Only 1 in 4 patients with COVID who were hospitalized fully recover a year after discharge

More than 505 million people have been diagnosed with coronavirus infection. More than 6.2 million have died. Although most of those affected develop a mild or moderate condition, COVID-19 can leave sequelae after the acute phase, especially in people who required hospitalization. A scientific study conducted in the UK found that only 1 in 4 patients who were infected with the coronavirus and had to be hospitalized recovered within a year of having the infection.

The work was done in the UK with more than 2,000 patients who had been hospitalized with COVID-19. It was presented days ago at the European Congress of Clinical Microbiology and Infectious Diseases, held in Lisbon, Portugal. It was also published in the specialized magazine The Lancet Respiratory Medicine.

Under the direction of Professor Christopher Brightling, Rachael Evans, and Louise Wain, from the Leicester Biomedical Research Centre of the National Institute for Health Research, the University of Leicester, and other institutions, it was demonstrated after a year of having COVID-19, only one in four patients who required hospitalization recovered completely.

The authors found that women are 32% less likely to have recovered within a year of having had the infection. Also suffering from obesity (50%) and having assisted breathing in the hospital (58% less) were associated with a lower probability of a full recovery in one year. The most common symptoms in persistent COVID were fatigue, muscle pain, body slowdown, poor sleep, and difficulty breathing.

The researchers used information from the PHOSP-COVID study in which adults (aged 18 and over) who were hospitalized for COVID-19 in the United Kingdom and later discharged were evaluated. Patients from 39 hospitals of the National Health Service (NHS) in the United Kingdom who accepted follow-up at five months and a year were included, in addition to their hospital care. The researchers took blood samples from the participants at five months to test for the presence of several inflammatory proteins.

A total of 2,320 patients were discharged from hospital between March 7, 2020 and April 18, 2021. All of them were evaluated 5 months after their discharge and 807 (33%) participants completed the 5-month and year-long follow-ups at the time of this analysis (as the study is still ongoing). The 807 patients had a mean age of 59 years, 279 (36%) were women and 28% received invasive assisted breathing. The proportion of patients who were reported as fully recovered was similar between 5 months and one year.

In a previous publication of the research, the authors had identified four groups or 'clusters' of severe symptoms at five months, which were confirmed in this new study conducted every year. Of the 2,320 participants, enough information was obtained from 1,636 of them to assign them to a cluster: 319 (20%) had a very serious deterioration in physical and mental health, 493 (30%) had a serious deterioration in physical and mental health, 179 (11%) had a deterioration in physical health with moderate cognitive problems, and 645 (39%) had a mild deterioration in physical and mental health.

Obesity or reduced ability to exercise, a greater number of symptoms and increased levels of the C-reactive protein biomarker were associated with people being in the most severe groups. In cases of very severe and moderate clusters of cognitive problems, levels of the inflammatory biomarker interleukin-6 (IL-6) were higher than in the mild cluster.

The authors noted that it was surprising “the poor recovery after hospitalization from 5 months per year in our study through symptoms, mental health, exercise capacity, organ deterioration and quality of life”.

They also commented: “We found that females and obesity are greater risk factors for not recovering every year. In our clusters, females and obesity were also associated with ongoing serious health problems including reduced exercise and a quality of life with respect to their health per year, potentially highlighting a group that may need a higher intensity of procedures such as supervised rehabilitation.”

On the lack of treatments for persistent COVID, the authors noted: “There are no specific therapies for persistent COVID and our information highlights the need for effective procedures as a matter of urgency. Our results on persistent systematic inflammation, particularly in the very severe and moderate cases of groups of cognitive problems, suggest that these groups may respond to anti-inflammatory strategies.”

They also stressed that after the acute phase of the disease in patients requiring hospitalization, consideration should be given to integrating medical care that covers both physical and mental health. “The agreement of severity in the physical and mental health problems that develop in persistent COVID highlights not only the need for close integration into the physical and mental health care of patients with persistent COVID, including assessments and treatments, but also the transfer of knowledge among health professionals in order to improve patient care,” they said.

In addition, the results also suggest the need for complex procedures aimed at alleviating symptoms of physical and mental health impairment. However, specific therapies may also be needed to control post-traumatic stress.

The researchers concluded that their study “highlights the urgent need on the part of health services to support this rapidly growing population group suffering from a substantial burden of symptoms, including reduced exercise capacity and deterioration in the quality of life with regard to their health one year after hospital discharge”.

Without effective treatments, persistent COVID could become a very frequent long-term condition, the researchers warned. In addition, “our study provides a basis for research into treatments for persistent COVID with a medically accurate approach to focus treatments on individualized patient profiles for the recovery of their health-related quality of life.”

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