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• Since the discovery of COVID-19 virus on January 2020, little published data are available on long-term outcomes and recovery after severe COVID-19.
• Yet studies in related patient populations, such as those affected with other coronaviruses, all-cause sepsis, or general critical illness, are helpful when considering the likely outcomes of COVID-19 survivors.
• Studies in these populations document several problems originating from sepsis and critical illness, which are collectively described as post-sepsis syndrome.
• Several studies which include more than 2500 patients examined long-term outcomes after severe disease by other coronaviruses such as SARS and MERS, and reported high occurrence of post-traumatic stress disorder at 38 percent, depression at 33 percent, and anxiety at 30 percent approximately 6 months after the illness.
• Long-term outcomes also include pulmonary dysfunction, reduced exercise tolerance, and reduced health-related quality of life.
• A prospective cohort study which includes more than 500 older adults who survived all-cause sepsis found that the odds of developing cognitive impairment is 3 times more increasing from 6.1 percent to 16.7 percent after sepsis.
• Development of one to two new functional limitations such as inability to bathe, toilet, or dress independently were also observed.
• People who survived sepsis are also prone to further health deterioration.
• 4 out of 10 patients discharged after sepsis hospitalization are re-hospitalized before 90 days, mostly for recurrent infection and exacerbation of chronic health conditions.
• One meta-analysis of more than 7000 patients who survived critical illness shows that only 33% returned to work by 3 months following critical illness, and only 56% returned to work by 12 months following critical illness.
• Cognitive, physical, psychological, and medical impairments are common after sepsis, but the clinical presentation varies considerably.
• Some patients develop predominantly cognitive symptoms such as memory deficits, difficulty concentrating.
• Some patients experience predominantly physical limitations such as exercise intolerance, fatigue, dysphagia.
• These adverse outcomes may not be limited to those who experience critical illness.
• Studies of all-cause pneumonia found that mild cognitive impairment and dementia were common in survivors, regardless of the severity of pneumonia.
• A study which includes 143 COVID-19 survivors shows that 13% of whom were admitted to an intensive care unit, found that nearly 90% were experiencing persistent symptoms with fatigue, dyspnea, and joint pain two months after onset of COVID-19.

Source:

JAMA. Published online August 5, 2020. doi:10.1001/jama.2020.14103 https://jamanetwork.com/journals/jama/fullarticle/2769290

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