Symptom Course in COVID-19 Outpatients

O039, James B; Keefe,; Tong, Elizabeth J; O039, Ghazala A Datoo; Tong, David C

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.