The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by the rapid outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has claimed more than 6.52 million lives worldwide. The emergence of SARS-CoV-2 variants due to genomic mutations prolonged the pandemic. Some variants of SARS-CoV-2, such as Omicron and Delta, are more transmissible and virulent than the parent strain.
Although most patients with COVID-19 recover from acute infection, some experience long-term health problems related to cognitive, physical, and psychological problems that significantly impair their quality of life. Therefore, conducting regular follow-ups of patients with COVID-19 discharged from hospitals is important. These studies will help understand the trajectory of symptom severity as well as long-term health outcomes associated with SARS-CoV-2 infection.
Previous research has revealed that patients with COVID-19 who require intensive care unit (ICU) treatment continue to experience physical, mental or cognitive symptoms even a year after being discharged from the hospital. Understanding the duration of persistence of COVID-19-related symptoms is imperative.
Recently JAMA Network Open The study assessed the dynamic trajectory of the severity of COVID-19 symptoms as well as the persistence of symptoms in those who survived SARS-CoV-2 infection for two years after hospital discharge.
About the research
In this longitudinal cohort study, the researchers collected data on survivors of COVID-19 who were discharged from Taikang Tongji and Huoshenshan Hospitals. Both hospitals are located in Wuhan, China.
All participants were interviewed by telephone after the first and second year of discharge from the hospital. The second year follow-up survey was conducted between March 1, 2022 and April 6, 2022.
In addition to the telephone interview, all participants also provided a self-reported symptom questionnaire along with a chronic obstructive pulmonary disease (COPD) assessment test (CAT). Participants’ symptoms were recorded as no problems, mild problems, moderate problems, or severe problems. Patients with at least one persistent symptom of COVID-19 present with prolonged COVID.
It was found that a total of 370 patients viz. 19.8% of the study cohort experienced symptoms of COVID-19 two years after being discharged from the hospital. 12.0% of the study cohort reported persistent symptoms, while 7.8% of patients had new-onset or worsening symptoms from a reported level of mild symptoms at first-year follow-up.
Some common symptoms experienced by participants are chest tightness, fatigue, dyspnea, myalgia, and anxiety. Most of the symptoms disappeared with time. Although dyspnea lasts longer, it subsides after one year. The results of this study are consistent with previous studies that have revealed a trend toward a reduction in symptoms over time.
In this study, a higher risk of symptom persistence was associated with ICU admission. In addition, infection with COVID-19 in patients with cerebrovascular disease is associated with the appearance of new symptoms. 6.2% of participants showed CAT scores of at least 10. The present study observed a higher risk of symptom persistence in recovered patients with COVID-19 who required intensive care unit care during their hospital stay or had chronic liver disease.
Chronic liver disease has been identified as an important factor associated with the risk of symptom persistence. Additionally, a CAT score of 10 and above also indicates a greater likelihood of experiencing prolonged symptoms of COVID-19.
Limitations of the study
The authors highlight several limitations, including the lack of a control group matched for age and comorbidities. Because of this limitation, the long-term symptoms of the patients’ acute illness could not be determined. Another weakness of the present study is the loss of participants, especially older patients, during follow-up. Age distribution is an important aspect, as it is considered an effect modifier of symptoms after COVID-19.
The current study also used a self-report symptom questionnaire instead of diagnostic instruments, which increases the risk of bias due to participant subjectivity. The number of symptoms examined in this study was small, given the fact that more than a hundred symptoms related to COVID-19 have been reported. The emergence of SARS-CoV-2 variants is endemic, which could alter the virulence and long-term consequences compared to the data analyzed in the present study.
The current longitudinal cohort study, which included survivors of COVID-19 after two years of hospital discharge, revealed that the common symptoms that persisted over a long period of time were fatigue, anxiety, chest tightness, dyspnea and myalgia. Although most of these symptoms resolved, dyspnea continued to decrease over time. Severely infected patients with COVID-19 who require admission to the intensive care unit are at higher risk of persisting symptoms. This study provided insight into the dynamic trajectory of health outcomes in survivors of COVID-19.