Aug. 30, 2021 -- Nearly half of people who are hospitalized with COVID-19 suffer at least one lingering symptom 1 year after discharge, according to the largest study yet to examine the recovery of a group of COVID-19 survivors 12 months after the illness.
The most common lingering symptoms are fatigue and muscle weakness. One third continue to have shortness of breath.
Overall, at 12 months, COVID-19 survivors had more problems with mobility, pain or discomfort, and anxiety or depression, and had lower self-assessment scores of quality of life than COVID-free peers, the investigators report.
The study was published online Aug. 26 in The Lancet.
"While most had made a good recovery, health problems persisted in some patients, especially those who had been critically ill during their hospital stay," Bin Cao, MD, from the National Center for Respiratory Medicine at the China-Japan Friendship Hospital in Beijing, said in a Lancet news release.
"Our findings suggest that recovery for some patients will take longer than 1 year, and this should be taken into account when planning delivery of health care services post-pandemic," Cao said.
"As the COVID-19 pandemic continues, the need to understand and respond to long COVID is increasingly pressing," says a Lancet editorial that published with the study. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01900-0/fulltext
"Symptoms such as persistent fatigue, breathlessness, brain fog, and depression could debilitate many millions of people globally. Long COVID is a modern medical challenge of the first order," the editorial board wrote.
Cao and colleagues studied 1,276 COVID-19 patients (median age 59; 53% men) discharged from a hospital in Wuhan, China, between Jan. 7 and May 29, 2020. The patients were examined at 6 and 12 months from the date they first experienced COVID-19 symptoms.
Many symptoms resolved over time, regardless of the severity of illness. Yet 49% of patients still had at least one symptom 12 months after their symptoms began, down from 68% at the 6-month mark, the authors report.
Fatigue and muscle weakness were seen in 52% of patients at 6 months and 20% at 12 months. Compared with men, women were 1.4 times more likely to report fatigue or muscle weakness.
Patients treated with corticosteroids during the acute phase of COVID-19 were 1.5 times as likely to experience fatigue or muscle weakness after 12 months compared with those who had not received corticosteroids.
Thirty percent of patients reported difficulty breathing at 12 months, slightly more than at 6 months (26%). Breathing problems were
more common in the most severely ill patients needing a ventilator during their hospital stay (39%) compared with those who did not need oxygen treatment (25%).
At the 6-month check, 349 study participants underwent lung function tests and 244 of those patients completed the same test at 12 months.
Breathing and lung function of most of these patients were normal at 12 months. But lung problems was seen in about 20% to 30% of patients who had been moderately ill with COVID-19 and as high as 54% in critically ill patients.
Compared with men, women were almost 3 times as likely to have lung problems after 12 months.
Mental Health Hit
As shown in multiple other studies, COVID-19 can take a toll on mental health. In this study, slightly more patients said they were experiencing anxiety or depression at 12 months than at 6 months (23% vs 26%), and the proportion was much greater than adults without COVID-19 (5%).
Compared with men, women were twice as likely to report anxiety or depression.
"We do not yet fully understand why psychiatric symptoms are slightly more common at 1 year than at 6 months in COVID-19 survivors," study author Xiaoying Gu, PhD, from the Institute of Clinical Medical Sciences, said in the news release.
"These could be caused by a biological process linked to the virus infection itself, or the body's immune response to it. Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness. Large, long-term studies of COVID-19 survivors are needed so that we can better understand the long term physical and mental health consequences of COVID-19," Gu said.
The authors caution that the findings represent a group of patients from a single hospital in China and included only a small number of patients who had been admitted to intensive care (94 of 1,276; 7.4%).
The Lancet editorial urges the scientific and medical community to "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 randomized controlled trials."