Initial symptoms and three months follow-up after acute COVID-19 in outpatients: An international prospective cohort study

Abstract

Background

Most studies on long-term follow-up of patients with COVID-19 focused on hospitalised patients. No prospective study with structured follow-up has been performed in non-hospitalised patients with COVID-19.

Objectives

To assess long-COVID and post-COVID (WHO definition: symptomatic at least 12 weeks), describe lingering symptoms, their impact on daily activities, and general practice visits and explore risk factors for symptom duration in outpatients.

Methods

A prospective study of adult outpatients with confirmed SARS-CoV-2 infection and symptoms consistent with COVID-19 in 11 European countries, recruited during 2020 and 2021 from primary care and the community. Structured follow-up by phone interviews (symptom rating, symptom impact on daily activities and general practice visits) was performed at weeks 2, 4, 8, and 12 by study personnel. Data was analysed descriptively by using correlation matrixes and Cox regression.

Results

Of 270 enrolled patients, 52% developed long-COVID and 32% post-COVID-syndrome. When only considering the presence of moderate or (very) severe symptoms at weeks 8 and 12, these percentages were 28% and 18%, respectively. Fatigue was the most often reported symptom during follow-up. The impact of lingering symptoms was most evident in sports and household activities. About half (53%) had at least one general practice contact during follow-up. Obese patients took twice as long to return to usual health (HR: 0.5, 95%CI: 0.3–0.8); no other risk profile could predict lingering symptoms.

Conclusion

Long-COVID and post-COVID are also common in outpatients. In 32%, it takes more than 12 weeks to return to usual health.

Keywords:

• COVID-19
• primary care
• lingering symptoms
• daily activities
• post-COVID
• long-COVID

Acknowledgements

The authors thank all participating patients and general practitioners. We particularly thank Sofie Jacobs, Leen Wyckmans, Neel Messeyne, Pieter-Jan Coene, Mads Nørding, Pia Touboul, Anne Simmenroth, René Bundschuh, Ryan Arner, Ketevan Sidamonidze, Ekaterine Khmaladze, Maia Abuladze, Karen Farrell, Veronica Giancola, Alice Serafini, Maciek Godycki-Cwirko, team from Katarzyna Kosiek Family Doctors’ Clinic, Aida Puia, Bianca Manzat Cojan, Emiliana Costiug, Ana Dascal, Cecilia Rosander, Petra Falk Hancic, Lena Heinebäck who were involved in inclusion procedures, phone interviews and/or data entry.

Ethical approval

All patients received detailed information about the study and individual informed consent was obtained. Each participating research team got ethical approval in their country if deemed necessary according to national regulations. The study was conducted per the EU GDPR and data stored according to the Danish Data Protection Act.

Disclosure statement

No potential conflict of interest was reported by the author(s).