More than three-quarters (76.5%) of 1,655 COVID-19 patients hospitalized in Wuhan, China, had at least one symptom 6 months after discharge, reports Lancet a study published late last week.
The most common self-reported symptoms were obesity or muscle weakness (62.7%) and sleep problems (26.4%), and follow-up tests showed lung impairment – which shows poor oxygen exchange – in 34.1% of patients. patients.
“Because COVID-19 is such a new disease, we are only just beginning to understand some of its long-term effects on patient health,” lead author Bin Cao, MD, said in a Lancet news release. “Our analysis shows that most patients live with at least some of the effects of the virus after leaving hospital, and show a need for post-discharge care. spread, especially for those suffering from serious diseases. “
The lungs were not recovered, antibodies escaped
Participants of the study were discharged from the hospital from January 7 to May 29, 2020, and the researchers followed an average of 186 days (more than 6 months) thereafter, from June 16 to September 3. Out of 1,733 people in the group, 1,172 (67.6%) required oxygen treatment, 122 (7.0%) required ventilation or a similar procedure, and 76 (4.4%) entered the unit intensive care (ICU).
Excluded from the study were patients who died (1.3% of the 2,469 able-bodied people), who had been followed for other reasons such as psychiatric disorder or readmission, or lived in nursing or welfare homes.
The researchers administered a subset of 390 patient lung tests and found impaired circulation in 21.7% of those who did not require additional oxygen, 29.1% of those who received additional oxygen, and 55.8% of those who did not. required ventilation of any kind or a similar approach. .
“This was consistent with conclusions that the most common abnormal CT pattern is lung interstitial change (GGO). [ground glass opacity] and irregular lines), which were similar to the long-term lung manifestations of SARS [severe acute respiratory disease] or the flu, “the researchers write, but noted that they did not have baseline data.
Patients in the most severe infectious group experienced an increase of 4.60 (95% confidence interval) [CI], 0.80 to 3.25) for impaired circulation than those that did not require additional oxygen, although the data also showed that in some cases the lungs continued to heal. For example, GGO levels decreased from 25% to 45% from the height of the disease to the follow-up, depending on the severity of the disease.
Antibody levels fell 52.5% (96.4% seropositivity to 58.5%) in 94 patients who received blood tests at the height of the disease and during their 6-month follow-up. Seven antibodies were measured to reduce levels prior to follow-up, but more than 90% of patients tested positive for N-immunoglobulin (Ig) G, S-IgG, and receptor-binding-IgG antibodies.
Other physical studies found that 13% of 822 patients had reduced renal activity after discharge (but without healthy baseline data) and 23% of 1,692 patients performed at subnatural levels at a walking test 6-minutes. None of the 390 patients who received continuous ultrasound had deep venous thrombosis of the legs.
The researchers evaluated 17 symptoms. In addition to muscle / muscle weakness and sleep problems, they included low-grade fever (0.0% frequency), erratic taste (7.3%) or odor (10.6%), palpitations (9.3%), and hair loss (21.7%). (The researchers do not know whether these symptoms started after discharge or whether they were stable or worse from hospital discharge.) They also found out 22.2% out of 1,617 suffered from anxiety or depression.
Need for close follow
In a Lancet reportedly, Italian researchers Monica Cortinovis, BiotechD, Norberto Perico, MD, and Giuseppi Remuzzi, MD, also confirm the need for outpatient clinic services, but add that this level of care is more difficult for countries with low and middle incomes. They write that long-term studies “enable us to evaluate the effectiveness of therapeutic interventions to reduce the long-term effects of COVID-19 on multiple organs and bones.
“This is consistent with the syndemic nature of COVID-19 pandemic disease, and has an impact on the long-term follow-up of COVID-19 sequelae, which should be largely defined against a background of non-communicable diseases. communication. and social and income inequalities that reduce the adverse effects of each of these diseases in many communities. “
Due to the small number of patients at the ICU level, the Lancet commenters state that the conclusions for this subset are uncertain. “However,” they add, “a previous study of patient outcomes after ICU stays reveals that several patients with COVID-19 who were seriously ill during their hospital stay will be hospitalized. thereafter problems with their mental and physical health or physical activity far beyond their discharge from hospital. “
Cortinovis and his colleagues conclude, “Unfortunately, there are few reports on the clinical picture of what happened after COVID-19. The study … is therefore relevant and timely.”