High rate of persistent symptom 4 months after community-managed COVID-19 infection

Background: The spectrum of recovery following community-managed and hospitalized SARS-CoV-2 infection remains uncertain. The aim of the ADAPT study was to determine prevalence and nature of persistent symptoms after community and hospitalised SARS-CoV-2 infection;and to evaluate lung function;health-related quality of life (HRQOL);and neurocognitive abnormalities. Methods: A prospective observational cohort study was performed at St Vincent's Hospital Sydney Australia. Adult patients with a positive SARS-CoV-2 RNA PCR test between Mar-2020 and Apr-2020 including mild, moderate, and severe acute infection were offered enrollment. The clinical outcomes included symptom prevalence at initial infection and follow-up, HRQOL measures, pulmonary function, neurocognition and COVID-19 antibody responses. Initial study assessments were performed up to 4 months after first detection of SARS-CoV-2. Results: Ninety-six patients were recruited following community-managed mild (39%) and moderate (50%), and hospitalized severe (11%) COVID-19 infection. 39.7% patients had persistent symptoms at median 72 days after diagnosis (IQR 65-87), including those in severe (77.8%), moderate (33.3%), and mild (36.7%) sub-populations. The most common persistent symptoms were fatigue (28%), shortness of breath (25%) and cough (21%). Total lung capacity (TLC) was significantly lower after severe, compared with community-managed, COVID-19, p=0.05. Abnormal diffusion capacity for carbon monoxide values were observed in 16% patients unrelated to acute illness severity. Twenty-four percent patients demonstrated anxiety/depression, as measured by SPHERE-34 item, with the highest proportion in the moderate sub-population (37%). Neurocognitive impairment was low (9%) but associated with abnormal olfaction (p=0.02). A high proportion of patients (77-85%) demonstrated positive antibody responses, on four commercial assays, at follow-up and titres were related to acute illness severity. Conclusion: A considerable proportion of patients experience persistent symptoms at 4 months after SARS-CoV-2 infection including one third of community managed patients. High rates of depression and anxiety were reported across the cohort. Outpatient follow-up to further assess those with persistent symptoms after COVID-19 is important to allow multi-disciplinary input, further investigation, and appropriate management. Data collection on the prevalence of persisting symptoms at 8 month follow-up of the ADAPT study is currently underway.