Rapid review question: What are the medium- and long-term health sequelae of COVID-19 infection among survivors?

In brief: 

General health sequelae 

• Symptoms commonly reported among recovered COVID-19 patients two to eight weeks after the onset of symptoms (or a positive COVID-19 test) include: fatigue, shortness of breath, muscle or joint pain, chest pain, cough, and insomnia and/or sleep disorders.(1-6)  

• A study of 202 confirmed COVID-19 patients with mild symptoms, found altered sense of smell or taste occurred in 18.6% of patients, feelings of being tired in 13.1%, problems breathing in 10.4% and muscle or joint pains in 7.7%.(2) Another study of 143 patients reported fatigue in 53.1%, dyspnea in 43.4%, joint pain in 27.3%, and chest pain 21.7% of patients.(1)  

• A study conducted among discharged intensive care unit (ICU) and ward COVID-19 patients found that post-traumatic stress disorder, anxiety and/or depression, voice change, laryngeal sensitivity, new continence problems and dysphagia were commonly reported among recovered patients.(5) 

Respiratory health sequelae 

• Commonly reported respiratory consequences among COVID-19 patients, two to five weeks after the onset of symptoms or being discharged from the hospital included: abnormal carbon monoxide diffusion capacity, abnormal forced expiratory volume in the first second (FEV1), abnormal forced vital capacity (FVC), abnormal FEV1/FVC, small airway dysfunction, abnormal forced inspiratory volume, abnormal maximal expiratory flow (MEF)25, MEF50, and MEF75,(7) abnormal residual computed tomography (CT) changes including ground-glass opacity and pulmonary fibrosis.(7-11)  

• Across studies, 33-81% of patients had reported abnormal pulmonary function.(7, 9, 10)  

• Respiratory consequences were worse in patients who had severe COVID-19 symptoms prior to discharge, compared to those with non-severe symptoms.(7, 10)  

Cardiovascular health sequelae 

• Reported cardiovascular consequences among some recovered COVID-19 patients five to ten weeks after diagnosis included: myocardial injury with either or both non-ischemic heart disease-related and ischemic heart disease-related pathology, presence of high-sensitivity troponin T (hsTnT) and elevated hsTnT, raised myocardial native T1 and T2, having myocardial late gadolinium enhancement and having pericardial enhancement.(12, 13) 

COVID-19 Critical Intelligence Unit 26 August 2020 

• In a study of 100 patients, 78% of patients had abnormal cardiovascular magnetic resonance imaging findings.(13) A study of 29 patients with no previously known cause for elevated hsTnT, 69% had identifiable mechanism of myocardial injury.(12)

Neurological sequelae 

• Commonly reported neurological consequences that persisted among some recovered COVID-19 patients three to eight weeks after being diagnosed or being discharged from the hospital included: deterioration in hearing and/or tinnitus, olfactory (sense of smell) dysfunction, gustatory dysfunction. (1, 2, 14-22) 

 • In small studies, 13% of patients reported a change in their hearing, 11-78% had persistent olfactory dysfunction, and 16% had gustatory dysfunction.(14, 17-19, 21, 22) 

Mental health sequelae 

• Reported mental health symptoms or conditions among some recovered COVID-19 patients three to four weeks after hospital discharge included: post-traumatic stress disorder, depression, anxiety, obsessive-compulsive symptomatology and insomnia.(23, 24) 

 • In one study, 55.7% of COVID-19 survivors had at least one form of psychopathological symptom that was in the clinical range.(23) Another found 50 (13.5%) had anxiety, 40(10.8%) had depression, and 23 (6.2%) had comorbid anxiety and depression.(24)