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Background: Persistent COVID-19 symptoms have been reported up to six months (M6) after hospital discharge. Little is known on the frequency and the nature of persistent symptoms beyond M6. Here we assessed, in the longitudinal prospective French COVID-19 cohort, symptoms that persisted twelve months after admission for COVID-19. Methods: Hospitalized patients with a virologically-confirmed COVID-19 were enrolled. Follow-up was planned with a physician's visit at M3, M6 and M12 post-admission. At M12, manual assessment of muscle strength of each limb was assessed using the modified Medical Muscle Research council Scale for testing muscle strength (mMRC). Patients were also interviewed on health-related quality-of-life (SF-12) and on psychological distress (HADS). Associations between persistence of ≥ 3 symptoms at M12 and clinical characteristics at admission were assessed through bivariate and multivariate logistic regression. Results: By September 2021, M12 data were available for 737 patients enrolled between February 3rd and July 15th 2020. Median age was 61 years, 64% were men and 37% were admitted to intensive care unit during the acute phase. At M12 visit, 27% of participants had ≥ 3 symptoms, with no change between M6 and M12 globally. Fatigue (46%), dyspnea (33%) and joint pain (21%) were the 3 most frequently reported symptoms. Presence of ≥ 3 symptoms was associated with both anxiety and depression, an impaired quality of life and mMRC scale < 57. The mean percentage of predicted value of distance walked in 6 min (6MWT) was 88% (IQR 74-100) for the 163 patients who realised the 6MWT, this percentage was lower in patients who reported dyspnea (85% [IQR 71;99] vs 95% [IQR 76;101], p=0.04). Compared to men, women more often reported presence of ≥ 3 symptoms (39% vs 21%), depression and anxiety (respectively, 12% vs 6% and 21% vs 10%), an altered quality of life for the physical component only (54% vs 46%), and a slight or a moderate disability (respectively, 20% vs 14% and 6% vs 4%). Women had less often returned to work than men (34% vs 23%). Conclusion: A fourth of individuals admitted to hospital for COVID-19 still had ≥3 persistent symptoms at M12 post-discharge, with no improvement between M6 and M12. Also, 25% of those who initially had a professional occupation were not back to work at M12. Women reported more often ≥3 symptoms, suffered more from anxiety and depression, and had less often returned to work than men.
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OBJECTIVES: Molecular assays on nasopharyngeal swabs remain the cornerstone of COVID-19 diagnostic. The high technicalities of nasopharyngeal sampling and molecular assays, as well as scarce resources of reagents, limit our testing capabilities. Several strategies failed, to date, to fully alleviate this testing process (e.g. saliva sampling or antigen testing on nasopharyngeal samples). We assessed the clinical performances of SARS-CoV-2 nucleocapsid antigen (N-antigen) ELISA detection in serum or plasma using the COVID-19 Quantigene R (AAZ, France) assay. METHODS: Performances were determined on 63 sera from 63 non-COVID patients and 227 serum samples (165 patients) from the French COVID and CoV-CONTACT cohorts with RT-PCR confirmed SARS-CoV-2 infection, including 142 serum (114 patients) obtained within 14 days after symptoms' onset. RESULTS: Specificity was 98.4% (95% confidence interval [CI], 95.3 to 100). Sensitivity was 79.3% overall (180/227, 95% CI, 74.0 to 84.6) and 93.0% (132/142, 95% CI, 88.7 to 97.2) within 14 days after symptoms onset. 91 included patients had a sera and nasopharyngeal swabs collected in the same 24 hours. Among those with high nasopharyngeal viral loads, i.e. Ct value below 30 and 33, only 1/50 and 4/67 tested negative for N-antigenemia, respectively. Among those with a negative nasopharyngeal RT-PCR, 8/12 presented positive N-antigenemia;the lower respiratory tract was explored for 6 of these 8 patients, showing positive RT-PCR in 5 cases. CONCLUSION: This is the first evaluation of a commercially available serum N-antigen detection assay. It presents a robust specificity and sensitivity within the first 14 days after symptoms onset. This approach provides a valuable new option for COVID-19 diagnosis, only requiring a blood draw and easily scalable in all clinical laboratories.
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Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2020