Persistence of Symptoms in Post-Discharge COVID 19 Patients in the Urban Field Practice Area of Bangalore Medical College and Research Institute - A Cross-Sectional Study

Introduction:

COVID 19 which emerged in late 2019, is causing an ongoing pandemic in many countries and has posed a global health threat.¹ 181 Countries have been affected by COVID-19 with approximately 72.2 million cases by (December 14 2020). COVID 19 statistics show that 80% of the infected cases are mild, 14 % severe and 5% categorized as critical disease.² People infected with COVID-19 experience respiratory illness with common symptoms including fever, cough, shortness of breath & loss of sense of smell. COVID-19 affects different people in different ways with older people and those with underling medical problems like cardiovascular diseases, chronic respiratory diseases, diabetes, and cancer more likely to develop serious illnesses or death.³

COVID-19 can sometimes result in prolonged illness, even in young adults and children. There are many case reports from people who do not regain their previous health following COVID-19. Little is known about the clinical course of COVID-19 following milder illness.

Persisting symptoms were defined by the presence at day 30,at least one of the following: weight loss ≥ 5%, severe dyspnea or asthenia, chest pain, palpitations, anosmia/ageusia, headache, cutaneous signs, arthralgia, myalgia, digestive disorders, fatigue, fever or using sick leave.⁴

Previous studies have shown that most patients requiring hospitalization for COVID-19 still have per-sistent symptoms, even after 30 days after being discharged, especially dyspnoea and fatigue.⁵ Older age and presence of multiple chronic medical conditions have previously been associated with longer duration of symptoms among COVID-19 patients. Other risk factors for persistence of symptoms include high blood pressure, obesity, and poor mental health conditions.⁶

The medium and long-term problems experienced by survivor’s of COVID-19 after discharge from hospital are currently unknown, but there is some emerging evidence. An Italian study followed-up 143 individuals 7 weeks post discharge and found 53% reporting fatigue, 43% breath lessness, and 27% joint pain. Post discharge symptoms may also be predicted from the previous corona-virus outbreaks of severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome(MERS) in 2012. A metaanalysis of 28 follow-up studies found that one-quarter of hospitalized survivors of SARS and MERS had reduced Lungs function and exercise capacity at 6 months post-discharge.⁷

Materials and methods

The present community based cross sectional study was undertaken among the discharged Covid-19 positive patients in the urban field practice area of Bangalore Medical College after getting permission from Medical Officer of H Siddaiah Road UHTC and Medical Officer of Health, Chickpet, Bangalore South.

There were 326 cases of Covid-19 reported under the urban field practice area of BMCRI from April till October. Total numbers of discharges were found to be 314, patients who were symptomatic at the time of testing or during hospitalization were found to be 112, out of which 90 of them gave consent after explaining the study.⁴

The data was collected using a semi-structured prevalidated questionnaire by telephonic interview of COVID-19 discharged patients between 40th to 45th days from the onset of symptom. The data was entered in MS Office Excel and analyzed using SPSS software ver. 20.0. P-value of <0.05 was considered statistically significant

Result  

The p value represent chi-square tests of independence indicating Associations between participant characteristics and persistence of symptoms 

In this study, out of 90 subjects, 50 (55.55%)were male and 40 (44.44%) were female. The mean age of the study participants was 42.06 ± 14.74 years. 68 of the participants did not have any co morbidity (75.55%), 16 (17.77%) participants were suffering from a single co morbidity and 6 of them (6.66%) from multiple co morbidities. 41.1% that is 37 participants had persistence of symptoms. Fatigue was the most common persistent symptom, it was followed by cough and myalgia. Other symptoms that were persistent include anosmia, head ache and sleep disturbance. There is a statistically significant association between persistence of symptoms and increase in age(p<0.05), number of co morbidities (p<0.05), addiction (p<0.05), hospitalization (p<0.05)

Discussion

COVID-19 can sometimes result in prolonged illness, even in young adults. There are many case reports from people who do not regain their previous health following COVID-19. Little is known about the clinical course of COVID-19 following milder illness. In the present study conducted, 41.1% of the patients interviewed had persistence of symptoms post discharge. Fatigue was the most common persistent symptom. A proper clinical examination of the patients and investigations are required to find out the actual cause behind persistence of symptoms and to rule out other causes other than COVID-19 infection.

Conclusion

These results emphasize the necessity for a long-term follow-up of those patients and rehabilitation programs.

Acknowledgments

My heartfelt thanks to the Dean cum Director of Bangalore Medical College and Research Institute for giving me this opportunity. My heartfelt gratitude to the Medical Officer of H Siddaiah Road UHTC and Medical Officer of Health, Chickpet, Bangalore South for giving me permission to conduct this study. I extend my heartfelt thanks to all the study participants who helped me in conducting this study. I also sincerely acknowledge all the faculty and post graduates of the department for their support.

Conflict of Interest

None.