Patient experience of symptoms and impacts of COVID-19: a qualitative investigation with symptomatic outpatients

Abstract

There is little in-depth qualitative evidence of how symptoms manifest themselves in outpatients with COVID-19 and how these in turn impact outpatients’ daily lives. The objective of the study was therefore to explore the experience of outpatients with COVID-19 qualitatively, concerning the symptomatic experience and its subsequent impact on daily life.

Setting

Qualitative research study comprising virtual in-depth, open-ended interviews with outpatients and clinicians.

Participants

Thirty US adult patients with COVID-19 were interviewed within 21 days of diagnosis. Patients were 60% female and 87% white, who had to self-report one of the following: fever, cough, shortness of breath/difficulty breathing, change/loss of taste/smell, vomiting/diarrhoea or body/muscle aches. Five independent clinicians were also interviewed about their experience treating outpatients.

Primary and secondary outcome measures

Transcripts were analysed thematically to organise symptoms and impacts of daily life into higher-order overarching categories, and subsequently propose a conceptual model. The adequacy of the sample size was assessed by conceptual saturation analysis.

Results

Patient-reported concepts were organised into six symptom themes (upper respiratory, lower respiratory, systemic, gastrointestinal, smell and taste, and other) and seven impact themes (activities of daily living, broad daily activities, leisure/social activities, and physical, emotional, professional and quarantine-specific impacts). Symptom type, severity, duration and time of onset varied by patient. Clinicians endorsed all patient-reported symptoms.

Conclusions

The manifestation of symptoms in outpatients is heterogeneous and affects all aspects of daily life. Outpatients offered new detailed insights into their symptomatic experiences, including heterogeneous experiences of smell and taste, and the impacts that symptoms had on their daily lives. Findings of this research may be used to supplement existing knowledge of the outpatient experience of mild-to-moderate COVID-19, to further inform treatment guidelines and to provide an evidence base for evaluating potential treatment benefits.

SciScore for 10.1101/2021.06.02.21257739: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	Consent: Ethics: Study documents, including the protocol, demographic and health information form, interview guide, screener and informed consent form, received ethical approval from the New England Independent Review Board (study number: 1291666) prior to any contact with patients. IRB: Ethics: Study documents, including the protocol, demographic and health information form, interview guide, screener and informed consent form, received ethical approval from the New England Independent Review Board (study number: 1291666) prior to any contact with patients.
Sex as a biological variable	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.

Table 2: Resources

…

SciScore for 10.1101/2021.06.02.21257739: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	Consent: Ethics: Study documents, including the protocol, demographic and health information form, interview guide, screener and informed consent form, received ethical approval from the New England Independent Review Board (study number: 1291666) prior to any contact with patients. IRB: Ethics: Study documents, including the protocol, demographic and health information form, interview guide, screener and informed consent form, received ethical approval from the New England Independent Review Board (study number: 1291666) prior to any contact with patients.
Sex as a biological variable	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.

Table 2: Resources

Software and Algorithms
Sentences	Resources
A data-driven approach was adopted whereby transcripts were coded in ATLAS.ti software10 using an open, inductive, thematic coding approach.	ATLAS.ti suggested: None

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

This study had some limitations. First, there was a time lapse between the onset of COVID-19 symptoms and the interview. Patients, on average, completed the interview 12 days after their positive diagnosis. Further studies could explore the symptom trajectory at an earlier stage of their COVID-19 experience, but challenges in recruitment made this difficult, such as the time between being tested and receiving the results, as well as restrictions on public spaces. Future studies may be able to overcome recruitment challenges with more readily available rapid testing. However, patients had vivid memories of their symptoms and provided detailed information on the experience. Second, the participants were not of a representative racial/ethnic background and therefore further research in a more diverse population is required. A final limitation was young average age; age is a documented risk factor for COVID-19 infection, and older patients have been disproportionately affected by COVID-19 symptoms.18 However, younger patients did report a range of symptoms and daily life impacts, emphasising the importance of infection prevention measures in younger adults.19 Further, the types of symptoms experienced by patients did not differ by participant age; further research should be conducted to confirm differentiation of symptoms by age groups. Additional research should also be conducted to explore the symptom experience quantitatively, including the long-term effects of COVID-19, throu...

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

Results from scite Reference Check: We found no unreliable references.

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