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Long-haul COVID-19 associated with white, female, middle age — UK hospital study

Researchers reporting on two non-peer–reviewed studies followed up months after adults' COVID-19 hospitalisation and found that 55% to 71% have not fully recovered. Middle age and female sex were associated with a higher likelihood of worse recovery in both studies.

The larger study by researchers at The Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, The Usher Institute, University of Edinburgh, University College London, Kings College London, Newcastle University, Newcastle upon Tyne Teaching Hospitals Trust, Manchester Metropolitan University, Salford Royal NHS Foundation Trust, Hull University Teaching Hospitals, University of Oxford, Warneford Hospital, Oxford Health NHS Foundation Trust, Guys and St Thomas NHS Foundation Trust, Queens University Belfast, Imperial College London, University of Swansea, University of Birmingham, NIHR Biomedical Research Centre, John Radcliffe Hospital, Queen Mary University of London, University of Liverpool, NIHR Cambridge Clinical Research Facility, University of Dundee, Ninewells Hospital and Medical School, University of Manchester, London School of Hygiene & Tropical Medicine , Asthma UK and British Lung Foundation, involved 1,077 UK patients (median age, 58) a median of 5 months after hospital discharge.

While 28.8% felt fully recovered, 19.6% had a new disability, 17.8% of those who were working in full- or part-time capacity no longer were, and 19.3% had undergone a health-related change in occupation. Additionally, 1 in 4 had clinically significant symptoms of anxiety and depression, 12.2% had post-traumatic stress disorder, 17% had mild cognitive impairment, and 46% had lower physical performance.

Factors associated with worse recovery included female sex, White ethnicity, and having two or more comorbidities. The researchers noted that age had a nonlinear association: Compared with those 50 to 59, those younger than 30 or older than 70 were 2.28 times and at least 2.07 times more likely to recover, respectively.

"The magnitude of the ongoing mental and physical health burden was substantial, but perhaps surprisingly were largely unrelated to acute severity," the researchers write.

The other study looked at 327 hospitalised UK COVID-19 patients (median age, 59.7). Most were not fully recovered after a median of 222 days (7.4 months), and women under 50 were the most burdened. Compared with men of the same age, women were 5.09 times less likely to feel recovered, 4.22 times more likely to report a greater disability, 2.06 times as likely to have worse fatigue, and 7.15 times more likely to experience breathlessness.

Breathlessness was not associated with age or comorbidities, fatigue intensity was not associated with age or disease severity, and new or worsened disability (such as mobility and memory) was not associated with comorbidities or disease severity.

"These symptoms were largely independent of age and prior comorbidity, suggesting that the long-term effects of COVID-19 are determined by factors that differ from those that predict increased mortality," write the researchers.


Study details 1
Physical, cognitive and mental health impacts of COVID-19 following hospitalisation – a multi-centre prospective cohort study

PHOSP-COVID Collaborative Group, Rachael Andrea Evans, Hamish McAuley, Ewen M Harrison, Aarti Shikotra, Amisha Singapuri, Marco Sereno, Omer Elneima, Annemarie B Docherty, Nazir I Lone, Olivia C Leavy, Luke Daines, J Kenneth Baillie, Jeremy S Brown, Trudie Chalder, Anthony De Soyza, Nawar Diar Bakerly, Nicholas Easom, John R Geddes, Neil J Greening, Nick Hart, Liam G Heaney, Simon Heller, Luke Howard, Joseph Jacob, R Gisli Jenkins, Caroline Jolley, Steven Kerr, Onn M Kon, Keir Lewis, Janet M Lord, Gerry P McCann, Stefan Neubauer, Peter JM Openshaw, Paul Pfeffer, Matthew Rowland, Malcolm G Semple, Sally J Singh, Aziz Sheikh, David Thomas, Mark Toshner, James D Chalmers, Ling-Pei Ho, Alex Horsley, Michael Marks, Krisnah Poinasamy, Louise V Wain, Christopher E Brightling

Published in medRxiv on 24 March 2021

The impact of COVID-19 on physical and mental health, and employment following hospitalisation is poorly understood.
PHOSP-COVID is a multi-centre, UK, observational study of adults discharged from hospital with a clinical diagnosis of COVID-19 involving an assessment between two- and seven-months later including detailed symptom, physiological and biochemical testing. Multivariable logistic regression was performed for patient-perceived recovery with age, sex, ethnicity, body mass index (BMI), co-morbidities, and severity of acute illness as co-variates. Cluster analysis was performed using outcomes for breathlessness, fatigue, mental health, cognition and physical function.
We report findings of 1077 patients discharged in 2020, from the assessment undertaken a median 5 [IQR4 to 6] months later: 36% female, mean age 58 [SD 13] years, 69% white ethnicity, 27% mechanical ventilation, and 50% had at least two co-morbidities. At follow-up only 29% felt fully recovered, 20% had a new disability, and 19% experienced a health-related change in occupation. Factors associated with failure to recover were female, middle-age, white ethnicity, two or more co-morbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial and weakly related to acute severity. Four clusters were identified with different severities of mental and physical health impairment: 1) Very severe (17%), 2) Severe (21%), 3) Moderate with cognitive impairment (17%), 4) Mild (46%), with 3%, 7%, 36% and 43% feeling fully recovered, respectively. Persistent systemic inflammation determined by C-reactive protein was related to cluster severity, but not acute illness severity.
We identified factors related to recovery from a hospital admission with COVID-19 and four different phenotypes relating to the severity of physical, mental, and cognitive health five months later. The implications for clinical care include the potential to stratify care and the need for a pro-active approach with wide-access to COVID-19 holistic clinical services.


Study details 2
Paper is still processing


CIDRAP material

medRxiv study 1 (Restricted access)

medRxiv study 2 (Restricted access)



See also MedicalBrief archives:

Catching up to ‘Long COVID’ — Diagnostic and treatment information, at last

Long Covid: Reviewing the Science and Assessing the Risk — Tony Blair Institute for Global Change report

Fauci announces new name for ‘COVID long-haulers’ and a new study

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