'Long-COVID': The need for multi-disciplinary working

ABSTRACT

Background: Patients discharged from hospital following admission for COVID-19 may have on-going sequelae and require multidisciplinary input to ensure optimal recovery and early detection of complications. We evaluated our COVID-19 follow-up service to understand on-going patient needs. Methods: The respiratory team at Trust hospital sites established a virtual post-COVID-19 clinic. A bespoke questionnaire was developed to capture demographic data, symptom burden and mental health outcomes to identify those who needed further support. All patients were offered blood tests and a repeat chest radiograph (CXR) if abnormal pre-discharge. (Table presented) Results: Of patients admitted between March and August 2020 with COVID-19, 908 were eligible for follow-up. 643 (71%) have been assessed thus far. 133 (15%) declined or were unreachable. Patients' demographic data are summarised in table 1. All patients, including the 5.4% who received CPAP/NIV and 11.1% admitted to intensive care, were offered virtual follow-up. Median follow-up was 63 (54-79) days from discharge. Persistent symptoms (i.e. same or worse since admission) included cough (23.0%), breathlessness (16.5%), myalgia (15.7%) and fatigue (14.4%). Some patients developed new symptoms including 'fuzzy head' (12%), diarrhoea or abdominal pain (8%). 11% and 9.3% were at risk of depression and post-traumatic stress disorder respectively. Under half (44.5%) felt they had fully recovered. Of the 363 who were eligible to return to work, 31.4% felt able to do so. 57.9% were immediately discharged from secondary care after their follow-up assessment. 28% had further virtual follow-up arranged, while 20.8% were scheduled for face-to-face respiratory follow-up. 23.5% had a subsequent repeat CXR or CT scan arranged. Patients who scored highly on mental health questionnaires were offered referral to local psychology services and 49% (n=64) agreed. Discussion Our data demonstrates a significant proportion of hospital inpatients develop physical or psychological sequelae after COVID-19, 'Long-COVID'. A significant number felt unable to return to work 9 weeks after discharge. Our virtual clinic provided a structured way to identify patients' on-going symptoms and demonstrates the importance of establishing structured multi-disciplinary pathways, particularly with referrals to physiotherapy, cardiology and neurology. We strongly recommend the development of clear follow-up protocols prior to the next wave of disease.