Symptoms of COVID-19 Often Last 6 Months or More, Study Finds

More than three-quarters (76.5%) of 1,655 COVID-19 hospital patients in Wuhan, China had at least one symptom 6 months after discharge, reports a Lancet study published at the end of last week.

The most common self-reported symptoms were fatigue or muscle weakness (62.7%) and sleep disturbance (26.4%), and follow-ups from physical exams also showed impaired pulmonary diffusion – indicating poor oxygen exchange – in 34.1% of patients.

“Because COVID-19 is such a new disease, we are only beginning to understand some of its long-term effects on patient health,” says lead author Bin Cao, MD, in a Lancet press release. “Our analysis indicates that most patients continue to live with at least some of the effects of the virus after discharge from hospital and highlights the need for post-discharge care, especially for those with severe infections. “

Lungs not recovered, antibodies decreased

Study participants were discharged from hospital Jan.7 to May 29, 2020, and researchers followed a median of 186 days (over 6 months) later, from June 16 to September 3. Of 1,733 people in the cohort, 1,172 (67.6%) required oxygen therapy, 122 (7.0%) required ventilation or a similar procedure, and 76 (4.4%) required been admitted to the intensive care unit (ICU).

Excluded from the study are patients who died (1.3% out of a total of 2,469 possible people), who were followed up for other reasons such as psychotic disorders or readmission, or living in retirement or care homes.

The researchers gave a subset of 390 patients for lung examinations and found impaired diffusion in 21.7% of those who did not need supplemental oxygen, 29.1% of those who received supplemental oxygen and 55.8% of those who needed ventilation of any type or similar procedure. .

“This was consistent with the findings that the most common abnormal CT pattern was pulmonary interstitial change (GGO [ground glass opacity] and irregular lines), which were similar to the long-term pulmonary manifestations of SARS [severe acute respiratory disease] or the flu, ”the researchers write, but noted that they had no baseline data.

Patients in the most severe infection group had an increased adjusted score of 4.60 (95% confidence interval [CI], 0.80 to 3.25) for impaired diffusion than those who did not need supplemental oxygen, although the data also revealed that the lungs continued to heal in some cases. For example, GGO levels decreased between 25% and 45% of the height of infection at follow-up, depending on the severity of the infection.

Antibody levels fell 52.5% (96.4% seropositivity to 58.5%) in 94 patients who had blood tests during the peak of their infection and during their 6-month follow-up. Seven antibodies measured had reduced amounts at follow-up, but over 90% of patients continued to test positive for N-immunoglobulin (Ig) G, S-IgG, and IgG antibodies at the receptor binding domain.

Further physical follow-up exams revealed that 13% of 822 patients had decreased kidney function after discharge (but no healthy baseline) and 23% of 1,692 patients performed at below normal levels during a 6 minute walk test. None of the 390 patients who received follow-up ultrasounds had deep vein thrombosis of the legs.

The researchers evaluated 17 symptoms. Besides muscle fatigue / weakness and sleep disturbances, they included mild fever (prevalence 0.0%), taste (7.3%) or smell (10.6%) disturbances, palpitations (9.3%) and hair loss (21.7%). (Researchers aren’t sure if these symptoms started after discharge from hospital or whether they remained stable or worsened after discharge from hospital.) They also found that 22.2% of 1617 suffered from anxiety or depression.

Need for close monitoring

In one Lancet Comment, Italian researchers Monica Cortinovis, BiotechD, Norberto Perico, MD, and Giuseppi Remuzzi, MD, also point out the need for outpatient services, but add that this level of care is more difficult for low- and middle-income countries. They write that long-term studies “allow us to assess the effectiveness of therapeutic interventions to mitigate the long-term consequences of COVID-19 on several organs and tissues.

“This is consistent with the syndemic nature of the COVID-19 pandemic and has implications for the long-term monitoring of the sequelae of COVID-19, which in most cases should be interpreted in the context of a set of diseases. non-communicable diseases. and the social and income inequalities that exacerbate the negative effects of each of these diseases in many communities. “

Due to the small number of patients at the intensive care level, the Lancet commentators say the results for this subset are inconclusive. “However,” they add, “previous research on patient outcomes after an intensive care stay suggests that several patients with COVID-19 who were critically ill during their hospital stay will then face health problems. their cognitive and mental health or physical function well beyond their discharge from hospital. “

Cortinovis and his colleagues conclude: “Unfortunately, there are few reports on the clinical picture of the sequelae of COVID-19. The study… is therefore relevant and timely.”