Experts warn COVID-19 recovery could take longer than a year

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Around one half of patients who were hospitalised with COVID-19 still experience health issues related to the virus after one year, a study has found.

Researchers from the National Center for Respiratory Medicine, China-Japan Friendship Hospital, China, conducted a study of 1,276 patients from Wuhan, China. Of those surveyed, half still experienced at least one persistent symptom of the virus after 12 months.

The findings from the study have been published in The Lancet.

Persistent symptoms

The results of the study showed that around one in three people continued to experience shortness of breath and that lung impairments persisted in some patients, especially those who had experienced the most severe illness with COVID-19. The researchers concluded that, in general, people who had previously been infected with COVID-19 were not as healthy as those in the wider community who had not contracted the SARS-CoV-2 virus.

Professor Bin Cao, from the National Center for Respiratory Medicine, China-Japan Friendship Hospital, China, said: “Our study is the largest to date to assess the health outcomes of hospitalised COVID-19 survivors after 12 months of becoming ill. While most had made a good recovery, health problems persisted in some patients, especially those who had been critically ill during their hospital stay. Our findings suggest that recovery for some patients will take longer than one year, and this should be taken into account when planning delivery of healthcare services post-pandemic.”

The study looked at 1,276 patients who had been discharged from Jin Yin-tan Hospital in Wuhan, China, between 7 January and 29 May 2020. Detailed health checks were carried out on these patients at six and 12 months (taken from the date they first experienced symptoms of COVID-19) to assess any ongoing symptoms and their health-related quality of life. The assessments included face-to-face questionnaires, physical examinations, lab tests, and a six-minute walking test to gauge patients’ endurance levels. The average age of patients in the study was 57.

Researchers observed that many symptoms resolved over time, regardless of the severity of initial COVID-19 disease. The proportion of patients still experiencing at least one symptom after one year fell from 68% at six months to 49% at 12 months. This decrease was observed regardless of the severity of COVID-19 infection the patients had experienced when hospitalised.

Fatigue or muscle weakness was the most common symptom reported, with around half (52%) of patients experiencing this at six months, falling to one in five patients at one year (20%). Almost one third of patients reported experiencing shortness of breath at 12 months, which was slightly higher than at six months (30% at 12 months compared to 26% at six months. This was more prevalent in patients who had been the most severely ill and had been on a ventilator during their time in hospital (39%), compared to those who had not required oxygen treatment (25%).

At the six-month check, 349 study participants underwent a lung function test and 244 of those patients completed the same test at 12 months. The proportion of patients experiencing diffusion impairment did not improve from six months to 12 months and this was seen across all groups regardless of how ill they had been when hospitalised.

Also at the six-month check, 353 study participants were given a chest CT scan. Around one half of them showed lung abnormalities on their scan and were offered a repeat scan at 12 months. Of the 118 patients who completed the scan at 12 months, the proportion of patients with abnormalities decreased substantially across all groups but was still high, particularly in the most critically ill group.

Gender differences

Compared with men, women were 1.4 times more likely to report fatigue or muscle weakness, twice as likely to report anxiety or depression, and almost three times as likely to have lung diffusion impairment after 12 months. People who had been treated with corticosteroids during the acute phase of their illness with COVID-19 were 1.5 times as likely to experience fatigue or muscle weakness after 12 months, compared to those who had not been treated with corticosteroids during their illness. The authors say these findings will be important to follow up in future research to better understand why COVID-19 symptoms persist in some people.

Mental health

Mental health is an important consideration in the recovery of COVID-19 patients. Slightly more patients experienced anxiety or depression at one year than at six months and the proportion was much greater in COVID-19 survivors than in matched people from the wider community.

Xiaoying Gu, one of the study’s authors, from Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, China, said: “We do not yet fully understand why psychiatric symptoms are slightly more common at one year than at six months in COVID-19 survivors. These could be caused by a biological process linked to the virus infection itself, or the body’s immune response to it. Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness. Large, long-term studies of COVID-19 survivors are needed so that we can better understand the long-term physical and mental health consequences of COVID-19.”

The authors recognise that their study was focused on a single hospital and so patient outcomes may not be generalisable to other settings. Additionally, the study included only a small number of patients who had been admitted to intensive care and researchers say that findings relating to the most critically ill patients should be interpreted with caution.

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