More than half of patients hospitalized for COVID-19 in Wuhan, China, during the initial outbreak reported at least one symptom a couple of years later, researchers found.
The proportion of COVID-19 survivors with at least one sequelae symptom 2 years later came in at 55%, and the most frequent symptoms were fatigue or muscle weakness, reported Bin Cao, MD, of China-Japan Friendship Hospital in Beijing, and colleagues.
In addition, 12% of patients reported symptoms of anxiety or depression 2 years later, they wrote in Lancet Respiratory Medicine.
“Regardless of initial disease severity, COVID-19 survivors had longitudinal improvements in physical and mental health, with most returning to their original work within 2 years; however, the burden of symptomatic sequelae remained fairly high,” the group wrote. “COVID-19 survivors had a remarkably lower health status than the general population at 2 years.”
Cao and colleagues examined data from 1,192 patients with COVID discharged from Jinyintan Hospital in Wuhan from Jan. 7 to May 29, 2020. Of those, 94% did a face-to-face interview 2 years following infection. Median age at discharge was 57, and 54% of patients were men. Almost 70% of patients received supplementary oxygen, while 8% received “higher-level” respiratory support, and 4% were admitted to intensive care, with a median length of stay of 18 days.
“To the best of our knowledge, this is the longest longitudinal follow-up study of individuals who have recovered from acute COVID-19, systematically and comprehensively describing the longitudinal evolution of health and functional outcomes among COVID-19,” the authors wrote.
Cao’s group found that the proportion of COVID survivors reporting at least one symptom decreased significantly from 68% at 6 months to 55% at 2 years (P<0.0001). The percentage of patients with a 6-minute walking distance test less than the lower limit of normal declined from 6 months to 2 years (14% vs 8%, respectively), as did the proportion of patients with dyspnea (14% vs 26%, respectively, based on a British Medical Research Council dyspnea scale score of 1).
Also, 89% of participants with a job prior to the pandemic returned to their original work 2 years later, regardless of symptoms. Those who did not return cited decreased physical function, unwillingness to return, and unemployment.
Adjusted analyses found that those with long-COVID symptoms were more likely to experience the following versus those without long-COVID symptoms:
- Anxiety or depression: adjusted odds ratio (aOR) 7.46 (95% CI 4.12-13.52)
- Pain or discomfort: aOR 4.42 (95% CI 3.14-6.21)
- Mobility problems: aOR 3.81 (95% CI 1.62-8.93)
Cao’s group then examined 1,172 matched pairs of COVID survivors and those without COVID infection (controls). Compared with the latter, a significantly higher proportion of COVID survivors experienced problems with pain or discomfort, anxiety or depression, and had a significantly lower median of self-assessment scores of quality of life, they reported.
Among the COVID-19 survivors who took part in the three assessments, there were 230 participants who completed pulmonary function tests 2 years later. There was no significant difference among those with lung diffusion impairment versus those who completed the test at 6 months and 12 months, except among those with severe disease, according to the authors. Compared to matched controls, a significantly higher percentage of survivors with a disease scale of 5-6 experienced lung diffusion impairment (65% vs 36%, P=0.0009), reduced residual volume (62% vs 20%, P<0.0001), and total lung capacity (39% vs 6%, P<0.0001).
Adjusted analyses found that women had higher odds of fatigue or muscle weakness, anxiety or depression, and lung diffusion impairment versus men. Corticosteroid therapy was also associated with higher risks of fatigue or muscle weakness, they added.
Study limitations included the lack of a control group of hospital survivors with a respiratory infection other than COVID, so there was no way to tell if these abnormalities are specific to COVID. There may have also been participation bias, where participants with fewer symptoms might have been less likely to participate. Finally, the data came from a single center early in the pandemic, which may limit its generalizability.
“Ongoing follow-up of COVID-19 survivors, particularly those with symptoms of long COVID, is essential to understand the longer course of the illness, as is further exploration of the benefits of rehabilitation [programs] for recovery,” said Cao in a statement. “There is a clear need to provide continued support to a significant proportion of people who’ve had COVID-19, and to understand how vaccines, emerging treatments, and variants affect long-term health outcomes.”
The study was supported by the Chinese government, China Evergrande Group, Jack Ma Foundation, Sino Biopharmaceutical, Ping An Insurance (Group), and New Sunshine Charity Foundation.
Cao and co-authors disclosed no relationships with industry.