Two years later, half of a group of patients hospitalized with COVID-19 in Wuhan, China, still have at least one lingering symptom, according to a study published in The Lancet Respiratory Medicine† The study followed 1192 participants in Wuhan who were infected with SARS-CoV-2 during the first phase of the pandemic in 2020.
While physical and mental health generally improved over time, the study found that COVID-19 patients still have worse health and quality of life than the general population. This is especially true for participants with long-term COVID, who usually still have at least one symptom, including fatigue, shortness of breath, and difficulty sleeping, two years after initially becoming ill.1
The long-term health effects of COVID-19 have remained largely unknown, as the longest follow-up studies to date have lasted about a year.2 The lack of pre-COVID-19 health status baselines and comparisons to the general population in most studies has also made it difficult to determine how well patients with COVID-19 have recovered.
Lead author Professor Bin Cao, of the China-Japan Friendship Hospital, China, said: “Our findings indicate that for a certain proportion of hospitalized COVID-19 survivors, although they may have cleared the initial infection, more than two years is needed to fully recover from COVID-19. Continued follow-up of COVID-19 survivors, especially those with symptoms of long-term COVID-19, is essential to understand the longer course of the disease, as well as further research into the benefits of rehabilitation programs for recovery. There is a clear need to provide continued support for a significant proportion of people who have had COVID-19 and to understand how vaccines, emerging treatments and variants affect long-term health outcomes.”3
The authors of the new study sought to analyze the long-term health outcomes of hospitalized COVID-19 survivors, as well as the specific health effects of long-term COVID. They evaluated the health of 1,192 participants with acute COVID-19 who were treated at Jin Yin-tan Hospital in Wuhan, China, between January 7 and May 29, 2020, after six months, 12 months and two years.
Assessments included a six-minute walk test, lab tests and questionnaires on symptoms, mental health, health-related quality of life, return to work after discharge, and healthcare utilization. The negative effects of long-term COVID on quality of life, exercise capacity, mental health and health care use were determined by comparing participants with and without long-term COVID symptoms. Health outcomes at two years were determined using a control group matched in age, gender and co-morbidity to people in the general population with no history of COVID-19 infection.
Two years after initially becoming ill, patients with COVID-19 are generally in worse health than the general population, with 31% reporting fatigue or muscle weakness and 31% reporting difficulty sleeping. The proportion of non-COVID-19 participants reporting these symptoms was 5% and 14%, respectively.
COVID-19 patients were also more likely to report a number of other symptoms, including joint pain, palpitations, dizziness and headaches. In QoL questionnaires, COVID-19 patients were also more likely to report pain or discomfort (23%) and anxiety or depression (12%) than non-COVID-19 participants (5% and 5%, respectively).
About half of the study participants had symptoms of long-term COVID after two years and reported a lower quality of life than those without long-term COVID. In mental health questionnaires, 35% reported pain or discomfort and 19% reported anxiety or depression. The proportion of COVID-19 patients without long-term COVID who reported these symptoms was 10% and 4%, respectively, after two years. Tall COVID participants were also more likely to report problems with their mobility (5%) or activity level (4%) than those without tall COVID (1% and 2%), respectively.
The authors acknowledged limitations to their study, such as a moderate response; slightly increased percentage of participants receiving oxygen; it was a one-center study from the start of the pandemic.
1. – National Institute for Health and Care Excellence – Scottish Intercollegiate Guidelines Network – Royal College of General Practitioners. COVID-19 rapid guideline: coping with the long-term effects of COVID-19. https://www.nice.org.uk/guidance/ng188
2. – Soriano – JB Murthy – S Marshall – JC Relan – P Diaz JV – on behalf of the WHO Clinical Case Definition Working Group on post-COVID-19 condition. A clinical case definition of a post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021; 22: e102-e107
3. – Huang L – Yao Q – Gu X – et al. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Lancet. 2021; 398: 747-758
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