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      Zufriedenheit COVID-19-Erkrankter mit den Akteuren des Gesundheitssystems und der rehabilitativen Therapieversorgung unter Verwendung des COVID-19-Rehabilitation Needs Questionnaire (C19-RehabNeQ) in Bayern

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          Zusammenfassung

          Ziel Die Auswirkungen der COVID-19-Pandemie sind wirtschaftlich, global aber auch individuell noch nicht abzu-schätzen. Aufgrund der Neuartigkeit wurden in Deutschland viele ad-hoc-Entscheidungen getroffen, die Einfluss auf das gesamte Gesundheitswesen hatten. Dies betraf sowohl Abläufe in Gesundheitsämtern, als auch direkt die medizinische Versorgung COVID-19-Erkrankter, die durch multiple Faktoren zum Teil keine adäquate ambulante Therapie erhielten. Das Ziel der Untersuchung war es, die Zufriedenheit von Personen während und nach COVID-19-Infektion mit den erhaltenen Therapien sowie den Akteuren des Gesundheitssystems darzustellen und somit diesen Aspekt in der aktuellen Diskussion stärker in den Fokus zu rücken.

          Methodik Der neu entwickelte Fragebogen zur Erfassung von Rehabilitationsbedürfnissen und der Zufriedenheit von COVID-19-Erkrankten (Rehabilitation Needs Questionnaire (RehabNeQ)) wurde in einer Kooperation mit zwei bayerischen Gesundheitsämtern per Post im Juli 2020 an die Betroffenen versandt. Die Auswertung erfolgte deskriptiv mit Darstellung der Häufigkeiten.

          Ergebnisse 1027 Fragebögen wurden verschickt. Die Rücklaufquote betrug 41%. 365 Datensätze konnten ausgewertet werden. Der Altersdurchschnitt lag bei 49,8 Jahren. Insgesamt waren 43,8% mit den Angeboten des Gesundheitswesens während des Befragungszeitraumes zufrieden oder sehr zufrieden. 54% waren mit den Mitarbeitern des Gesundheitsamtes zufrieden. 28,5% gaben an, sich weitere Therapien gewünscht, diese aber vor allem durch Ablehnung oder fehlende Ansprechpartner, nicht erhalten zu haben. Nur ein geringer Anteil hatte Kontakt zu einem Facharzt für Physikalische und Rehabilitative Medizin. Termine in speziellen Nachsorgeeinrichtungen wurden von den meisten Befragten als weiterer Therapiewunsch genannt.

          Schlussfolgerung Die Zufriedenheit mit den Beteiligten des Gesundheitswesens in den ersten Monaten der Pandemie war bei den Befragten der beiden bayerischen Landkreise hoch, wenngleich viele Befragte sich gewünscht hätten schneller besser informiert zu sein. Besonders bzgl. der erhaltenen Therapien zeigt sich weiterer Handlungsbedarf. Die multifaktoriellen funktionellen, zum Teil langanhaltenden Defizite nach einer SARS-CoV-2 Infektion bedürfen eines rehabilitativen Gesamtkonzepts. Die Bildung weiterer COVID-19 Nachsorgeeinrichtungen sollte Teil dieser Strategie sein, in denen eine multidisziplinäre Behandlung nach entsprechender Diagnostik stattfindet. Dadurch könnte zu einer schnelleren Rückkehr in die normale Belastbarkeit und Arbeitsfähigkeit beigetragen werden.

          Summary

          Purpose The impact of the COVID-19 pandemic cannot yet be assessed economically, globally but also individually. Due to the novelty of the pandemic, many ad-hoc decisions were made in Germany that had an impact on the entire health care system. This affected both procedures in health offices and the medical care of COVID-19 patients directly, some of whom did not receive adequate outpatient therapy due to multiple factors. The aim of the study was to show the satisfaction of persons with and after COVID-19 with the therapies received and the actors of the health care system, and thus to bring this aspect more into focus in the current discussion.

          Methods The newly developed questionnaire to assess the rehabilitation needs and satisfaction of COVID-19 patients (Rehabilitation Needs Questionnaire (RehabNeQ)) was sent to the patients by mail in July 2020 in cooperation with two Bavarian health authorities. The evaluation was carried out descriptively with presentation of the frequencies.

          Results 1027 questionnaires were sent out. The response rate was 41%. 365 data sets could be evaluated. The average age was 49.8 years. Overall, 43.8% were satisfied or very satisfied with the health services offered during the survey period. 54% were satisfied with the health department staff. 28.5% said they wanted further therapies but did not receive them, mainly due to rejection or lack of contact persons. Only a small proportion had contact with a specialist in physical and rehabilitative medicine. Appointments in special aftercare facilities were mentioned by most respondents as a further wish for therapy.

          Conclusion Satisfaction with those involved in the health care system in the first months of the pandemic was high among respondents in both Bavarian districts, although many respondents would have liked to get sooner better informed. Particularly with regard to the therapies received, there is a need for further action. The multifactorial functional, partly long-lasting deficits after a SARS-CoV-2 infection require a rehabilitative overall concept. The formation of further COVID-19 after-care facilities should be part of this strategy, in which multidisciplinary treatment takes place after appropriate diagnostics. This may contribute to a faster return to normal resilience and working capacity.

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          6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

          Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences. Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Funding National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.
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            Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020

            Prolonged symptom duration and disability are common in adults hospitalized with severe coronavirus disease 2019 (COVID-19). Characterizing return to baseline health among outpatients with milder COVID-19 illness is important for understanding the full spectrum of COVID-19–associated illness and tailoring public health messaging, interventions, and policy. During April 15–June 25, 2020, telephone interviews were conducted with a random sample of adults aged ≥18 years who had a first positive reverse transcription–polymerase chain reaction (RT-PCR) test for SARS-CoV-2, the virus that causes COVID-19, at an outpatient visit at one of 14 U.S. academic health care systems in 13 states. Interviews were conducted 14–21 days after the test date. Respondents were asked about demographic characteristics, baseline chronic medical conditions, symptoms present at the time of testing, whether those symptoms had resolved by the interview date, and whether they had returned to their usual state of health at the time of interview. Among 292 respondents, 94% (274) reported experiencing one or more symptoms at the time of testing; 35% of these symptomatic respondents reported not having returned to their usual state of health by the date of the interview (median = 16 days from testing date), including 26% among those aged 18–34 years, 32% among those aged 35–49 years, and 47% among those aged ≥50 years. Among respondents reporting cough, fatigue, or shortness of breath at the time of testing, 43%, 35%, and 29%, respectively, continued to experience these symptoms at the time of the interview. These findings indicate that COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults. Effective public health messaging targeting these groups is warranted. Preventative measures, including social distancing, frequent handwashing, and the consistent and correct use of face coverings in public, should be strongly encouraged to slow the spread of SARS-CoV-2. Prolonged illness is well described in adults with severe COVID-19 requiring hospitalization, especially among older adults ( 1 , 2 ). Recently, the number of SARS-CoV-2 infections in persons first evaluated as outpatients have increased, including cases among younger adults ( 3 ). A better understanding of convalescence and symptom duration among outpatients with COVID-19 can help direct care, inform interventions to reduce transmission, and tailor public health messaging. The Influenza Vaccine Effectiveness in the Critically Ill (IVY) Network, a collaboration of U.S. health care systems, is conducting epidemiologic studies on COVID-19 in both inpatient and outpatient settings ( 4 , 5 ). Fourteen predominantly urban academic health systems in 13 states each submitted a list of adults with positive SARS-CoV-2 RT-PCR test results obtained during March 31–June 4, 2020, to Vanderbilt University Medical Center. Site-specific random sampling was then performed on a subset of these patients who were tested as outpatients and included patients tested in the emergency department (ED) who were not admitted to the hospital at the testing encounter and those tested in other outpatient clinics. At 14–21 days from the test date, CDC personnel interviewed the randomly sampled patients or their proxies by telephone to obtain self-reported baseline demographic, socioeconomic, and underlying health information, including the presence of chronic medical conditions. Call attempts were made for up to seven consecutive days, and interviews were conducted in several languages ( 4 ). Respondents were asked to report the number of days they felt unwell before the test date, COVID-19–related symptoms experienced at the time of testing ( 6 ), whether symptoms had resolved by the date of the interview, and whether the patient had returned to their usual state of health. For this data analysis, respondents were excluded if they did not complete the interview, if a proxy (e.g., family member) completed the interview (because of their incomplete knowledge of symptoms), if they reported a previous positive SARS-CoV-2 test (because the reference date for symptoms questions was unclear), or (because this analysis focused on symptomatic persons) if they did not answer symptoms questions or denied all symptoms at testing. Descriptive statistics were used to compare characteristics among respondents who reported returning and not returning to their usual state of health by the date of the interview. Generalized estimating equation regression models with exchangeable correlation structure accounting for clustering by site were fitted to evaluate the association between baseline characteristics and return to usual health, adjusting for potential a priori-selected confounders. Resolution and duration of individual symptoms were also assessed. Statistical analyses were conducted using Stata software (version 16; StataCorp). At least one telephone call was attempted for 582 patients (including 175 [30%] who were tested in an ED and 407 [70%] in non-ED settings), with 325 (56%) interviews completed (89 [27%] ED and 236 [73%] non-ED). Among 257 nonrespondents, 178 could not be reached, 37 requested a callback but could not be reached on further call attempts, 28 refused the interview, and 14 had a language barrier. Among the 325 completed interviews, 31 were excluded: nine (3%) because a proxy was interviewed, 17 (5%) because a previous positive SARS-CoV-2 test was reported, and five (2%) who did not answer the symptoms questions. Two additional respondents were called prematurely at 7 days and were also excluded.* Among the 292 remaining patient respondents, 274 (94%) reported one or more symptoms at testing and were included in this data analysis. Following outpatient testing, 7% (19 of 262 with available data) reported later being hospitalized, a median of 3.5 days after the test date. The median age of symptomatic respondents was 42.5 years (interquartile range [IQR] = 31–54 years), 142 (52%) were female, 98 (36%) were Hispanic, 96 (35%) were non-Hispanic white, 48 (18%) were non-Hispanic black, and 32 (12%) were other non-Hispanic race. Overall, 141 of 264 (53%) with available data reported one or more chronic medical conditions. The median interval from test to interview date was 16 days (IQR = 14–19 days); the median number of days respondents reported feeling unwell before being tested for SARS-CoV-2 was 3 (IQR = 2–7 days). Return to Usual State of Health Among the 270 of 274 interviewees with available data on return to usual health, † 175 (65%) reported that they had returned to their usual state of health a median of 7 days (IQR = 5–12 days) from the date of testing (Table 1). Ninety-five (35%) reported that they had not returned to their usual state of health at the time of interview. The proportion who had not returned to their usual state of health differed across age groups: 26% of interviewees aged 18–34 years, 32% aged 35–49 years, and 47% aged ≥50 years reported not having returned to their usual state of health (p = 0.010) within 14–21 days after receiving a positive test result. Presence of chronic conditions also affected return to health rates; among 180 persons with no or one chronic medical condition, 39 with two chronic medical conditions, and 44 with three or more chronic medical conditions, 28%, 46%, and 57%, respectively, reported not having returned to their usual state of health (p = 0.003) within 14–21 days after having a positive test result. Among respondents aged 18–34 years with no chronic medical condition, 19% (nine of 48) reported not having returned to their usual state of health. Adjusting for other factors, age ≥50 versus 18–34 years (adjusted odds ratio [aOR] = 2.29; 95% confidence interval [CI] = 1.14–4.58) and reporting three or more versus no chronic medical conditions (aOR = 2.29; 95% CI = 1.07–4.90) were associated with not having returned to usual health (Table 2). Obesity (body mass index ≥30 kg per m2) (aOR 2.31; 95% CI = 1.21–4.42) and reporting a psychiatric condition § (aOR 2.32; 95% CI = 1.17–4.58) also were associated with more than twofold odds of not returning to the patient’s usual health after adjusting for age, sex, and race/ethnicity. TABLE 1 Characteristics of symptomatic outpatients with SARS-CoV-2 real-time reverse transcription–polymerase chain reaction (RT-PCR)—positive test results (N = 270)* who reported returning to usual state of health or not returning to usual state of health at an interview conducted 14–21 days after testing — 14 academic health care systems, † United States, March–June 2020 Characteristic Total Returned to usual health, no. (row %) P-value§ Yes (n = 175) No (n = 95) Sex 0.14 Women 140 85 (61) 55 (39) Men 130 90 (69) 40 (31) Age group (yrs) 0.010 18–34 85 63 (74) 22 (26) 35–49 96 65 (68) 31 (32) ≥50 89 47 (53) 42 (47) Race/Ethnicity 0.29 White, non-Hispanic 94 58 (62) 36 (38) Black, non-Hispanic 46 26 (57) 20 (43) Other race, non-Hispanic 32 24 (75) 8 (25) Hispanic 98 67 (68) 31 (32) Insurance (14 missing) 0.69 No 46 31 (67) 15 (33) Yes 210 135 (64) 75 (36) No. of medical conditions (7 missing) 0.003 0 123 87 (71) 36 (29) 1 57 41 (72) 16 (28) 2 39 21 (54) 18 (46) ≥3 44 19 (43) 25 (57) Individual medical conditions (7 missing all) ¶ Hypertension 64 33 (52) 31 (48) 0.018 Obesity (body mass index >30 kg/m2) 51 23 (45) 28 (55) 0.002 Psychiatric condition 49 23 (47) 26 (53) 0.007 Asthma 36 23 (64) 13 (36) 0.99 Diabetes 28 16 (57) 12 (43) 0.43 Immunosuppressive condition 15 6 (40) 9 (60) 0.047 Autoimmune condition 13 7 (54) 6 (46) 0.44 Blood disorder 8 4 (50) 4 (50) 0.47 Chronic kidney disease 7 3 (43) 4 (57) 0.26 Chronic obstructive pulmonary disease 7 4 (57) 3 (43) 0.71 Liver disease 6 4 (67) 2 (33) 1.00 Neurologic condition 6 3 (50) 3 (50) 0.48 Coronary artery disease 4 3 (75) 1 (25) 1.00 Congestive heart failure 2 2 (100) 0 (0) 0.54 * 294 patients responded to an interview 2–3 weeks after testing, did not report a previous positive SARS-CoV-2 test before the reference test, and answered questions about symptoms. Of these, 276 (94%) reported one or more symptoms at the time of SARS-CoV-2 RT-PCR testing, with 272 (99%) reporting whether they had returned to their usual state of health by the time of the interview. Two additional patients excluded who were called at 7 days, with 270 included here. † Patients were randomly sampled from fourteen academic healthcare systems in 13 states (University of Washington [Washington], Oregon Health and Sciences University [Oregon], University of California Los Angeles and Stanford University [California], Hennepin County Medical Center [Minnesota], Vanderbilt University [Tennessee], Ohio State University [Ohio], Wake Forest University [North Carolina], Montefiore Medical Center [New York], Beth Israel Deaconess Medical Center and Baystate Medical Center [Massachusetts], Intermountain Healthcare [Utah/Idaho], University of Colorado Hospital [Colorado], and Johns Hopkins University [Maryland]). § Respondents who reported returning to usual health and respondents who reported not returning to usual health were compared using the chi-square test or Fisher's exact test. ¶ Excluding seven (3%) patients who did not answer questions about chronic underlying medical conditions; for those who answered questions about underlying conditions, some respondents were missing data on obesity (two), neurologic conditions (one), and psychiatric conditions (one). TABLE 2 Characteristics associated with not returning to usual health among symptomatic outpatients with SARS-CoV-2 real-time reverse transcription–polymerase chain reaction (RT-PCR)–positive test results (N = 270)* reported at an interview conducted 14–21 days after testing — 14 academic health care systems, † United States, March–June 2020 Characteristic Odds of not returning to “usual health” at 14–21 days after testing Unadjusted odds ratio (95% CI)§ Adjusted odds ratio (95% CI)§,¶ Age group (yrs) 18–34 Referent Referent 35–49 1.40 (0.73–2.67) 1.38 (0.71–2.69) ≥50 2.64 (1.39–5.00) 2.29 (1.14–4.58) Sex Women Referent Referent Men 0.68 (0.41–1.13) 0.80 (0.46–1.38) Race/Ethnicity White, non-Hispanic Referent Referent Black, non-Hispanic 1.23 (0.60–2.53) 1.13 (0.53–2.45) Other, non-Hispanic 0.53 (0.21–1.31) 0.63 (0.24–1.61) Hispanic 0.74 (0.40–1.34) 0.83 (0.44–1.58) No. of medical conditions 0 Referent Referent 1 0.94 (0.47–1.89) 0.74 (0.35–1.55) 2 2.09 (1.00–4.38) 1.50 (0.68–3.33) ≥3 3.19 (1.56–6.50) 2.29 (1.07–4.90) Individual medical conditions** Hypertension 1.98 (1.12–3.52) 1.30 (0.67–2.51) Obesity (BMI >30 kg/m2) 2.65 (1.42–4.95) 2.31 (1.21–4.42) Psychiatric condition 2.42 (1.29–4.56) 2.32 (1.17–4.58) Asthma 1.00 (0.48–2.08) 1.02 (0.47–2.20) Diabetes 1.38 (0.62–3.05) 1.06 (0.46–2.44) Immunosuppressive condition 2.84 (0.98–8.26) 2.33 (0.77–7.04) Autoimmune condition 1.55 (0.51–4.76) 1.05 (0.32–3.46) Blood disorder 1.82 (0.45–7.45) 1.43 (0.33–6.24) Chronic kidney disease 2.42 (0.53–11.05) 2.36 (0.48–11.51) Chronic obstructive pulmonary disease 1.34 (0.29–6.12) 0.70 (0.14–3.48) Liver disease 0.88 (0.16–4.90) 0.72 (0.12–4.25) Neurologic condition 1.78 (0.35–9.01) 1.23 (0.23–6.62) Coronary artery disease 0.58 (0.06–5.70) 0.48 (0.05–4.92) Congestive heart failure — — Abbreviations: BMI = body mass index; CI = confidence interval. * 294 patients responded to 14–21-day interview, did not report a previous positive SARS-CoV-2 test before the reference test, and answered questions about symptoms; 276 (94%) of these reported one or more symptoms at the time of SARS-CoV-2 RT-PCR testing, with 272 (99%) reporting whether they had returned to their usual state of health by the time of the interview. Two additional patients who were called at 7 days were excluded, with 270 included here. † Patients were randomly sampled from academic healthcare systems in 13 states (University of Washington [Washington], Oregon Health and Sciences University [Oregon], University of California Los Angeles and Stanford University [California], Hennepin County Medical Center [Minnesota], Vanderbilt University [Tennessee], Ohio State University [Ohio], Wake Forest University [North Carolina], Montefiore Medical Center [New York], Beth Israel Deaconess Medical Center and Baystate Medical Center [Massachusetts], Intermountain Healthcare [Utah/Idaho], University of Colorado Hospital [Colorado], and Johns Hopkins University [Maryland]). § For this analysis, generalized estimation equation (GEE) models with exchangeable correlation structure were used to estimate the association between characteristics and the odds of not returning to usual health by the date of the 14–21-day interview. GEE models were used to account for clustering of cases by site. 95% CIs including 1.00 are not considered statistically significant. ¶ In adjusted GEE models for age, sex, race/ethnicity, and number of chronic medical conditions, the other variables were used to adjust for potential confounders. Models for individual conditions (e.g., hypertension) were adjusted for age, sex, and race/ethnicity. ** Medical conditions are not exclusive and individual patients could have more than one chronic medical condition. Resolution of Symptoms and Duration Among the 274 symptomatic outpatients, the median number of symptoms was seven of 17 listed in the interview tool (IQR = 5–10), with fatigue (71%), cough (61%), and headache (61%) those most commonly reported (Figure). Among respondents who reported fever and chills on the day of testing, these resolved in 97% and 96% of respondents, respectively. Symptoms least likely to have resolved included cough (not resolved in 43% [71 of 166]) and fatigue (not resolved in 35% [68 of 192]); among 90 who reported shortness of breath at the time of testing, this symptom had not resolved in 26 (29%). The median interval to symptom resolution among those who reported individual symptoms at the time of testing but not at the time of the interview ranged from 4 to 8 days from the test date, with the longest intervals reported for loss of smell (median = 8 days; IQR = 5–10.5 days) and loss of taste (median = 8 days; IQR = 4–10 days). Among respondents who reported returning to their usual state of health, 34% (59 of 175) still reported one or more of the 17 queried COVID-related symptoms at the time of the interview. FIGURE Self-reported symptoms at the time of positive SARS-CoV-2 reverse transcription–polymerase chain reaction (RT-PCR) testing results and unresolved symptoms 14–21 days later among outpatients (N = 274)* — 14 academic health care systems, † United States, March–June 2020 * 294 patients responded to 14–21-day interview, did not report a previous positive SARS-CoV-2 test before the reference test, and answered questions about symptoms; 276 (94%) of these reported one or more symptoms at the time of SARS-CoV-2 RT-PCR testing; those who were interviewed at 7 days were excluded, with 274 included here. † Patients were randomly sampled from 14 academic health care systems in 13 states (University of Washington [Washington], Oregon Health and Sciences University [Oregon], University of California Los Angeles and Stanford University [California], Hennepin County Medical Center [Minnesota], Vanderbilt University [Tennessee], Ohio State University [Ohio], Wake Forest University [North Carolina], Montefiore Medical Center [New York], Beth Israel Deaconess Medical Center and Baystate Medical Center [Massachusetts], Intermountain Healthcare [Utah/Idaho], University of Colorado Hospital [Colorado], and Johns Hopkins University [Maryland]). The figure is a bar chart showing self-reported symptoms at the time of positive SARS-CoV-2 reverse transcription–polymerase chain reaction testing results and unresolved symptoms 14–21 days later among outpatients (N = 274), using data from 14 academic health care systems in the United States, during March–June 2020. Discussion Most studies to date have focused on symptoms duration and clinical outcomes in adults hospitalized with severe COVID-19 ( 1 , 2 ). This report indicates that even among symptomatic adults tested in outpatient settings, it might take weeks for resolution of symptoms and return to usual health. Not returning to usual health within 2–3 weeks of testing was reported by approximately one third of respondents. Even among young adults aged 18–34 years with no chronic medical conditions, nearly one in five reported that they had not returned to their usual state of health 14–21 days after testing. In contrast, over 90% of outpatients with influenza recover within approximately 2 weeks of having a positive test result ( 7 ). Older age and presence of multiple chronic medical conditions have previously been associated with illness severity among adults hospitalized with COVID-19 ( 8 , 9 ); in this study, both were also associated with prolonged illness in an outpatient population. Whereas previous studies have found race/ethnicity to be a risk factor for severe COVID-19 illness ( 10 ), this study of patients whose illness was diagnosed in an outpatient setting did not find an association between race/ethnicity and return to usual health although the modest number of respondents might have limited our ability to detect associations. The finding of an association between chronic psychiatric conditions and delayed return to usual health requires further evaluation. These findings have important implications for understanding the full effects of COVID-19, even in persons with milder outpatient illness. Notably, convalescence can be prolonged even in young adults without chronic medical conditions, potentially leading to prolonged absence from work, studies, or other activities. The findings in this report are subject to at least three limitations. First, nonrespondents might have differed from survey respondents; for example, those with more severe illness might have been less likely to respond to telephone calls if they were subsequently hospitalized and unable to answer the telephone. Second, symptoms that resolved before the test date or that commenced after the date of testing were not recorded in this survey. Finally, as a telephone survey, this study relied on patient self-report and might have been subject to incomplete recall or recall bias. Nonhospitalized COVID-19 illness can result in prolonged illness and persistent symptoms, even in young adults and persons with no or few chronic underlying medical conditions. Public health messaging should target populations that might not perceive COVID-19 illness as being severe or prolonged, including young adults and those without chronic underlying medical conditions. Preventative measures, including social distancing, frequent handwashing, and the consistent and correct use of face coverings in public, should be strongly encouraged to slow the spread of SARS-CoV-2. Summary What is already known about this topic? Relatively little is known about the clinical course of COVID-19 and return to baseline health for persons with milder, outpatient illness. What is added by this report? In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health when interviewed 2–3 weeks after testing. Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health. What are the implications for public health practice? COVID-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions. Effective public health messaging targeting these groups is warranted.
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              Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection

              Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it is unknown if COVID-19 results in persistent fatigue in those recovered from acute infection. We examined the prevalence of fatigue in individuals recovered from the acute phase of COVID-19 illness using the Chalder Fatigue Score (CFQ-11). We further examined potential predictors of fatigue following COVID-19 infection, evaluating indicators of COVID-19 severity, markers of peripheral immune activation and circulating pro-inflammatory cytokines. Of 128 participants (49.5 ± 15 years; 54% female), more than half reported persistent fatigue (67/128; 52.3%) at median of 10 weeks after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (leukocyte, neutrophil or lymphocyte counts, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, C-reactive protein) or pro-inflammatory molecules (IL-6 or sCD25) and fatigue post COVID-19. Female gender and those with a pre-existing diagnosis of depression/anxiety were over-represented in those with fatigue. Our findings demonstrate a significant burden of post-viral fatigue in individuals with previous SARS-CoV-2 infection after the acute phase of COVID-19 illness. This study highlights the importance of assessing those recovering from COVID-19 for symptoms of severe fatigue, irrespective of severity of initial illness, and may identify a group worthy of further study and early intervention.
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                Author and article information

                Journal
                Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin
                Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin
                Georg Thieme Verlag KG
                0940-6689
                1439-085X
                February 09 2022
                February 2022
                August 25 2021
                February 2022
                : 32
                : 01
                : 11-18
                Affiliations
                [1 ]Institut für Physiotherapie, Universitätsklinikum Jena, Jena
                [2 ]Klinik für Rehabilitationsmedizin, Medizinische Hochschule Hannover
                Article
                10.1055/a-1528-1667
                b1e1e544-ce51-4af0-9231-a78c10b69cce
                © 2022
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