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Disclosures: The authors report no relevant financial disclosures.
April 30, 2021
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COVID-19 ‘long-haulers’ face ‘substantial burden of health loss’

Disclosures: The authors report no relevant financial disclosures.
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Patients more than 30 days out from a COVID-19 diagnosis experience an excess burden of a variety of health conditions, and even patients with mild cases face an increased risk for death in the ensuing 6 months, researchers reported.

The findings, published in Nature, are from a study of more than 86,000 people who had COVID-19 — believed to be the largest study of so-called COVID-19 “long-haulers” to date, the researchers said.

Doctor Holding Test Tube That Reads COVID-19
Beyond the first 30 days of illness, COVID-19 survivors had increased risk of death and faced a substantial burden of health loss.
Credit: Adobe Stock.

“We have been hearing a lot and seeing patients who did not fully recover from acute COVID-19. Some people were complaining about shortness of breath, some about memory problems, and some were having blood clots months after the initial infection,” Ziyad Al-Aly, MD, FASN, director of the Clinical Epidemiology Center and chief of the research and education service at the Veterans Affairs Saint Louis Health Care System, told Healio. “So, we decided to take a comprehensive look at all the clinical manifestations that may be encountered in 30-day survivors of COVID-19 — people who survive the acute phase of the illness.”

Al-Aly and colleagues used the national health care databases of the United States Department of Veterans Affairs to identify 6-month incident sequelae, including diagnoses, medication use and laboratory abnormalities in 30-day survivors of COVID-19.

Ziyad Al-Aly

The cohort included 73,435 nonhospitalized patients with COVID-19 who survived at least the first 30 days after diagnosis and 4,990,835 matched controls, and 13,654 hospitalized patients with COVID-19 and 13,997 hospitalized patients with seasonal influenza.

Overall, the study demonstrated that beyond the first 30 days of illness, nonhospitalized COVID-19 survivors had a nearly 60% increased risk for death (HR = 1.59; 95% CI, 1.46-1.73) and a 20% increased risk for outpatient care encounter (HR = 1.2; 95% CI, 1.19-1.21). The researchers estimated that 8.39 excess deaths occurred per 1,000 people (95% CI, 7.09-9.58) in this cohort at 6 months.

Beyond 30 days, hospitalized patients with COVID-19 faced a 51% increased risk for death (HR = 1.51; 95% CI, 1.3-1.76), and excess deaths at 6 months in this group were measured to be approximately 29 per 1,000 people (95% CI, 19.51-36.85).

Additionally, Al-Aly and colleagues evaluated the risk for 379 diagnoses of diseases possibly related to COVID-19 occurring beyond the first 30 days and found that COVID-19 survivors faced a “substantial burden of health loss” involving nearly every organ and regulatory system in the body.

According to the study, survivors faced an excess burden of respiratory conditions more so than any other set of conditions, including respiratory failure, insufficiency, arrest and lower respiratory disease. Excess burden of nervous system disorders, cardiovascular conditions and gastrointestinal problems were evident, including neurocognitive disorders and headache, hypertension, cardiac dysrhythmias, circulatory signs and symptoms and chest pain, and esophageal disorders, abdominal pain and an increased use of laxatives, histamine antagonists, antacids and antidiarrheal agents, the researcher reported.

Additionally, COVID-19 survivors faced an excess burden of mental health issues including sleep/wake disorders, anxiety and fear-related disorders and trauma and stress-related disorders, as well as poor general well-being, which included symptoms such as fatigue, musculoskeletal pain and anemia, according to the study.

“There are likely to be millions of people in the U.S. with long COVID-19 who will have chronic conditions that require integrated multidisciplinary care,” Al-Aly said. “Health systems must be prepared for this.”

“We got caught unprepared for COVID-19,” he said. “Let's not drop the ball on long COVID-19.”