40% COVID-19 patients at Max Hospitals suffered from long-term symptoms, reveals study

New Delhi: The exhaustive study titled “Long term health consequences of COVID-19 in hospitalised patients from North India: A follow up study of up to 12 months” led by Dr Sandeep Budhiraja, Group Medical Director, Max Healthcare, is possibly the longest post-COVID follow-up study conducted on a cohort of nearly 1000 RT-PCR confirmed COVID-19 patients admitted across 3 hospitals in north India.

The study, designed as a two-step tele-interview, based on symptoms recall to a set of questions was undertaken to shed light on the burden of prolonged symptoms faced by the hospitalised COVID-19 patients in India after discharge and their duration in a follow-up of up to one year.

During the study, doctors assessed persistent symptoms up to one year in patients who were discharged from the hospital after recovery from acute phase of COVID-19, with an aim to describe the consequences of long COVID and to identify potential factors associated with those symptoms. This study will help in assessing the need and type of long-term follow-up and rehabilitation programs required for patients hospitalised for COVID -19. For the study, all the patients who were admitted at the 3 hospitals between April – August 2020 were contacted twice over the telephone for follow-up. The first follow-up was done in September 2020 (4 weeks to 16 weeks from the onset of disease) and the second follow up call was done in March 2021 with those patients who had reported symptoms during the first follow-up and profile of prolonged symptoms of long COVID. The details were captured using a questionnaire along with the pre discharge and discharge data which was extracted from the hospital’s Computerized Patient Record System (CPRS).

Talking about the findings of the study and the persistence of Covid symptoms, Dr Budhiraja said, “We found that overall, long-COVID occurred in almost 40% of the cases. Of the 990 patients studied, 31.8% patients had post COVID symptoms beyond three months, and 11% of the patients continued to have some form of symptoms for as long as 9-12 months from the onset of disease. Of the notable findings, fatigue was found to be the most commonly reported with 12.5% cases followed by myalgia (9.3%). Persistence of breathlessness was also reported significantly more often in those who had severe disease at the onset.”

The patients in the study group also reported neuro-psychiatric symptoms like depression, anxiety, “brain fog” and sleep disorder and persistence of breathlessness. The duration of symptom resolution was significantly associated with severity of illness at the time of admission. However, there were no reports of severe organ damage from the study group.

Dr. Budhiraja further said “that the study found no correlation between developing post COVID symptoms and age, gender, comorbidities, or the severity of disease; however, duration of post COVID symptoms had significant correlations to the disease severity at time of admission but not to age, gender and comorbidities”.

Commenting on fatigue as a persisting symptom in the study, Dr Budhiraja, said, “Fatigue showed significant association with age (P = 0.017), with only 1 of 44 (2.3%) in the age group of less than 30 years had fatigue, which increased to 21.5% in the age-group of 60 years or more. Fatigue was also significantly associated with severity of COVID-19 illness at admission (P = 0.016), while Neuro-psychiatric symptoms, such as anxiety, depression, “brain-fog”, and sleep disorder, were reported by 9.0% cases. It was significantly associated with pre-existing comorbidity (P=0.018) and not with age, gender, or severity of illness.”

Elaborating on the severity of the illness at the time of admission to the hospital, Dr Budhiraja added, “Of the 990 patients who responded to the first interview, 62.2% (615 patients) had mild illness, 22.9% (227 patients) had moderate and 15.0% (148) had severe COVID-19 illness at the time of admission. It was also noted that nearly 40% (399) of these 990 patients reported at least one symptom at that time. Of these 399 long-COVID patients, almost 78% (311 patients) responded to the second follow-up and nearly 8% reported ongoing symptomatic COVID, lasting 1-3 months and 32% patients having post-COVID phase with symptoms lasting 3-12 months.”

Among the 990 respondents of the first follow-up, 32.3% (320 patients) were females and 67.7% (670 patients) were males. It was also noted that more than one-third (37.3%) reported at least one comorbidity at admission; diabetes (23.7%) and hypertension (20.4%) being the most common.

Regarding the severity of the disease in relation to age, Dr Budhiraja said, “The severity of the disease at the time of admission was significantly associated with age (P<0.001). Mild cases were relatively more in cases of 0-29 years age and serious more in cases of age >60 years or more. While the pre-existing comorbidity was present in only 8.3% patients of age less than 30 years, 34.2% in patients of age 30-59 years and 61.0% in patients of age 60 years and above.”

He further commented on the age-comorbidity correlation and said, “The association of age with the presence of comorbidity was highly significant (P<0.001). Moderate and serious cases reported at least one comorbidity (48.9% and 45.3% respectively), significantly more often (P<0.001) than in mild cases (31.1%). Diabetes was reported more often (43.3%) in cases with moderate severity compared to mild (19.3%) and severe (25.7%) cases (P<0.001). Hypertension was reported more often in cases with severe (26.4%) and moderate (24.7%) disease as compared to mild cases (17.4%) (P= 0.010). Hypothyroidism was twice more common in cases with severe illness (6.8%) compared to the cases with mild illness (3.3%).”

Speaking about the time of recovery, Dr Budhiraja said, “It was observed that of the 331 patients responding to the second interview, 68.8% (214 patients) reported that they were able to resume their daily routine within a month of discharge, 24.8% (77 patients) took 1 to 3 months, and 6.4% (20 patients) took 4 months or more. The differences across age-groups, gender, severity, and pre-existing comorbidity were not significant (minimum P = 0.307).”