Half of COVID-19 Patients Report Symptoms 4 Months After Hospitalization

Four months after hospitalization for COVID-19, many patients experience ongoing symptoms, including fatigue, cognitive problems and dyspnea, a new study found.

The COMEBAC study (Consultation Multi-Expertise de Bicêtre Après COVID-19), published in JAMA, included 478 patients who were hospitalized with COVID-19 at a university hospital in France between March 1 and May 29, 2020. They participated in telephone surveys 4 months after discharge and assessed with a Q3PC cognitive screening questionnaire and a checklist of symptoms. Those who had been in the intensive care unit and those who had relevant symptoms were evaluated further at an ambulatory care visit.

Corresponding author Xavier Monnet, MD, PhD, professor of intensive care at Paris South University, told Contagion that the biggest takeaway from the study was that half of patients (51%) have persistent symptoms at 4 months after hospitalization for COVID-19.

“The sequelae of the disease in critically ill patients do not seem more common than for some similar disease (lung sequelae for viral pneumonia, psychic sequelae for all ICU patients),” Monnet said. “Nevertheless, our study did not compare COVID-19 vs. non-COVID-19 patients.”

He encouraged clinicians to watch for lasting symptoms in their patients after their COVID-19 episode.

Symptoms included fatigue reported among 31% of patients, cognitive symptoms among 21%, dyspnea among 16%. Of 171 patients assessed at ambulatory visits, computed tomographic lung scan abnormalities were reported among 63% and fibrotic lesions among 19%. Among 83 ICU patients, the left ventricular ejection fraction was less than 50% in 8 (10%) and chronic kidney disease was observed in 2.

Some of those who had been in ICU suffered anxiety (23%), depression (18%) and posttraumatic symptoms (7%). The study also found that among the quality-of-life survey, scores were lowest for role limited, such as difficulty performing daily activities, with a median score of 25 out of 100 with 100 being best. Median score for “reduced motivation” was 4.5 out of 5 with 5 being worst.

“These scores best convey some of the key consequences of long COVID because return to normal living and absence of fatigue are viewed by patients as among the most important factors for overall quality of life after critical illness,” Hallie C. Prescott, MD, MSc, associate professor of pulmonary and critical care medicine at the University of Michigan, wrote in an associated editorial.

While so-called “long COVID” has been a topic of growing interest, this study is among the first to systematically and comprehensively evaluate patients after hospitalization with COVID-19, she noted.

Prescott noted that patients were treated during a surge, with only 4% receiving corticosteroids and suggested that patients treated with current best practices may fare better.

“Importantly, symptoms among participants in this study varied markedly, consistent with prepandemic cohorts of critical illness survivors,” Prescott wrote.

More research is needed to understand why some patients experience chronic symptoms while others have minimal symptoms and recover quickly. New approaches are needed to identify and treat patients who need follow-up care.

“Along with funding for research to better understand and treat long COVID, simultaneous investment in clinical infrastructure will be needed to support patients as they recover from this challenging disease,” Prescott said.

Monnet said investigators are starting a similar study of patients of the “second hit” with a focus on evaluation of treatments and variants.

The Infectious Diseases Society of America recently addressed the need for clinics focusing on the aftermath of COVID-19 infections and the patients experiencing lingering symptoms, some of which have lasted for close to a year.

Such clinics should include multidisciplinary teams including psychiatrists, experts have said, noting previous research, including a study in Frontiers in Psychology that found long-term neuropsychiatric and cognitive consequences of COVID-19.