COVID patients from ICUs report symptoms six months after infection

Experts have been tracking the long-term health outcomes of Australians recovering from severe COVID-19 disease, and early results show roughly two in three people have ongoing issues.

The study is being conducted across 30 different hospitals in Australia and is a collaboration between researchers, physiotherapists, doctors, and nursing staff who work in intensive care units (ICUs).

Dubbed the COVID Recovery Study, experts have been interviewing about 200 COVID-19 patients to learn more about outcomes six to 12 months after infection.

Carol Hodgson, Monash University professor and ICU physiotherapist at Melbourne’s The Alfred Hospital, said the team had just completed its follow-ups and while they hadn’t yet analysed the final dataset, early results showed about 30 per cent of people were “alive and disability free” six months after contracting the virus.

For the other 70 per cent of patients, most have only been reporting mild symptoms such as mild shortness of breath and weakness, with a small number having a persistent cough, headache, or loss of taste and smell.

Professor Hodgson said patients who were already critically ill with a wide range of infections were more likely to report lingering issues.

Their study has been aiming to figure out if there are any “unique symptoms and long-term outcomes” of COVID-19 disease that are markedly different to general illnesses.

“The question isn’t whether COVID can have an impact, the question really is whether COVID is any different from what we usually see with critical illness,” she said.

Play Video. Duration: 6 minutes 56 seconds
Up to a third of people take longer to recover from COVID(Nadia Daly)

‘Very specific symptoms’ of COVID-19
Most studies published to date about the long-term impacts of COVID-19 are from international research teams.

That’s because other countries have higher caseloads of infection and SARS-CoV-2 (the virus that causes COVID-19 disease) has been circulating in Europe and Asia for longer than Australia, where it was first detected in January 2020.

One Swedish study found 15 per cent of people who experienced mild COVID-19 suffered symptoms for at least eight months after infection.

And a separate US study found people who tested positive to COVID-19 were more likely to need future medical help for a range of issues such as respiratory conditions, nervous system disorders, mental health problems and fatigue.

Burnet Institute principal research fellow Joseph Doyle said there were “definitely some very specific symptoms”, such as weakness and tiredness, which lingered following COVID infection in some patients.

But Dr Doyle said other serious viral infections could also result in “chronic fatigue-type symptoms”.

Patients who had been critically ill with influenza, for example, could have lingering issues such as tiredness and reduced physical function for up to five years post-recovery.

Dr Doyle stressed COVID-19 was “far more serious” than influenza as both an initial infection and the potential longer-term impacts.

“[COVID-19] clearly has a much higher chance of killing you when you get it than the flu does, and a much higher chance of getting you into hospital and intensive care,” he said. 

But not everyone will experience these ongoing issues.

“Most people do recover, and most people do recover fully,” Dr Doyle said.

“If you were fortunate to have a very mild COVID infection, you’re probably not going to get any of these problems at all, you’re probably going to make a complete recovery.”

How COVID-19 causes ongoing symptoms
Dr Doyle explained that because COVID-19 disease was predominantly a lung infection, there was a risk of lung damage.

“For people who have had more severe [COVID-19] disease, sometimes there’s this problem [post-infection] where they lack the exercise capacity, the fitness, the lung reserve, and that can take weeks and months to recover,” he said.

“Some people clearly get these things worse than others, and we don’t understand why.”

And we don’t yet know when, or if, they will recover.

For some very sick patients, their immune system becomes overactive, which means their body can’t tell the difference between normal cells and infection.

“[You] end up getting blood clots, you can end up getting heart attacks, you can end up getting strokes, and those diseases themselves can have long-term consequences as well,” Dr Doyle said. 

“COVID doesn’t just affect the lungs and make you sick like some other viruses do.”

And hospitalisation itself causes independent issues.

“If you spend a long time in the ICU, you always have those problems, no matter what condition puts you in the ICU,” Dr Doyle said.

Professor Hodgson agreed and said half of the critically ill COVID-19 patients in her study needed ventilators while in the ICU, which meant they were hospitalised for long periods.

“The length of care for patients who were ventilated is about two weeks,” she explained.

“Four weeks [total] in hospital, that does result in significant ICU-acquired weaknesses.”

Professor Hodgson said this weakness was due to a “cytokine storm”, where the body’s cells released a protein called cytokine, which caused inflammation and a breakdown of proteins in the muscles.

“It’s more than just the result of bed rest,” she said.

“We know that this [muscle breakdown] can be quite prolonged and can last up to five years in other types of critically ill patients.”

What about the mental impact?
Professor Hodgson said so far, the symptoms being reported in their Australian study were more likely to be physical (such as tiredness and weakness) than psychological (such as anxiety).

But that’s not to say that those recovering from COVID-19 disease aren’t struggling with their mental health.

One UK study found in the six months after a COVID-19 infection, one in three people had experienced a psychiatric or neurological diagnosis.

Professor Hodgson said based on preliminary data, the rates of anxiety and depression in COVID-19 patients were less than 20 per cent – on par with other patients recovering from critical illness.

“One thing we are seeing is much higher rates when we screen for post-traumatic stress – we’re not diagnosing PTSD, but we screen for it – we are seeing an increased number of patients who test positive to being at risk of post-traumatic stress,” she said.

Dr Doyle said a lot of people who had been critically sick for long periods of time come out of hospital with psychological sequelae (conditions such as acute stress disorder which emerge days, months, or years afterward).

He said the infection itself had a high risk of stroke, which led to a lack of oxygen and could impact a patient’s mental health and brain function.

When will we know more about the long-term impact?
Time will tell.

To understand the impact COVID-19 disease could have in five years, experts need to literally wait five years to look at the patient data.

“The research is starting to paint a picture, but it’s early days,” Dr Doyle said.

“It will take a number of years to really know whether people who have been sick in the last year end up with lingering problems, or whether it’s just a few months of symptoms.”

Professor Hodgson said for now, the best thing people could do was get vaccinated.

“The one thing that we can do to protect Australians at this point in time is to have as many people vaccinated as possible for the coming winter,” she said.

Dr Doyle agreed.

“I think that anyone who is offered a vaccine should be seriously thinking about taking it up,” he said.

“If you can avoid getting infected and avoid getting a more serious type of the illness, you’re more likely to avoid getting more of these long term consequences of the virus.

“Vaccines are going to be our best protection in the long run.”

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