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Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?

Yvonne M.J. Goërtz, Maarten Van Herck, Jeannet M. Delbressine, Anouk W. Vaes, Roy Meys, Felipe V.C. Machado, Sarah Houben-Wilke, Chris Burtin, Rein Posthuma, Frits M.E. Franssen, Nicole van Loon, Bita Hajian, Yvonne Spies, Herman Vijlbrief, Alex J. van ’t Hul, Daisy J.A. Janssen, Martijn A. Spruit
ERJ Open Research 2020 6: 00542-2020; DOI: 10.1183/23120541.00542-2020
Yvonne M.J. Goërtz
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
9These authors contributed equally
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Maarten Van Herck
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
4REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
9These authors contributed equally
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Jeannet M. Delbressine
1Dept of Research and Development, Ciro, Horn, the Netherlands
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Anouk W. Vaes
1Dept of Research and Development, Ciro, Horn, the Netherlands
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Roy Meys
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Felipe V.C. Machado
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Sarah Houben-Wilke
1Dept of Research and Development, Ciro, Horn, the Netherlands
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Chris Burtin
4REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Rein Posthuma
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Frits M.E. Franssen
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Nicole van Loon
1Dept of Research and Development, Ciro, Horn, the Netherlands
5Dept of Internal Medicine, MUMC+, Maastricht, the Netherlands
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Bita Hajian
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Yvonne Spies
6Lung Foundation Netherlands, Amersfoort, the Netherlands
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Herman Vijlbrief
6Lung Foundation Netherlands, Amersfoort, the Netherlands
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Alex J. van ’t Hul
7Dept of Pulmonary Disease, Radboud University Medical Center, Nijmegen, the Netherlands
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Daisy J.A. Janssen
1Dept of Research and Development, Ciro, Horn, the Netherlands
8Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Martijn A. Spruit
1Dept of Research and Development, Ciro, Horn, the Netherlands
2Nutrim School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands
3Dept of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
4REVAL – Rehabilitation Research Center, BIOMED – Biomedical Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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  • Article
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Figures

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  • FIGURE 1
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    FIGURE 1

    Prevalence and change in the total number of symptoms during and 3 months after infection. The width of lines in the figure are proportional to the flow rate.

  • FIGURE 2
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    FIGURE 2

    Prevalence of symptoms during the infection and at follow-up (79 days later). BW: body weight; HR: heart rate.

  • FIGURE 3
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    FIGURE 3

    Prevalence and change in self-reported health status during and 3 months after the infection. The width of lines in the figure are proportional to the flow rate.

Tables

  • Figures
  • TABLE 1

    Clinical characteristics of the whole sample and stratified for COVID-19 diagnosis

    Whole sample (n=2113)Hospitalised (n=112)Nonhospitalised (confirmed COVID-19) (n=345)Nonhospitalised (symptom-based COVID-19) (n=882)Nonhospitalised (suspected COVID-19) (n=774)p-value
    Women1803 (85.3)78 (69.6)314 (91.0)774 (87.8)637 (82.3)<0.001
    Age years47.0 (39.0–54.0)53.0 (46.3–60.0)47.0 (37.0–53.5)46.0 (38.0–53.0)47.0 (39.0–54.0)<0.001
    BMI kg·m−225.2 (22.6–28.8)26.9 (24.5–30.9)26.0 (23.2–29.4)25.0 (22.3–28.7)24.9 (22.5–28.4)<0.001
    Self-reported pre-existing comorbidities
     None1293 (61.2)51 (45.5)225 (65.2)523 (59.3)494 (63.8)0.007
     1 comorbidity541 (25.6)40 (35.7)77 (22.3)240 (27.2)184 (23.8)
     ≥2 comorbidities279 (13.2)21 (18.8)43 (12.5)119 (13.5)96 (12.4)
    Self-reported health status before the onset of symptoms
     Good1799 (85.1)88 (78.6)316 (91.6)743 (84.2)652 (84.2)0.011
     Moderate301 (14.2)23 (20.5)27 (7.8)134 (15.2)117 (15.1)
     Poor13 (0.6)1 (0.9)2 (0.6)5 (0.6)5 (0.6)
    Received health care during/after the onset of symptoms
     General practitioner1285 (60.8)62 (55.4)191 (55.4)584 (66.2)448 (57.9)<0.001
     Physiotherapist432 (20.4)42 (37.5)74 (21.4)214 (24.3)102 (13.2)<0.001
     Medical specialist366 (17.3)49 (43.8)68 (19.7)153 (17.3)96 (12.4)<0.001
     Psychologist112 (5.3)16 (14.3)23 (6.7)42 (4.8)31 (4.0)<0.001
     Dietician78 (3.7)17 (15.2)15 (4.3)34 (3.9)12 (1.6)<0.001
     Nurse63 (3.0)16 (14.3)10 (2.9)25 (2.8)12 (1.6)<0.001
     Occupational therapist25 (1.2)2 (1.8)5 (1.4)15 (1.7)3 (0.4)0.080

    Data are presented as n (%) or median (interquartile range), unless otherwise stated. BMI: body mass index.

    • TABLE 2

      Symptoms during the infection of the whole sample and stratified for COVID-19 diagnosis

      Whole sample (n=2113)Hospitalised (n=112)Nonhospitalised (confirmed COVID-19) (n=345)Nonhospitalised (symptom-based COVID-19) (n=882)Nonhospitalised (suspected COVID-19) (n=774)p-value
      Number of symptoms14.0 (11.0–17.0)14.0 (9.3–17.0)14.0 (11.0–18.0)14.0 (11.0–18.0)13.0 (10.0–17.0)<0.001
      Symptoms
       Fatigue2006 (94.9)104 (92.9)324 (93.9)847 (96.0)731 (94.4)0.226
       Dyspnoea1892 (89.5)100 (89.3)300 (87.0)827 (93.8)665 (85.9)<0.001
       Headache1605 (76.0)80 (71.4)273 (79.1)682 (77.3)570 (73.6)0.097
       Chest tightness1588 (75.2)68 (60.7)248 (71.9)709 (80.4)563 (72.7)<0.001
       Cough1438 (68.1)89 (79.5)235 (68.1)620 (70.3)494 (63.8)0.002
       Muscle pain1367 (64.7)60 (53.6)245 (71.0)578 (65.5)484 (62.5)0.003
       Sore throat1309 (61.9)49 (43.8)188 (54.5)564 (63.9)508 (65.6)<0.001
       Increased body temp. (37.0–37.9°C)1293 (61.2)44 (39.3)189 (54.8)571 (64.7)489 (63.2)<0.001
       Pain between shoulder blades1289 (61.0)53 (47.3)216 (62.6)584 (66.2)436 (56.3)<0.001
       Pain/burning feeling in lungs1279 (60.5)53 (47.3)178 (51.6)587 (66.6)461 (59.6)<0.001
       Heart palpitations1159 (54.9)44 (39.3)191 (55.4)521 (59.1)403 (52.1)<0.001
       Increased resting heart rate1154 (54.6)58 (51.8)199 (57.7)519 (58.8)378 (48.8)<0.001
       Dizziness1091 (51.6)46 (41.1)171 (49.6)490 (55.6)384 (49.6)0.006
       Nose cold928 (43.9)38 (33.9)169 (49.0)363 (41.2)358 (46.3)0.006
       Burning feeling in the  trachea927 (43.9)37 (33.0)121 (35.1)428 (48.5)341 (44.1)<0.001
       Fever (≥38.0°C)903 (42.7)94 (83.9)178 (51.6)380 (43.1)251 (32.4)<0.001
       Ageusia893 (42.3)73 (65.2)218 (63.2)350 (39.7)252 (32.6)<0.001
       Diarrhoea869 (41.1)49 (43.8)150 (43.5)374 (42.4)296 (38.2)0.225
       Anosmia839 (39.7)67 (59.8)223 (64.6)308 (34.9)241 (31.1)<0.001
       Joint pain808 (38.2)37 (33.0)151 (43.8)340 (38.5)280 (36.2)0.066
       Nausea772 (36.5)51 (45.5)124 (35.9)341 (38.7)256 (33.1)0.021
       Mucus764 (36.2)42 (37.5)107 (31.0)328 (37.2)287 (37.1)0.193
       Sneezing667 (31.6)27 (24.1)123 (35.7)274 (31.1)243 (31.4)0.129
       Hot flushes548 (25.9)18 (16.1)90 (26.1)224 (25.4)216 (27.9)0.061
       Eye problems542 (25.7)20 (17.9)76 (22.0)245 (27.8)201 (26.0)0.045
       Ear pain459 (21.7)12 (10.7)74 (21.4)210 (23.8)163 (21.1)0.015
       Sudden loss of body weight388 (18.4)42 (37.5)81 (23.5)165 (18.7)100 (12.9)<0.001
       Vomiting191 (9.0)24 (21.4)41 (11.9)76 (8.6)50 (6.5)<0.001
       Red spots on toes/feet118 (5.6)9 (8.0)15 (4.3)50 (5.7)44 (5.7)0.512
       Others623 (29.5)19 (17.0)87 (25.2)284 (32.2)233 (30.1)0.002

      Data are presented as n (%) or median (interquartile range), unless otherwise stated.

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      Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?
      Yvonne M.J. Goërtz, Maarten Van Herck, Jeannet M. Delbressine, Anouk W. Vaes, Roy Meys, Felipe V.C. Machado, Sarah Houben-Wilke, Chris Burtin, Rein Posthuma, Frits M.E. Franssen, Nicole van Loon, Bita Hajian, Yvonne Spies, Herman Vijlbrief, Alex J. van ’t Hul, Daisy J.A. Janssen, Martijn A. Spruit
      ERJ Open Research Oct 2020, 6 (4) 00542-2020; DOI: 10.1183/23120541.00542-2020

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      Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?
      Yvonne M.J. Goërtz, Maarten Van Herck, Jeannet M. Delbressine, Anouk W. Vaes, Roy Meys, Felipe V.C. Machado, Sarah Houben-Wilke, Chris Burtin, Rein Posthuma, Frits M.E. Franssen, Nicole van Loon, Bita Hajian, Yvonne Spies, Herman Vijlbrief, Alex J. van ’t Hul, Daisy J.A. Janssen, Martijn A. Spruit
      ERJ Open Research Oct 2020, 6 (4) 00542-2020; DOI: 10.1183/23120541.00542-2020
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