Most COVID-19 survivors included in a study of people who were hospitalized in the early stages of the outbreak still had symptoms two years later, according to a study published Wednesday in the Lancet journal.
“To the best of our knowledge, this is the longest longitudinal follow-up study of individuals who have recovered from acute COVID-19,” said the study authors.
During a two-year evaluation, 55% of 1192 patients who had first been hospitalized at the Jun Yin-tan Hospital in Wuhan, China between Jan.
7 and May 29 2020 had at least one symptom related to their COVID-19 infection, the study showed.
Around six months after infection, 68% of the cohort had at least one symptom. At one year, that percentage went down to 49% before increasing to 55%.
Long COVID, or long-term conditions related to COVID-19 infection, have already been a concern and the U.S. Centers for Disease Control and Prevention said symptoms may last years.
American Medical Association member Dr. Devang Sanghavi, MD, an intensivist and medical director of the medical intensive care unit (ICU) at Mayo Clinic in Jacksonville, Fla., said there are three types of long COVID: ongoing symptoms stemming from cell damage, conditions related to chronic hospitalization and symptoms that appear after recovery.
According to a Wednesday article from the AMA, an estimated 10% to 30% of patients “might experience long COVID after recovering—even if they weren’t very sick in the first place.”
Fatigue or muscle weakness and sleep difficulties were the most common symptoms found in the recent study. Researchers said that there is also a high prevalence of fatigue during the recovery phase of severe acute respiratory syndrome (SARS), which could last up to four years.
“The mechanism was largely unclear, most probably due to a combination of central, peripheral, and psychological factors,” said researchers of COVID-19 related fatigue.
As for mental health issues related to COVID-19, the study found that the proportion of individuals with symptoms or anxiety or depression decreased from 23% of 1105 at 6 months to 12% of 1191 at two years. An assessment of mental health questionnaires indicated that 8% of 1187 patients had anxiety symptoms at two years, 6% of 1190 had depression symptoms, and 2% of 1189 had PTSD symptoms.
“Mental health disorders after acute COVID-19, including mainly anxiety, depression, and PTSD, have attracted widespread attention, but the prevalence varies widely among studies,” researchers said. Direct effects of SARS-CoV-2 infection, isolation, physical distancing, incomplete recovery of physical health, and financial difficulties could all be factors impacting the mental health of COVID-19 patients.
Loss of taste and smell – well-known side effects of COVID-19 infection – appeared to decrease over time, said researchers.
The study identified pulmonary fibrosis – a disease caused by scarred or damaged lung tissue – as a possible long-term outcome of COVID-19. However, difficult breathing symptoms associated with COVID-19 decreased significantly over the two-year period.
Indeed, despite a “fairly high burden of symptoms,” at two years, the study authors said that “throughout the [two] years after acute infection, hospital survivors with COVID-19 continued to recover,” regardless of the severity of infection. Areas of recovery included long-lasting symptoms, exercise capacity, mental health, and overall quality of life.
Even as patients were still reporting symptoms, many had returned to work two years after their hospitalization. According to the study, 89% of the 494 participants who had a job prior to contracting COVID-19 had returned to work. For those who didn’t return, decreased physical function, unwillingness to return, and unemployment were their reported reasons.
Overall, researchers found that COVID-19 survivors still had not returned to the same level of health as the general population two years post infection. Going forward, they plan to conduct yearly follow-ups with the study cohort.
“The value of rehabilitation [programs] in mitigating the effects of long COVID and in accelerating recovery requires further exploration,” they said. Additionally, the research team recommended further study of long COVID pathogenesis and to improve mental health evaluations related to COVID-19.