Roughly half of 1,276 adult COVID-19 survivors in Wuhan, China, still had at least one symptom—with a third still reporting shortness of breath—a year after their release from the hospital, finds a single-center study yesterday in The Lancet.
Led by researchers at Capital Medical University in Beijing, the study involved evaluating and interviewing COVID-19 survivors 6 and 12 months after symptom onset (Jan 7 to May 29, 2020).
Median age was 59 years, 53% were men, and median follow-up time was 185 days for the first visit and 349 for the second. A matched control group included 3,383 adults never infected with SARS-CoV-2.
Heart, breathing, mental health problems
At 6 months, 68% of patients still had at least one persistent COVID-19 symptom (eg, sleep problems, heart palpitations, joint pain, chest pain), falling to 49% at 12 months. But the proportion of patients with shortness of breath rose slightly over that period, from 26% to 30%.
Also, more patients reported anxiety or depression at 12 months than at 6 months (26% vs 23%). Six-minute walk test results weren't significantly different at the two visits. At 12 months, three patients had had an ischemic stroke, and one had developed stable angina pectoris (chest pain due to coronary artery disease).
At 6 months, 353 study participants received a chest computed tomography (CT) scan, with 52.7% showing lung abnormalities. Among the 118 patients who completed a 12-month scan, the proportion of patients with abnormalities fell substantially across all groups but remained high, especially in those who had been the most critically ill (87%).
Relative to men, women had an odds ratio (OR) of 1.43 for fatigue or muscle weakness, 2.00 for anxiety or depression, and 2.97 for impaired lung diffusion (the result of a reduction in lung perfusion and alveolar-capillary membrane conductance). Increasing age was positively associated with higher risk of anxiety or depression (OR, 1.18) and impaired diffusion (OR, 1.30), especially among those with the most severe acute illness.
At 12 months, hospitalized COVID-19 patients reported more problems with mobility, pain or discomfort, and anxiety or depression and had more prevalent symptoms than control patients. Corticosteroid treatment during the acute illness was linked to increased risk of fatigue or muscle weakness (OR, 1.51), while intravenous immunoglobulin treatment lowered that risk (OR, 0.65).
Among 479 patients who were employed before they had COVID-19, 88% had returned to their work at 12 months, 76% of them at the same level of work. Of the 12% who didn't return to their work, 32% cited decreased physical function, 25% said they were unwilling to do the same work, and 18% because they were receiving unemployment benefits.
Of the 1,252 COVID-19 patients who reported healthcare usage and work status at 12 months, 18% had visited an outpatient clinic, and 13% were hospitalized, but none were admitted to an intensive care unit. Eleven patients visited the rehabilitation department, and five took part in the professional rehabilitation program to address physical dysfunction.
Long recovery for many
The authors noted that COVID-19 survivors' health status was lower than that of the control group at 6 and 12 months. "We found that most patients had a good physical and functional recovery during follow-up, and the majority of study participants who were employed before COVID-19 had returned to their original work," they wrote.
"However, sequelae symptoms, lung diffusion impairment, and radiographic abnormalities persisted to 12 months in some patients, especially in patients who were critically ill during hospital stay."
In a Lancet news release, senior author Bin Cao, MD, of the National Center for Respiratory Medicine at the China-Japan Friendship Hospital, said that the study has important implications for COVID-19 patient care. "Our findings suggest that recovery for some patients will take longer than one year, and this should be taken into account when planning delivery of healthcare services post-pandemic," he said.
In a commentary, the Lancet editorial board said that the study highlights the need for more robust health services for COVID-19 long-haulers.
"First, only 0.4 of patients with COVID-19 said that they had participated in a professional rehabilitation programme," they wrote. "The reason for such low use of rehabilitation services is unclear, but poor recognition of long COVID and lack of clear referral pathways have been common problems worldwide."
Second, they said, research is urgently needed on the mental health effects of long-haul COVID-19 and persistent symptoms in other patient groups, such as those not admitted to a hospital, younger age-groups, and racial minorities and other disadvantaged groups disproportionately affected by the pandemic.
"The scientific and medical communities must collaborate to explore the mechanism and pathogenesis of long COVID, estimate the global and regional disease burdens, better delineate who is most at risk, understand how vaccines might affect the condition, and find effective treatments via randomised controlled trials," the board wrote.