United States: Recent investigations illuminate the phenomenon of long COVID in the United States; one study indicates that a substantial majority of severely afflicted individuals endured lingering impairments for up to 12 months, while another study reveals that US military veterans faced a tripled risk of avoidable hospitalization in the month following infection. Furthermore, a third study uncovers that one-third of survivors of COVID-19 experienced persistent symptoms at one juncture.
Approximately 57% of severely affected individuals suffered enduring physical complications. In a study published today in Critical Care Medicine, scholars from the University of California San Francisco (UCSF) detail their examination of 156 critically unwell COVID-19 patients transferred to extended acute-care facilities in various states for ventilation withdrawal and rehabilitation from March 2020 to February 2021.
Patients participated in digital or telephonic surveys one year post-hospital discharge. The average age of patients was 65, with an average hospitalization duration of two months. Most individuals underwent mechanical ventilation for approximately one month and were in good health prior to infection.
Out of the 156 patients, nearly two-thirds (64%) reported enduring impairments, encompassing physical (57%), respiratory (49%), psychiatric (24%), and cognitive (15%) challenges, one year later. Almost half (47%) experienced multiple types of impairments, with 19% still reliant on supplementary oxygen.
“We bear witness to millions of survivors grappling with the most severe and protracted COVID illness worldwide,” remarked lead author Anil Makam, MD, in a UCSF press release. “Our research is pivotal in comprehending their recuperation and persistent impairments, offering a nuanced insight into their life-altering ordeal.”
Approximately 79% of patients indicated incomplete recovery at one year, with 99% having returned home and 60% of former employees re-entering the workforce. Many patients attributed their improvement to physical activity and rehabilitation, social support, and the passage of time.
“The enduring impairments we observed are typical among survivors of prolonged critical illnesses, not unique to COVID, and necessitate comprehensive rehabilitation,” added Makam.
Veterans face significantly elevated risks over the course of a year. In a study published today in JAMA Network Open, a team led by researchers from the Veterans Affairs (VA) Portland Health Care System in Oregon utilized a simulated-target randomized trial design to compare the risk of avoidable hospitalization among COVID-19-infected veterans with matched uninfected counterparts.
The study enrolled 189,136 veterans diagnosed with COVID-19 from March 2020 to April 2021 and 943,084 controls. The average age of participants was 60.3 years, with 89.1% being male, 69.4% White, and 23.4% Black. The primary endpoint was avoidable hospitalization at a VA facility, VA-purchased community care, or Medicare fee-for-service care.
“The delay or insufficiency of ambulatory care for treatable conditions can lead to hospitalization,” noted the study authors.
A heightened risk of hospitalization among veterans with SARS-CoV-2 emphasizes the necessity for research into post-infection care requirements and health system engagement.
A total of 3.1% of participants (3.8% of COVID-19 survivors and 3.0% of controls) experienced avoidable hospitalization during the one-year follow-up period. The risk of hospitalization was higher among COVID-19 survivors during various intervals post-infection.
“In this observational study, the increased risk of avoidable hospitalization among veterans with SARS-CoV-2, persisting for at least one year post-infection, underscores the imperative for research into post-infection care needs and health system engagement,” the researchers stated. “Efforts are needed to mitigate avoidable hospitalizations following SARS-CoV-2.”
An estimated 17 million adults currently contend with long COVID. According to the latest data from KFF, rates of this condition have remained stable for approximately a year, indicating that the burden may persist unless novel prevention and treatment modalities emerge.
These findings follow the release of updated COVID-19 recommendations by the Centers for Disease Control and Prevention (CDC) in March 2024, which do not mandate isolation following a positive test.
“The revised CDC guidelines offer a unified approach to respiratory virus risks and reflect the nation’s advancements in combating severe COVID-19 illness,” wrote author Alice Burns, Ph.D., KFF’s associate director of the Program on Medicaid & Uninsured.
While rates of long COVID have stabilized, the 17 million affected adults may encounter numerous employment and material challenges.
“Nevertheless, as the nation gradually moves beyond the COVID-19 pandemic, rates of long COVID persist, with 7% of all adults—roughly 17 million individuals—reporting current affliction with long COVID as of March 2024.”
Among the key findings:
– Thirty percent of adult COVID-19 survivors report enduring long COVID symptoms at some point, with 10% still experiencing them.
– Approximately 79% of adults with long COVID report limitations in their daily activities, with a quarter stating significant limitations.
– Individuals who are transgender or have disabilities are more likely to experience persistent symptoms.
– Treating COVID-19 solely as a respiratory ailment may hinder healthcare access for disproportionately affected groups.
– Between 5% and 10% of adults may continue to experience long COVID at any given time, underscoring the need for ongoing research to enhance diagnosis and treatment.
“Although rates of long COVID have stabilized, the 17 million adults with long COVID may experience many employment and material hardships, with 4 in 10 reporting food insecurity, 2 in 10 reporting difficulty paying rent or mortgage, and 1 in 10 reporting that they had to stop working for a period of time because of their symptoms,” Burns concluded.