COVID: prolonged symptoms in mild cases

The CDC reported a telephone survey of 292 outpatients with mildly symptomatic Covid-19 documented by PCR, finding that 35% had NOT returned to their prior state of health 2-3 weeks later (see https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w#contribAff). 

Details:
--292 patients, from 14 predominantly urban academic health systems in 13 states

--274 (94%) reported at least one symptom at the time of testing, with symptom prevalence: 

    --fatigue 71% 

    --cough 61% 

    --headache 61% 

--underlying medical conditions: hypertension 64 (22%), obesity 51 (17%), psychiatric condition 49 (17%), asthma 36 (12%), diabetes 16 (5%), rest <10 people 

--study done from April 15-June 25 

--median telephone interview: 16 days from testing date 

 

Results: 

--those returning to their usual state of health did so a median of 7 days after date of testing 

--not returning to usual state of health, by age: 

    --age 18-34: 26% 

    --age 35-49: 32% 

    --age >49: 47% 

        --overall, adjusting for other factors: those >49yo vs 18-34 were more than twice as likely to have continuing symptoms, aOR 2.29 (1.14-4.58) 

-- not returning to usual state of health, by presenting symptom: 

    --cough: 43%  

    --fatigue: 35% 

    --shortness of breath: 29% 

-- not returning to usual state of health, by chronic medical conditions: 

    --0-1 chronic medical condition (180 people): 28% 

    --2 (39 people): 46% 

    --3 or more (44 people): 57% 

        -- overall, adjusting for other factors: those with 3 or more vs no medical conditions were more than twice as likely to have continuing symptoms, aOR 2.29 (1.07-4.90) 

--in the lowest probability group of age 18-34 with no chronic medical condition (48 people): 19% reported not returning to usual state of health 

--also there was a >2-fold probability of prolonged symptoms in those with: 

    --obesity, aOR 2.31 (1.21-4.42) 

    --underlying psychiatric condition, aOR 2.32 (1.17-4.58) 

 

Commentary: 

--several studies have documented that patients with severe Covid-19 may have prolonged symptom duration and disability, more so in the elderly. This study specifically assessed those with mild symptomatic disease 

--this study reported on continuing symptoms 2-3 weeks after PCR testing: we do not have information on how long these symptoms continued after the phone interview 

--and 25% of younger people reported prolonged symptoms, including 19% with no underlying medical conditions 

    --this number is profound given that prolonged symptoms of Covid-19 may prevent return to work or school, or ability to function at home, with family or in the community, and: 

        --younger people are more often cavalier about getting the virus 

        --there has been a recent upsurge in Covid-19 cases particularly among the young 

        --and the absolute numbers of infected people in the US (as the global leader!!) and worldwide is so extraordinarily high, that more than 2-3 weeks of incapacity or reduced functioning leads to huge personal and societal repercussions 

--as a point of reference, >90% of outpatients with influenza recover within 2 weeks 

--this study found no difference in prolonged symptoms by race/ethnicity 

--this study also complements and quantifies some prior information on prolonged symptoms even in those with mild cases: see http://gmodestmedblogs.blogspot.com/2020/06/covid-longterm-symptoms.html

 

Limitations 

--we do not know how long the symptoms lasted after the phone call. ?months??? 

--we also do not know the intensity of the symptoms, if the symptoms at 2-3 weeks were actually getting significantly better, or how functionally impairing they were 

--there may be a bias as to who responds to telephone interviews (eg, those getting worse and hospitalized may not be available to respond), and the results rely on self-report 

 

So, this study adds to the prior studies done in sicker patients. And my concern is that many younger people in particular are not seeing the true potential awfulness of this virus, hearing that maybe 40% of people are asymptomatic, 80% have “mild disease”, and bad results are really in the old folks. And these younger ones are the ones going to beaches and bars in those states with less restrictive mask use/social distancing, those states that are now experiencing the predicted surge of infections and bad outcomes. and, even if the younger people do not have a severe infection or prolonged disability, they are also the potential vectors to family, schoolmates and workers at schools, and the local community (which, of course, includes many higher risk individuals). But younger people also do need to hear that even 1 in 5 healthy ones have prolonged symptoms after infection.

the strong and unequivocal public health message (eg closing sites of gatherings, use of masks, and social distancing) needs be reinforced in a consistent manner to all, including the young and healthy ones... (which seems to be really hard to do in the US)

geoff

 

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