Persistent Poor Health after COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity

Ann Am Thorac Soc. 2021 Jun;18(6):997-1003. doi: 10.1513/AnnalsATS.202009-1175OC.


Rationale: Much is known about the acute infective process of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of the coronavirus disease (COVID-19) pandemic. The marked inflammatory response and coagulopathic state in acute SARS-CoV-2 infection may promote pulmonary fibrosis. However, little is known about the incidence and seriousness of post-COVID-19 pulmonary pathology. Objectives: To describe the respiratory recovery and self-reported health after infection at the time of outpatient attendance. Methods: Infection severity was graded into three groups: 1) not requiring admission, 2) requiring hospital admission, and 3) requiring intensive care unit care. Participants underwent chest radiography and a 6-minute walk test (6MWT). Fatigue and subjective return to health were assessed, and concentrations of CRP (C-reactive protein), IL-6 (interleukin-6), sCD25 (soluble CD25), and D-dimer were measured. The associations between initial illness and abnormal chest X-ray findings, 6MWT distance, and perception of maximal exertion were investigated. Results: A total of 487 patients were offered an outpatient appointment, of whom 153 (31%) attended for assessment at a median of 75 days after diagnosis. A total of 74 (48%) had required hospital admission during acute infection. Persistently abnormal chest X-ray findings were seen in 4%. The median 6MWT distance covered was 460 m. A reduced distance covered was associated with frailty and length of inpatient stay. A total of 95 (62%) patients believed that they had not returned to full health, whereas 47% met the case definition for fatigue. Ongoing ill health and fatigue were associated with an increased perception of exertion. None of the measures of persistent respiratory disease were associated with initial disease severity. Conclusions: This study highlights the rates of objective respiratory disease and subjective respiratory symptoms after COVID-19 and the complex multifactorial nature of post-COVID-19 ill health.

Keywords: COVID-19; breathlessness; respiratory complications.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care
  • COVID-19 / complications*
  • COVID-19 / diagnostic imaging
  • COVID-19 / physiopathology
  • Dyspnea / physiopathology
  • Fatigue / physiopathology*
  • Female
  • Frailty / physiopathology*
  • Health Status
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Length of Stay / statistics & numerical data
  • Lung / diagnostic imaging
  • Lung / physiopathology*
  • Male
  • Middle Aged
  • Physical Exertion
  • Post-Acute COVID-19 Syndrome
  • Radiography, Thoracic
  • Recovery of Function*
  • SARS-CoV-2
  • Severity of Illness Index
  • Walk Test