outpatient setting, while the rest were diagnosed on admission. Of the one-third of patients requiring ICU care, 85.7% of the patients reported persistent symptoms post-discharge. Of the patients with persistent symptoms, dyspnea (57.1%), fatigue (53.6%), headache (35.7%), and loss of smell/taste (17.9%) were common. Patients with persistent symptoms more often required more COVID therapeutics and had higher oxygen requirements and inflammatory markers. Age or time since diagnosis was similar between the two groups. Overall, almost one-third of patients felt worse with people's attitudes towards COVID-19 and felt they were treated differently in the hospital with 15.4% feeling guilty about their diagnosis. Anxiety was reported in 76.9% of all patients, including 20.5% of those without symptoms. Most reported concerns for anxiety were personal health (46%), spreading COVID-19 to others (60%), and reinfection (17%). Anxiety from being isolated was alleviated in 46% of patients with a provider explanation with 18% of patients felt a negative impact from being in isolation. Meanwhile, nearly two-thirds of patients reported a negative impact due to the no-visitor policy. Amongst those with persistent symptoms, common comorbidities were obesity, hypertension, type 2 diabetes mellitus, malignancy history, and chronic lung disorders. More COVID therapeutic use, higher inflammatory markers and higher level of oxygen therapy were associated with persistent symptoms, correlating with more severe disease. Anxiety was common in both groups of patients with predominant worries of personal health and spreading COVID-19 to others. We need to consider the mental health impact on all COVID-19 patients even in those with quick recovery due to the stigmatizing nature of this infection.