• Comprehensive Ophthalmology

    Review of: Sequelae in Adults at 6 Months After COVID-19 Infection

    Logue J, Franko N, McCulloch D, et al. JAMA, February 2021

    Investigators evaluated the long-term sequelae in outpatients following COVID-19 infection.

    Study design

    This longitudinal prospective cohort study of adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection included patients enrolled at the University of Washington and a concurrent cohort of healthy patients in a control group. COVID-19 symptom data were obtained at the time of acute illness or retrospectively recounted at a 30-day enrollment visit. A total of 234 study participants were contacted between August and November 2020 to complete a single follow-up questionnaire between 3 and 9 months after illness onset.


    A total of 177 participants (mean age 48 years; 57.1% women) with COVID-19 completed the survey.

    Approximately 30% reported persistent symptoms and 29% reported worsened health-related quality-of-life metrics. The most common persistent symptoms were fatigue (13.6%) and loss of sense of smell or taste (13.6%). Fourteen participants (7.9%), including 9 non-hospitalized individuals, reported negative impacts on activities of daily living after infection, the most common being household chores. Four patients (2.3%) reported continued neurologic symptoms or "brain fog." Persistent symptoms were reported by 17 of 64 patients (26.6%) aged 18 to 39 years, 25 of 83 patients (30.1%) aged 40 to 64 years and 13 of 30 patients (43.3%) aged 65 years and older. Of 31 patients with hypertension or diabetes, 11 (35.5%) experienced ongoing symptoms.

    At the time of initial acute COVID-19 infection, 11 (6.2%) were asymptomatic, 150 (84.7%) were outpatients with mild illness and 16 (9.0%) had moderate or severe COVID-19 requiring hospitalization.


    Study limitations include a small sample size, the single study location, potential bias from self-reported symptoms during illness episode, and loss to follow-up of 57 participants. Comprehensive long-term investigation will be necessary to fully understand the impact of this evolving viral pathogen.

    Clinical significance

    Health consequences of COVID-19 extend far beyond acute infection, even among those who experience mild illness. With over 111 million COVID-19 cases worldwide and a growing number of cases each day, even a small incidence of long-term debilitating symptoms could have enormous health and economic consequences.