A recent study published in The Lancet suggests that many patients previously hospitalized with Covid-19 have experienced lingering symptoms for months. And for nearly half of them, at least one symptom has persisted past the one-year mark, Molly Walker reports for MedPage Today.

Recovery clinics for Covid-19 long-haulers

Study details

For the study, researchers from Wuhan, China, examined data from Covid-19 survivors who were discharged from Jin Yin-tan Hospital between Jan. 7 and May 29, 2020. Patients were excluded from the study if they died after being discharged; lived in a nursing or welfare home; had a psychotic disorder, dementia, or osteoarthropathy; or were immobile.

Researchers also recruited adults who had not been infected with the coronavirus to serve as controls between Dec. 24, 2020 and Jan. 16, 2021. The participants and controls were proportional in terms of age range, sex, and comorbidities such as cardiovascular disease, hypertension, and diabetes.

The researchers followed up with participants 6 and 12 months after the onset of Covid-19 symptoms to assess their health status. At each visit, participants were interviewed, completed questionnaires, underwent a physical examination and laboratory tests, and completed a six-minute walking test.

Overall, 1,276 participants attended both follow-up visits. The median age of the participants was 59 years old, and 53% were men. Around 70% of the participants had received oxygen via nasal cannula when hospitalized, and 7% had needed a high-flow nasal cannula or non-invasive or invasive mechanical ventilation. In addition, 4% of participants had been admitted to the ICU, with a median duration of 18 days.

According to the researchers, the study's limitations included its single-center design, focusing only on patients hospitalized early in the pandemic, its relatively small sample size, a potential for bias due to the moderate response rate, and the fact that the health status of the participants prior to coronavirus infection could not be determined.

Findings

The researchers found that 68% of Covid-19 survivors reported at least one post-Covid symptom—which included difficulty sleeping, heart palpitations, joint pain, and chest pain—six months after symptom onset. This decreased to 49% at the one-year mark.

The most commonly reported symptom was fatigue or muscle weakness, although the researchers noted that there was significant decline in reports from the six-month visit (52%) to the 12-month visit (20%).

In addition, the researchers found that more patients reported anxiety or depression at the 12-month visit than the 6-month visit (26% vs 23%, respectively). More patients also reported dyspnea or difficulty breathing at 12 months than at 6 months (30% vs 26%, respectively).

Overall, the researchers reported that many of the participants' symptoms—including difficulty sleeping, hair loss, and smell and taste disorder—"significantly resolved over time." However, some patients, particularly those who had been critically ill when hospitalized, continued to experience "sequelae symptoms, lung diffusion impairment, and radiographic abnormalities" 12 months later.

Comments

According to the authors, the study is the largest longitudinal study of hospitalized Covid-19 survivors to assess the health effects of the disease 12 months after symptom onset. The authors had previously analyzed data of Covid-19 survivors 6 months after infection.

Xiaoying Gu, a physician at China-Japan Friendship Hospital and one of the study's authors, said the authors did not understand why psychiatric symptoms were more prevalent at 12 months than 6 months.

"These could be caused by a biological process linked to the virus infection itself, or the body's immune response to it." Gu said. "Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness."

The authors also cited prior research that found Covid-19 survivors were more likely to use medications, such as antidepressants, bronchodilators, and expectorants six months later.

In addition, while the authors said it was "worrying" that there was a higher percentage of patients with dyspnea and anxiety or depression at 12 months than 6 months, "the increased proportion in our cohort is relatively low."

Ultimately, the authors called for more longitudinal studies following Covid-19 survivors to better understand the natural history and long-term health consequences of the disease.

In an accompanying editorial, editors at The Lancet agreed with the researchers, writing, "[Health care] providers must acknowledge and validate the toll of the persistent symptoms of long Covid on patients, and health systems need to be prepared to meet [individualized], patient-oriented goals, with an appropriately trained workforce involving physical, cognitive, social, and occupational elements." (Walker, MedPage Today, 8/26)