Three studies spotlight long-term burden of COVID in US adults

Long COVID dominos

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Three new studies shed new light on long COVID in the United States, with one finding that two thirds of severely ill patients reported persistent impairments for up to 1 year, another showing that US veterans were at three times the risk of preventable hospitalization in the month after infection, and the last revealing that one third of COVID-19 survivors had lingering symptoms at one time.

57% of very ill had persistent physical problems

Today in Critical Care Medicine, University of California San Francisco (UCSF) researchers  describe their study of 156 critically ill COVID-19 patients transferred to long-term acute-care hospitals in Georgia, Kentucky, Nebraska, and Texas for weaning from ventilation and rehabilitation from March 2020 to February 2021. 

Patients completed online or phone interviews 1 year after hospital release. The average patient age was 65, and average hospital stay was 2 months. Most spent an average of 1 month on mechanical ventilation and were healthy before their infection.

Of the 156 patients, almost two-thirds (64%) said they had a persistent impairment, including physical (57%), respiratory (49%), psychiatric (24%), and cognitive (15%) problems, 1 year later. Nearly half (47%) reported more than one type of impairment, and 19% still needed supplemental oxygen. 

"We have millions of survivors of the most severe and prolonged COVID illness globally," first author Anil Makam, MD, said in a UCSF news release. "Our study is important to understand their recovery and long-term impairments, and to provide a nuanced understanding of their life-changing experience."

About 79% of patients said they hadn't fully recovered at 1 year, 99% were back at home, and 60% of the previously employed had returned to work. Many patients said they were more affected by hospital-related issues such as bedsores and nerve damage that limited use of their extremities than by COVID-related problems. Participants attributed improvement to exercise and rehabilitation, support, and time.

"The long-lasting impairments we observed are common to survivors of any prolonged critical illness, and not specific to COVID, and are best addressed through multidisciplinary rehabilitation," Makam said.

Veterans at much higher risk for 1 year

Today in JAMA Network Open, a team led by researchers from the Veterans Affairs (VA) Portland Health Care System in Oregon used an emulated-target randomized trial design with monthly sequential trials to compare the risk of potentially preventable hospitalization among COVID-infected veterans to those of matched uninfected controls.

The study enrolled 189,136 veterans diagnosed as having COVID-19 from March 2020 to April 2021 and 943,084 controls. The average patient age was 60.3 years, 89.1% were men, 69.4% were White, and 23.4% were Black. The primary outcome was a potentially preventable hospitalization at a VA facility, VA-purchased community care, or Medicare fee-for-service care.

"Delayed or inadequate treatment of ambulatory care–sensitive conditions (acute or chronic conditions that can be treated effectively through quality ambulatory care [ACSCs]) can result in hospitalization," the study authors wrote. 

An increased risk of preventable hospitalization in veterans with SARS-CoV-2 ... highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system.

"Thus, hospitalizations for ACSCs (hereinafter referred to as potentially preventable hospitalizations) are widely recognized as an indicator of ambulatory care access and quality. They are also increasingly used as a measure of health system performance during public health emergencies." 

A total of 3.1% of participants (3.8% of COVID-19 survivors and 3.0% of controls) had a potentially preventable hospitalization during the 1-year follow-up. The risk of hospitalization was higher among COVID-19 survivors at 0 to 30 days (adjusted hazard ratio [AHR], 3.26), 0 to 90 days (AHR, 2.12), 0 to 180 days (AHR, 1.69), and 0 to 365 days (AHR, 1.44).

"In this cohort study, an increased risk of preventable hospitalization in veterans with SARS-CoV-2, which persisted for at least 1 year after initial infection, highlights the need for research on ways in which SARS-CoV-2 shapes postinfection care needs and engagement with the health system," the researchers wrote. "Solutions are needed to mitigate preventable hospitalization after SARS-CoV-2."

17 million adults currently have long COVID

Yesterday, KFF reported its latest long-COVID data, which show that rates of the condition have remained relatively steady for a year, suggesting that the burden will persist unless new methods of prevention and treatment are developed.

The data follow the March 2024 release of updated Centers for Disease Control and Prevention (CDC) COVID-19 recommendations, which don't instruct people to isolate after testing positive. 

"The new CDC guidance brings a unified approach to the risks from respiratory viruses and reflects the nation’s progress against severe illness from COVID-19," wrote author Alice Burns, PhD, KFF associate director of the Program on Medicaid & Uninsured. 

Although rates of long COVID have stabilized, the 17 million adults with long COVID may experience many employment and material hardships.

"However, as the nation moves further from the COVID-19 pandemic, rates of long COVID remain steady and 7% of all adults—roughly 17 million people—reported currently having long COVID in March 2024."

Among the findings:

  • Of adult COVID-19 survivors (60%), 3 in 10 report having long COVID at one time, and about 1 in 10 say they still have it.
  • Roughly 17 million adults currently have long COVID.
  • A total of 79% of adult with long COVID say their condition has limited their participation in activities, with 25% reporting it limits their activities "a lot."
  • Persistent symptoms occur most often among people who are transgender or have disabilities.
  • Regarding COVID-19 as just another respiratory virus may make accessing healthcare more difficult for groups disproportionately affected by persistent symptoms.
  • A total of 5% to 10% of adults may continue to have long COVID at any point, and research to improve diagnosis and treatment takes time. 

"Although rates of long COVID have stabilized, the 17 million adults with long COVID may experience many employment and material hardships, with 4 in 10 reporting food insecurity, 2 in 10 reporting difficulty paying rent or mortgage, and 1 in 10 reporting that they had to stop working for a period of time because of their symptoms," Burns wrote.

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