Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can cause a wide array of symptoms ranging from mild to severe or fatal forms of coronavirus disease 2019 (COVID-19). Furthermore, it has been observed that in a proportion of patients a variable range of symptoms may persist for a long time.

An increasing number of studies have been focused on long COVID, but they have mainly been concentrated on previously hospitalized severe COVID-19 patients reporting symptoms up to 6-months after illness. The main aim of this study was to evaluate the prevalence of COVID-related symptoms 12-months after the onset of mild-to-moderate disease

Antonucci, Paolo

Borsetto, Daniele

Boscolo-Rizzo, Paolo

Capriotti, Vincenzo

D'Alessandro, Andrea

Gardenal, Nicoletta

Guida, Francesco

Lazzarin, Chiara

Marcuzzo, Alberto Vito

Marzolino, Riccardo

Pengo, Martino

Polesel, Jerry

Sacchet, Erica

Tirelli, Giancarlo

Tofanelli, Margherita

Zanelli, Enrico

PubMed

Boscolo Rizzo Paolo.

Guida F.

Polesel Jerry

Marcuzzo A. V.

Capriotti V.

D'Alessandro A.

Zanelli E.

Marzolino R.

Lazzarin C.

Antonucci P.

Sacchet E.

Tofanelli M.

Borsetto Daniele

Gardenal Nicoletta

Pengo Martino

Tirelli G.

Archivio istituzionale della ricerca - Università di Trieste

Received: 27 April 2021 Revised: 10 May 2021 Accepted: 17 May 2021DOI: 10.1002/alr.22832RESEARCH NOTESequelae in adults at 12 months after mild-to-moderatecoronavirus disease 2019 (COVID-19)Paolo Boscolo-Rizzo MD1 Francesco Guida MD1 Jerry Polesel ScD2Alberto Vito Marcuzzo MD1 Vincenzo Capriotti MD3 Andrea D’Alessandro MD1Enrico Zanelli MD1 Riccardo Marzolino MD1 Chiara Lazzarin MD1Paolo Antonucci MD1 Erica Sacchet MD1 Margherita Tofanelli PhD1Daniele Borsetto MD4 Nicoletta Gardenal MD1 Martino Pengo MD5Giancarlo Tirelli MD11 Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy2 Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy3 Department of Neurosciences, Section of Otolaryngology, Papa Giovanni XXIII General Hospital, Bergamo, Italy4 Department of ENT, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK5 Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, ItalyCorrespondencePaoloBoscolo-Rizzo,MD,Department ofMedical, Surgical andHealth Sciences, SectionofOtolaryngology,University of Trieste, 447, StradaDiFiume,34149Trieste, Italy.Email: paolo.boscolorizzo@units.itKEYWORDSchronic COVID syndrome, COVID-19, long COVID, long haulers, SARS-CoV-2INTRODUCTIONSevere acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can cause a wide array of symptoms rang-ing from mild to severe or fatal forms of coronavirus dis-ease 2019 (COVID-19).1 Furthermore, it has been observedthat in a proportion of patients a variable range of symp-toms may persist for a long time.2An increasing number of studies have been focused onlong COVID, but they have mainly been concentrated onpreviously hospitalized severe COVID-19 patients report-ing symptoms up to 6-months after illness.3,4 The mainaim of this study was to evaluate the prevalence of COVID-related symptoms 12-months after the onset of mild-to-moderate disease.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2021 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and AmericanRhinologic SocietyMETHODSWe conducted a prospective study on mild-to-moderatesymptomatic patients consecutively assessed betweenMarch 1 and March 31, 2020, who tested positive forSARS-CoV-2 RNA by polymerase chain reaction (PCR) onnasopharyngeal and throat swabs performed according toWorld Health Organization recommendation. An interdis-ciplinary task force of medical doctors and nurses wascreated in our region in response to the COVID-19 pan-demic in order to monitor all isolated patients with PCR-confirmed SARS-CoV-2 infection. The task force providedus with the names and telephone contacts of the home-isolated COVID-19 patients. The study was approved bythe Ethics Committee of the Friuli Venezia Giulia RegionInt Forum Allergy Rhinol. 2021;11:1685–1688. wileyonlinelibrary.com/journal/alr 16851686 Sequelae at 12 months after COVID-19(CEUR-2020-Os-156). Additional informed consent wasobtained from all individual participants for whom iden-tifying information is included in this article.In order to have a homogeneous population of patientswho could be contacted by telephone, only mild-to-moderately symptomatic subjects were included in thestudy. Patients were considered mild-to-moderately symp-tomatic if they had less severe clinical symptoms, oxy-gen saturation (SpO2) ≥ 94%, not requiring hospitaliza-tion, and therefore considered suitable for being treatedat home. Asymptomatic patients were not included in thestudy.Of the 496 eligible patients, 354 (71.4%) completed thebaseline telephone interview, whichwas conductedwithin3 weeks after the first positive swab performed fromMarch1, 2020 to March 31, 2020. The median time from onset ofsymptoms to SARS-CoV-2 testing was 7 days (interquartilerange [IQR], 4–12 days). All patients completing the base-line interview were phoned from March 5, 2021 to March22, 2021, so that all patients were re-contacted 12-monthsafter the onset of symptoms; in case of a nonresponse,patients were re-contacted twice.Finally, of the 354 patients who completed the survey atbaseline, 304 completed the 12-months follow-up survey(85.9%) as well; no differences emerged between respon-ders and nonresponders in terms of baseline sociodemo-graphic and clinical characteristics, including the numberand the severity of symptoms (data not shown).Differences in prevalence were evaluated throughFisher’s exact test and odds ratio (OR) for symptoms per-sistence was calculated according to multivariable uncon-ditional logistic regression model.RESULTSBaseline sociodemographic and clinical characteristics of304 patients are reported in Table 1. The median age of thestudy cohort was 47 years (range, 18–76 years).During the acute phase of COVID-19 themost frequentlyreported symptoms were fever (n = 232, 76.3%), felt tired(n = 216, 71.1%), smell impairment (n = 201, 66.1%), tasteimpairment (n= 198, 65.1%), and joint pain (n= 181, 59.5%)(Figure 1).Persistence of at least one symptom at 12 months wasreported by 161 patients (53.0%) with the most frequentbeing "felt tired" (n= 83, 27.3%), followed by "smell or tasteimpairment" (n = 67, 22.0%), "shortness of breath" (n = 39,12.8%), and "muscle pain" (n = 28, 9.2%).The risk of symptom’s persistence at 12-months follow-up was trending upward in females (OR = 1.64; 95% con-fidence interval [CI], 1.00–2.70; p = 0.051), and signifi-cantly higher in subjects aged between 40 and 54 yearsTABLE 1 Sociodemographic and clinical characteristics of 304patients positive for COVID-19Characteristic n (%)GenderMale 119 (39.1)Female 185 (60.9)Age (years)a<40 93 (30.6)40–54 119 (39.1)≥55 92 (30.3)Smoking habitsNever 179 (58.9)Former 74 (24.3)Current 51 (16.8)Drinking habitsNever 202 (66.5)Former 30 (9.9)Current 72 (23.7)BMI (kg/m2)<25 170 (55.9)≥25 134 (44.1)ComorbidityNone 206 (67.8)Any 98 (32.2)Obesity 36 (11.8)Cardiovascular disease 26 (8.6)Chronic respiratory disease 21 (6.9)Immunosuppression 18 (5.9)Diabetes 10 (3.3)Cancer 5 (1.6)Liver disease 5 (1.6)Kidney disease 2 (0.7)Time for a negative swab (days)≤23 157 (51.6)>23 147 (48.4)Abbreviations: BMI, body mass index; COVID-19, coronavirus disease 2019;IQR, interquartile range.aMedian age (IQR): 47 years (37–56 years).(OR = 1.92; 95% CI, 1.07–3.44; p = 0.029) and in those witha body mass index BMI ≥ 25 k/mg2 (OR = 1.67; 95% CI,1.00–2.78; p= 0.049). The presence of three to seven symp-toms during the acute phase of the disease was associatedwith a significantly higher chance of symptoms persistenceafter 12 months (OR = 3.22; 95% CI, 1.01–10.24; p = 0.048),with this association being stronger in those havingeight or more symptoms (OR = 8.71; 95% CI, 2.73–27.76;p < 0.001).BOSCOLO-RIZZO et al. 1687F IGURE 1 COVID-19-related symptoms. The percentages of patients with COVID-19-related symptoms during the acute phase of illness(blue) and at 12-months follow-up (orange) according to severity (light, mild; dark, severe). Abbreviations: ARTIQ, Acute Respiratory TractInfection Questionnaire; COVID-19, coronavirus disease 2019.DISCUSSIONTwelve months after the onset of illness, 53.0% of patientswith mild-to-moderate disease endorsed at least one per-sistent symptom. A previous investigation in a large cohortof previously hospitalized patients reported at least onesymptom in 76% of cases 6 months after acute infection,4whereas in another study, including outpatients with milddisease, ∼30% reported persistent symptoms at 6 months.5Thus, taking into account that our series included only out-patients with mild-to-moderate disease representing theoverwhelmingmajority of COVID-19 patients,6 the burdenof long haulers on the healthcare systems will be pressingand urged researchers to identify strategies for preventionand treatment and to plan education and rehabilitation ser-vices in order to face with the considerable health and eco-nomic concerns.2In agreement with other evidence, the most commonlyreported symptom was fatigue followed by chemosensorydysfunction.2 Chemosensory dysfunction has been consis-tently reported as one of the most predominant symptomduring the acute phase of the disease as well as amongthe most frequent long-lasting symptoms in patients withCOVID-19, with a higher prevalence in patients withmild-to-moderate disease.7 Some authors have speculatedthat mild-to-moderate COVID-19 patients may be affectedby nasal-centric viral spread, whereas patients requiringhospitalization may be experiencing a more pulmonary-centric and systemic viral infection, consequently impact-ing the prevalence of different symptoms both in acute1688 Sequelae at 12 months after COVID-19phase and in the context of long COVID syndrome.8 How-ever, although all patients in the study were not formallydiagnosed with pneumonia having an SpO2 ≥ 94%, about30% reported shortness of breath at the onset and 13% stillcomplained shortness of breath at 12-months follow-upinterview. Interestingly, an abnormal pulmonary functionconsisting in an impaired diffusing-capacity was observedin 30% of patients after the acute phase of mild COVID-19without pneumonia.9 However, shortness of breath can bea manifestation of underlying acute stress or anxiety withthese conditions being reported in patients with COVID-19.4Experiencing more symptoms at baseline was the mostsignificant factor associated with long COVID. Moreover,the prevalence of long haulers was higher in females,patients in their middle age, and those with BMI ≥ 25.Thus, models to identify patients at risk for long COVIDmay be developed.This study has several limitations. First, the absence ofa control group may have an impact on the interpreta-tion of results. Hospitalized patients were not includedin the study. Although this made our cohort morehomogeneous, studies comparing the long-term out-comes in inpatients and outpatients are definitely needed.Symptoms were self-reported and based on telephoneinterview. Though we tried to perform a comprehensivesymptoms assessment, some symptoms may have beenundetected. Furthermore, a more precise evaluation of thechemosensory function by psychophysical assessment waslacking. Finally, a total of 14.1% of responders at base-line did not complete the follow-up interview, thus intro-ducing a potential bias in the results. Nonetheless, non-responders were comparable to responders in terms ofsymptoms frequency and severity, thus limiting selectionbias.In conclusion, our study indicates that persistent symp-toms of SARS-CoV-2 infection can be detected beyond 12months from the onset of the illness in more than halfof outpatients. Identifying patients at risk for preven-tion and treatment will be critical to improving outcomesand reducing health costs. Finally, a structured and val-idated questionnaire for the assessment of symptoms inCOVID-19 patients is highly desirable to characterize thefull clinical spectrum of long COVID and improve the reli-ability and reproducibility of clinical studies.CONFL ICT OF INTERESTThe authors declare that they have no conflicts of interest.REFERENCES1. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC.Pathophysiology, transmission, diagnosis, and treatment of Coro-navirus disease 2019 (COVID-19): a review. JAMA. 2020;324:782-793.2. Sudre CH,Murray B, Varsavsky T, et al. Attributes and predictorsof long COVID. Nat Med. 2021;27(4):626-631.3. Carfì A, Bernabei R, Landi F. Gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients afteracute COVID-19. JAMA. 2020;324:603-605.4. Huang C, Huang L, Wang Y, et al. 6-month consequences ofCOVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021;397.5. Logue JK, Franko NM, McCulloch DJ, et al. Sequelae inadults at 6 months after COVID-19 infection. JAMA Netw Open.2021;4:e210830.6. Gandhi RT, Lynch JB, del Rio C. Mild or moderate Covid-19. NEngl J Med. 2020;383:1757-1766.7. Boscolo-Rizzo P, Polesel J, Spinato G, et al. Predominance ofan altered sense of smell or taste among long-lasting symp-toms in patients with mildly symptomatic COVID-19. Rhinology.2020;58:524-525.8. Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Asso-ciation of chemosensory dysfunction and COVID-19 in patientspresenting with influenza-like symptoms. Int Forum Allergy Rhi-nol. 2020;10(7):806-813.9. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function inCOVID-19 patients at time of hospital discharge. Eur Respir J.2020;55(6):2001217.How to cite this article: Boscolo-Rizzo P, GuidaF, Polesel J, et al. Sequelae in adults at 12 monthsafter mild-to-moderate coronavirus disease 2019(COVID-19). Int Forum Allergy Rhinol.2021;11:1685–1688. https://doi.org/10.1002/alr.22832

English

Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19)

Apollo (Cambridge)

Received: 27 April 2021 Revised: 10 May 2021 Accepted: 17 May 2021DOI: 10.1002/alr.22832RESEARCH NOTESequelae in adults at 12 months after mild-to-moderatecoronavirus disease 2019 (COVID-19)Paolo Boscolo-Rizzo MD1 Francesco Guida MD1 Jerry Polesel ScD2Alberto Vito Marcuzzo MD1 Vincenzo Capriotti MD3 Andrea D’Alessandro MD1Enrico Zanelli MD1 Riccardo Marzolino MD1 Chiara Lazzarin MD1Paolo Antonucci MD1 Erica Sacchet MD1 Margherita Tofanelli PhD1Daniele Borsetto MD4 Nicoletta Gardenal MD1 Martino Pengo MD5Giancarlo Tirelli MD11 Department of Medical, Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy2 Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy3 Department of Neurosciences, Section of Otolaryngology, Papa Giovanni XXIII General Hospital, Bergamo, Italy4 Department of ENT, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK5 Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano IRCCS, Ospedale San Luca, Milano, ItalyCorrespondencePaoloBoscolo-Rizzo,MD,Department ofMedical, Surgical andHealth Sciences, SectionofOtolaryngology,University of Trieste, 447, StradaDiFiume,34149Trieste, Italy.Email: paolo.boscolorizzo@units.itKEYWORDSchronic COVID syndrome, COVID-19, long COVID, long haulers, SARS-CoV-2INTRODUCTIONSevere acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection can cause a wide array of symptoms rang-ing from mild to severe or fatal forms of coronavirus dis-ease 2019 (COVID-19).1 Furthermore, it has been observedthat in a proportion of patients a variable range of symp-toms may persist for a long time.2An increasing number of studies have been focused onlong COVID, but they have mainly been concentrated onpreviously hospitalized severe COVID-19 patients report-ing symptoms up to 6-months after illness.3,4 The mainaim of this study was to evaluate the prevalence of COVID-related symptoms 12-months after the onset of mild-to-moderate disease.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium,provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.© 2021 The Authors. International Forum of Allergy & Rhinology published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngic Allergy and AmericanRhinologic SocietyMETHODSWe conducted a prospective study on mild-to-moderatesymptomatic patients consecutively assessed betweenMarch 1 and March 31, 2020, who tested positive forSARS-CoV-2 RNA by polymerase chain reaction (PCR) onnasopharyngeal and throat swabs performed according toWorld Health Organization recommendation. An interdis-ciplinary task force of medical doctors and nurses wascreated in our region in response to the COVID-19 pan-demic in order to monitor all isolated patients with PCR-confirmed SARS-CoV-2 infection. The task force providedus with the names and telephone contacts of the home-isolated COVID-19 patients. The study was approved bythe Ethics Committee of the Friuli Venezia Giulia RegionInt Forum Allergy Rhinol. 2021;1–4. wileyonlinelibrary.com/journal/alr 12 Sequelae at 12 months after COVID-19(CEUR-2020-Os-156). Additional informed consent wasobtained from all individual participants for whom iden-tifying information is included in this article.In order to have a homogeneous population of patientswho could be contacted by telephone, only mild-to-moderately symptomatic subjects were included in thestudy. Patients were considered mild-to-moderately symp-tomatic if they had less severe clinical symptoms, oxy-gen saturation (SpO2) ≥ 94%, not requiring hospitaliza-tion, and therefore considered suitable for being treatedat home. Asymptomatic patients were not included in thestudy.Of the 496 eligible patients, 354 (71.4%) completed thebaseline telephone interview, whichwas conductedwithin3 weeks after the first positive swab performed fromMarch1, 2020 to March 31, 2020. The median time from onset ofsymptoms to SARS-CoV-2 testing was 7 days (interquartilerange [IQR], 4–12 days). All patients completing the base-line interview were phoned from March 5, 2021 to March22, 2021, so that all patients were re-contacted 12-monthsafter the onset of symptoms; in case of a nonresponse,patients were re-contacted twice.Finally, of the 354 patients who completed the survey atbaseline, 304 completed the 12-months follow-up survey(85.9%) as well; no differences emerged between respon-ders and nonresponders in terms of baseline sociodemo-graphic and clinical characteristics, including the numberand the severity of symptoms (data not shown).Differences in prevalence were evaluated throughFisher’s exact test and odds ratio (OR) for symptoms per-sistence was calculated according to multivariable uncon-ditional logistic regression model.RESULTSBaseline sociodemographic and clinical characteristics of304 patients are reported in Table 1. The median age of thestudy cohort was 47 years (range, 18–76 years).During the acute phase of COVID-19 themost frequentlyreported symptoms were fever (n = 232, 76.3%), felt tired(n = 216, 71.1%), smell impairment (n = 201, 66.1%), tasteimpairment (n= 198, 65.1%), and joint pain (n= 181, 59.5%)(Figure 1).Persistence of at least one symptom at 12 months wasreported by 161 patients (53.0%) with the most frequentbeing "felt tired" (n= 83, 27.3%), followed by "smell or tasteimpairment" (n = 67, 22.0%), "shortness of breath" (n = 39,12.8%), and "muscle pain" (n = 28, 9.2%).The risk of symptom’s persistence at 12-months follow-up was trending upward in females (OR = 1.64; 95% con-fidence interval [CI], 1.00–2.70; p = 0.051), and signifi-cantly higher in subjects aged between 40 and 54 yearsTABLE 1 Sociodemographic and clinical characteristics of 304patients positive for COVID-19Characteristic n (%)GenderMale 119 (39.1)Female 185 (60.9)Age (years)a<40 93 (30.6)40–54 119 (39.1)≥55 92 (30.3)Smoking habitsNever 179 (58.9)Former 74 (24.3)Current 51 (16.8)Drinking habitsNever 202 (66.5)Former 30 (9.9)Current 72 (23.7)BMI (kg/m2)<25 170 (55.9)≥25 134 (44.1)ComorbidityNone 206 (67.8)Any 98 (32.2)Obesity 36 (11.8)Cardiovascular disease 26 (8.6)Chronic respiratory disease 21 (6.9)Immunosuppression 18 (5.9)Diabetes 10 (3.3)Cancer 5 (1.6)Liver disease 5 (1.6)Kidney disease 2 (0.7)Time for a negative swab (days)≤23 157 (51.6)>23 147 (48.4)Abbreviations: BMI, body mass index; COVID-19, coronavirus disease 2019;IQR, interquartile range.aMedian age (IQR): 47 years (37–56 years).(OR = 1.92; 95% CI, 1.07–3.44; p = 0.029) and in those witha body mass index BMI ≥ 25 k/mg2 (OR = 1.67; 95% CI,1.00–2.78; p= 0.049). The presence of three to seven symp-toms during the acute phase of the disease was associatedwith a significantly higher chance of symptoms persistenceafter 12 months (OR = 3.22; 95% CI, 1.01–10.24; p = 0.048),with this association being stronger in those havingeight or more symptoms (OR = 8.71; 95% CI, 2.73–27.76;p < 0.001).BOSCOLO-RIZZO et al. 3F IGURE 1 COVID-19-related symptoms. The percentages of patients with COVID-19-related symptoms during the acute phase of illness(blue) and at 12-months follow-up (orange) according to severity (light, mild; dark, severe). Abbreviations: ARTIQ, Acute Respiratory TractInfection Questionnaire; COVID-19, coronavirus disease 2019.DISCUSSIONTwelve months after the onset of illness, 53.0% of patientswith mild-to-moderate disease endorsed at least one per-sistent symptom. A previous investigation in a large cohortof previously hospitalized patients reported at least onesymptom in 76% of cases 6 months after acute infection,4whereas in another study, including outpatients with milddisease, ∼30% reported persistent symptoms at 6 months.5Thus, taking into account that our series included only out-patients with mild-to-moderate disease representing theoverwhelmingmajority of COVID-19 patients,6 the burdenof long haulers on the healthcare systems will be pressingand urged researchers to identify strategies for preventionand treatment and to plan education and rehabilitation ser-vices in order to face with the considerable health and eco-nomic concerns.2In agreement with other evidence, the most commonlyreported symptom was fatigue followed by chemosensorydysfunction.2 Chemosensory dysfunction has been consis-tently reported as one of the most predominant symptomduring the acute phase of the disease as well as amongthe most frequent long-lasting symptoms in patients withCOVID-19, with a higher prevalence in patients withmild-to-moderate disease.7 Some authors have speculatedthat mild-to-moderate COVID-19 patients may be affectedby nasal-centric viral spread, whereas patients requiringhospitalization may be experiencing a more pulmonary-centric and systemic viral infection, consequently impact-ing the prevalence of different symptoms both in acute4 Sequelae at 12 months after COVID-19phase and in the context of long COVID syndrome.8 How-ever, although all patients in the study were not formallydiagnosed with pneumonia having an SpO2 ≥ 94%, about30% reported shortness of breath at the onset and 13% stillcomplained shortness of breath at 12-months follow-upinterview. Interestingly, an abnormal pulmonary functionconsisting in an impaired diffusing-capacity was observedin 30% of patients after the acute phase of mild COVID-19without pneumonia.9 However, shortness of breath can bea manifestation of underlying acute stress or anxiety withthese conditions being reported in patients with COVID-19.4Experiencing more symptoms at baseline was the mostsignificant factor associated with long COVID. Moreover,the prevalence of long haulers was higher in females,patients in their middle age, and those with BMI ≥ 25.Thus, models to identify patients at risk for long COVIDmay be developed.This study has several limitations. First, the absence ofa control group may have an impact on the interpreta-tion of results. Hospitalized patients were not includedin the study. Although this made our cohort morehomogeneous, studies comparing the long-term out-comes in inpatients and outpatients are definitely needed.Symptoms were self-reported and based on telephoneinterview. Though we tried to perform a comprehensivesymptoms assessment, some symptoms may have beenundetected. Furthermore, a more precise evaluation of thechemosensory function by psychophysical assessment waslacking. Finally, a total of 14.1% of responders at base-line did not complete the follow-up interview, thus intro-ducing a potential bias in the results. Nonetheless, non-responders were comparable to responders in terms ofsymptoms frequency and severity, thus limiting selectionbias.In conclusion, our study indicates that persistent symp-toms of SARS-CoV-2 infection can be detected beyond 12months from the onset of the illness in more than halfof outpatients. Identifying patients at risk for preven-tion and treatment will be critical to improving outcomesand reducing health costs. Finally, a structured and val-idated questionnaire for the assessment of symptoms inCOVID-19 patients is highly desirable to characterize thefull clinical spectrum of long COVID and improve the reli-ability and reproducibility of clinical studies.CONFL ICT OF INTERESTThe authors declare that they have no conflicts of interest.REFERENCES1. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC.Pathophysiology, transmission, diagnosis, and treatment of Coro-navirus disease 2019 (COVID-19): a review. JAMA. 2020;324:782-793.2. Sudre CH,Murray B, Varsavsky T, et al. Attributes and predictorsof long COVID. Nat Med. 2021;27(4):626-631.3. Carfì A, Bernabei R, Landi F. Gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients afteracute COVID-19. JAMA. 2020;324:603-605.4. Huang C, Huang L, Wang Y, et al. 6-month consequences ofCOVID-19 in patients discharged from hospital: a cohort study.Lancet. 2021;397.5. Logue JK, Franko NM, McCulloch DJ, et al. Sequelae inadults at 6 months after COVID-19 infection. JAMA Netw Open.2021;4:e210830.6. Gandhi RT, Lynch JB, del Rio C. Mild or moderate Covid-19. NEngl J Med. 2020;383:1757-1766.7. Boscolo-Rizzo P, Polesel J, Spinato G, et al. Predominance ofan altered sense of smell or taste among long-lasting symp-toms in patients with mildly symptomatic COVID-19. Rhinology.2020;58:524-525.8. Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Asso-ciation of chemosensory dysfunction and COVID-19 in patientspresenting with influenza-like symptoms. Int Forum Allergy Rhi-nol. 2020;10(7):806-813.9. Mo X, Jian W, Su Z, et al. Abnormal pulmonary function inCOVID-19 patients at time of hospital discharge. Eur Respir J.2020;55(6):2001217.How to cite this article: Boscolo-Rizzo P, GuidaF, Polesel J, et al. Sequelae in adults at 12 monthsafter mild-to-moderate coronavirus disease 2019(COVID-19). Int Forum Allergy Rhinol. 2021;1-4.https://doi.org/10.1002/alr.22832

Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19).

Boscolo‐Rizzo P

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Sequelae in adults at 12 months after mild‐to‐moderate coronavirus disease 2019 (COVID‐19)

Boscolo‐Rizzo, Paolo

PubMed Central

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Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19).

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