Broadening the definition of COVID: prolonged symptoms in individuals not meeting the threshold for in-patient care

  • Emma A. Webb, Paediatric Endocrine Consultant, Norfolk and Norwich University Hospital, University of East Anglia
  • Other Contributors:
    • Iulia V. Hammond, GP trainee, Stepping Hill Hospital, Stepping Hill Hospital
    • Elspeth J. Webb, Retired Professor of Paediatrics, University of Cardiff, University of Cardiff
3 June 2020
We agree with your editorial highlighting the need to protect doctors’ health during the pandemic.1 We draw attention to a group not hospitalised, but experiencing persistent, severe symptoms in the community.
 
We noted many doctors requesting advice regarding prolonged COVID symptoms on an online forum for women doctors (membership = 11,348). We designed an online survey to assess:
  • symptom duration and impact
  • healthcare accessed
  • subsequent complications
After four days, 151 doctors, (89% female, mean age 40.6 years, mean BMI 24.8) responded. All were symptomatic for ≥28days with more than one of: fever; chest pain; neurological symptoms; shortness of breath.
 
Eighty reported fever, 111 chest pain, 56 neurological symptoms and 115 tachypnea lasting ≥28days. Of the tachypneic group 20 had a respiratory rate >30. Of the 151 responders 104 measured oxygen saturation at home; 29 recorded SaO2 <92% on exertion of which 21 underwent investigations. One each was diagnosed with cardiomyopathy, peri-myocarditis and pulmonary embolism.
 
A hundred and sixteen contacted their GP: 21 underwent investigations, 13 were reviewed in a COVID clinic, 10 referred to ED and 38 prescribed antibiotics without a face-to-face appointment. Thirty-four were told there was nothing the GP could contribute.
 
There is a significant impact on the medical work force with 94/151 individuals remaining off work. Fifty-three individuals reported being unable to complete simple acts of daily living after 46 days.
 
Symptoms lasting longer than 14 days are currently treated as post-viral syndrome, but given the severity of sequelae and continuing acute nature of these symptoms it is reasonable to consider whether this reflects ongoing viraemia, or possibly a milder variant of the presumed Covid-19 related severe Kawasaki-like inflammatory response being seen in children.2
 
There are currently no guidelines or pathways for assessment and management of what appears to be a chronic variant of COVID-19. We believe this data highlights the eminent need for these: of our professional cohort 34 were refused help. Failing to include these patients in the care pathway also means we are missing out an important opportunity to investigate and document the longer-term natural history of this new disease.
 
References
1. Majeed, A. Molokhia, M. Pankhania, B. Asanti, K. Protecting the health of doctors during the COVID-19 pandemic. Br J Gen Pract 2020; 7: (695): 268-269.
2. Verdoni, L. Mazza, A. Gervasoni,A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet May 13
 
* We would be happy offer the data collected as the basis for a research proposal.
 
Competing Interests: None declared.