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Seven in 10 patients hospitalised with Covid-19 have still not fully recovered after five months, and they appear to cluster into four distinct categories based on their symptoms, research suggests.
The study, one of the world’s largest into long Covid in hospitalised patients, includes a group with persistent brain fog, which bears little relation to the severity of their other symptoms.
More than 300,000 Britons are estimated to have received hospital care for Covid-19 during the pandemic, and the UK-wide Phosp-Covid study has been following the health of 1,077 of those discharged between March and November 2020 – ranging from intensive care patients to some who only visited hospital for a few hours.
Five months later, the patients had nine persistent symptoms on average, with one in five meeting the threshold for a new disability. Among those who had previously been employed, 18% had been unable to work since developing Covid-19.
The 10 most common symptoms they 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. More than a quarter also had clinically significant symptoms of anxiety and depression, and 12% had symptoms of post-traumatic stress disorder (PTSD) at five months.
“Much of the wide variety of persistent problems was not explained by the severity of the acute illness – the latter largely driven by acute lung injury – indicating other, possibly more systemic, underlying mechanisms,” said Dr Rachael Evans, an associate professor at the University of Leicester and respiratory consultant at Leicester’s hospitals, who co-authored the study.
The research, which has not yet been peer-reviewed, found that patients broadly fell into one of four different groups based on their mental and physical impairments: those with very severe mental and physical health impairments accounted for 17% of patients; people with severe impairments accounted for 21%; those with mild impairments at 46%; while the fourth group, who had pronounced brain fog and moderate impairments, accounted for 17%.
White middle-aged women were the most likely to fall into the first two categories – particularly if they were obese and had pre-existing conditions such as type 2 diabetes, and heart or lung disease. “It may be that the immune response is different in women, such that you then have a continued inflammatory reaction that then leads them to a higher likelihood of having long Covid,” said Chris Brightling, a professor of respiratory medicine at the University of Leicester and the study’s chief investigator. Middle-aged women are also more susceptible to other autoimmune conditions.
Curiously, those with the mildest ongoing symptoms often included individuals aged 70 and above, as well as those under 40. The reason for this is unclear, but it could be that older individuals who survived the infection were relatively healthy overall, or were less susceptible to autoimmunity because older people tend to have weaker immune responses.
However, older men with a healthy body mass index were the most likely to develop brain fog. “There’s a lot of uncertainty about exactly what is driving this, but it seems to be slightly disconnected from the other symptoms and disabilities we’re seeing,” said John Geddes, a professor of epidemiological psychiatry at the University of Oxford, who was also involved in the study.
Brightling said: “Our findings support the need for a proactive approach to clinical follow-up with a holistic assessment to include symptoms, mental and physical health, but also an objective assessment for cognition. The four severity clusters highlight potential to stratify care, but also the need for wide access to post-Covid-19 holistic clinical services to include mental health, memory and cognition, and rehabilitation services.
Source: The Guardian
Keyword: Seven in 10 UK Covid patients still affected months after leaving hospital | World news