In a recent study published in the Journal of Clinical Medicine, researchers followed unhospitalized post-coronavirus disease 2019 (COVID-19) patients in France for two years and determined when they returned to work. These patients had persistent symptoms, some of which had disabling symptoms lasting up to 22 months in some cases, rendering them unable to work.
About 10% of COVID-19 patients may have developed persistent post-COVID symptoms from which they did not recover. However, studies have scarcely examined these non-hospitalized patients and often report their feelings of inadequate support. Their management thus remains challenging and contradictory.
In the current study, researchers tested whether a coordination team consisting of medical-social staff can help patients who feel trapped in a complex situation with access to medical facilities. According to the authors, expanding such aid could improve patient care and the health care system in the city.
About the study
In the current prospective study, researchers captured all questions posed to the coordination team by assisting physicians, patients, and other structures (e.g., social helpers) between September 2021 and March 2022. 19 conditions called the investigator for 45 to 65 minutes to collect the patient’s clinical and demographic profile. They recorded their age, gender, and any pre-existing health conditions, plus the symptom profile. The nurse has created a patient file containing all COVID-19 related examinations and treatments.
The nurse recorded whether the symptoms, divided into general and psychological symptoms, that a patient experienced were minimal or moderate and whether the patient had recovered from those symptoms (symptom profiling) or was no longer able to return to work. The team then developed a therapeutic proposal for the patient, focusing on the main symptoms.
The researchers also examined whether the primary symptoms and pre-existing comorbidities were related. So they analyzed the comorbidity distribution of patients, taking into account symptoms such as fatigue, neurocognitive impairment and pain. For data analysis, they used chi-square tests, where quantitative values were expressed as percentages, taking into account the statistical significance of p < 0.05.
Of the 105 patients who contacted the coordination team, a practice nurse with post-COVID expertise called only 72 patients. Thereafter, 54 patients received guidance from the coordination team and only 45 received the second call. Of these patients, 62% were female and all were less than 50 years old with a mean body mass index (BMI) less than 26 kg/m22. Despite contracting COVID-19, ten patients were actively engaged in sports, jogging, football, and so on. Only six (14%) patients had no comorbidity prior to COVID-19. However, the remainder had a history of cardiovascular disease, musculoskeletal disease, and cancer or psychiatric disease.
Intriguingly, 45% of patients contacted the coordination team directly, while 19% used the Regional Physician Support Platform (RSP). The coordination team also directly contacted 9% of patients with complex symptoms related to COVID-19.
The therapeutic proposals mainly include rehabilitation measures. Thus, 24, nine, 13, four, and 11 patients, respectively, benefited from exercise and olfactory rehabilitation, respiratory re-education, speech therapy, and psychological support. In particular, 14 patients benefited from holistic care that included psychological and nutritional therapies and exercise in rehabilitation centers. However, the remaining patients were mainly engaged in physical activities in a primary health care setting, e.g., cycling, under the supervision of a physiotherapist.
15 months after COVID-19, more than 90% of patients reported fatigue. Similarly, more than 75% of them suffered from neurocognitive disorders and more than 50% had joint or muscle pain, shortness of breath and anxiety. About 40% of patients complained of chest pain, taste and smell abnormalities and digestive problems. Despite following the proposed therapeutic action, fatigue remained a commonly reported symptom for up to 22 months. Similarly, the frequency of neuro- and musculoskeletal problems did not decrease remarkably.
The chi-square test showed a significant reduction in the frequency of chest pain (p = 0.007) and, to some extent, of anxiety and shortness of breath after the therapeutic action. Problems related to taste, smell and the digestive system were also reduced. The researchers noted no association between pre-existing comorbidities and COVID-19-related symptoms.
Fewer patients (9%) reported improvement in their condition at 22 months, and 33% and 20% reported only moderate or minimal improvement, while 38%, i.e. about a third of patients, reported no improvement in their post-COVID -19 symptoms. Accordingly, they stopped working almost two years after COVID-19. Unfortunately, of the 36% of patients who did not recover, 40% still had to work full-time.
Overall, the study results showed that despite their active participation in the proposed therapeutic action, self-reported symptoms often persisted for two years after the initial infection and prevented these patients from returning to work. The researchers found it acceptable because most of these patients had pre-existing comorbidities and their main symptom was fatigue.
All patients appreciated being contacted again after COVID-19, suggesting that psychological help enabled better symptom management. It reduced feelings of abandonment and worked better than early rehabilitation. Most importantly, the study results highlighted the need to implement appropriate vaccination and maintain barrier gestures to prevent post-COVID-19 disease.