The coronavirus disease 2019 (COVID-19), instigated by the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exacted an enormous toll on public health worldwide. On top of the immediate healthcare burden of individuals who fall severely or critically ill, the extent of long-term health problems for many survivors of COVID-19, and their attendant healthcare requirements, is slowly beginning to emerge.
While the majority of those who catch the virus and develop mild to moderate COVID-19 are able to fully recover fairly swiftly, a sizable minority across diverse disease outcomes have experienced persistent sequelae – including fatigue, breathlessness and ‘brain fog’ – for up to six months or longer from symptom onset.
Because SARS-CoV-2 is a novel virus, these complications, which have varied largely from person to person and across disease severity, are still in the process of being understood by the health science community. Moreover, as the COVID-19 pandemic continues to unfold, and more and more individuals are beginning to exhibit these long-term complications, the extent of healthcare burden and post-viral care requirements for this group is mounting.
Although long COVID and post-COVID syndrome were first detected in April 2020, more study is still needed to better understand these conditions. While there were 17 articles and 7 systematic reviews on “long COVID,” “post-COVID syndrome” in PubMed and medRxiv, most of them considered symptoms, multi-organ, or functional issues, and only one study had considered these variables in non-hospitalized patients. None of the studies compared symptom burden and management among hospitalized and non-hospitalized patients in a dedicated post-COVID service.
Observational analysis of 1,325 COVID-19 patients assessed in UK’s first post-COVID service
Complications following COVID-19 infection require quick identification and management to help plan policy and health system responses. Researchers in the UK recently described the 12-month experience of the first dedicated post-COVID clinical service in the UK to include both hospitalized and non-hospitalized COVID-19 patients. This study has been released on the medRxiv* the preprint server.
The study was a single-center, observational analysis, and the outcomes for 1,325 individuals assessed in the University College London Hospitals NHS Foundation Trust post-COVID service between April 2020 and April 2021 were reported. Parameters such as demography of the participants, comorbidities, symptoms, investigations, therapy, functional recovery, specialist referral, and rehabilitation were compared by referral route.
The researchers used multivariable logistic regression to assess symptoms linked to poor recovery or inability to go back to full-time work. Out of the 1,325 individuals were assessed, 547 (or 41.3%) were assessed “post-hospitalization,” 212 [16%] were assessed post-emergency department” (PED), and 566 (42.7%) were non-hospitalized” (NH).
NH patients were younger, more likely to be female, and less likely to be an ethnic minority compared to other groups
The findings showed that compared to PH and PED groups, NH patients were younger, with a median age of 44.6 and age range of 35.6 to 52.8 years. They were also more likely to be female (68.2%), while the PH group had 43.0% females and the PED group had 59.9% females.
NH patients were less likely to be an ethnic minority (30.9%), compared to PH 52.7% and PED 41.0%. Patients in the NH group had similar specialist referral rates as those in PH and PED groups (NH 18.7%, PH 16.1%, and PED 18.9%). They were also more likely to need support for breathlessness (NH 23.7%, PH 5.5%, and PED 15.1%) and fatigue (NH 17.8%, PH 4.8%, PED 8.0%).
Hospitalized patients showed higher pulmonary emboli rates, long-term lung interstitial abnormalities, and other organ dysfunction. While 716 (54.0%) patients reported <75% of optimal health, less than 50% of employed individuals were able to return to full-time work at the first assessment.
As with other long-term conditions, care of patients experiencing Long COVID or specific end-organ effects require consistent, integrated, patient-centered approaches to investigation and management.”
Real-world findings may help inform models of care for long COVID patients
The observations above suggest that symptoms following SARS-CoV-2 infection were significant in post- hospitalized and non-hospitalized patients, with considerable ongoing healthcare needs and utilization. According to the authors, this is the first time a report is being published on the baseline characteristics, investigation, and outcomes of eligible patients in a dedicated post-COVID service, with 547 PH, 566 NH, and 212 PED patients.
Post-COVID morbidity can be severe, regardless of severity of acute illness, and scale of healthcare utilization and inability to return to employment represent a major burden to individuals, healthcare and welfare systems, and economies.”
The report shows that despite the relatively low comorbidity and risk burden in NH patients, both NH and hospitalized patients with persistent symptoms following SARS-CoV-2 infection had high rates of functional impairment, specialist referral and rehabilitation, 6-12 months after the infection. The authors hope that these real-world data will help inform models of care during and after the pandemic.
At public health and policy level, burden of post-COVID morbidity demands renewed focus on effective infection suppression for all age groups,” say the researchers.
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.