Open Access
Focus on COVID-19

COVID-19 Summaries: a recap of recent research

Open Access
Focus on COVID-19

COVID-19 Summaries: a recap of recent research

Anne Chang, Richard T. Ellison III, Rajesh T. Gandhi, Andrew Henderson, Christine McDonald, Renae McNamara, Natasha Smallwood

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Professor Anne Chang am,* Respiratory Specialist, Head, Child Health Division, Menzies School of Health Research, Darwin, NT. Professor Richard T. Ellison III, MD, Professor of Medicine, Microbiology, and Physiological Systems, Division of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, USA. Professor Rajesh T. Gandhi, MD, Professor of Medicine, Harvard Medical School; Director, HIV Clinical Services and Education, Massachusetts General Hospital, Boston, USA. Dr Andrew Henderson,* Infectious Diseases Specialist, Princess Alexandra Hospital, Brisbane, Qld. Professor Christine McDonald am,* Director, Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Vic; Department of Medicine, University of Melbourne, Melbourne, Vic. Dr Renae McNamara,* Clinical Specialist Physiotherapist, Pulmonary Rehabilitation Coordinator, Prince of Wales Hospital, Sydney, NSW. Associate Professor Natasha Smallwood, Clinical Associate Professor and Honorary Principal Fellow, Department of Medicine, University of Melbourne, and Respiratory Physician, Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Vic. Acknowledgements We thank Dr Sebastian Le Feuvre, Thoracic and Sleep Physician, and Professor Ian Yang, Thoracic Physician, The Prince Charles Hospital and The University of Queensland, Brisbane, Qld, for reviewing the selection of research papers summarised in this article. We are also grateful for the assistance of members of Lung Foundation Australia’s COVID-19 Expert Working Group,* in compiling this article.

 

Recovering from COVID-19: the long road ahead

A pattern of longer-term symptoms likely to be experienced by survivors of COVID-19 is emerging.1

Fatigue, breathlessness, psychological distress and general decline in quality of life are among the longer-term symptoms likely to be experienced by patients after hospi-talisation for COVID-19, a UK study has reported.

The study, published in the Journal of Medical Virology, followed 100 patients recovering from COVID-19 four to eight weeks after discharge from a large tertiary teaching hospital. Patients were contacted by phone by the hospital’s rehabilitation team and asked about their recovery and persisting symptoms.

Thirty-two of the patients had been treated in the intensive care unit (ICU group; median age, 58.5 years) and 68 had not needed ICU care (ward group; median age, 70.5 years). Most patients had had respiratory dysfunction requiring oxygen or noninvasive ventilation; only one had been intubated.

Fatigue was the most prevalent symptom. More than 60% in the ward group had fatigue, with one-third saying it was moderate or severe. In the ICU group, 72% reported fatigue and more than half said it was moderate or severe. 

Breathlessness was the next most common symptom, affecting 65.6% of the ICU group and 42.6% of the ward group, and the third most common symptom, psychological distress, was reported by 46.9% of the ICU group and 23.5% of the ward group.

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The researchers found a clinically significant drop in quality of life (measured by the  EuroQol-5 Dimension). More than two-thirds (68.8%) of the ICU group and almost half (45.6%) of the ward group said their overall quality of life had deteriorated. At the time of the interview, 60% of the ICU group and 15% of the ward group were too sick to return to work.

Symptoms relating to communication, voice, swallow and laryngeal sensitivity (including persistent cough) were more common in the ICU group than the ward group.

The researchers said the greater prevalence of symptoms in almost all reported symptom domains in the ICU group, despite being a younger, less comorbid group, was in keeping with the postintensive care syndrome.

They called for rehabilitation care for COVID-19 survivors to be need-focused, delivered by specialist multidisciplinary teams and planned for the longer term.

Comment by Dr Renae McNamara

Nine months after the first report of SARS-CoV-2 infection, evidence of the sequelae of COVID-19 in the recovery period is starting to emerge which indicates a broad range of symptoms and impairments persisting long after the infection, many of which may be amenable to rehabilitation. Profound fatigue and breathlessness dominate reports.

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People with moderate or severe COVID-19 admitted to hospital will likely have received multidisciplinary rehabilitation during their inpatient stay. However, with 80% of people diagnosed with mild COVID-19, many people experiencing persistent symptoms and impairments in the recovery phase will be managed in primary care. There will be a period of natural recovery in COVID-19, where rest, pacing and a gradual increase in activity would be recommended. However, in people slow to recover or those with protracted symptoms or impairments beyond six to eight weeks, rehabilitation delivered in the hospital outpatient or community setting would be indicated (which could include telerehabilitation, especially in the case of positive infection). Older people and those with underlying diseases (such as cardiovascular disease, diabetes, chronic respiratory disease and cancer) are more likely to require intervention.

A comprehensive rehabilitation assessment will identify the person’s main symptoms and impairments, and interventions can be tailored to address physical and mental treatable traits. Although trials of rehabilitation post-COVID-19 have yet to be published, consensus-based recommendations indicate the model of pulmonary rehabilitation may be suitable.

1. Halpin SJ, et al. Post-discharge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol 2020; doi.org/10.1002/jmv.26368 (accepted article, peer reviewed).

Further reading

Alison J, et al. Rehabilitation following COVID-19 in the pulmonary rehabilitation setting. Agency for Clinical Innovation 2020. www.aci.health.nsw.gov.au
Greenhalgh T, et al. Management of post-acute  COVID-19 in primary care. BMJ 2020; 370: m3026.
Siordia JA. Epidemiology and clinical features of  COVID-19: a review of current literature. J Clin Virol 2020; 127: 104357.
Spruit MA, et al. COVID-19: Interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J 2020; doi.org/10.1183/13993003.02197-2020.