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Pattern of longer-term symptoms for hospitalised COVID-19 patients identified

Researchers have identified a pattern of longer-term symptoms likely to be experienced by people who were hospitalised with COVID-19. They include fatigue, breathlessness, psychological distress – including problems with concentration and memory – and a general decline in quality of life. Some patients, particularly those who had been in intensive care, had symptoms associated with cases of PTSD (post-traumatic stress disorder).

The findings provide the first detailed insight into problems facing patients recovering from COVID-19.

Dr Manoj Sivan, associate clinical professor at the University of Leeds and a consultant in rehabilitation medicine at Leeds General Infirmary, supervised the research project. He said: “COVID-19 is a new illness and we have very little information on longer term problems in individuals after discharge from hospital.

“The emerging evidence is that for some, the road to recovery may take months and it is vital specialist rehabilitation is on hand to support them. This research gives an important insight into patient needs, and that will help shape services in the community.”

Lead author Dr Stephen Halpin, senior research fellow in the School of Medicine and consultant in rehabilitation medicine at Leeds Teaching Hospitals NHS Trust, said: “This research follows our previous work of predicting COVID-19 patients' long-term needs based on previous coronavirus outbreaks of SARS in 2002 and MERS in 2012. "The health problems are similar but on a larger scale given the number of people affected.”

The research team – involving multidisciplinary specialists from the University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds Community Healthcare NHS Trust and Leeds Beckett University – followed 100 people recovering from COVID-19 in the community, four-to-eight weeks after discharge from hospital.

The COVID-19 survivors were divided into two groups: those who had become critically ill and needed intensive care – 32 people were in this category; and those who were treated on a ward without needing intensive care – 68 people were in this category.
Patients were contacted by a member of the hospital's rehabilitation team and asked a series of questions about their recovery and symptoms they were still experiencing.

The most prevalent symptom was fatigue. More than 60% of people who had been treated on a ward reported fatigue, and one-third of them described it as moderate or severe. For patients who had been in intensive care, 72% reported fatigue. Of those, more than half said it was moderate or severe.

The second most common symptom was breathlessness. People in both groups said they had feelings of breathlessness which had not existed before they contracted COVID-19. This was higher in the group that had been the most ill, the intensive care group versus those who had been treated in a ward – 65.6% versus 42.6%.

The third most prevalent symptoms were neuro-psychological. The research survey found that almost one quarter of the people who had been on a ward and just under a half of the people who had been in intensive care had some of the symptoms of PTSD.

Writing in the paper, the researchers said: “PTSD symptoms are a well-recognised component of post-intensive care unit syndrome caused by a variety of factors including fear of dying, invasive treatment, pain, delirium, inability to communicate, weakness, immobility, and sensory problems and sleep deprivation.”

More than two-thirds (68.8%) of patients in the intensive care group and just under half (45.6%) of the other group said their overall quality of life had deteriorated.
The researchers say the rehabilitation needs of patients who did not require hospital care need to be further investigated and they are working on understanding this in future research.

Abstract
Background: There is currently very limited information on the nature and prevalence of post-COVID-19 symptoms after hospital discharge.
Methods: A purposive sample of 100 survivors discharged from a large University hospital were assessed 4- 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telephone screening tool designed to capture symptoms and impact on daily life. EQ-5D-5L telephone version was also
completed.
Results: Participants were between 29 and 71 days (mean 48 days) post-discharge from hospital. Thirty-two participants required treatment in intensive care (ICU group) and 68 were managed in hospital wards without needing ICU care (ward group). New
illness-related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group; 42.6% in ward group) and psychological distress(46.9% in ICU group; 23.5% in ward group). There was a clinically significant drop in
EQ5D in 68.8% in ICU group and in 45.6% in ward group.
Conclusions: This is the first study from the United Kingdom (UK) reporting on post-discharge symptoms. We recommend planning rehabilitation services to manage these symptoms appropriately and maximise the functional return of COVID-19 survivors.

Authors
Stephen J Halpin, Claire McIvor, Gemma Whyatt, Anastasia Adams, Olivia Harvey, Lyndsay McLean, Christopher Walshaw, Steven Kemp, Joanna Corrado, Rajinder Singh, Tamsin Collins, Rory J O’Connor, Manoj Sivan

 

[link url="http://www.leeds.ac.uk/news/article/4649/covid-19_the_long_road_to_recovery"]Leeds University material[/link]

 

[link url="https://onlinelibrary.wiley.com/doi/epdf/10.1002/jmv.26368"]Journal of Medical Virology abstract[/link]

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