Study finds half of those hospitalized with Covid are still experiencing long-term effects two years later

(ORDO NEWS) — In the context of the ongoing COVID-19 pandemic, growing evidence suggests that a large proportion of people who recover from COVID-19 have long-term effects across multiple organs and systems.

Several longitudinal studies reported persistent health effects of COVID-19, but were limited to 1 year after acute infection. The aim of our study was to characterize the longitudinal evolution of health outcomes in hospital survivors with varying baseline disease severity over 2 years after acute COVID-19 infection and to determine their recovery status.

We conducted an ambiguous longitudinal cohort study of COVID-19 hospitalization survivors discharged from Jin Yin-tang Hospital (Wuhan, China) between January 7 and May 29, 2020.

We assessed health status 6 months (June 16 – September 3, 2020), 12 months (December 16, 2020 – February 7, 2021) and 2 years (November 16, 2021 – January 10, 2022) after symptom onset with a test 6-minute walking distance (6MWD), laboratory tests, and a series of questionnaires on symptoms, mental health, health-related quality of life (HRQoL), return to work, and post-discharge health care utilization.

A subgroup of COVID-19 survivors received a functional lung exam and chest imaging at each visit. To determine the recovery status of COVID-19 survivors over 2 years, age, sex, and comorbidities matched participants without COVID-19 infection (controls) were included in the study.

Primary outcomes included symptoms, modified British Medical Research Council (mMRC) dyspnea scale, HRQoL, 6MWD and return to work and were assessed in all COVID-19 survivors who attended all three follow-up visits. Symptoms, mMRC breathlessness scale and HRQoL were also assessed in the control group.

2,469 COVID-19 patients were discharged from Jin Yin-tang Hospital between January 7 and May 29, 2020. 1192 COVID-19 survivors completed evaluation at three follow-up visits and were included in the final analysis, 1119 (94%) of whom participated in a face-to-face interview 2 years after infection.

The mean age at discharge was 57-0 years (48-0-65-0), 551 (46%) were women. Median follow-up time after symptom onset was 185-0 days (IQR 175-0-197-0) for the 6-month visit, 349-0 days (337-0-360-0) for the 12-month visit, and 685-0 days (675-0-698-0) for a visit in 2 years.

The proportion of COVID-19 survivors with at least one symptom of continuation decreased significantly from 777 (68%) of 1149 at 6 months to 650 (55%) of 1190 at 2 years (p<0-0001), with the most common symptoms always had fatigue or muscle weakness.

The proportion of COVID-19 survivors with an mMRC score of at least 1 was 168 (14%) of 1191 at 2 years, significantly lower than 288 (26%) of 1104 at 6 months (p<0-0001).

HRQoL continued to improve in almost all areas, especially for anxiety or depression: the proportion of individuals with symptoms of anxiety or depression decreased from 256 (23%) of 1105 at 6 months to 143 (12%) of 1191 at 2 years (p<0- 0001).

The proportion of individuals with a 6MWD score less than the lower limit of the normal range consistently declined in COVID-19 survivors overall and in the three subgroups with varying baseline disease severity.

Survivors with prolonged COVID symptoms at 2 years had lower HRQoL, worse exercise capacity, more psychiatric abnormalities, and more frequent use of healthcare services after discharge than survivors without prolonged COVID symptoms.

Survivors of COVID-19 still had more common symptoms and more problems related to pain or discomfort, and anxiety or depression, at 2 years compared to controls.

In addition, a significantly higher proportion of survivors who received higher levels of respiratory support during hospitalization experienced impaired lung diffusion (43 [65%] of 66 vs. 24 [36%] of 66, p=0-0009), reduced residual volume (41 [62%] vs. 13 [20%], p<0-0001) and total lung capacity (26 [39%] vs. four [6%], p<0-0001) than controls.

Regardless of baseline disease severity, COVID-19 survivors experienced longitudinal improvement in physical and mental health, with most returning to their previous jobs within 2 years; however, the burden of symptomatic sequelae remained fairly high.

The health status of people who survived COVID-19 was significantly lower than that of the general population after 2 years. The results of the study indicate an urgent need to study the pathogenesis of long-term COVID and develop effective measures to reduce the risk of long-term COVID.

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