You're finished with COVID-19, but is it finished with you?
An
early but interesting retrospective study of patients treated by the U.S. Veterans Administration*, based on data from a large cohort of 87,000 COVID-19 patients and a comparison group of almost five million others, indicates that the coronavirus survivors had a significantly higher risk of death in the six months following their recovery, even those whose symptoms were considered mild and did not require hospitalization:
The results suggest that beyond the first 30 days of illness, people with COVID-19 are at higher risk of death, health care resource utilization, and exhibit a broad array of incident pulmonary and extrapulmonary clinical manifestations including nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, and signs and symptoms related to poor general wellbeing including malaise, fatigue, musculoskeletal pain, and anemia. Increased risk of incident use of several medication classes was also observed including pain medications (opioids and non-opioids), antidepressants, anxiolytics, antihypertensives, anti-hyperlipidemics, oral hypoglycemics, insulin, and other medication classes. Our analyses of pre-specified outcomes complement the high dimensional approach to identify specific post-acute sequalae with greater diagnostic resolution and reveal two key findings: a) the risk and associated burden of post-acute sequalae is evident even among those whose acute disease was not severe enough to necessitate hospitalization — the segment that represents the majority of people with COVID-19, and b) the risk and associated burden increases across the severity spectrum of the acute COVID-19 infection (non-hospitalized, hospitalized, admitted to intensive care). Our comparative approach to examine post-acute sequalae in those hospitalized with COVID-19 vs. seasonal influenza (using a high dimensional approach and through examination of pre-specified outcomes) suggests substantially higher burden of a broad array of post-acute sequelae in those hospitalized with COVID-19 vs. seasonal influenza — providing differentiating fea-tures of post-COVID-19 (both in magnitude of risk and breadth of organ involvement) from a post-influenza viral syndrome. The constellation of evidence suggests that 30-day survivors of COVID-19 exhibited increased risk of death and health resource utilization, and substantial burden of health loss (spanning pulmonary and several extrapulmonary organ systems) and highlights the need for a holistic and integrated multidisciplinary long-term care of COVID-19 survivors.
The authors of the study note that "[t]he mechanism(s) which underly the post-acute and chronic manifestations of COVID-19 are not entirely clear. Some of the manifestations may be driven by a direct effect of the viral infection and may be putatively explained by several hypotheses including persistent virus in immune-privileged sites, aberrant immune response, hyperactivation of the immune system, or autoimmunity. Indirect effects including changes in social (e.g. reduced social contact and loneliness), economic (e.g. loss of employment), and behavioral conditions (e.g. changes in diet and exercise) that may be differentially experienced by people with COVID-19 may also shape health outcomes in COVID-19 survivors. . . . "
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*The Veterans Administration manages a network of government-operated hospitals that provide medical services to former members of the military services of the United States.