Half of hospitalised COVID patients develop complications: Research

An analysis of more than 70,000 people hospitalised with COVID-19 in the United Kingdom appears to verify an already widely held view – that the disease often has a nasty sting in the tail.
 
The study, published last week in The Lancet, has been described as the most comprehensive of its kind, analysing the impact on 73,197 adults with severe COVID-19.
 
Of those, almost half (36,367) developed at least one health complication – beyond the recognised symptoms of COVID-19 – during their time in hospital.
 
The most frequently observed issues were renal, complex respiratory and systemic complications. Cardiovascular, neurological, gastrointestinal and liver impacts were also reported.
 
While the complications appear most prevalent among men and those aged above 60, the authors found there high rates across all age groups, even in previously healthy young adults. They also say the conditions often affect a person’s ability to look after themselves.
 
‘Occurrence of complications was associated with a significantly reduced ability to self-care at discharge, which was seen in all age and comorbidity groups,’ they wrote.
 
Just how long the effects last however, is yet to be established. But the short-term implications of the study’s findings are such that the authors flagged significant future challenges for the health-care system as a result.
 
‘Many of the complications identified are likely to have important long-term effects. Healthcare systems and policy makers should prepare for increases in population morbidity arising from COVID-19 and its subsequent complications,’ the authors wrote.
 
‘As complications following COVID-19 are common across all age groups and comorbidities, public health messaging around the risk COVID-19 poses to younger, otherwise healthy people should be considered alongside vaccine prioritisation.’
 
The study was carried out in patients aged 19 and over who were hospitalised in the UK between 17 January and 4 August last year, with 85.9% of those registering a positive SARS-CoV-2 RT-PCR test. The remaining patients had ‘highly suspected’ SARS-CoV-2 infection.
 
The mortality rate among the study’s patient cohort was 31.5% (23,092 of 73,197), and the overall complication rate was 49.7%.
 
For surviving patients, the rate was lower but still significant, with 43.5% (21,784 of 50,105) registering at least one complication. The patients’ mean age was 71.1 years old (standard deviation 18.7).
 
The hospital admissions took place before the UK’s large-scale vaccination program was launched and prior to strains such as Delta becoming prevalent. However, there are clear implications surrounding the impact of the disease on those who are unvaccinated in Australia.
 
For Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care and Co-Chair on the National COVID-19 Clinical Evidence Taskforce, the study backs up previous research into the lingering effect of the disease.
 
As well as noting the implications of the study for policymakers, he said the findings are important for individuals weighing up the risks of the disease.
 
‘It is devastating to think of the avoidable harm that can happen to people who are unlucky enough to get severe COVID-19 and this is avoidable by vaccination,’ he told newsGP.
 
‘The study adds further evidence that COVID-19 should not be treated as a benign disease even in
young adults.
 
‘The reality is they have shown people that get serious COVID have lasting damage that needs to be managed.’
 
Professor Morgan also directed GPs to relevant information compiled by the COVID-19 Clinical Evidence Taskforce – specifically the Care of People with Post-acute COVID-19 flowchart – and said the study reinforces the importance of effectively organised post-hospital care.
 
‘I think there is a real need for a co-ordinated approach on discharge,’ he said. ‘There needs to be thought given to effective rehabilitation once somebody leaves hospital having had severe infection.
 
‘Then it’s up to GPs to do what we do very well, which is to help people live with complex medical conditions and organise the multidisciplinary team to help.’
 
Dr Zoë Hyde, an epidemiologist and biostatistician at the University of Western Australia, wrote on a similar theme this earlier month. Considering the long-term implications for those who contract COVID-19, she countered the notion that dealing with the disease will be like treating influenza.
 
‘Death and hospitalisation aren’t the only outcomes of COVID-19 we need to prevent. New research shows even young people can be left with chronic health problems after infection,’ Dr Hyde wrote in The Conversation.
 
‘Inevitably, Australia will experience future outbreaks of COVID-19, just as we sometimes do with measles. But we should have a very low tolerance for the degree of transmission we’re prepared to accept.’
 
The authors of the UK study suggest healthcare planners should expect the need for a considerable amount of health and social care resources for those who survive COVID-19.
 
‘This includes adequate provision of staffing and equipment; for example, provision of follow-up clinics for those who have sustained in-hospital complications such as acute kidney injury or respiratory tract infection,’ they wrote.
 
However, the authors note that further work is needed to consider consequences of the complications and whether they are temporary or linked to poorer long-term outcomes.
 
‘Data on long-term health difficulties posed by COVID-19 will be of great importance, particularly as a large proportion of COVID-19 survivors come from economically active age groups,’ they conclude.
 
‘This should be considered on a policy level in terms of return to work and education; but importantly, it could have effects on individual behaviour around perceived benefits of engaging with preventive measures, including vaccination.’

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