Patient experience with healthcare: Feedback for a ‘Post COVID-19 clinic’ at a tertiary care center in rural area (preprint)

Purpose Post-acute sequelae of SARS-CoV-2 (PASC) is a complex condition with multisystem involvement. We assessed patients’ perspectives and experience with a PASC clinic established at University of Iowa in June 2020. Methods We conducted a mixed-method survey in June 2021 to ask PASC clinic patients about 1) PASC symptoms and their impact on physical and mental health, and cognition using the PROMIS Global Health and Cognitive Function abilities items, and 2) satisfaction with clinic services and referrals, barriers to care, and recommended support resources. Findings Ninety-seven patients (97/277, 35% response rate) completed the survey. Most were women (67%, n=65/97), Caucasian (93%, n=90/97) and received outpatient care during acute COVID-19 illness (79%). Fifty percent reported wait time of 1-3 months and 40% traveled >1 hour for appointment. The most common symptoms >3 months from initial infection were fatigue (77%), “brain fog” (73%), exercise intolerance (73%), anxiety (63%), sleep difficulties (56%) and depression (44%). Qualitative analysis of open-ended answers added valuable context to quantitative results. A minority of patients reported significantly reduced functioning (≥1.5 SD below mean) of their physical health (22.5%), mental health (15.9%) and cognitive abilities (17.6%). Satisfaction with clinical services was high though participants identified barriers to care including scheduling delays and financial concerns. Respondents suggested potential strategies for optimizing recovery including continuity of care, a co-located multispecialty clinic and being provided with timely information from emerging research. Conclusion Our study reports high PASC symptom burden, its impact on health and patient experience with healthcare. It is important that primary healthcare professionals listen to patients with empathy and support them during recovery. Healthcare systems and policymakers should focus on accessible, comprehensive, and patient-centered integrated care.

Small Airway Disease as long-term Sequela of COVID-19: Use of Expiratory CT despite Improvement in Pulmonary Function test (preprint)

Background- It is important to understand the spectrum of pulmonary diseases that patients are presenting after recovery from initial SARS-CoV-2 infection. We aim to study small airway disease and changes in Computed Tomography (CT) and pulmonary function tests (PFTs) with time. Methods: This is retrospective observation study including adult patients with confirmed SARS-CoV-2 infection with at-least two CT scans either during acute (defined as < 1 month) or subacute (1-3 months) or chronic (>3months) phase after positive test. Radiological features and follow up PFTs were obtained. Results: 22 patients met the inclusion criteria with mean age 57.6 years (range 36-83). Out of these,18 (81.81%) were hospitalized. Mean duration of diagnosis to CT and PFT was 192.68 (112-385) days and 161.54 (31-259) days respectively. On PFTs, restrictive pulmonary physiology was predominant finding during subacute 56.25% (9/16) and chronic phases 47% (7/15). PFTs improved significantly with time {FEV1((p=0.0361), FVC (p=0.0341), FEF 25%-75% (p=0.0259) and DLCO (p=0.0019)}, but there was persistent air trapping in the expiratory chronic phase CT. There was resolution of ground glass opacity, consolidation, and bronchiectasis however air trapping increased with time in 41.61% (10/21) of subacute CTs compared to 81.25% (13/16) in chronic CTs. Conclusion - Our study shows evidence of airway as well as parenchymal disease as relatively long-term sequel of SARS-CoV-2 infection. It also highlights the natural course and spontaneous recovery of some radiological and pulmonary function test abnormalities over time with evidence of persistent small airway disease (air trapping) on expiratory CT imaging months after infection.