The health effects of COVID-19 not only can stretch for months
but appear to increase the risk of death and chronic medical conditions, even
in people who were never sick enough to be hospitalized, a large new study
finds.
اضافة اعلان
In the study, published Thursday in the journal Nature,
researchers looked at medical records of more than 73,000 people across the
United States whose coronavirus infections did not require hospitalization.
Between one and six months after becoming infected, those patients had a significantly
greater risk of death — 60% higher — than people who had not been infected with
the virus.
The research, based on records of patients in the Department of
Veterans Affairs health system, also found that nonhospitalized COVID survivors
had a 20% greater chance of needing outpatient medical care over those six
months than people who had not contracted the coronavirus.
The COVID survivors experienced a vast array of long-term
medical problems that they had never had before — not just lung issues from the
respiratory effects of the virus, but symptoms that could affect virtually any
organ system or part of the body, from neurological to cardiovascular to
gastrointestinal. They were also at greater risk of mental health problems,
including anxiety and sleep disorders.
“We found it all,” said an author of the study, Dr. Ziyad
al-Aly, chief of the research and development service at the VA St. Louis
Health Care System.
“What was shocking about this when you put it all together was
like ‘Oh my God,’ you see the scale,” he added. “It’s still jarring, honestly.”
What’s more, some of the patients’ post-COVID medical issues —
like diabetes, kidney disease and some heart problems — could become chronic
conditions that would require treatment for the rest of their lives.
“People have continued respiratory disease, continued headache,
this, that and the next thing,” said Dr. Laurie Jacobs, chairwoman of internal
medicine at
Hackensack University Medical Center, who was not involved in the
study. “It’s not gone away. And we don’t yet understand the underlying cause,
and it’s become chronic in some cases, disabling in other cases. In some areas,
people have gotten better, but it’s very variable.”
The study is believed to be the largest yet to evaluate such a
comprehensive array of health conditions. The non-hospitalized COVID survivors
in the study tested positive for the virus from March 1, 2020, through
November.
Most of the nearly 32 million people who have contracted the
coronavirus in the United States have not needed hospitalization, so in some
ways the study may be applicable to a wide swath of the population. But the
Veterans Health System patients in the study may not be representative in other
ways, including that 88% of them were male and their median age was 61. Nearly
25% were Black, 70% were white and nearly 5% were other races.
Researchers compared their risk of death and other
characteristics with data from nearly 5 million patients in the Veterans system
who did not have COVID-19 and were not hospitalized during that time. That
group had a median age of 67, was 90% male and had a somewhat larger proportion
of white patients and a somewhat smaller proportion of Black patients.
Jacobs said her clinic was seeing the wide range of symptoms in
the study. But she said the risk of death among the study’s patients was
considerably higher than she would have expected. “I was really shocked by the
number,” she said.
Between one and six months after experiencing a relatively mild
or moderate infection, 1,672 of the 73,345 patients — about 2.3% — died, the
study reported. It did not indicate what caused the deaths or anything specific
about those patients’ conditions.
The researchers also could not say if people had underlying
health conditions and whether their new symptoms were direct effects of their
coronavirus infection, corollary effects of medications they were taking to
treat some of the symptoms, stress from other pandemic-related problems or
other influences. Experts said the study’s findings reflect a cascade of issues
driven not just by the virus itself but by the medical system’s struggle to
grapple with COVID-19 and its long-term effects.
“We have hundreds of thousands of people with an unrecognized
syndrome and we are trying to learn about the immune response and how the virus
changes that response and how the immune response can include all the organ
systems in the body,” said Dr. Eleftherios Mylonakis, chief of infectious
diseases at Brown University’s Warren Alpert Medical School and Lifespan
hospitals, who was not involved in the study. “The health system is not made to
deal with something like this.”
In many cases, Mylonakis said, people experiencing new symptoms
who were never acutely sick from the viral infection enter a confusing and
balkanized medical world, where they seek help from primary care doctors and
then are referred to various specialists who each try to figure out how to
treat conditions that fall under their particular area of expertise. That helps
explain why the study found that the COVID survivors had about 1 1/2 times more
outpatient visits a month than patients in the general VA population.
“We’re dealing with silos,” Mylonakis said. “Every time that we
have a transfer, something is lost. The patient loses and that may make their
other long COVID symptoms worse.”
Al-Aly and his co-authors Yan Xie and Benjamin Bowe, both at
Washington University in St. Louis, also analyzed records of 13,654 patients
who had been hospitalized for their initial coronavirus infection.
Unsurprisingly, they found that the sickest patients — those who needed intensive
care — were at the greatest risk of long-term complications, followed by those
who were hospitalized in regular wards, followed by patients who were never
hospitalized.
Nonetheless, virtually every category of symptom — from chest
pain to shortness of breath to diabetes to muscle weakness — were experienced
by at least some of the people who were never hospitalized.
Mylonakis and other experts noted that the understanding of the
virus and the status of medical treatment are evolving quickly, and this
progress is already translating into improvement for some patients. In
addition, some people with long COVID have gotten better over time, either on
their own or with the help of treatment.
Still, al-Aly said: “What we will grapple with for years to
come, maybe even for decades, is the effect of the pandemic on the long-term
health of Americans.”
He added, “We got caught unprepared for COVID. Let’s not drop
the ball on long COVID.”
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