key: cord-1019629-8vlsz26g authors: Garg, Prerna; Arora, Umang; Kumar, Arvind; Wig, Naveet title: The “Post‐COVID” Syndrome: How Deep is the Damage? date: 2020-08-27 journal: J Med Virol DOI: 10.1002/jmv.26465 sha: 5197de97b74ecffb1b320115d97d887b67b2bdad doc_id: 1019629 cord_uid: 8vlsz26g We congratulate Halpin and colleagues(1) on their work to identify residual symptoms in patients with microbiological recovery from COVID‐19. The prevalence of residual symptoms in their cohort is much higher than estimates of 35% among out‐patient, (2) but comparable with recent cohorts of hospitalized patients (87%).(3) This article is protected by copyright. All rights reserved. Conflict of interest statement: The authors declare that they have no conflicts of interest to declare with respect to the submitted manuscript. We congratulate Halpin and colleagues 1 on their work to identify residual symptoms in patients with microbiological recovery from COVID-19. The prevalence of residual symptoms in their cohort is much higher than estimates of 35% among out-patient, 2 but comparable with recent cohorts of hospitalized patients (87%). 3 Apart from fatigue, a significant proportion of their patients suffer from persistent dyspnea and neuropsychological symptoms. The reasons for this may be manifold. The study population is older (median age 70.5 years in the ward group) and sicker than the ones previously reported. The majority of patients (67.7% among ward patients and all ICU patients) required oxygen supplementation, 32% were admitted to Intensive Care Units, and one patient underwent invasive mechanical ventilation. Thus, patients of severe and critical COVID were over-represented in their cohort when compared to other studies where mild-moderate, severe, and critical COVID comprised 81%, 14%, and 5% of patients, respectively. 4 Previous experience has shown that critically ill Accepted Article patients face prolonged functional impairment after discharge, which may last several years. 5 Older age is a known risk factor for impairment. The study population includes a large proportion of patients with significant comorbidities, like chronic respiratory diseases (COPD and asthma), malignancy, and cardiovascular disease. These diseases carry significant morbidity themselves and may have contributed to the aforementioned symptoms. Thus, analysis with adjustments for baseline health before the illness would provide more meaningful data about the 'Post-COVID' syndrome. An important distinction should be made between symptoms due to persistent chronic inflammation (convalescent phase), sequelae of organ damage (acute lung and kidney injury resulting in pulmonary fibrosis and chronic kidney disease, respectively), and non-specific effects from the hospitalization and social isolation (nutritional anemia, muscle wasting). A subgroup analysis including only mild COVID patients would provide more insight into the post-viral syndrome, as this group is unlikely to have chronic organ impairment. Evaluation for the cause of fatigue in this subgroup using simple blood investigations may reveal treatable etiologies, including anemia, vitamin D deficiency, hypothyroidism, cortisol insufficiency, and chronic kidney disease. For example, subclinical thyroid dysfunction is seen in more than half of hospitalized COVID-19 patients as per some reports, although the data of persistence of these lab abnormalities post-discharge is not available. 6 Pulmonary recovery in COVID-19 lags behind virological clearance. 7 Further, there exists anecdotal evidence of post-COVID fibrosis, which may cause significant dyspnea and cough. Findings on chest imaging and pulmonary function tests in This article is protected by copyright. All rights reserved. patients with the authors' study population would help delineate the basis of fatigue and dyspnea. Finally, information on the treatment offered at the post-COVID clinics and the subsequent response would be invaluable to healthcare workers worldwide, who, after facing the first wave of COVID, are now suddenly battling this new 'Post-COVID' Syndrome. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network -United States Persistent Symptoms in Patients After Acute COVID-19 Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention ICU-Acquired Weakness and Recovery from Critical Illness Thyroid Function Analysis in 50 Patients with COVID-19: A Retrospective Study Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19)