Persistent Post COVID-19 Symptoms and Functional Status after 12-14 weeks of recovery, Tamil Nadu, India, 2021

Evidence-based position paper on physical and rehabilitation medicine professional practice for persons with COVID-19, including post COVID-19 condition: the European PRM position (UEMS PRM Section)

Although multiple factors still pose challenges to inpatient/outpatient rehabilitation for survivors of COVID-19, rehabilitation plays a key role for this patient population. This study aimed to improve Physical and Rehabilitation Medicine (PRM) physician's professional practice for persons with COVID-19-related functioning limitations, to promote functional recovery and reduce activity limitations and/or participation restrictions. A systematic review of the scientific literature was performed from December 2019 to August 2022, followed by production of recommendations through 5 Delphi rounds, by consensus among the delegates of all European countries represented in the Union of European Medical Specialists PRM Section. The systematic literature review is reported together with thirty-two recommendations resulting from the Delphi procedure. The PRM physician's role for persons with COVID-19-related limitations of functioning is to develop, foster, and monitor the implementation of an individual rehabilitation project tailored to the patient's age, previous medical and functional status, current comorbidities and complications, activity limitations and participation restrictions and personal and environmental factors. This is done by applying the concept of a multi-specialty integrated service model with multi-professional/interdisciplinary teams, providing care at all stages of COVID-19 illness. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section.

Persistent respiratory symptoms and lung function abnormalities in recovered patients of COVID-19

Background and Objectives

COVID-19 is a disease caused by SARS-CoV-2 which belongs to a family of coronaviruses. After the acute phase of illness, the majority of the patients recover quickly but, in some cases, symptoms can persist for a variable duration, bringing into light another entity known as post-COVID syndrome. The objective was to estimate the burden of various persistent respiratory symptoms and lung function abnormalities among recovered patients of COVID-19 and also to correlate them with initial disease severity, demographic factors and comorbidities.

Methods

Eighty-five post-COVID patients were recruited as per inclusion/exclusion criteria. Detailed history taking, physical examination and spirometry were done in all patients and data were correlated with baseline disease severity.

Results

Fatigue and breathlessness were the most common symptoms followed by cough, chest pain and fever. Persistent symptoms and their severity were significantly higher in severe/moderate cases. Spirometry was abnormal in 45.88% of subjects and the most common pattern was restrictive type. It was seen that the likelihood of persistent symptoms and abnormal lung function increased significantly with the severity of COVID-19, age, comorbidities, hospital stay duration and steroid/oxygen therapy.

Conclusion

The current study estimated the burden and array of various pulmonary sequelae encountered by post-COVID patients and elicited various risk factors associated with their occurrence after recovery from active infection. Awareness of these symptoms/sequelae and their risk factors is necessary for their follow-up and timely management, as the threat of this relatively new virus has still not abated.

Risk factors associated with limited functional status among out-of-hospital patients 30 days and one year after a diagnosis of COVID-19: a cohort study

Some people experience indefinitely persistent and disabling symptoms after acute COVID-19, even those who have not been hospitalized. The purpose of this study was to analyze the long-term health consequences at 30 days and one year among people who were not hospitalized after a diagnosis of COVID-19 and to analyze which variables predict limitations in functional status. This is a prospective cohort study with non-hospitalized adults infected with SARS-CoV-2 in the city of Londrina. After 30 days and one year of the acute symptoms of COVID-19, participants received the questionnaire through a social media that consisted of sociodemographic data and data on functionality through the Post-COVID Functional State Scale (PCFS)-the primary outcome of the study "presence of functional status limitation" was grouped into without functional status limitation (value: zero) and with functional limitation (value 1 to 4), fatigue through of the Fatigue Severity Scale (FSS) and dyspnea using the modified Borg scale. In the statistical analysis, multivariable analysis was performed. Statistical significance was set to 5%. Of 140 individuals analyzed, 103 (73.6%) were female with a median age of 35.5 (27-46) years. One year after the diagnosis of COVID-19, 44.3% had at least one self-reported symptom: memory loss (13.6%), gloominess (8.6%), anosmia (7.9%), body pain (7.1%), ageusia (7%), headache (6.4%), and cough (3.6%). According to the FSS and modified Borg scale 42.9% reported fatigue and 18.6% reported dyspnea, respectively. As for functionality, 40.7% reported some limitation, being 24.3% negligible functional limitation, 14.3% slight and 2.1% moderate according to the PCFS. There was a univariate association between the presence of limitation in the functional status with the female sex, diagnosis of anxiety and depression, presence of persistent symptoms after one year, fatigue and dyspnea. In the multivariable analysis, the predictor variables for functional status limitation were female sex, diagnosis of anxiety/depression, presence of at least one persistent symptom and fatigue one year after the diagnosis of COVID-19. One year after the disease, the patients presented functional limitation according to the PCFS, even without hospitalization. Risk factors associated with functional limitation include female sex, presence of fatigue, anxiety and depression, and at least one persistent symptom after one year of COVID-19 diagnosis.

Burden of respiratory problems in low-income and middle-income countries

PURPOSE OF REVIEW

Chronic respiratory diseases are a leading cause of morbidity and mortality in low-income and middle-income countries (LMICs). We aim to review prevalence of respiratory diseases and related symptoms, which contribute significantly to burden of disease in LMICs. We report global estimates of respiratory problems amongst adults in LMICs and recent findings relating to community prevalence and impact of respiratory problems. We conclude by identifying research priorities for improved recognition and palliation of respiratory problems.

RECENT FINDINGS

We report findings from 16 studies, highlighting key issues relevant to burden of respiratory problems in LMICs. COPD and associated symptoms are identified as important drivers of increasing respiratory problems in LMICs, with an estimated prevalence of 7.2%. Negative impacts of respiratory diseases include: reduced physical function (capacity to work), quality of life (depression; anxiety) and socioeconomic wellbeing (healthcare costs; earning potential). Locally appropriate palliative care interventions may improve quality of life without increasing costs.

SUMMARY

Prevention and treatment of respiratory diseases is essential for improved wellbeing. We identify missed opportunities for measurement and understanding of burden caused by respiratory problems within efforts to measure illness prevalence. We highlight need for symptom management interventions, developed in context of local cultural beliefs and behaviours.