Physical, cognitive and mental health impacts of COVID-19 following hospitalisation – a multi-centre prospective cohort study

Abstract

Background The impact of COVID-19 on physical and mental health, and employment following hospitalisation is poorly understood. Methods PHOSP-COVID is a multi-centre, UK, observational study of adults discharged from hospital with a clinical diagnosis of COVID-19 involving an assessment between two- and seven-months later including detailed symptom, physiological and biochemical testing. Multivariable logistic regression was performed for patient-perceived recovery with age, sex, ethnicity, body mass index (BMI), co-morbidities, and severity of acute illness as co-variates. Cluster analysis was performed using outcomes for breathlessness, fatigue, mental health, cognition and physical function. Findings We report findings of 1077 patients discharged in 2020, from the assessment undertaken a median 5 [IQR4 to 6] months later: 36% female, mean age 58 [SD 13] years, 69% white ethnicity, 27% mechanical ventilation, and 50% had at least two co-morbidities. At follow-up only 29% felt fully recovered, 20% had a new disability, and 19% experienced a health-related change in occupation. Factors associated with failure to recover were female, middle-age, white ethnicity, two or more co-morbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial and weakly related to acute severity. Four clusters were identified with different severities of mental and physical health impairment: 1) Very severe (17%), 2) Severe (21%), 3) Moderate with cognitive impairment (17%), 4) Mild (46%), with 3%, 7%, 36% and 43% feeling fully recovered, respectively. Persistent systemic inflammation determined by C-reactive protein was related to cluster severity, but not acute illness severity. Interpretation We identified factors related to recovery from a hospital admission with COVID-19 and four different phenotypes relating to the severity of physical, mental, and cognitive health five months later. The implications for clinical care include the potential to stratify care and the need for a pro-active approach with wide-access to COVID-19 holistic clinical services. Funding: UKRI and NIHR

Post-COVID-19 Syndrome and the Potential Benefits of Exercise

“…It should be noted that the quality of the studies from which the information is extracted is low, and so is the power of the conclusions (mostly cohort studies, in some of which, the main objective was not the nature of symptoms, and in which the method of recruitment was variable, including self-selection surveys (high risk of bias)). There are few prospective studies with assessments beyond 12 weeks [31,[35][36][37][38][39] fulfilling the NHS current criteria for post-COVID-19 syndrome. [40][41][42][43][44][45][46][47][48][49][50] or outpatients [51][52][53][54][55][56], evaluated between 4 and 12 weeks after diagnosis.…”

Covid-19: Middle aged women face greater risk of debilitating long term symptoms

“…Seven in 10 patients admitted to hospital with covid-19 reported “long covid” symptoms an average of five months after discharge in the larger PHOSP-COVID study, and symptoms were more prevalent in women aged 40-60 1. White ethnicity, two or more comorbidities at admission, and receiving invasive ventilation while in hospital increased the risk, but severity of acute covid-19 disease did not seem to affect the likelihood of experiencing long covid symptoms.…”

Chronic fatigue and post-exertional malaise in people living with long COVID

“…Several studies have focused on persistent symptoms, recovery or rehabilitation after hospital admission due to COVID-19 [3,[23][24][25][26]. In contrast, few studies have included people who were not hospitalized (the majority of individuals affected by COVID- 19) or did not have a laboratory diagnosis of COVID-19, but who have experienced an acute illness equivalent to the acute symptomatic presentation of COVID-19 and/or had a known exposure to the virus.…”