In a recent study published in the Journal of Clinical Medicine, researchers followed non-hospitalized post-coronavirus disease 2019 (COVID-19) patients in France for two years and determined when they returned to work. These patients had persistent symptoms, with some disabling symptoms lasting up to 22 months in some cases, which prevented them from working again.
Approximately 10% of COVID-19 patients may have developed persistent post-COVID symptoms from which they have not recovered. However, studies have little investigated these non-hospitalized patients, often reporting their feelings of inadequate support. Thus, its management remains challenging and conflicting.
In the present study, the researchers tested whether a coordination team composed of medico-social staff could help patients who feel trapped in a complex situation in accessing medical facilities. According to the authors, extending this help could improve patient care and the city’s health system.
about the study
In the present prospective study, the investigators captured all issues raised by the coordination team when meeting physicians, patients and other structures (eg social workers) between September 2021 and March 2022. COVID-19 conditions made a 45- to 65-minute phone call to the enumerator to collect the patient’s clinical and demographic profile. They recorded their age, gender, and pre-existing health problems, if any, in addition to their symptom profile. The nurse made a patient file containing all investigations and treatments related to COVID-19.
The nurse recorded whether the symptoms, categorized into general and mental health symptoms, experienced by a patient were minor or moderate and whether the patient had recovered from these symptoms (symptom profile) or was unable to return to work. Then, the team generated a therapeutic proposal for the patient, targeting the main symptoms.
The researchers also investigated whether primary symptoms and pre-existing comorbidities were linked. Thus, they analyzed the distribution of patients’ comorbidities considering symptoms such as fatigue, neurocognitive disorder and pain. For data analysis, chi-square tests were used, expressing quantitative values as percentages, considering the statistical significance of p < 0.05.
Of the 105 patients who contacted the coordination team, an advanced practice nurse with post-COVID experience called only 72 patients. Thereafter, 54 patients received guidance from the coordination team and only 45 received the second follow-up call. Of these patients, 62% were women and all were under 50 years of age with a mean body mass index (BMI) below 26 kg/mtwo. Despite contracting COVID-19, ten patients practiced sports, running, football, etc. Only six (14%) patients had no comorbidity before COVID-19. However, the others had a history of cardiovascular, musculoskeletal, cancer or psychiatric illnesses.
Interestingly, 45% of patients contacted the coordination team directly, with 19% using 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 consisted mainly of rehabilitation measures. Thus, 24, nine, 13, four and 11 patients benefited from exercises and olfactory rehabilitation, respiratory reeducation, speech therapy and psychological support, respectively. Specifically, 14 patients benefited from holistic care that encompassed psychological and nutritional therapies and exercise in rehabilitation centers. However, the remaining patients mainly practiced physical activities in a basic health unit, for example, cycling, under the supervision of a physiotherapist.
At 15 months post-COVID-19, more than 90% of patients reported having fatigue. Likewise, more than 75% of them suffered from neurocognitive disorders and more than 50% had joint or muscle pain, dyspnoea and anxiety. About 40% of the patients complained of chest pain, taste and smell aberrations and digestive problems. Despite following the proposed therapeutic action, fatigue remained a frequently reported symptom for up to 22 months. Likewise, the frequency of neuro- and musculoskeletal problems did not decrease markedly.
The chi-square test showed a significant reduction in the frequency of chest pain (p = 0.007) and, to a certain extent, in anxiety and dyspnea after therapeutic action. In addition, problems related to taste, smell and digestive system were reduced. The researchers did not see any link between pre-existing comorbidities and COVID-19-related symptoms.
Fewer patients (9%) reported improvement in their condition after 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. So they didn’t go back to work for nearly two years after COVID-19. Unfortunately, of the 36% of patients who did not recover, 40% still had to work full time.
Overall, the results of the study showed that, despite active participation in the proposed therapeutic action, self-reported symptoms often persisted for two years from the initial infection and made it difficult for these patients to return to work. The researchers found it acceptable because most of these patients had significant pre-existing comorbidities and their main symptom was fatigue.
All patients appreciated being contacted again after COVID-19, suggesting that psychological help allowed for better symptom management. It reduced feelings of abandonment and worked better than early rehabilitation. Most importantly, the study results highlighted the need to carry out adapted vaccination and maintain barrier gestures to avoid post-COVID-19 conditions.