More than three quarters (76.5%) of 1,655 hospitalized COVID-19 patients in Wuhan, China, had at least one symptom 6 months after discharge, reports a Lancet study published late last week.
The most common self-reported symptoms were muscle fatigue or weakness (62.7%) and difficulty sleeping (26.4%), and monitoring of the physical examination also showed impaired pulmonary diffusion – which indicates deficient oxygen exchange – in 34 , 1% of patients.
“Because COVID-19 is such a new disease, we are just beginning to understand some of its long-term effects on patients’ health,” said senior author Bin Cao, MD, in a Lancet press release. “Our analysis indicates that the majority of patients continue to live with at least some of the effects of the virus after hospital discharge and highlights the need for post-discharge care, especially for those with severe infections.”
Lungs not recovered, antibodies decreased
Study participants were discharged from the hospital from January 7 to May 29, 2020, and the researchers followed an average of 186 days (more than 6 months) later, from June 16 to September 3. Of 1,733 people in the cohort, 1,172 (67.6%) needed oxygen therapy, 122 (7.0%) needed ventilation or a similar procedure and 76 (4.4%) were admitted to the intensive care unit (ICU).
Among those excluded from the study were patients who died (1.3% of the total of 2,469 possible people), were followed up for other reasons, such as psychotic disorders or readmission, or lived in nursing homes or social assistance.
The researchers gave a subset of 390 lung exams to patients and found diffusion impairment 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 from any similar type or procedure.
“This was consistent with the findings that the most common abnormal tomographic pattern was pulmonary interstitial abnormalities (GGO [ground glass opacity] and irregular lines), which were similar to the long-term pulmonary manifestations of SARS [severe acute respiratory disease] or influenza “, write the researchers, but noted that they lacked basic data.
Patients in the most severe infection group had adjusted odds increased by 4.60 (95% confidence interval [CI], 0.80 to 3.25) for diffusion deficiency 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 by 25% to 45% from the peak of infection until follow-up, depending on the severity of the infection.
Antibody levels dropped by 52.5% (96.4% seropositivity to 58.5%) in 94 patients who had blood tests at the height of the infection and during the 6-month follow-up. Seven measured antibodies had decreased amounts at the time of follow-up, but more than 90% of patients continued to test positive for N-immunoglobulin (Ig) G, S-IgG and IgG receptor-binding domain antibodies.
Other physical follow-up tests found that 13% of 822 patients had decreased renal function after discharge (but without healthy baseline data) and 23% of 1,692 patients performed at subnormal levels in a 6-minute walk test. None of the 390 patients who received follow-up ultrasound had deep venous thrombosis of the legs.
The researchers evaluated 17 symptoms. In addition to muscle fatigue / weakness and difficulty sleeping, included low fever (prevalence of 0.0%), taste (7.3%) or smell (10.6%), palpitations (9.3%) and hair loss (21.7%). (The researchers do not know whether these symptoms started after discharge, whether they remained stable or if they worsened with hospital discharge.) They also found that 22.2% of 1,617 were experiencing anxiety or depression.
Need for close monitoring
On a Lancet Commentary, Italian researchers Monica Cortinovis, BiotechD, Norberto Perico, MD, and Giuseppi Remuzzi, MD, also highlight 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 various organs and tissues.
“This is consistent with the union nature of the COVID-19 pandemic and has implications for the long-term follow-up of COVID-19 sequelae, which in most cases must be interpreted in the context of a series of non-communicable diseases and social inequalities. and income that exacerbate the adverse effects of each of these diseases in many communities. “
Due to the small number of patients at the ICU level, the Lancet commentators say the findings for this subset are inconclusive. “However,” they add, “previous research on patient outcomes after ICU admission suggests that several patients with COVID-19 who were seriously ill during hospitalization will subsequently face deficiencies in relation to their cognitive health and mental or physical function far beyond hospital discharge. “
Cortinovis and colleagues conclude: “Unfortunately, there are few reports on the clinical picture of the consequences of COVID-19. The study … is therefore relevant and timely.”