- Majority of patients hospitalised with COVID-19 have not fully recovered after five months
- Those who experience more persistent symptoms tend to be middle-aged, white, female, with underlying health conditions
- Little relationship between the severity of initial illness and ongoing symptoms
- Cognitive impairment, also referred to as ‘brain fog’, occurs as a predominant symptom in a sub-set of patients who tend to be older and male
Seriously ill Covid-19 patients continued to experience negative impacts on their physical and mental health several months after discharge from hospital, according to a major UK study into the long-term impacts of the disease.
The University of Dundee’s Professor James Chalmers, who represents Scotland on the PHOSP-COVID study management board, said the results showed the need for a comprehensive plan for dealing with the large number of Scottish Long Covid patients requiring care over the next year and beyond.
The research found that the majority of survivors who left hospital following Covid-19 did not fully recover five months after discharge and found their ability to work severely impaired. Furthermore, one in five participants reached the threshold for a new disability.
The UK-wide study, led by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre and jointly funded by the NIHR and UK Research and Innovation (UKRI), analysed 1077 patients who were discharged from hospital between March and November 2020 following an episode of Covid-19.
Researchers found that each participant had an average of nine persistent symptoms. The ten most common symptoms reported were: muscle pain, fatigue, physical slowing down, impaired sleep quality, joint pain or swelling, limb weakness, breathlessness, pain, short-term memory loss, and slowed thinking.
Patients were also assessed for mental health. The study reports that over 25% of participants had clinically significant symptoms of anxiety and depression and 12% had symptoms of post-traumatic stress disorder (PTSD) at their five-month follow-up appointment.
Of the participants employed before contracting Covid-19, 17.8% were no longer working, and nearly a fifth had experienced a health-related change in their occupational status.
Professor Chalmers said, “These results are shocking in the sense that so few patients have fully recovered five months after their stay in hospital and it shows once again that this disease has a long tail that we are only beginning to understand.
“One of the most important things about this study is that it is not necessarily those patients who found themselves in ICU who continue to experience these symptoms. Even those who would have been regarded as being mildly ill continue to suffer, showing that we cannot predict who will experience these symptoms on the severity of the initial illness.
“This pre-print looks at data from the first 1000 patients on the PHOSP-COVID study. We will continue to follow up with these participants up to a year after their discharge and we need to enroll many more volunteers to keep learning more about the ongoing effects of Covid-19.
“Although this is a UK-wide study, it highlights the need for a comprehensive plan for the treatment of Long Covid patients in Scotland. Over the next year there will be a large number of Scots experiencing these symptoms and we need a strategy in place to aid their rehabilitation and help them return to work.”
The researchers were able to the classify types of recovery into four different groups or ‘clusters’ based on the participants’ mental and physical health impairments.
One cluster group in particular showed impaired cognitive function, or what has colloquially been called ‘brain fog’. Patients in this group tended to be older and male. Cognitive impairment was striking even when taking education levels into account, suggesting a different underlying mechanism compared to other symptoms.
Chris Brightling, Professor of respiratory medicine at the University of Leicester and the chief investigator for the PHOSP-COVID study, said, “While the profile of patients being admitted to hospital with Covid-19 is disproportionately male and from an ethnic minority background, our study finds that those who have the most severe prolonged symptoms tend to be white women aged approximately 40 to 60 who have at least two long term health conditions, such as asthma or diabetes.”
The research has also uncovered a potential biological factor behind some post-Covid symptoms. In all but the mildest of these cases, levels of a chemical called C-reactive protein [CRP], which is associated with inflammation, were elevated. Systemic inflammation is associated with poor recovery from illnesses across the disease spectrum.
Autoimmunity, where the body has an immune response to its own healthy cells and organs, is more common in middle-aged women. This may explain why post-Covid syndrome seems to be more prevalent in this group.
One of the purposes of the PHOSP-COVID study is to measure the impact of medicines given during hospitalisation to see if they affect patients’ recovery. Early indicators from the study show that while giving corticosteroids is a factor in reducing mortality in hospital, it does not appear to have an impact on longer term recovery.
There are more than 300,000 post-hospitalisation survivors in the UK that have been discharged from hospital following Covid-19. While the study only represents a small sample of these patients, and participants are younger than the whole population in the UK that survived Covid-19 hospitalisation, this is the largest study to report in detail on prospectively assessed outcomes across multiple UK centres to describe the impact of Covid-19 on the medium-term health of survivors.
Health and Social Care Secretary, Matt Hancock, said, “I know Long Covid can have a lasting and debilitating impact on the lives of those affected and I'm determined to improve the care we can provide.
“Studies like this help us to rapidly build our understanding of the impact of the condition and we are working to develop new research so we can support and treat people. We are learning more about Long Covid all the time and have given £20 million research funding to support innovative projects, with clinics established across the country to help improve the treatment available.”
The pre-print, ‘Physical, cognitive and mental health impacts of COVID-19 following hospitalisation: a multi-centre prospective cohort study’, which is yet to be peer-reviewed, will be available at https://connect.medrxiv.org/relate/content/181