key: cord-0781917-xvus0eyf authors: Dinh, Aurélien; Jaulmes, Luc; Dechartres, Agnès; Duran, Clara; Mascitti, Hélène; Lescure, Xavier; Yordanov, Youri; Jourdain, Patrick title: Time to resolution of respiratory and systemic COVID-19 symptoms in community setting date: 2021-09-03 journal: Clin Microbiol Infect DOI: 10.1016/j.cmi.2021.08.021 sha: 5b41e3b9188c1a98fc608abfc32e193316d62086 doc_id: 781917 cord_uid: xvus0eyf OBJECTIVES: During the Coronavirus disease 2019 (COVID-19), symptom course among outpatients is not well known. Our aim was to assess the time to resolution of respiratory and systemic symptoms and their associated factors. METHODS: Cohort study including adult outpatients, managed with Covidom, a telesurveillance solution, with RT-PCR confirmed diagnosis, from March 9(th) 2020 until February 23(rd) 2021. Follow-up was 30 days after symptom onset. RESULTS: Among the 9,667 patients included, mean age was 43.2±14.0 years, and 67.5% were female (n=6,522). Median body mass index (BMI) (IQR) was 25.0 kg/m(2) (22.1-28.8). Main comorbidities were: hypertension (12.9%; n=1247), asthma (11.0%; n=1063), and diabetes mellitus (5.5%; n=527). The most frequent symptom during follow-up was dyspnea (65.1%; n=6,296), followed by tachypnea (49.9%; n=4,821), shivers (45.6%; n=4,410), and fever (36.7%; n=3,550). Median time to resolution of systemic and respiratory symptoms were 3 days (95% CI: 2−4) and 7 days (95% CI: 6−8), respectively. Ultimately, 17.2% (95% CI: 15.7%−18.8%) still presented respiratory symptoms at day 30. Longer time to respiratory symptom resolution was associated with older age, increased BMI, chronic obstructive pulmonary disease (COPD), coronary artery disease, asthma, and heart failure. Regarding systemic symptoms, coronary artery disease, asthma, age above 40 years, and elevated BMI were associated with longer time to resolution. CONCLUSIONS: Time to symptom resolution among outpatients with COVID-19 seemed shorter for systemic than respiratory symptoms. Prolonged respiratory symptoms were common at day 30. Risk factors associated with later resolution included age, cardiovascular and pulmonary diseases. The clinical manifestations in COVID-19 patients range from asymptomatic to severe forms 62 requiring critical care, and the duration of symptoms can vary widely [1, 2] . Most studies 63 described the clinical course of hospitalized severe cases [3] [4] [5] . However, most patients 64 present with milder forms of COVID-19 [6] , and are therefore managed as outpatients. Data 65 on this population is scarce, but describing the symptom course of outpatients with COVID-66 19 and factors associated with symptom duration may help provide adequate follow-up 67 [2,7-9]. 68 Our study aimed to evaluate the time to resolution of COVID-19 respiratory and systemic 69 symptoms, and factors associated with a longer duration in a large cohort of outpatients. 70 71 This study included adult (≥ 18 years) patients, initially managed as outpatients, from March 73 9 th 2020 to February 23 rd 2021 by Covidom, a telesurveillance solution for home monitoring 74 of patients with COVID-19 in the greater Paris area [10] . Covidom outpatients were 75 registered by a physician after consulting for COVID-related symptoms and agreeing to the 76 monitoring. We included patients with a RT-PCR confirmed diagnosis, having answered at 77 least one monitoring questionnaire, and who provided medical background at inclusion. 78 Available data for each patient included age, gender, date of first symptoms, weight, height, 79 and comorbidities. 80 When included in Covidom, the patients completed, on a daily basis, one or two self-81 administered questionnaires on symptoms until 30 days after symptoms onset. Self-reported 82 data were: respiratory rate (tachypnea defined as >20 breaths per minute), heart rate 83 (tachycardia defined as >100 beats per minute), temperature (fever and hypothermia 84 defined by temperature >38.5°C and <35.5°C, respectively), dyspnea (on a 1-to-5 modified 85 Borg scale [11], slight dyspnea defined by a rating ≥2, and moderate dyspnea ≥3), oxygen 86 saturation (desaturation defined by <95%), dizziness, and shivers. 87 Two main groups of symptoms were defined: 88 -Systemic symptoms: fever or hypothermia, dizziness, tachycardia, shivers. 89 -Respiratory symptoms: dyspnea, tachypnea, low oxygen saturation. 90 Kaplan-Meier estimators were used to evaluate time to resolution of symptoms. Patients 91 were considered at risk from the date of first symptom onset (declared at inclusion) until the 92 last occurrence of each symptom in daily questionnaires. Regarding symptom groups, 93 patients were considered at risk until the last day of any symptom occurrence of the group. 94 Patients were censored at the end of their follow-up (30 days or earlier in case of premature 95 ending). Factors independently associated with longer time to resolution of systemic and 96 respiratory symptoms were evaluated separately on complete cases using multivariate Cox 97 models and inversed hazard ratios as the event of interest was initially resolution of 98 symptoms. Alpha risk was set at 5%. 99 Patients provided electronic consent for the Covidom telesurveillance program and were 100 informed of the use of their anonymized data for research. This study was approved by the 101 scientific and ethical committee of APHP (IRB00011591). 102 medical background at inclusion and thus were included in this study (patients 108 characteristics presented in Table S1 in Supplementary appendix). 109 Mean age was 43.2 years old (SD 14.0) and 67.5% were female (n=6,522). Median body mass 110 index (BMI) (IQR) was 25.0 kg/m² (22.1-28.8). Main comorbidities were hypertension (12.9%; 111 n=1247), asthma (11.0%; n=1,063), and diabetes mellitus (5.5%; n=527). Other comorbidities 112 were reported by less than 1.5% of patients. Weight (and BMI) was missing for 121 patients, 113 and gender for 18 patients. 114 The last answer to a daily questionnaire occurred at a median time of 28 days after symptom Lastly, the number and proportion of patients per monitoring question, answer, and day are 147 described in Figure S1 in Supplementary appendix. Symptom 201 Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network -United States Features 206 of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical 207 Characterisation Protocol: prospective observational cohort study Clinical course and risk factors for 210 mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort 211 study Longitudinal 214 symptom dynamics of COVID-19 infection Coronavirus Disease Clinical features of 224 1487 COVID-19 patients with outpatient management in the Greater Paris: the COVID-225 call study Clinical characteristics of 228 asymptomatic and symptomatic patients with mild COVID-19 Telesurveillance Solution for Home Monitoring Patients With COVID-19 Comparison of Scales 234 Used to Quantitate the Sense of Effort to Breathe in Patients with Chronic Obstructive 235 Pulmonary Disease The Lancet. Facing up to long COVID Post-COVID-19 chronic symptoms: a 240 postinfectious entity? Review of the Clinical Characteristics 246 of Coronavirus Disease 2019 (COVID-19)