Three quarters of hospitalized COVID-19 patients report symptoms months after recovery

UBC researchers have published a clinical study on the occurrence of COVID-19-related symptoms in patients post-recovery.

The study, which analyzed patient-reported symptoms and overall quality of life, utilized data from a patient cohort recruited from the Post-COVID-19 Respiratory Clinic situated in Vancouver General Hospital and St. Paul’s Hospital.

“I think that there’s a lot of areas that we don’t know about COVID. And one of the things was what are the long-term outcomes?” said Dr. Alyson Wong, a clinical instructor in the UBC Faculty of Medicine and lead author of the study.

“We created this Post-COVID Respiratory Clinic to basically follow patients to see what kind of things developed after they were infected,” said Wong.

“Back in March, when it became apparent the pandemic was heading our way, there were several of us in the division of respiratory medicine, who are active clinicians and researchers, who anticipated the need for us to learn more about these patients and to do so relatively quickly,” said Dr. Christopher Ryerson, head of respirology at St. Paul’s Hospital and division head of respiratory medicine at Providence Health Care who was the corresponding author of the study.

“So that we would be able, in the future, to identify which patients required targeted follow-up and, potentially, interventions,” added Ryerson.

Patients who were hospitalized in British Columbia from SARS-CoV-2 infection — the virus responsible for COVID-19 — were seen beginning in May of this year and data was collected for three months post-hospitalization in a clinic visit.

Experiencing symptoms

Information about post-recovery symptoms was collected through a combination of “surveys [and] investigations including CT scans and breathing tests,” added Wong.

The study focused on patient reported outcome measures (PROMs), which allowed the researchers to quantify symptoms such as quality of life, frailty, sleep and shortness of breath.

Seventy-six per cent of all patients reported at least one abnormal PROM, with 56 per cent reporting at least two. Shortness of breath and impaired quality of life were the two most common adverse outcomes, at incidence rates of 50 per cent and 51 per cent respectively.

Twenty-three per cent of patients reported the presence of cough.

“We saw that it really didn’t matter how many chronic conditions the patients had prior to getting COVID-19. Even people who were relatively well prior to their acute illness ended up having some of the same persistent deficits,” noted Ryerson.

While the causes underlying these delayed symptoms are currently under study, the authors offered insight into possible causes.

“What we found [from imaging and breathing tests] was that 88 per cent of people had imaging abnormalities and the most common abnormalities … are features that make us think of inflammation and scarring in the lung,” said Wong.

Long-term implications

The authors also spoke of more long-term epidemiological ramifications and the impact on mental health from the emergence of these delayed symptoms.

“The fact that we demonstrated that over 50 per cent of people reported abnormal mood, I think it tells us that COVID in the current context is affecting people in terms of their anxiety and depression,” said Wong.

“If people are still experiencing symptoms and seeking medical attention several months after their illness, then that increases the need for health care resources,” she added.

Ryerson echoed this sentiment, citing the social isolation caused by the pandemic and highlighting groups of people with “chronic conditions … or even acute conditions that are having limited access to the clinical care that they would normally need.”

He gave the example of people with signs of cancer that would be picked up on a CT scan, going undiagnosed due to their hesitance to seek medical assistance in the midst of the pandemic or due to a lack of referral.

The study was limited by a lack of baseline PROM data to compare the post-infection PROMs against. Because the participants were all hospitalized for severe infection, Wong added that generalizing to the whole population would be difficult without further study and qualification.

“Because we were limited in terms of the clinic only seeing hospitalized patients, it would be interesting to get the PROM data on patients who weren’t hospitalized,” said Wong.

Speaking of future directions, Ryerson mentioned the collection of detailed data from patients at the time of their hospitalization to compare with data from later clinic visits.

“So that we can say to people when they’re admitted to a hospital, ‘You feel really bad right now, but three months from now, things are going to be looking a whole lot better.’”

Wong emphasized the importance of prevention in dealing with the pandemic.

“Because we can’t predict who’s going to have severe illness, I think it’s really important that people take the public health measures seriously and just take COVID in general seriously,” said Wong.