March 19, 2021
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About a third of the patients who reported COVID-19 symptoms weeks after diagnosis were initially asymptomatic, according to a preprint study in medRxiv.
“Asymptomatic individuals may be monitored less intensively because the risk of severe acute illness is low. However, this is problematic because asymptomatic individuals make up 32% of the long-distance drivers observed in this study. ” Yong Huang, a graduate student in the Sue & Bill Gross School of Nursing at the University of California at Irvine, and colleagues wrote.
Reference: Reference: Huang Y, et al. medRxiv. 2021; doi: 10.1101 / 2021.03.03.21252086.
Recent data shows that approximately 10% of patients hospitalized with COVID-19 become “long-distance drivers,” the researchers wrote. They added that research on “long distance drivers” is lacking, particularly 99% of the cases where hospitalization is not required. Therefore, Huang and colleagues analyzed electronic health records of 1,407 patients of all ages within the University of California’s COVID research dataset who were not hospitalized for the condition.
Twenty-seven percent (n = 382) of patients in shared apartments with COVID-19 had persistent symptoms that lasted more than 60 days after diagnosis and were considered “long-distance drivers,” wrote Huang and colleagues. Of these patients, the most common symptom was chest pain, followed by shortness of breath, anxiety, abdominal pain, cough, lower back pain, and fatigue.
According to the researchers, women and members of under-represented groups were more likely to become “long-distance drivers”. More than 72% of the “long-distance drivers” were 50 ± 20 years old and 34 were younger than 18 years (mean age = 9.29 years).
The researchers reported that many “long-distance riders” – approximately 32% – had no symptoms at the time they were tested for SARS-CoV-2.
“The age distribution of all people infected with SARS-CoV-2 on day 0-11 was very similar to that of long-distance drivers, suggesting that the latter group is distributed across all age groups,” wrote Huang and colleagues. “Although our study supported a possible association with the female gender and a higher likelihood of becoming a long-distance driver, the race appeared to be less predictive of both Caucasian and Hispanic ethnicity.”
The researchers found that “long distance drivers are a very important public health problem and there are no guidelines that address their diagnosis and management.”
They said more research is needed to better understand the emotional, mental, and physical effects of persistent COVID-19 symptoms.
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Kathleen Bell, MD
This is a very interesting, yet peer-reviewed study that was retrospectively derived from medical records for a university health care system in California. The study found that there were a significant number (nearly 30%) of people with persistent COVID-19 symptoms 61 days or more after diagnosis.
The takeaway news from this study is that even those who were not initially hospitalized with COVID-19 infection can have persistent symptoms. The researchers also found that persistent symptoms were more common in women, white populations, and interestingly, women of “normal” weight (as defined by the BMI). This is interesting because risk factors for severe lung disease are obesity and racial / ethnic minority status.
One of the limitations of this study is that the survey focused on acute symptoms associated with viral infections. Therefore, there was no survey on neuropsychiatric or autonomic complaints. These complaints have been found to be quite common in clinical populations, and persistence of breathlessness or the perception of breathlessness is also quite common. The grouping of back pain / joint pain or the grouping of patients with anxiety tachycardia may also include patients with neurological disorders.
After careful peer review, this study is likely to add to our growing knowledge of the post-acute consequences of COVID-19 and the targeted management of this population.
Kathleen Bell, MD
Professor, Kimberly Clark Distinguished Chair in Mobility Research
Physical Medicine and Rehabilitation Department
University of Texas Southwestern Medical Center
Disclosure: Bell does not report any relevant financial information.
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