An interesting comment in The Lancet published January 8, 2021, long term follow up  of recovered patients with COVID-19.  

By early January 2021, COVID-19, caused by SARS-CoV-2, has resulted in more than  83 million confirmed cases and more than 1.8 million deaths worldwide. The clinical  spectrum of SARS-CoV-2 infection is wide, encompassing asymptomatic infection,  fever, fatigue, myalgias, mild upper respiratory tract illness, severe life threatening viral  pneumonia requiring admission to hospital, and death.  

Physicians are observing persisting symptoms and unexpected, substantial organ  dysfunction after SARS-CoV-2 infection in an increasing number of patients who have  recovered. This was previously observed in the SARS outbreak. 

However, COVID-19 is a new disease and uncertainty remains regarding the possible  long term health sequelae. This is particularly relevant for patients with severe  symptoms, including those who required mechanical ventilation during the hospital  stay, for whom long term complications and incomplete recovery after discharge will  be expected.  

Unfortunately, few reports exist on the clinical picture of the aftermath of COVID-19.  

The study by Chaolin Huang and colleagues in The Lancet is relevant. They describe  the clinical follow up of a cohort of 1,733 adult patients, 48% women, 52% men with a  median age of 57 years with COVID-19 who were discharged from Jin Yan-Tan  Hospital in Wuhan.  

Six months after the illness onset 76%, that is 1,265 of the 1,655 patients, reported at  least one symptom persisted, with fatigue or muscle weakness being the most  frequently reported symptom. 63% out of 10,038 of 1,655 reported fatigue or muscle  weakness.  

More than 50% of patients presented with residual chest imaging abnormalities.  

Disease severity during the acute phase was independently associated with extensive  lung diffusion impairment at follow up. These findings are consistent with those from  earlier small studies that reported lingering radiological and pulmonary diffusion  abnormalities in a sizeable proportion of COVID-19 patients up to three months after  hospital discharge. 

Evidence from previous Coronavirus outbreaks suggests that some degree of lung  damage could persist, as shown in patients who recovered from SARS, 38% of whom  had reduced lung diffusion capacity 15 years after infection. 

Although SARS-CoV-2 primarily affects the lungs, several other organs, including the kidneys, can also be affected. Therefore, Huang and colleagues assess the sequelae  of extra pulmonary manifestations of COVID-19.  

Unexpectedly 13% 107 of 822 of the patients who did not develop acute kidney injury  during their hospital stay and presented with normal renal function, based on  estimated glomerular filtration rate, eGFR, during the acute phase, exhibited a decline  in eGFR at follow up.  

Deep venous thrombosis was not diagnosed in any of the patients who underwent  ultrasound at follow up – this is an encouraging finding, in light of the frequent  development of venous thromboembolism in patients with COVID-19 who are critically  ill whilst in hospital.  

This study offers a comprehensive clinical picture of the aftermath of COVID-19 in  patients who have been admitted to hospital. However, only 4%, that is 76 of 1733, were admitted to an intensive care unit and therefore the information from the study  about long term consequences for most patients admitted to ICU is inconclusive.  However, previous research on patient outcomes after ICU stay suggests that several  patients with COVID-19 who are critically ill during their hospital stay will subsequently  face impairments regarding their cognitive and mental health or physical function far  beyond their hospital discharge.  

Clearly, these further studies are important to understand and mitigate the long term  consequences of COVID-19 on multiple organs and tissues.  

The London General Practice has worked with many physicians involved with COVID 19 patients to develop a care pathway for patients who are suffering long COVID. 

Dr Paul Ettlinger 
BM, DRCOG, FRCGP, FRIPH, DOccMed

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