Michael Coston
Editor, Senior Moderator
BMJ: Post-covid Syndrome In Individuals Admitted to Hospital with Covid-19: Retrospective Cohort Study
#15,897
It became apparent very early on (spring, 2020) that COVID-19 was producing a high morbidity - low mortality pandemic; several times deadlier than than seasonal flu, but not as lethal as might be expected from MERS-CoV, SARS, or avian H5N1, H5N6, or H7N9.
While obviously welcomed news, it was tempered by reports of long hospitalizations, and slow recoveries by many COVID-19 patients.
Many COVID patients `recovered' with permanent damage, due to pulmonary embolisms, thrombotic events, strokes, kidney damage, and heart attacks. Others reported `brain fog', fatigue, and other debilitating symptoms lingering long after the virus had cleared their body.
PAHO Epi Alert: Complications & Sequelae Of COVID-19
JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury
In early July of 2020, Dr. Anthony Fauci expressed concerns that many COVID patients were suffering from a post-viral syndrome - similar to ME/CFS - which has disabled and traumatized as many as two and half million Americans over the past 3 decades (see NIH About CFS/ME).
Often dubbed `Long COVID', this post-COVID syndrome is poorly understood, and is likely due to more than just one cause.
Last October, in UK NIHR: Living With COVID-19 (Long COVID), we looked at the potential for many patients to develop what appears to be a Post Viral Fatigue syndrome - similar to ME/CFS - that could cause permanent disability.
The CDC describes these cases in:
Long-Term Effects of COVID-19
Updated Nov. 13, 2020
CDC is actively working to learn more about the whole range of short- and long-term health effects associated with COVID-19. As the pandemic unfolds, we are learning that many organs besides the lungs are affected by COVID-19 and there are many ways the infection can affect someone?s health.
While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness. Even people who are not hospitalized and who have mild illness can experience persistent or late symptoms. Multi-year studies are underway to further investigate. CDC continues to work to identify how common these symptoms are, who is most likely to get them, and whether these symptoms eventually resolve.
The most commonly reported long-term symptoms include:
Also in November of 2020, in MMWR: Readmission Of COVID-19 Patients Within 2 Months Of Hospital Discharge, we looked at a CDC study that found:
More recently (January) the CDC held a COCA (Clinician Outreach & Communication Activity) Call on clinician's experiences with `Long COVID' cases, which is now archived for viewing.
All of which brings us to a new, large, retrospective cohort study from the UK, published last week in The BMJ that finds nearly 30% of patients hospitalized with COVID were rehospitalized within 140 days of release, and over 12% had died.
Rates that were (respectively) 3.5 and 7.7 times higher than matched controls.
Due to its length, I've only reproduced the Abstract. Follow the link below to read it - and the accompanying editorial - in their entirety.
CCBY Open access
Research
Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n693 (Published 31 March 2021)
Cite this as: BMJ 2021;372:n693
Deaths and hospital readmissions don't tell the full story, of course. Many `recovered' COVID cases endure long lasting, and sometimes debilitating, chronic symptoms, such as brain fog, fatigue, myalgias, recurrent fevers, and cough.
While early recognition of long-term sequelae from COVID-19 is encouraging, it remains to be seen whether these patients will be treated better than the millions of ME/CFS, Post Lyme Disease Syndrome, and Gulf War Illness patients that have too often been marginalized and/or ignored by the medical system over the past few decades.
And while the evidence isn't in yet, and may not be for years, there are some neurologists and cardiologists who worry that many serious post-COVID syndromes may not become apparent for years. A few blogs include:
So there is a precedent of sorts, which means we should be prepared for more grief from this pandemic, even after the immediate crisis has waned.
https://afludiary.blogspot.com/2021/04/bmj-post-covid-syndrome-in-individuals.html
#15,897
It became apparent very early on (spring, 2020) that COVID-19 was producing a high morbidity - low mortality pandemic; several times deadlier than than seasonal flu, but not as lethal as might be expected from MERS-CoV, SARS, or avian H5N1, H5N6, or H7N9.
While obviously welcomed news, it was tempered by reports of long hospitalizations, and slow recoveries by many COVID-19 patients.
Many COVID patients `recovered' with permanent damage, due to pulmonary embolisms, thrombotic events, strokes, kidney damage, and heart attacks. Others reported `brain fog', fatigue, and other debilitating symptoms lingering long after the virus had cleared their body.
PAHO Epi Alert: Complications & Sequelae Of COVID-19
JAMA: Two Studies Linking SARS-CoV-2 Infection To Cardiac Injury
In early July of 2020, Dr. Anthony Fauci expressed concerns that many COVID patients were suffering from a post-viral syndrome - similar to ME/CFS - which has disabled and traumatized as many as two and half million Americans over the past 3 decades (see NIH About CFS/ME).
Often dubbed `Long COVID', this post-COVID syndrome is poorly understood, and is likely due to more than just one cause.
Last October, in UK NIHR: Living With COVID-19 (Long COVID), we looked at the potential for many patients to develop what appears to be a Post Viral Fatigue syndrome - similar to ME/CFS - that could cause permanent disability.
The CDC describes these cases in:
Long-Term Effects of COVID-19
Updated Nov. 13, 2020
CDC is actively working to learn more about the whole range of short- and long-term health effects associated with COVID-19. As the pandemic unfolds, we are learning that many organs besides the lungs are affected by COVID-19 and there are many ways the infection can affect someone?s health.
While most persons with COVID-19 recover and return to normal health, some patients can have symptoms that can last for weeks or even months after recovery from acute illness. Even people who are not hospitalized and who have mild illness can experience persistent or late symptoms. Multi-year studies are underway to further investigate. CDC continues to work to identify how common these symptoms are, who is most likely to get them, and whether these symptoms eventually resolve.
The most commonly reported long-term symptoms include:
- Fatigue
- Shortness of breath
- Cough
- Joint pain
- Chest pain
- Difficulty with thinking and concentration (sometimes referred to as ?brain fog?)
- Depression
- Muscle pain
- Headache
- Intermittent fever
- Fast-beating or pounding heart (also known as heart palpitations)
- Cardiovascular: inflammation of the heart muscle
- Respiratory: lung function abnormalities
- Renal: acute kidney injury
- Dermatologic: rash, hair loss
- Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems
- Psychiatric: depression, anxiety, changes in mood
Also in November of 2020, in MMWR: Readmission Of COVID-19 Patients Within 2 Months Of Hospital Discharge, we looked at a CDC study that found:
After discharge from an initial COVID-19 hospitalization, 9% of patients were readmitted to the same hospital within 2 months of discharge. Multiple readmissions occurred in 1.6% of patients. Risk factors for readmission included age ?65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the first COVID-19 hospitalization, and discharge to a skilled nursing facility or with home health care.
More recently (January) the CDC held a COCA (Clinician Outreach & Communication Activity) Call on clinician's experiences with `Long COVID' cases, which is now archived for viewing.
All of which brings us to a new, large, retrospective cohort study from the UK, published last week in The BMJ that finds nearly 30% of patients hospitalized with COVID were rehospitalized within 140 days of release, and over 12% had died.
Rates that were (respectively) 3.5 and 7.7 times higher than matched controls.
Due to its length, I've only reproduced the Abstract. Follow the link below to read it - and the accompanying editorial - in their entirety.
CCBY Open access
Research
Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study
BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n693 (Published 31 March 2021)
Cite this as: BMJ 2021;372:n693
Daniel Ayoubkhani, principal statistician1,Kamlesh Khunti, professor of primary care diabetes and vascular medicine2,Vah? Nafilyan, principal statistician1,Thomas Maddox, statistician1,Ben Humberstone, deputy director of health analysis and life events division1,Ian Diamond, UK national statistician1,Amitava Banerjee, associate professor of clinical data science and honorary consultant cardiologist
Correspondence to: A Banerjee ami.banerjee@ucl.ac.uk
Accepted 15 March 2021
Accepted 15 March 2021
Abstract
Objective To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.
Design Retrospective cohort study.
Setting NHS hospitals in England.
Participants 47?780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.
Main outcome measures Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.
Results Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14?060 of 47?780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ?70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).
Conclusions Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.
Objective To quantify rates of organ specific dysfunction in individuals with covid-19 after discharge from hospital compared with a matched control group from the general population.
Design Retrospective cohort study.
Setting NHS hospitals in England.
Participants 47?780 individuals (mean age 65, 55% men) in hospital with covid-19 and discharged alive by 31 August 2020, exactly matched to controls from a pool of about 50 million people in England for personal and clinical characteristics from 10 years of electronic health records.
Main outcome measures Rates of hospital readmission (or any admission for controls), all cause mortality, and diagnoses of respiratory, cardiovascular, metabolic, kidney, and liver diseases until 30 September 2020. Variations in rate ratios by age, sex, and ethnicity.
Results Over a mean follow-up of 140 days, nearly a third of individuals who were discharged from hospital after acute covid-19 were readmitted (14?060 of 47?780) and more than 1 in 10 (5875) died after discharge, with these events occurring at rates four and eight times greater, respectively, than in the matched control group. Rates of respiratory disease (P<0.001), diabetes (P<0.001), and cardiovascular disease (P<0.001) were also significantly raised in patients with covid-19, with 770 (95% confidence interval 758 to 783), 127 (122 to 132), and 126 (121 to 131) diagnoses per 1000 person years, respectively. Rate ratios were greater for individuals aged less than 70 than for those aged 70 or older, and in ethnic minority groups compared with the white population, with the largest differences seen for respiratory disease (10.5 (95% confidence interval 9.7 to 11.4) for age less than 70 years v 4.6 (4.3 to 4.8) for age ?70, and 11.4 (9.8 to 13.3) for non-white v 5.2 (5.0 to 5.5) for white individuals).
Conclusions Individuals discharged from hospital after covid-19 had increased rates of multiorgan dysfunction compared with the expected risk in the general population. The increase in risk was not confined to the elderly and was not uniform across ethnicities. The diagnosis, treatment, and prevention of post-covid syndrome requires integrated rather than organ or disease specific approaches, and urgent research is needed to establish the risk factors.
Deaths and hospital readmissions don't tell the full story, of course. Many `recovered' COVID cases endure long lasting, and sometimes debilitating, chronic symptoms, such as brain fog, fatigue, myalgias, recurrent fevers, and cough.
While early recognition of long-term sequelae from COVID-19 is encouraging, it remains to be seen whether these patients will be treated better than the millions of ME/CFS, Post Lyme Disease Syndrome, and Gulf War Illness patients that have too often been marginalized and/or ignored by the medical system over the past few decades.
And while the evidence isn't in yet, and may not be for years, there are some neurologists and cardiologists who worry that many serious post-COVID syndromes may not become apparent for years. A few blogs include:
- In August, in J. Neurology: COVID-19 As A Potential Risk Factor For Chronic Neurological. Disorders, we revisited the growing concerns over the long-term neurological impacts of COVID-19 infection.
- In September (see Parkinsonism as a Third Wave of the COVID-19 Pandemic?) we looked at a Review Article, published in the Journal of Parkinson's Disease, that examined the parallels between COVID-19 and epidemics of the past, and the potential for seeing a new wave of neurological disorders.
- Last July, JAMA published Coronavirus Disease 2019 (COVID-19) and the Heart?Is Heart Failure the Next Chapter? by Clyde W. Yancy, MD, MSc1,2; Gregg C. Fonarow, MD3,4
- Also in July, Brain Behav Immun. published Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. by Troyer EA, Kohn JN, Hong S.
But the decade following the 1918 pandemic saw a still-unexplained epidemic of neurological diseases, including Encephalitis Lethargica and Parkinsonian syndromes (see The Lancet: COVID-19: Can We Learn From Encephalitis Lethargica?).
So there is a precedent of sorts, which means we should be prepared for more grief from this pandemic, even after the immediate crisis has waned.
https://afludiary.blogspot.com/2021/04/bmj-post-covid-syndrome-in-individuals.html