Persitent Inflammatory Interstitial Lung Disease Following SARS-CoV-2 Infection at 6 Weeks Post Discharge Responds Rapidly to Oral Corticosteroids

Abstract

Summary: The natural history of recovery from Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov2) has not yet been well documented. Outcomes from 1272 patients who were diagnosed between February and May 2020 are reported here. Methods: Patients were telephoned four weeks after discharge from hospital to assess if they had returned to their functional baseline. Those with ongoing symptoms had clinical asssessment at six weeks. Findings: Telephone assessment was completed for 696 patients. 321 (50·1%) reported ongoing symptoms and underwent structured assessment. Of these, 10·9% had persistent interstitial lung disease (ILD) on Computerised Tomography (CT) with associated functional impairment. They were assessed in the ILD clinic to consider oral prednisolone (initial dose up to 0·5mg/kg with wean over three weeks). To date, 13 patients have completed treatment and follow up. There was a decrease in symptoms, increase in transfer factor 24·7% (range 5·9-47·4%, p=0·025) and radiological improvement. Interpretation: Fibrosis is a previously-described feature of patients recovering from infection with similar coronaviruses, resulting in persistent physiological defecit. SARS-CoV2 pneumonitis leaves a subset of patients with persistent interstitial lung disease at six weeks post-discharge. Oral prednisolone was associated with rapid symptomatic, physiological and radiological improvement. Early treatment of patients with persistent ILD with physiological impairment represents an opportunity to modify the disease course and potentially prevent irreversible fibrosis. Funding Statement: No funding was received for this research.Declaration of Interests: The authors have no conflicts of interest to report.Ethics Approval Statement: This project was internally submitted for service improvement and accepted (reference 11007) prior to commencement, and ethical approval was not sought.