Original Article

Delayed Symptoms in Patients Recovered from COVID-19


Background: COVID-19 is a new disease, so we don’t know what comes next. Since information on delayed symptoms is limited, this study was conducted to assess the frequency of delayed symptoms in patients with COVID-19.

Methods: This follow-up cross-sectional study was conducted in a referral general hospital in Tehran, Iran from Feb to Apr 2020. Two hundred patients hospitalized for COVID-19 and were discharged were assessed for delayed symptoms 6 wk after discharge.

Results: The mean age of the participants was 55.58±13.52, and 160 (80%) Of them were male. On admission to hospital, patients reported a mean of 5.63±2.88 symptoms per patient, range from 1 to 14 symptoms. Dyspnea was seen in 119 (59.5%) 0f them as the most frequent symptom. Then weakness, myalgia, and shivering were reported with a frequency of 111 (55.5%), 107 (53.5%), and 103 (51.5%), respectively. Six weeks after discharge reassessment was done. None of the patients was readmitted to the hospital. Ninety-four (42%) of them were symptom-free. Fatigue was the most frequent delayed symptom with a frequency of 39 (19.5%), and then dyspnea, weakness, and activity intolerance with a frequency of 37 (18.5%), 36 (18%), and 29 (14.5%) were reported, respectively.

Conclusion: Fatigue, dyspnea, weakness, anxiety, and activity intolerance were most frequent delayed symptoms, respectively. Majority of patient was symptoms free and those with symptom, had mild to moderate symptoms. The importance of symptoms is not fully recognized. Follow up clinics and in some cases rehabilitation programs may be helpful.

1. Adhikari SP, Meng S, Wu Y-J, et al (2020). Epidemiology, causes, clinical manifesta-tion and diagnosis, prevention and con-trol of coronavirus disease (COVID-19) during the early outbreak period: a scop-ing review. Infect Dis Poverty, 9(1):29.
2. Gorbalenya AE (2020).Severe acute respira-tory syndrome-related coronavirus–The species and its viruses, a statement of the Coronavirus Study Group. Biorxiv, doi.org/10.1101/2020.02.07.937862.
3. Ung COL (2019). Community pharmacist in public health emergencies: quick to action against the coronavirus 2019-ncov out-break. Res Social Adm Pharm, 16 (4), 583-586.
4. Cao M, Zhang D, Wang Y, et al (2020). Clinical features of patients infected with the 2019 novel coronavirus (COVID-19) in Shanghai, China. medRxiv, doi: 10.1101/2020.03.04.20030395.
5. Huang C, Wang Y, Li X, et al (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395:497-506.
6. X Yang, Y Yu, J Xu, et al (2020). Clinical course and outcomes of critically ill pa-tients with SARS-cov-2 pneumonia in Wuhan, China: a single-centered, retro-spective, observational study. The Lancet Respiratory Medicine, 8(5):457-481.
7. Li T, Wei C, Li W, et al (2020). Beijing Un-ion Medical College Hospital on" pneu-monia of novel coronavirus infection" diagnosis and treatment proposal (V2. 0). Med J Peking Union Med Coll Hosp.
8. Disilvio B, Young M, Gordon A, et al (2019). Complications and outcomes of acute respiratory distress syndrome. Crit Care Nurs Q, 42(4):349-361.
9. Moldofsky H, Patcai J (2011). Chronic wide-spread musculoskeletal pain, fatigue, de-pression and disordered sleep in chronic post-SARS syndrome; a case-controlled study. BMC Neurol, 11(1):37.
10. Zhou F, Yu T, Du R, et al (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wu-han, China: a retrospective cohort study. Lancet, 395(10229):1054-1062.
11. Hayes G. Revealed: the long-term severe ef-fects of Covid-19 that could go on for months 21 May 2020: Telegraph 2020 [updated 21 May 2020; cited 2020 25 JU-LY]. Available from: https://www.telegraph.co.uk/global-health/science-and-disease/revealed-long-term-severe-effects-covid-19-can-go-months/
12. Sales J. What happens after you recover from coronavirus? 5 questions answered 20 Mar 2020: The World Economic Fo-rum COVID Action Platform; [updated 20 Mar 2020; cited 2020 25 JULY]. Avail-able from: https://www.weforum.org/agenda/2020/03/coronavirus-recovery-what-happens-after-covid19/
13. Drillinger M. What to Know About a Long Recovery Period After Surviving COVID: Healthline; 2020 [updated April 29; cited 2020 25 JULY]. Available from: https://www.healthline.com/health-news/what-to-do-after-recovering-from-covid-19
14. WHO. Coronavirus disease (COVID-19) pandemic 2020 [cited 2020 24 JULY]. https://www.who.int/emergencies/diseases/novel-coronavirus-2019?Gclid=Cj0KCQjwjer4BRCZARIsABK4QeWvNs9cyJ10E8aNiL-0vtqfbqxp_jntbhkyq-yw3fbecfd4shyos7aaamleealw_wcb
15. Williams F. Coronavirus: why are some people experiencing long-term fatigue? 2020 [cited 2020 21 JULY]. July 16:[Available from: https://medicalxpress.com/news/2020-07-coronavirus-people-experiencing-long-term-fatigue.html
16. White P, Thomas J, Amess J, et al (1998). Incidence, risk and prognosis of acute and chronic fatigue syndromes and psy-chiatric disorders after glandular fever. Br J Psychiatry, 173(6):475-81.
17. Lam MH-B, Wing Y-K, Yu MW-M, et al (2009). Mental morbidities and chronic fatigue in severe acute respiratory syn-drome survivors: long-term follow-up. Arch Intern Med, 169(22):2142-7.
18. Carfì A, Bernabei R, Landi F (2020). Persis-tent symptoms in patients after acute covid-19. JAMA, 324(6):603-605.
19. Hayes G. Editorial: The seven stages of my bipolar diagnosis 2018 [updated 10 Oc-tober, 2018;cited 2020 20 JULY]. https://glasgowguardian.co.uk/2018/10/10/editorial-the-seven-stages-of-my-bipolar-diagnosis/
20. Sironi M, Hasnain SE, Phan T, et al (2020). SARS-cov-2 and COVID-19: A genetic, epidemiological, and evolutionary per-spective. Infect Genet Evol, 84:104384.
21. Mccallum K. Recovering From Coronavirus: What to Expect During and After Your Recovery 2020 [updated April 8, 2020; cited 2020 25 JULY]. Available from: https://www.houstonmethodist.org/blog/articles/2020/apr/recovering-from-coronavirus-what-to-expect-during-and-after-your-recovery/
22. Zhang P, Li J, Liu H, et al (2020). Long-term bone and lung consequences associated with hospital-acquired severe acute respir-atory syndrome: a 15-year follow-up from a prospective cohort study. bone re-search, 8(8):1-8.
23. Monaco K. Mental Health Challenges After COVID-19 Recovery — Short- and long-term depression, anxiety, PTSD may be an issue post-ICU: Medical News and Free CME Online; 2020 [updated May 18, 2020 cited 2020 20JULY]. Available from: https://www.medpagetoday.com/infectiousdisease/covid19/86556
24. Bashar FR, Vahedian-Azimi A, Hajiesmaeili M, et al (2018). Post-ICU psychological morbidity in very long ICU stay patients with ARDS and delirium. J Crit Care, 43:88-94.
25. Parshley L. The emerging long-term compli-cations of Covid-19, explained: Vox Me-dia,; 2020 [updated Jun 12, 2020; cited 2020 22 JULY]. Available from: https://www.vox.com/2020/5/8/21251899/coronavirus-long-term-effects-symptoms
26. Wang CH, Tsay SL, Elaine Bond A (2005). Post‐traumatic stress disorder, depres-sion, anxiety and quality of life in patients with traffic‐related injuries. J Adv Nurs, 52(1):22-30.
27. Liu N, Zhang F, Wei C, et al (2020). Preva-lence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychia-try Res, 287:112921.
28. Natoli S, Oliveira V, Calabresi P, et al (2020). Does SARS‐Cov‐2 invade the brain? Translational lessons from animal models. Eur J Neurol , 27(9): 1764– 1773.
29. Gong J, Ou J, Qiu X, et al (2020). A tool to early predict severe 2019-novel corona-virus pneumonia (COVID-19): a multi-center study using the risk nomogram in Wuhan and Guangdong, China. Clin Infect Dis, doi: 10.1093/cid/ciaa443.
30. Clauw DJ (2010). Perspectives on fatigue from the study of chronic fatigue syn-drome and related conditions. PM R, 2(5):414-30.
31. Raison CL, Lin J-MS, Reeves WC (2009).Association of peripheral inflam-matory markers with chronic fatigue in a population-based sample. Brain Behavior and Immunity, 23(3):327-337.
32. Jacobson SK, Daly JS, Thorne GM, et al (1997). Chronic parvovirus B19 infection resulting in chronic fatigue syndrome: case history and review. Clin Infect Dis. 24(6):1048-1051.
33. Imboden JB, Canter A, Cluff LE, et al (1959). Brucellosis: III. Psychologic as-pects of delayed convalescence. AMA Arch Intern Med, 103(3):406-14.
IssueVol 49 No 11 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v49i11.4729
COVID-19 Fatigue Activity intolerance Rehabilitation

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
MORADIAN ST, PARANDEH A, KHALILI R, KARIMI L. Delayed Symptoms in Patients Recovered from COVID-19. Iran J Public Health. 49(11):2120-2127.