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What do we know about COVID survivors?

Question: What do we know about COVID survivors? Are long-term complications really all that common?

Answer: We talked about this a bit in our recent Q&A of 10/5 #Recovery. Yesterday, the UK’s National Institute for Health Research published a very informative report, “A dynamic review of the evidence around ongoing Covid19 symptoms (often called Long Covid).” This offers a more robust synthesis of the limited evidence to date on longer-term issues for recovery (see evidence bulleted below), highlighting that the outcomes of COVID-19 disease are not the binary (death/recovery) that many of us assume; rather “recovery” can be a long road with various challenges. For many of those with severe COVID, the road to recovery is likely long, and for a substantial proportion (~10%) of those with mild/moderate COVID, symptoms may last for >4 weeks.

One of the main findings of the team of researchers and doctors who reviewed the current evidence and interviewed patients to inform this report is — “Long covid” does not seem to be one syndrome and the long-term effects of the multisystem disease may instead manifest as different syndromes, including post-intensive care syndrome, post-viral fatigue syndrome, and/or long-term covid syndrome. As report author, Elaine Maxwell, said in an interview with BMJ News, “We are not saying that we have identified four definitive syndromes. We are raising this as a possibility and a possible explanation for why so many people feel they are not being believed or heard and are not getting access to supportive treatments.”

Evidence of Long Covid (quoted from NIHR report)

  • “A team from Italy, one of the earliest affected countries, reported that 87% of people discharged from a Rome hospital were still experiencing at least one symptom 60 days after the onset on Covid19 and 55% had three or more symptoms including fatigue (53%), difficulty in breathing (43%), joint pain (27%), and chest pain (22%) with 40% saying it had reduced the quality of their life.
  • On 5th June 2020, NHS England published ‘After-care needs of inpatients recovering from COVID-19’. This estimated that up to that date, more than 95,000 patients had been admitted to hospitals across England with Covid19 and it assumed 45% would need ongoing support.
  • Some estimates suggest that up to 50% of people hospitalised would need formal rehabilitation services.
  • An unknown number of people have had Covid19 symptoms (both with and without access to a test) and self-cared at home. Public Health England published guidance on 7th September 2020 stating that around 10% of ‘mild’ Covid19 cases who were not admitted to hospital have reported symptoms lasting more than four weeks and a number of hospitalised cases reported continuing symptoms for eight or more weeks following discharge.
  • Similar findings are reported by a patient group who surveyed a self-selected sample of 640 people with symptoms lasting over two weeks (respondents were predominantly US-based white females and not hospitalised at any time). The vast majority of participants experienced fluctuations in the type of symptoms (70%) and the intensity of symptoms (89%) over time.
  • The UK Covid Symptom Study app has over 4 million regular contributors and suggests that a ‘significant number’ of people report symptoms for a month and between 10% and 20% report complications for longer.”