COVID-19 and what comes after?

At the end of January 2020, the WHO declared the SARS-CoV-2 outbreak a public health emergency of international concern, its highest level of alarm. Although measures in the UK to reduce spread and ‘protect the NHS’ did prevent a complete collapse of the acute healthcare system, delay in the implementation of a lockdown until 23 March led to tens of thousands of excess deaths and, by December, more than 220,000 COVID-19 hospital admissions, with effects for many individuals persisting beyond hospital discharge (https://coronavirus.data.gov.uk/healthcare).1–5 The SARS-CoV-2 targets the respiratory epithelium and has a myriad of clinical consequences ranging from asymptomatic illness, through to mild, moderate and severe disease. Although the initial illness leads primarily to respiratory symptoms, many patients will have physical, cognitive and psychological disability that will require long-term management. In this edition of Thorax , four Brief Communications from the UK and Canada report the short-term to medium-term post-discharge outcome of hospitalised COVID-19 patients, identifying a pattern of five key persisting symptoms: breathlessness, cough, fatigue, muscle and joint pain and poor sleep quality.6–9 Mandal and colleagues recruited 384 patients from three large London hospitals.6 A median 54 days after discharge, approximately half of the patients reported persistent breathlessness with a third reporting an ongoing cough. Two-thirds of patients described persistent fatigue and poor sleep with 15% reporting scores consistent with depression. Biomarkers of ongoing inflammation (D-dimer and CRP) were commonly elevated. Only 11% of patients reported an absence of all four of these key symptoms. Of note, although respiratory disease was a common comorbidity in hospitalised patients, the MRC Dyspnoea Score at follow-up was not different between those with and …