Lungs Clear But Still Not Well Post-COVID

Persistent lung problems were seldom seen in the months after COVID-19, whereas fatigue and deconditioning persisted for many, a study affirmed.

Routine follow-up chest imaging showed persistent infiltrate or atelectasis at a median of 75 days after diagnosis in 4% of people attending an outpatient post-COVID clinic (five of 115 with repeat imaging).

Those objective findings from repeat radiography followed by CT for persistent abnormalities were “reassuring regarding the long-term respiratory impact of COVID-19,” reported Liam Townsend, MBBCh, of St. James’s Hospital in Dublin, Ireland, and colleagues in the Annals of the American Thoracic Society.

Together with the “very low” 3% rate of significant oxygen desaturation during the 6-minute walk test (6MWT), they “suggest that clinically-relevant fibrosis is an uncommon consequence of SARS-CoV-2 infection.”

However, the 6MWT distance covered (median 460 m) was lower than expected for a healthy population and more in line with what was seen in 2003 among SARS survivors, the group noted.

Adding to that “significant morbidity,” 62% of patients reported not feeling back to full health and 48% met criteria for fatigue (median score was 15 on the 33-point Chalder Fatigue Scale).

“These results support the need for more in-depth cardiovascular health and fitness assessment of those most severely affected, including cardiac imaging and maximal oxygen uptake assessment,” the researchers concluded.

These numbers are similar to what’s being seen at Mount Sinai’s Center for Post-COVID Care in New York City, noted its medical director, Zijian Chen, MD.

While all of the persistent lung abnormalities found in the study were in people who had been admitted at some point in their disease course, neither that nor the other findings correlated with initial disease severity.

“These findings have implications for clinical care, in that they demonstrate the importance of following up with all patients who were diagnosed with COVID-19, irrespective of severity of initial infection. It is not possible to predict who will have ongoing symptoms,” Townsend said in a press release.

The study included 153 patients who attended a post-COVID clinic out of a possible 487 contactable patients diagnosed with SARS-CoV-2 at the single institution in the 3-month period from March through May 2020. Among them, 48% had been hospitalized for COVID-19 and 12% were admitted to the ICU.

Notable limitations of the study were the largely Caucasian population studied and substantial proportion of patients who declined an outpatient appointment.

“Telephone follow-up was not feasible due to resource constraints,” the researchers noted. “It is possible that those who have persistent ill health are over-represented in our cohort. Similarly, we cannot generalize our objective respiratory results to the total COVID cohort.”