Persisting symptoms in Covid-19

Irish Thoracic Society, Annual Scientific Meeting, 3-4 December 2020

Dr Caoimhe Leneghan and Dr Jane O’Connor from Our Lady of Lourdes Hospital, Drogheda, presented their findings on persisting symptoms in Covid-19 patients to the audience. Dr Leneghan began the presentation by highlighting the current lack of knowledge surrounding the long-term health effects of the novel coronavirus SARS-CoV-2 on individuals.

Their study therefore followed 72 Covid-19 patients discharged from Our Lady of Lourdes Hospital in an attempt to monitor any persisting symptoms following an acute Covid-19 infection.

Participants were discharged from hospital and followed up six-to-eight weeks later through a virtual clinic to assess symptoms, clinical presentation, and medical background using a questionnaire.

If participants had persisting symptoms that warranted further investigation, they came back to hospital for a chest x-ray and routine blood tests. If symptoms continued to persist or there were abnormal findings made through diagnostic imaging, participants came back again for an in-person clinical review by a consultant and repeat blood samples were taken, including a test for D-dimer and troponin.

Results were monitored, and if relevant, a coronary function test, a diffusion capacity, a CT of the thorax, or a CT pulmonary angiogram were performed. A pathway was also set up for GPs to refer previously confirmed Covid-19 patients with persistent symptoms or abnormal investigations to the hospital.

It was found that 82 per cent of participants experienced persisting symptoms. This included fatigue in 73 per cent of participants, shortness of breath in 69 per cent, dizziness in 42 per cent, palpitations in 41 per cent, hair loss in 40 per cent, atypical chest pain in 24 per cent, and myalgia, insomnia, and headaches in 21 per cent.

Furthermore, six per cent of patients were referred to the Department of Psychiatry due to possible diagnosis of post-traumatic stress syndrome using Breslau’s Short Screening Scale. Coughing was not found to be a persisting symptom.

Dr O’Connor then informed the audience of some of the finer details of the study. She reported that all of the study participants initially referred to the clinic had an abnormal chest x-ray. Six-to-eight weeks post-discharge, 81 per cent of these patients had a complete resolution of their chest radiograph.

During this study, nine patients required a CT thorax or CT pulmonary angiogram; through this, one new diagnosis of pulmonary fibrosis was made, and there was one new finding of bilateral small pulmonary emboli. Nine patients also had an echocardiogram, but they were all normal. It was also discovered that raised D-dimers after two months post-infection correlated with persistent symptoms.

Dr O’Connor concluded that this study has demonstrated that people are experiencing long-term health impacts of Covid-19. “This is going to be a new burden on healthcare from both a psychological perspective and a physical health perspective,” she told the audience, while also pointing out that this is not an area that is currently being given adequate resources.