More than half of patients still had at least one post-COVID-19 symptom 2 years after the acute infection, whether they were hospitalized or not, a cross-sectional cohort study showed.
Among nearly 700 patients infected during the first wave of the pandemic, 59.7% of those who were hospitalized and 67.5% of those who were not hospitalized still had at least one symptom 2 years later (P= 0.01), reported César Fernández-de-las-Peñas, PT, PhD, of Universidad Rey Juan Carlos, Madrid, Spain, and his colleagues at Open JAMA Network.
The most common symptoms for the hospitalized and non-hospitalized groups at the 2-year follow-up were:
- Fatigue: 44.7% versus 47.7%
- Pain (including headache): 35.8% vs. 29.9%
- Memory loss: 20% vs. 15.9%
“Our results revealed similar proportions of hospitalized and non-hospitalized patients with post-COVID-19 symptoms 2 years after acute infection, suggesting that although they were not hospitalized during the acute phase, symptoms of long COVID are also found in the non-hospitalized cohort,” the authors wrote. “This finding could be explained by the fact that the severity of COVID-19 is not a risk factor for the development of long COVID symptoms.”
“Long COVID will require specific management attention regardless of whether the patient has been hospitalized or not,” they concluded.
It should be noted that uninfected controls were not included in this study. “The lack of inclusion of uninfected controls limits the ability to assess a direct association of SARS-CoV-2 infection with overall and specific post-COVID-19 symptoms 2 years later,” they wrote. writing. “As a result, future studies could include uninfected control populations.”
When patients first presented with COVID-19, the most common symptoms were fever, dyspnea, myalgia, and cough, but dyspnea was more common in hospitalized patients (31.1% vs. 11.7% of non-hospitalized patients, P<0.001). Anosmia was more common in non-hospitalized patients (21.4% versus 10.0%, P=0.003).
“These differences could be explained by the fact that people with less bothersome and less severe symptoms (eg, anosmia, ageusia and sore throat) did not seek hospitalization during the first wave of the pandemic,” said Fernández-de-las-Peñas and the team wrote.
Among hospitalized patients, the number of pre-existing comorbidities was associated with post-COVID fatigue (OR 1.93, 95% CI 1.09-3.42, P=0.02) and dyspnea (OR 1.91, 95% CI 1.04-3.48, P=0.03), while the number of pre-existing comorbidities (OR 3.75, 95% CI 1.67-8.42, P=0.001) and number of symptoms at disease onset (OR 3.84, 95% CI 1.33-11.05, P= 0.01) were related to post-COVID fatigue in non-hospitalized patients.
Most previous studies looking at post-COVID symptoms had shorter follow-up periods. A meta-analysis which included 40 studies and followed patients for up to 120 days suggested a greater prevalence of post-COVID symptoms in hospitalized patients compared to non-hospitalized patients. “Data on non-hospitalized patients are based on follow-up periods no longer than 6 months; therefore, we cannot directly compare our results with previous data,” the authors noted.
To assess COVID-19 symptoms 2 years after infection, Fernández-de-las-Peñas and his team included 360 hospitalized patients (mean age 60.7%, 45% female) and 308 non-hospitalized patients (age average 56.7%, 59.4% women) from two urban hospitals. and several GP centers who were infected with SARS-CoV-2 from March 20 to April 30, 2020. These patients did not experience reinfection over the 2-year follow-up.
Common comorbidities among hospitalized and outpatients included hypertension (33.3% versus 24.7%), diabetes (13.6% versus 4.9%), heart disease (11.9% versus 11 .0%) and obesity (7.8% versus 10.1%).
Participants were required to be interviewed by telephone 2 years after acute infection. Hospitalization and clinical data were collected from medical records.
Besides not including uninfected controls, other limitations of the study included that the researchers did not control for vaccination status. Additionally, the data were self-reported in telephone interviews, which may lead to recall bias.
This study was supported by a grant from the Comunidad de Madrid y la Unión Europea, a través del Fondo Europeo de Desarrollo Regional, Recursos REACT-UE del Programa Operativo de Madrid 2014-2020, financiado como parte de la respuesta de la Unión a the COVID-19 pandemic.
Fernández-de-las-Peñas has not reported any conflicts of interest. A co-author reported receiving personal fees from the World Health Organization and grants from Gerencia Regional de Salud, Castilla y Leon during the conduct of this study.