COVID-19 impact does not end with hospital discharge

A hospital discharge is not always the end of the disease for COVID-19 patients, according to recent research.  A team in China has examined COVID patients six months after discharge and reported long-term health effects. 

The ongoing COVID-19 pandemic has infected many millions since its emergence in December 2019.  Although most infected people experience mild symptoms, severely ill patients require hospitalization. While the main aspects of COVID-19 during the acute phase have been extensively investigated, the long-term consequences of the disease remain unclear. 

Bin Cao of the China-Japan Friendship Hospital and Capital Medical University in Beijing, who led the new study, explains that lasting physical and psychological effects have been seen in patients with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), which suggests that COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)could similarly affect discharged patients. “These long-term sequelae urgently need to be understood,” he says.

Cao says that this study includes the largest cohort with the longest follow-up time for potential sequelae in COVID-19 adult patients. The researchers examined 1733 patients released from the first COVID-19-designated hospital in Wuhan, China between January and May 2020. The follow up visit occurred on average about six months after symptom onset and five months after discharge. 

To investigate long-term effects in detail, the researchers used multiple diagnostic tools to evaluate new and persisting symptoms, changes in lung function and physiology, and quality of life. For the first time, they also determined how the disease impacts other organs. 

They observed at least one symptom in 76% of the patients, predominantly fatigue or muscle weakness, anxiety or depression and sleep difficulties.  Reduced lung function and abnormal chest images reminiscent of SARS sequelae were seen in over one third of the patients, especially those who received oxygen support and mechanical ventilation. Some COVID-19 survivors exhibited emerging signs of impaired kidney function, diabetes, and blood clots.

 “This means that many people have not recovered completely six months after symptom onset,” Cao says. “We should continue follow-up and monitor the recovery of these patients after discharge.”

Certain patients showed a dramatic drop in SARS-CoV-2-targeting antibody levels after discharge. The protective ability of these antibodies is unknown, but “their decrease definitely raises concern about COVID-19 reinfection,” Cao says.

“We still do not know how long it takes to recover fully or whether complete recovery is possible,” Cao says. The team is currently extending the follow-up of these patients to 12 months to further assess COVID-19 consequences and better understand recovery. 

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