ABSTRACT
Objective Describe the disease course in a cohort of outpatients with covid-19 and evaluate factors predicting duration of symptoms
Design Retrospective cohort study
Setting Telemedicine clinic at a large medical system in Atlanta, Georgia
Participants 273 patients with COVID-19. Exclusion criteria included: (1) intake more than 10 days after symptom onset, (2) hospitalization for covid-19, (3) symptoms at less than two visits.
Main outcome measures Symptom duration in days
Results Common symptoms at diagnosis are upper respiratory (64% cough, 53% loss of smell or taste, 50% sinus congestion, 22% sore throat), systemic (50% headache, 48% body aches, 36% chills, 22% dizziness, 18% fever). The most frequent remaining symptoms at 30 days were cough (7%), loss of smell or taste (5%), body aches (5%), nasal congestion (5%), shortness of breath with exertion (5%), and joint pain (5%). Day of symptom onset was earliest for upper respiratory symptoms (mean 1.26 days, 95% confidence interval 1.15 to 1.4), followed by systemic symptoms (1.54, 1.39 to 1.7), with later onset of lower respiratory (2.86, 2.54 to 3.22) and gastrointestinal symptoms (3.46, 3.07 to 3.89), when present. Cough had the longest duration when present with 12.2 days (10.9 to 13.6). Loss of smell or taste had the second longest duration with 11.0 days (9.9 to 12.2). Provider-Assessed Symptom Severity (PASS) is the best predictor of symptom duration (P <0.005 for multiple symptoms) and patients with “Moderate” PASS compared to “Mild” at their intake visit have higher rates of symptoms at 30 days, including cough (12%), nasal congestion (10%), joint pain (10%), body aches (9%), loss of taste or smell (7%), headache (7%), and shortness of breath with exertion (6%).
Conclusions Covid-19 illness in outpatients follows a pattern of progression from systemic symptoms to lower respiratory symptoms and persistent symptoms are common across categories. Provider-assessed symptom severity is the best predictor of disease duration.
Competing Interest Statement
Dr. G. OKeefe served on an advisory board of Eyepoint Pharmaceuticals in 2019. It is unrelated to the current work.
Funding Statement
No external funding
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The study was approved by the Emory University Institutional Review Board (STUDY00000766), which granted both a waiver of informed consent and a waiver of the Health Information Portability and Privacy Act as the study posed no more than minimal risk.
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
Footnotes
Additional analyses of (1) symptom duration by initial severity, (2) symptom onset timing
Data Availability
Deidentified data are available for sharing upon reasonable request.
