A study of 153 patients with coronavirus disease 2019 (COVID-19) showed that only about 4% had persistently abnormal chest x-rays at a median of 75 days after diagnosis, although many continued to have fatigue.
The findings were published in the Annals of the American Thoracic Society.
“We found that fatigue, ill-health, and breathlessness were all common following COVID-19,” said Liam Townsend, MD, St. James’s Hospital, and Trinity College, Dublin, Ireland. “However, these symptoms appeared to be unrelated to the severity of initial infection or any single measurement at the time of an outpatient appointment.”
For the study, 487 patients were offered an outpatient appointment, of which 153 (31%) attended for assessment at a median of 75 days after diagnosis. Of the patients, 74 (48%) had required hospital admission during acute infection. Infection severity was graded as (1) not requiring admission, (2) requiring hospital admission, or (3) requiring admission into the intensive care unit. Fatigue and subjective return to health were assessed after initial infection.
After a median of 75 days after initial infection, persistently abnormal chest x-rays were seen in 4% of patients, and the median 6-minute walk test (6MWT) distance covered was 460 m. Reduced distance covered was associated with frailty and length of inpatient stay.
“We were surprised by our findings,” said Dr. Townsend. “We expected a greater number of abnormal chest x-rays. We also expected the measures of ongoing ill-health and abnormal findings to be related to severity of initial infection, which was not the case.”
Of the patients, 95 (62%) felt that they had not returned to full health, and 47% met the case definition for fatigue. Patients who felt they had to exert themselves during moderate exercise also reported they felt fatigued and in poor health.
“These findings have implications for clinical care, in that they demonstrate the importance of following-up all patients who were diagnosed with COVID-19, irrespective of severity of initial infection,” said Dr. Townsend. “It is not possible to predict who will have ongoing symptoms.”