Perspectives

Postdischarge Evaluation for Individuals Hospitalized with COVID-19

Authors: Gail Berkenblit, MD, PhD, Kaelin O’Connell, MD, Sara Mixter, MD, MPH, Caitlin Dowd-Green, PharmD, Rosalyn W. Stewart, MD, MS

Abstract

Primary care providers (PCPs) now face a novel clinical scenario: postdischarge care for patients with COVID-19. In a study of 138 patients hospitalized for COVID-19 in Wuhan, China, discharged patients had an average hospital stay of 10 days, with courses that were complicated by ARDS, venous thromboembolism (VTE), arrhythmias, and shock.1 The World Health Organization estimates an overall recovery time from COVID-19 of 2 weeks for mild infections and 3 to 6 weeks for severe disease.2 Thus, many discharged patients will need continuing management of pulmonary conditions, surveillance for secondary infections, monitoring for cardiac complications, and screening for depression or posttraumatic stress disorder (PTSD) in the outpatient setting. Clinicians also must address ending home isolation and safe timelines for returning to work. Here, we discuss special considerations in caring for patients with COVID-19 following hospital discharge.
Posted in: Infectious Disease146

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References

1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA 2020;323:1061–1069.
 
2. World Health Organization. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 24 February 2020. https://www.who. int/dg/speeches/detail/who-director-general-s-opening-remarks-at-themedia-briefing-on-covid-19—24-february-2020. Published 2020. Accessed March 21, 2020.
 
3. Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–1720.
 
4. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239–1242.
 
5. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
 
6. Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol 2020;115:766–773.
 
7. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323:2052–2059.
 
8. Karrasch C, Gallo RA. The acutely injured knee. Med Clin North Am 2014; 98:719–736.
 
9. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. Br Med J 2020;368:m1182.
 
10. Moore C, Wisnivesky J, Williams S, et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003;18:646–651.
 
11. Agency for Healthcare Research and Quality. Re-Engineered Discharge (RED) toolkit. https://www.ahrq.gov/patient-safety/settings/hospital/red/ toolkit/index.html. Published 2020. Accessed April 26, 2020.
 
12. Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: examining the effects of timing of primary care provider follow-up. J Hosp Med 2010;5: 392–397.
 
13. Salama C, Han J, Yau L, et al. Tocilizumab in patients hospitalized with Covid-19 pneumonia. N Engl J Med 2021;384:20–30.
 
14. Kalil AC, Patterson TF, Mehta AK, et al. Baricitinib plus remdesivir for hospitalized adults with Covid-19. N Engl J Med 2021;384:795–807.
 
15. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-up. J Am Coll Cardiol 2020;75:2950–2973.
 
16. Wang X, Xu H, Jiang H, et al. Follow-up study of 131 COVID-19 discharged patients: is the current Chinese discharge criteria reliable? https://papers, ssrn.com/sol3/papers.cfm?abstract_id=3551342. Published 2020. Accessed November 8, 2021
 
17. Zhou B, She J, Wang Y, et al. The duration of viral shedding of discharged patients with severe COVID-19. Clin Infect Dis 2020;71:2240–2242.
 
18. Stay at home: guidance for households with possible coronavirus (COVID-19) infection. 2020; https://www.gov.uk/government/publications/covid-19- stay-at-home-guidance.
 
19. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol 2020;75: 2950–2973.
 
20. Moores LK, Tritschler T, Brosnahan S, et al. Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019. Chest 2020; 158:1143–1163.
 
21. American Society of Hematology. COVID-19 and VTE/anticoagulation: frequently asked questions. https://www.hematology.org/covid-19/covid19-and-vte-anticoagulation. Published 2020. Accessed February 9, 2021.
 
22. Sreenivasan J, Khan MS, Anker SD, et al. Cardiovascular risk factors and complications in patients infected with COVID-19: a systematic review. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3569855. Published 2020. Accessed November 8, 2021.
 
23. Gupta AK, Jneid H, Addison D, et al. Current perspectives on coronavirus 2019 (COVID-19) and cardiovascular disease: a white paper by the JAHA editors. J Am Heart Assoc. 2020;9:e017013.
 
24. European Society of Cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESC-COVID-19- Guidance. Published 2020. Accessed May 13, 2020.
 
25. Wu C, Hu X, Song J, et al. Mental health status of survivors following COVID-19 in Wuhan, China: a descriptive study. https://papers.ssrn. com/sol3/papers.cfm?abstract_id=3559616. Published 2020. Accessed November 8, 2021.
 
26. Parker A, Sricharoenchai T, Raparla S, et al. Posttraumatic stress disorder in critical illness survivors: a metaanalysis. Crit Care Med 2015;43:1121–1129.
 
27. Portnoy J, Waller M, Elliott T. Telemedicine in the Era of COVID-19. J Allergy Clin Immunol Pract 2020;8:1489–1491.
 
28. Jordan TB, Meyers CL, Schrading WA, et al. The utility of iPhone oximetry apps: a comparison with standard pulse oximetry measurement in the emergency department. Am J Emerg Med 2020;38:925–928.
 
29. Johns Hopkins COVID Ambulatory Response Team. COVID Ambulatory Response Team Triage Management Protocol. Internal report. Baltimore, MD: Johns Hopkins Hospital; 2020.
 
30. World Health Organization. Clinical management: living guidance. https:// www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1. Published 2021. Accessed November 8, 2021.
 
31. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–1062.
 
32. Owusu D, Pomeroy MA, Lewis NM, et al. Persistent SARS-CoV-2 RNA Shedding Without Evidence of Infectiousness: a Cohort Study of Individuals With COVID-19. J Infect Dis. 2021. doi:10.1093/infdis/jiab107external icon.
 
33. van Kampen JJ, van de Vijver DA, Fraaij PL, et al. Duration and key determinants of infectious virus shedding in hospitalized patients with coronavirus disease-2019 (COVID-19). Nat Commun 2021;12:1–6.
 
34. Centers for Disease Control and Prevention. Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings (Interim Guidance). 2020; https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-inhome-patients.html. Accessed February 9, 2021.
 
35. Centers for Disease Control and Prevention. Caring for someone sick at home. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/care-forsomeone.html. Published 2020. Accessed November 8, 2021.
 
36. Centers for Disease Control and Prevention. Return to work criteria for healthcare personnel with SARS-CoV-2 infection. https://www.cdc.gov/ coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html?CDC_AA_ refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov% 2Fhcp%2Freturn-to-work.html. Published 2020. Accessed November 8, 2021.