Long-term prognosis of adults with moderately severe SARS-CoV-2 lower respiratory tract infection managed in primary care: Prospective cohort study

BACKGROUND: Information about the incidence of persisting symptoms after COVID-19 and its impact on patients treated in primary care are scarce.

OBJECTIVES: To determine differences in health-related quality of life (HRQoL) and symptomatology between adults with and without SARS-CoV-2 moderately severe lower respiratory tract infection (LRTI) in the 12 months following their primary care visit.

METHODS: Prospective cohort study in 35 Dutch practices. Individuals aged ≥18 years who presented to their general practitioner (GP) with a moderately severe LRTI during the first COVID-19 waive in The Netherlands (March-June 2020, n  = 277; 268 (97%) with complete follow-up) were included between September and December 2020, then underwent serology testing (participants, GPs and study personnel remained blinded for serology outcomes during study conduct) and completed baseline and follow-up questionnaires. Main outcome measures: (1) SF-36 scores, and (2) risk of persisting symptoms during 12 months follow-up.

RESULTS: The change in SF-36 PSC ( p  = 0.13), MCS ( p  = 0.30) during 12 months follow-up did not differ between SARS-CoV-2 serology positive and negative participants after adjusting for sex, age, BMI, diabetes, and chronic pulmonary conditions. The risk of any persisting symptom during 12 months follow-up did not significantly differ between the groups (aHR 0.61, 95% CI 0.33-1.15), nor did the risk of individual symptoms.

CONCLUSIONS: In the 12 months following their moderately severe LRTI, primary care patients with and without confirmed SARS-CoV-2 infection had a comparable HRQoL profile. A substantial proportion of participants reported persisting symptoms, indicating that persisting symptoms can occur following LRTIs irrespective of causative pathogen.