Long-term conditions in post-acute COVID-19 phase

One in seven adults with COVID-19 developed at least one new condition that required medical care during the post-acute phase of illness, a new US study has found.

The research, led by UnitedHealth Groups in Minneapolis, MN, and the School of Public Health in Boston, MS, recorded conditions in a range of organs and systems, including the heart, kidneys, lungs and liver, and mental health complications.

Although the risk of developing new conditions during the post-acute phase of illness increased with age, pre-existing conditions, and admission to hospital due to COVID-19, the results suggest that younger adults and those with no previous conditions were also at some increased risk.

Because few studies have examined the excess risk of new clinical conditions due to coronavirus infection beyond the initial recovery period, the researchers, led by Sarah Daugherty, of UnitedHealth Group, evaluated the excess risk of developing new clinical conditions after the acute phase of coronavirus infection.

They used health insurance records to identify 266,586 adults, aged 18-65 who were diagnosed with COVID-19 from 1 January to 31 October 2020 and assessed if they were diagnosed with at least one of 50 conditions up to six months after initial infection.

Individuals were matched to three comparison groups with no COVID-19 infection from 2020, 2019, and a group diagnosed with other viral lower respiratory infections.

The results revealed that 14% of COVID-19 infected adults had at least one new condition that required medical attention after the acute phase of illness, which was 5% higher than in the 2020 comparison group and 1.65% higher than individuals diagnosed as having viral lower respiratory tract illness.

The team also found that the risk for specific conditions in the four months after the acute phase of COVID-19 infection, including chronic respiratory failure, heart rhythm problems, amnesia, diabetes, anxiety, and fatigue, was greater than in all three comparison groups.

They point out that the overall absolute risk was small – with an extra 0.02 to 2.26 per 100 people developing specific types of conditions compared with the 2020 comparison group – it persisted up to six months after initial infection.

Although this was an observational study, they warn that as the number of individuals infected with coronavirus worldwide continues to rise, “the number of survivors with potential sequelae after COVID will continue to grow”.

Daugherty S, Guo Y, Heath K et al. Risk of clinical sequelae after the acute phase of SARS-CoV-2 infection: retrospective cohort study. BMJ 20 May 2021; doi: 10.1136/bmj.n1098

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