The patient experience of COVID-19: A qualitative investigation with symptomatic outpatients
Authors: Rofail Diana , McGale Nadine , Podolanczuk Anna J. , Rams Alissa , Przydzial Krystian , Sivapalasingam Sumathi , Mastey Vera , Marquis Patrick 
Published: June 2021

Background

Coronavirus disease 2019 (COVID-19) is an acute respiratory illness characterised by a range of symptoms. Severe cases of COVID-19 could lead to hospitalisation and intensive care unit admission. However, little is known about the symptomatic experience of outpatients with COVID-19, or its daily life impact; the objective of this qualitative research was to document this experience.

Methods

Thirty US adult patients with COVID-19 were interviewed within 21 days of diagnosis. To be included, patients 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. Patients were asked open-ended questions to elicit their symptoms and the impacts COVID-19 had on their daily lives. Interviews were transcribed and inductively coded to perform thematic analysis and propose a conceptual model. The adequacy of the sample size was assessed by conceptual saturation analysis. Five independent clinicians were also interviewed about their experience treating outpatients with COVID-19.

Findings

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, physical impacts, emotional impacts, professional impacts and quarantine-specific impacts). Symptom type, severity, duration and time of onset varied greatly by patient. Clinicians endorsed all symptoms reported by patients.

Interpretation

The manifestation of symptoms in outpatient COVID-19 is heterogeneous and affects all aspects of daily life. While reported symptoms were in line with previously published reports, patients offered new detailed insights into their symptomatic experiences and the impacts that symptoms had on their daily lives. Future studies should explore the symptoms and impacts of COVID-19 longitudinally, to better understand their early onset, their progression/resolution and the possible long-term implications of COVID-19.

Funding

This research was sponsored and paid for by Regeneron Pharmaceuticals, Inc.

Research in context

Evidence before this study

Databases used: PubMed. Criteria for inclusion: qualitative study of the outpatient experience of COVID-19 (December 2019 – March 2021). Search terms included “qualitative” OR “interviews” AND “COVID-19” or “coronavirus”. The quality of the evidence was deemed not relevant to the current study, as the work was related to other contexts (eg, hospitalized patients or treatment of COVID-19), or data was collected quantitively (ie, questionnaire/survey) and did not include an in-depth perspective of the outpatient experience.

Added value of this study

This research fills important gaps in the literature, as the outpatient experience (ie, symptoms and daily life impacts) of COVID-19 has not been documented qualitatively.

Implications of all the available evidence

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. This work also provides an evidence base for identifying the symptoms and impacts important for evaluating potential treatment benefit in outpatients.