Two years later, half of the group of patients hospitalized with COVID-19 in Wuhan, China, still had at least one residual symptom, according to a study published in Lancet Respiratory Medicine. The study followed 1,192 participants in Wuhan infected with SARS-CoV-2 during the first phase of the epidemic in 2020.
While overall physical and mental health has improved over time, the study found that COVID-19 patients still had lower health and quality of life than the general population. This is particularly the case for participants with prolonged COVID-19, who typically still have at least one symptom including fatigue, shortness of breath and sleep difficulties two years after their initial illness.1
The long-term health effects of COVID-19 have remained largely unknown, with the longest follow-up studies to date spanning about one year.2 The lack of baselines for pre-COVID-19 health status and comparisons with the general population in most studies made it difficult to determine the recovery of patients with COVID-19.
Lead author Professor Ben Kao, from Sino-Japanese Friendship Hospital, China, said, “Our results indicate that for a certain proportion of hospitalized COVID-19 survivors, while they may have cleared the primary infection, more than two years is needed. In order to fully recover from COVID-19 Continuous monitoring of COVID-19 survivors, especially those with prolonged COVID symptoms, is essential to understanding the longer course of the disease, as well as further exploring the benefits of rehabilitation programs for recovery There is a clear need to provide ongoing support to a significant proportion of people who have contracted COVID-19, and to understand how vaccines, treatments, and emerging variables 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 severe COVID-19 who were treated at Jin Yin-tan Hospital in Wuhan, China, between January 7 and May 29, 2020, at six months, 12 months and two years.
Assessments included a six-minute walking test, lab tests, and questionnaires about symptoms, mental health and health-related quality of life, if they returned to work and health care use after hospital discharge. The negative effects of prolonged COVID-19 on quality of life, ability to exercise, mental health, and health care use were determined by comparing participants with and without prolonged COVID symptoms. Health outcomes were determined at 2 years of age using a control group matched for age, sex, and comorbidities in the general population with no history of COVID-19 infection.
Two years after initially becoming ill, patients with COVID-19 are generally less healthy than the general population, with 31% reporting muscle fatigue or weakness and 31% reporting difficulties sleeping. The proportion of non-COVID-19 participants who reported these symptoms was 5% and 14%, respectively.
COVID-19 patients were more likely to report a number of other symptoms including joint pain, heart palpitations, dizziness and headache. On quality of life questionnaires, COVID-19 patients also reported more often pain or discomfort (23%) and anxiety or depression (12%) than non-COVID-19 participants (5% and 5%, respectively).
Nearly half of the study participants had prolonged COVID symptoms within two years, and reported lower quality of life than those without prolonged COVID symptoms. On mental health questionnaires, 35% reported pain or discomfort and 19% reported anxiety or depression. The proportion of COVID-19 patients who had not reported these symptoms for a long time was 10% and 4% within two years, respectively. Long-term COVID participants also reported problems with their movement (5%) or activity levels (4%) compared to those without long COVID (1% and 2%, respectively).
The authors acknowledged limitations to their study, such as the moderate response rate; Slight increase in the proportion of participants who received oxygen; It has been one central study since early in the pandemic.
1. – National Institute for Health and Care Excellence – Scottish Intercollegiate Extension Network – Royal College of General Practitioners. COVID-19 Quick Guide: Managing the Long-Term Effects of COVID-19. https://www.nice.org.uk/guidance/ng188
2. – Soriano – J.P. Murthy – S. Marshall – J.C. Rylan – B. Diaz JV – on behalf of the WHO Clinical Case Definition Post-COVID-19 Working Group. Defining a clinical case for a post-COVID-19 case by the Delphi consensus. Lancet infects dis. 2021; 22: e102-e107
3. – Huang Il – Yao Kyu – Ju X – et al. One-year outcomes on hospitalized survivors with MERS-CoV: a longitudinal cohort study. Lancet. 2021; 398: 747-758