Two Years After Infection, Covid-19 Patients Tend To Have Poorer Health And Quality Of Life: Study In Lancet

Participants with long Covid usually still have at least one symptom including fatigue, shortness of breath, and sleep difficulties two years after initially contracting SARS-CoV-2.

New Delhi: Patients who were infected with Covid-19 two years back and hospitalised for it still have at least one symptom, the largest follow-up study to date has found. As many as 1,192 participants in China infected with SARS-CoV-2 during the first phase of the pandemic were involved in the analysis. 

The study was recently published in The Lancet Respiratory Medicine. 

Covid-19 Patients Still Tend To Have Poorer Health Than General Population

The analysis suggests that Covid-19 patients, especially those with long Covid, still tend to have poorer health and quality of life than the general population. Participants with long Covid usually still have at least one symptom including fatigue, shortness of breath, and sleep difficulties two years after initially contracting SARS-CoV-2.

The longest follow-up studies to date have spanned around one year, because of which the long-term health impacts of Covid-19 have remained largely unknown. Since most studies lack pre-Covid-19 health status baselines and comparisons with the general population, determining how well patients with Covid-19 have recovered has become difficult.

In a statement issued by The Lancet, Professor Bin Cao of the China-Japan Friendship Hospital, China, and the lead author of the study, said the findings indicate that for a certain proportion of hospitalised Covid-19 survivors, more than two years is needed to fully recover from Covid-19, even if they may have cleared the initial infection. 

In order to understand the longer course of the illness, ongoing follow-up of Covid-19 survivors, particularly those with symptoms of long Covid, and further exploration of the benefits of rehabilitation programmes for recovery, are essential, Cao said. There is a clear need to provide continued support to a significant proportion of people who have had Covid-19, and to understand how vaccines, emerging treatments, and variants affect long-term health outcomes.

How Was The Study Conducted?

The researchers sought to analyse the long-term health outcomes of hospitalised Covid-19 survivors, as well as specific health impacts of long Covid. The participants were evaluated between January 7 and May 29, 2020, at six months, 12 months, and two years. 

A six-minute walking test, laboratory tests, and questionnaires on symptoms, mental health, health-related quality of life were the various assessments conducted in the participants who had returned to work, and health-care use after discharge. By comparing participants with and without long Covid symptoms, the negative effects of long Covid on the quality of life, exercise capacity, mental health, and health-care use were determined. 

Findings Of The Study

According to the study, the median age of the participants was 57 years, and 54 per cent were men. At least one long Covid symptom was reported by 68 per cent of the participants, six months after initially falling ill. Reports of symptoms had fallen to 55 per cent, by two years after infection. The symptoms most often reported were fatigue or muscle weakness and fell from 52 per cent at six month to 30 per cent at two years. Also, 89 per cent of participants had returned to their original work after two years, regardless of their initial illness.

Patients with Covid-19 are generally in poorer health than the general population, two years after initially falling ill. Fatigue or muscle weakness was reported by 31 per cent of the participants. Also, 31 per cent of the patients reported sleep difficulties. The proportion of non-Covid-19 participants reporting fatigue and sleep difficulties was five per cent and 14 per cent, respectively.

According to the study, Covid-19 patients were more likely to report a number of other symptoms including joint pain, palpitations, dizziness, and headaches. Covid-19 patients more often reported pain or discomfort, anxiety or depression in quality of life questionnaires, than non-Covid-19 participants.

At two years, around half of study participants had symptoms of long Covid. They reported lower quality of life than those without long Covid. 

Pain or discomfort were reported by 35 per cent of participants in the mental health questionnaires. 

According to the study, 19 per cent reported anxiety or depression. The proportion of Covid-19 patients without long Covid reporting pain or discomfort, and anxiety or depression, was 10 per cent and four per cent at two years, respectively.

Compared to people without long Covid, the participants with long Covid more often reported problems with their mobility, or activity levels.

According to mental health assessments of long Covid participants, 13 per cent of them displayed symptoms of anxiety, and 11 per cent of them displayed symptoms of depression. The proportion for anxiety and depression in non-long Covid participants was three per cent and one per cent, respectively. After being discharged, long Covid participants more often used health-care services, with 26 per cent reporting an outpatient clinic visit compared to 11 per cent of non-long Covid participants. Hospitalisation among long Covid participants was higher than the 10 per cent reported by participants without long Covid.

Limitations To The Study

The authors noted certain limitations to the study, which include the fact that without a control group of hospital survivors unrelated to Covid-19 infection, it is hard to determine whether observed abnormalities are specific to Covid-19.

Also, there is a potential for information bias when self-reported health outcomes are analysed. Moreover, certain outcome measures such as work status and health-care use after discharge were not recorded at all visits. This meant that only partial analysis of long-term impacts on these outcomes was possible, the authors noted in the study.