Late manifestations of coronavirus disease of 2019 (COVID-19) patients, are we heading to chronic COVID-19?

Introduction: Data regarding clinical characteristics of patients presenting lately after being infected with Coronavirus disease (COVID-19) is scarce. The aim of the current study was to evaluate the clinical characteristics and outcomes of patients with confirmed COVID-19 presenting at least 14-day from symptoms onset.

Methods: A Retrospective, single-center study, was conducted with confirmed Covid-19 patients presenting at Shaare Zedek Medical Center >14 days after symptoms onset, between March through June 2020. Patient demographics, clinical characteristics, and relevant risk factors were collected and compared with patients who presented early at the beginning of the pandemic.

Results: Overall 152 patients were included, of them 91 (59%) were male with a mean age of 67.6 ±13.5 years. Seventy-five (49.3%) patients presented early (< 14-day) after symptoms onset (the “early group”) while seventy-seven (50.7%) patients presented late after symptoms onset (the “late group”). The most common symptoms at presentation in the early group were fever (n=62, 82.7%) and cough (n=47, 62.7%) compared with 16 (20.8%) and 8 (10.4%) in the late group, p<0.001. The most common presenting symptoms in the late group were chest pain (n=35, 45.5%) and shortness of breath (n=20, 26%). Cardiovascular outcomes occurred in 4 (5.3%) patients in the early group compared with 14 (18.2%) patients in the late group (p=0.02).

Conclusion: Patients presenting with late symptoms of COVID-19 infection, suffered more frequently from chest pain and shortness of breath as presenting symptoms and had more frequent cardiovascular outcomes as opposed to patients presenting with early symptoms. Future studies are needed to establish their true prevalence.