A majority of survivors who left hospital following COVID-19 had not fully recovered five months after discharge and continued to experience negative impacts on their physical and mental health, as well as their ability to work, according to results released by a major national study into the longer-term effect of the COVID-19.
The PHOSP-COVID study, which involves a number of Oxford researchers across a range of disciplines, also found that one in five of the participant population reached the threshold for a new disability.
These initial findings of the study, which is supported by the NIHR oxford Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC, were published on the medRxiv pre-print server.
The UK-wide study, which is led by the NIHR Leicester BRC, analysed 1,077 patients who were discharged from hospital between March and November 2020 following an episode of COVID-19.
Researchers found that each participant had an average of nine persistent symptoms. The ten most common symptoms reported were: muscle pain, fatigue, physical slowing down, impaired sleep quality, joint pain or swelling, limb weakness, breathlessness, pain, short-term memory loss, and slowed thinking.
Patients were also assessed for mental health. The study reports that over 25 per cent of participants had clinically significant symptoms of anxiety and depression and 12 per cent had symptoms of post-traumatic stress disorder (PTSD) at their five-month follow-up.
Of the 67.5 per cent of participants who were working before COVID, 17.8 per cent were no longer working, and nearly 20 per cent experienced a health-related change in their occupational status.
Those who experience more persistent symptoms tend to be middle-aged, white, female, with at least two comorbidities, such as diabetes, lung or heart disease. Cognitive impairment, also referred to as ‘brain fog’, occurs as a predominant symptom in a sub-set of patients who tend to be older and male.
Professor John Geddes, Director of the NIHR Oxford Health BRC and a professor of psychiatry, is one of the leads for the PHOSP-COVID study in Oxford. He said:
These first results from PHOSP-COVID begin to clarify the experience of patients who have been admitted to hospital with COVID-19. The study has been another impressively swift and collaborative national NHS effort so far and my thanks to the patients and investigators who have made it happen. PHOSP-COVID will gain on power as it proceeds and promises to provide critical insights into the mechanisms that underly the mental, cognitive and physical symptoms that make up Long Covid. That should allow us to design better treatments and tailor care to individual patient needs ”
The other Oxford leads on the study are Professor Stefan Neubauer, the Oxford BRC Theme Lead for Imaging and Professor Ling-Pei Ho, a respiratory consultant and specialist in respiratory immunology.
The latest findings also show a biological marker associated with inflammation, C-Reactive Protein (CRP), is elevated in all but the most mild of post-hospital cases. Prof Ho said:
These findings are a clear message that COVID-19 leaves the majority of hospitalised patients with symptoms and mental health issues. Persistently elevated CRP, a marker of inflammation, suggests a relationship between these issues and leftover biological effects from the infection. There is still a lot to understand and unpick in the coming months. PHOSP-COVID and other studies linked to it will continue to investigate.”
The NIHR Oxford BRC’s Director, Prof Helen McShane, said:
This has been a very huge effort from a strong team in Oxford, led by Professors Ho, Neubauer and Geddes, who have contributed to the national leadership and impetus of this study. PHOSP-COVID provides a clear indication that further research is required over the coming months and years to better understand the long-term impact of COVID-19 on individuals and groups of patients.”
Professor Chris Whitty, Chief Medical Officer and co-lead for the NIHR, said:
We are in the foothills of our understanding of long-term effects of COVID. This research provides useful information on the debilitating effects of COVID some people are living with months after being hospitalised. It is important that we work out what exactly the various elements of what is currently termed ‘Long Covid’ are so we can target actions to prevent and treat people suffering with long term effects.”
Selected press coverage:
Medscape UK COVID-19 Update
PA via Belfast Telegraph