A team of scientists from the United Kingdom has recently conducted a multicenter, prospective cohort study to investigate long-term consequences of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The findings reveal that a significant proportion of COVID-19 recovered individuals present with persistent complications, including severe fatigue, breathlessness, development of new disability, and diminished quality of life. The study is currently available on the medRxiv* preprint server.
Since the emergence of the COVID-19 pandemic, many studies have been done to characterize the clinical consequences of SARS-CoV-2 infection. Ample evidence is now available to demonstrate the wide-range of symptoms observed in mild, moderate, or severe COVID-19 patients. Moreover, with the progression of the pandemic, it is becoming more evident that many COVID-19 recovered patients develop long-term symptoms, which is commonly known as long-COVID.
Regarding active SARS-CoV-2 infection, it is now well-established that although most COVID-19 patients remain asymptomatic or mildly symptomatic, the risk of developing serious complications is high among older adults and those with pre-existing comorbidities. However, sufficient information is not available to identify at-risk individuals who are more likely to develop long-COVID.
In the current study, the scientists have characterized the long-term symptoms reported by COVID-19 recovered individuals who had been hospitalized during the course of active SARS-CoV-2 infection.
The study was conducted on a total of 327 hospitalized COVID-19 patients who were discharged from the hospitals at least 90 days before the commencement of the study. The enrolled patients were from 31 hospitals in the UK. A questionnaire-based survey was conducted wherein the patients self-reported their recovery status at least 90 days after the onset of the first COVID-19 symptom.
The primary parameter assessed in the survey was patient-reported recovery at 3 – 12 months after the onset of initial COVID-19 symptom. In addition, the patients were asked to mention persistent or newly developed symptoms, newly developed disabilities, fatigue level, breathlessness, and overall quality of life.
Among the participants, the majority were male and of white ethnicity. The most commonly reported comorbidities were asthma and diabetes.
According to the survey data, about 55% of all participants reported not feeling recovered at follow-up time. The participants who had severe COVID-19 were found to be more likely to feel not fully recovered.
Importantly, the majority of participants (93%) reported persistent or new symptoms, with fatigue being the most frequently reported symptom. Other reported symptoms were breathlessness and sleep disturbance. Specifically, two major groups of symptoms were identified in the study: 1) fatigue, myalgia, and sensorineural deficits; and 2) olfactory, appetite, and urinary problems.
About 47% of participants mentioned experiencing higher breathlessness compared to their pre-COVID baseline. In general, female participants and those admitted to critical care units were found to be more susceptible to develop breathlessness during follow-up.
Although most participants reported experiencing fatigue during follow-up, no correlation was observed between the intensity of fatigue and the in-hospital COVID-19 severity. However, the susceptibility of developing fatigue was found to be higher among females than males.
The most commonly reported post-COVID disabilities were walking and mobility, followed by memory and concentration. In general, visual, memory, and walking disabilities were found to be more common among females than males.
An overall reduction in quality of life was observed among study participants. In this context, the most commonly reported contributing factors were anxiety and/or depression, pain and/or discomfort, and impaired daily activities. All these complications were found to be higher among females than males.
Factors contributing to long-COVID
A series of statistical analyses were conducted in the study to identify the contributing factors for long-COVID. The findings revealed that female participants under the age of 50 years were less likely to feel completely recovered during follow-up. A similar trend was observed for participants who received invasive mechanical ventilation in hospitals. Importantly, no correlation was observed between participant’s age and their post-COVID long-term symptoms. However, participants with comorbidities were found to be more likely to experience fatigue, disability, and reduced quality of life.
The study reveals that a significant proportion of COVID-19 patients are at higher risk of experiencing persistent symptoms even several months after recovery. In general, females and critically ill patients are more likely to develop long-term complications, such as fatigue, breathlessness, disability, and reduced quality of life.
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.