Clinico-radiological recovery following severe COVID-19 pneumonia

Background The recovery course following COVID-19 pneumonia remains poorly understood Analysis of routine clinical and imaging follow up of patients admitted with COVID-19 pneumonia undertaken in accordance with British Thoracic Society (BTS) guidance offers an opportunity to improve our understanding of the recovery course following acute infection Methods All patients requiring Intensive or Respiratory High Dependency Unit care with COVID-19 pneumonia who survived to discharge were offered telephone review and interval chest radiograph (CXR) at 6 and 12 weeks respectively in accordance with BTS guidance Patients were contacted in chronological order by discharge date The data presented here covers discharges between 25/03-03/05/20 inclusive All chest radiographs were reported by a consultant radiologist Results A total of N=73 patients were identified (74% male, mean age 57 6 years, range 22-84) N=41 (56 1%) had been admitted to ITU, with the remainder admitted to HDU Following discharge, N=6 (8 2%) were re-admitted within 30 days (median time to first re-admission 19 1 days) N=2 (3 5%) patients were diagnosed with pulmonary emboli following the index admission 1 patient died within 30 days of discharge (unrelated to COVID infection) Follow up calls occurred with N=57 patients, at median 9 6 weeks post discharge (range 6-12 weeks) Patient reported persistence of symptoms at time of review is summarised in table 1 Interval CXR was available in N=49 patients Of these, N=34 (71 7%) were clear, N=10 (19 5%) showed linear atelectasis, and N=5 (8 7%) showed persistent consolidation (all improved compared to admission CXR) Discussion These data describe the clinico-radiological course following admission with severe COVID-19 pneumonia Limitations of this analysis include limitation to patients receiving HDU/ITU level care and the retrospective categorisation of symptom persistence Prospective studies serially assessing full symptomatology are required Nevertheless, these data highlight persistent symptoms at 6-12 weeks;particularly exertional dyspnoea and fatigue 91% of patients were free from cough at this time;investigating for possible alternative causes should therefore be considered in patients experiencing chronic cough These data are valuable in planning long-term support for patients following COVID-19 pneumonia, and support the BTS recommendations for early proactive follow up of this cohort