As the pandemic continues, we are understanding the long-term effects of COVID-19 infection better. In the early stages of the pandemic, there were anecdotal reports that some people still had symptoms one month after infection. It now appears that symptoms may be persistent for much longer and surveys and series of cases from hospitals and the community are beginning to characterise the long-term conditions that follow COVID-19.

An Italian study reviewed 143 patients about two months after hospital admission. Around half reported fatigue or shortness of breath, while half said it still affected their quality of life. Most of these people had a severe infection with pneumonia. A community based Dutch survey found similar reports 2-3 months after COVID symptoms among people who hadn’t sought medical attention.

Persistent problems are not unusual following severe viral infections and these findings highlight the need for well planned, comparative studies with long-term follow-up of lab test results and patient-reported outcome data.

Where did the story come from?

Various media outlets have either reported on publications or quoted experts who have altered to the possible long-term consequences of COVID-19. Among them, BBC News and Forbes reported on a study published in the Journal of the American Medical Association while the Guardian highlighted a Dutch report, both of which have surveyed samples of recovered patients.

What is the basis for the claim?

In the JAMA study, doctors in Rome, Italy set up an outpatient service for people discharged from hospital after COVID recovery. Between 21 April and 29 May, 143 patients (80% of those discharged) attended follow-up. They had been hospitalised for nearly two weeks on average, 75% had pneumonia and 20% had required some form of ventilator support.

Around two months after their first symptoms, only 18 patients (13%) were completely free of symptoms. Commonly reported symptoms were:

  • Fatigue (53%)
  • Shortness of breath (43%)
  • Joint pain (27%)
  • Chest pain (22%)
  • General poorer quality of life (44%)

From this data we don’t know what their underlying health was prior to COVID, or whether symptoms could persist for longer. These were also all hospitalised patients with a fairly severe infection.

On the other hand a community survey by the Dutch Lung Foundation has suggested that symptoms may persist even among patients not admitted to hospital. The survey was conducted among 1,600 people (average age 53) who had ‘corona-type complaints.’ A massive 95% were said to have residual effects on their everyday activities several months after their first symptoms. Again, the most common symptoms were fatigue (88%) and shortness of breath (74%). Also, of concern, 85% reported having experienced good health prior to COVID symptoms. There are limitations to this data too, we don’t know about their initial presentation or definite duration of symptoms, and nearly half were said not to been diagnosed by a doctor.

Nevertheless, both studies highlight the need for comparative research studies on people who have recovered from COVID-19, preferably both hospitalised and not that follow the same people for longer.

What do trusted sources say?

NHS England has issued guidance on the after-care needs of patients who’ve recovered from COVID-19 and been discharged from hospital, recognising that ‘the virus and treatment required will have a lasting impact on their health.’ It covers extensive potential physical rehabilitation needs, as well as psychological and social effects, particularly if the person has required intensive care.

The British Thoracic Society has also issued guidance on the respiratory follow-up of patients who’ve had COVID pneumonia, with specific recommendations according to disease severity.

Analysis by EIU Healthcare, supported by Reckitt Benckiser

 

Citation

  1. Carfì A, Bernabei R, et al. Persistent Symptoms in Patients After Acute COVID-19. JAMA. Research Letter July 9, 2020.
  2. Dutch Lung foundation: Health of Corona patients at home in alarmingly poor health even after months. Publication, based on an Interview with Longfonds Director, Michael Rutgers.  Translated from Dutch https://www.ad.nl/binnenland/longfonds-gezondheid-thuiszittende-coronapatienten-schrikbarend-slecht~a45346fe/

Reading list

  1. NHS England. After-care needs of inpatients recovering from COVID-19. 5 June 2020
  2. British Thoracic Society. Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia. Published 11 May 2020