Studies reveal burden of long Covid

The majority of people hospitalised by Covid-19 have not fully recovered months after discharge, two major studies have revealed.

Long term symptoms were found to affect physical and mental health with many reporting a cognitive impairment – or brain fog – as well as breathlessness and disability months after discharge.

Women in middle-age are most affected by symptoms of long Covid, according to both studies, which could have implications for policy makers, say researchers.

Covid-19 survivors

There are more than 300,000 survivors in the UK that have been discharged from hospital following Covid-19, including 20,000 in Scotland.

Researchers from PHOSP COVID – the largest study to describe the impact on medium term health of survivors – analysed 1077 patients who were discharged from hospital between March and November 2020 following treatment for Covid-19.

UK-wide study

The UK-wide study, which involved Edinburgh researchers, found that seven in ten survivors did not fully recover five months after discharge and continued to experience poor health.

Furthermore, one in five of the participants reached the threshold for a new disability.

Less than a third of survivors described themselves as fully recovered five months after discharge from hospital. People with severe COVID-19 disease admitted to intensive care were most likely to have ongoing symptoms. Given that over 20,000 people have been admitted with COVID-19 to hospitals in Scotland, this study highlights the need for comprehensive care for hospital survivors of Covid-19.

Common symptoms

The team, which included researchers from the University’s Usher and Roslin Institutes, found that each participant had an average of nine persistent symptoms.

The most common symptoms reported were muscle pain, physical slowing down, impaired sleep quality, joint pain or swelling, limb weakness, breathlessness, pain, short-term memory loss, and slowed thinking.

More than 25 per cent of participants had clinically significant symptoms of anxiety and depression and 12 per cent had symptoms of post-traumatic stress disorder (PTSD) at their five-month follow-up.

Effects

The study found that white women aged around 40 to 60 and with at least two long term health conditions, such as asthma or diabetes, were most likely to have the most severe long-term symptoms.

Of the 68 per cent of participants who were working before Covid-19, almost 18 per cent were no longer working, and nearly 20 per cent experienced a health-related change in their occupational status.

Further evidence

A separate study, led by the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC), has also revealed the toll of long Covid.

ISARIC’s Clinical Characterisation Protocol study, which involved experts from the University’s Usher Institute, showed that nearly all adults admitted to hospital experienced some degree of ongoing symptoms three months or more after the onset of their Covid-19 infection.

Overall, 55 per cent of participants reported that they did not feel fully recovered. Ongoing symptoms were reported by 93 per cent of participants, with similar common symptoms reported in the PHOSP study, including fatigue, breathlessness and muscular pain.

It is becoming increasingly clear that Covid-19 has profound consequences for those who survive the disease. It's really important that people living with the consequences of Covid-19 get the right support they need. Governments, both in the UK and across the world, need to think about the impact this will have in the long-term and fund urgent research to find treatments for long Covid.

Quality of life

The study looked at the impact of Covid-19 on the day-to-day functioning and quality of life of 327 adults from 31 hospitals around the UK who had been admitted to hospital between 5 February 2020 and 5 October 2020.

Participants were contacted between three and 11 months via telephone to document their physical and psychological health and their quality of life.

Impact on women

This study also showed that women were disproportionately affected. Women under the age of 50 years-old in the ISARIC study were five times less likely to report feeling fully recovered.

They were also twice as likely to report worse fatigue andwere seven times more likely to be more breathless.

Younger women were more likely to have worsening difficulties or a new disability – especially relating to memory, mobility and communication but also vision, hearing and self-care – than men of the same age in the study.

These findings were present even in young, previously healthy working age adults, and were most common in younger females. The fact that women under the age of 50 are the group with the worst outcomes could have profound implications for pandemic policy decision, as well as vaccination strategy.

Inflammation

The PHOSP COVID researchers also uncovered a potential biological factor behind some post-Covid symptoms.

They found levels of C-reactive protein – a chemical associated with inflammation – was elevated in almost all but the mildest cases five months after patients were discharged from hospital. Inflammation is known to be associated with poor recovery from illness.

Immunity

Also, autoimmunity – where the immune system responds to its own healthy cells – is more common in middle-aged women, which may help to explain why Long Covid seems to be more prevalent in this group, experts say.

The authors note that the studies represent a small sample of Covid patients, and that many people living in the community who were not hospitalised could also be affected.

Collaboration

The PHOSP COVID study is led by the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre. It is funded by the MRC-UK Research and Innovation, and NIHR and by core funding provided by NIHR Leicester Biomedical Research Centre - a partnership between the University Hospitals of Leicester NHS Trust, the University of Leicester and Lounghborough University.

The ISARIC Long Covid study was funded by the NIHR, MRC-UKRI, Wellcome and the Bill and Melinda Gates Foundation. The study is led by the University of Glasgow in collaboration with the Universities of Edinburgh, Oxford, Liverpool and Imperial College London, working with ISARICs global Covid-19 follow up working group.

Both papers have been published as preprints and have been submitted to journals to undergo peer review.

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