Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months

Abstract

ImportanceIndividuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited.ObjectiveTo measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19–related hospitalization.Design, Setting, and ParticipantsA national US multicenter prospective cohort study with 1-, 3-, and 6-month postdischarge visits was conducted at 44 sites participating in the National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Network's Biology and Longitudinal Epidemiology: COVID-19 Observational (BLUE CORAL) study. Participants included hospitalized English- or Spanish-speaking adults without severe prehospitalization disabilities or cognitive impairment. Participants were enrolled between August 24, 2020, and July 20, 2021, with follow-up occurring through March 30, 2022.ExposureHospitalization for COVID-19 as identified with a positive SARS-CoV-2 molecular test.Main Outcomes and MeasuresNew or worsened cardiopulmonary symptoms, financial problems, functional impairments, perceived return to baseline health, and quality of life. Logistic regression was used to identify factors associated with new cardiopulmonary symptoms or financial problems at 6 months.ResultsA total of 825 adults (444 [54.0%] were male, and 379 [46.0%] were female) met eligibility criteria and completed at least 1 follow-up survey. Median age was 56 (IQR, 43-66) years; 253 (30.7%) participants were Hispanic, 145 (17.6%) were non-Hispanic Black, and 360 (43.6%) were non-Hispanic White. Symptoms, disabilities, and financial problems remained highly prevalent among hospitalization survivors at month 6. Rates increased between months 1 and 6 for cardiopulmonary symptoms (from 67.3% to 75.4%; P = .001) and fatigue (from 40.7% to 50.8%; P < .001). Decreases were noted over the same interval for prevalent financial problems (from 66.1% to 56.4%; P < .001) and functional limitations (from 55.3% to 47.3%; P = .004). Participants not reporting problems at month 1 often reported new symptoms (60.0%), financial problems (23.7%), disabilities (23.8%), or fatigue (41.4%) at month 6.Conclusions and RelevanceThe findings of this cohort study of people discharged after COVID-19 hospitalization suggest that recovery in symptoms, functional status, and fatigue was limited at 6 months, and some participants reported new problems 6 months after hospital discharge.

Self-Reported Everyday Functioning After COVID-19 Infection

“…For example, patients hospitalized with sepsis with no prior limitations in activities of daily living or instrumental activities of daily living reported a mean of 1.6 new limitations a year later. 17 Similarly, hospitalizations for pneumonia were associated with 1.0 new health-related limitations in activities and instrumental activities of daily living among those with no or mild-to-moderate prehospitalization limitations. 18 …”

Long COVID and its association with neurodegenerative diseases: pathogenesis, neuroimaging, and treatment

“…According to recent reports, more than two-thirds of COVID-19 patients who have been hospitalized do not fully recover even after several months of hospitalization ( 3 ). A significant number of individuals who have recovered from acute COVID-19 experience a sustained immune response and chronic inflammation, which can lead to severe tissue damage ( 4 ).…”

“…This can be attributed to damage to the olfactory epithelium caused by the SARS-CoV-2 virus. The damage then affects the olfactory neural network, which is connected to the primary olfactory cortex ( 3 , 5 , 21 ). The study suggests that SARS-CoV-2 may pass through nerves within the olfactory mucosa, potentially creating a pathway for nerve invasion through the mucosal interface into the nervous system ( 21 , 22 ).…”

Patient adverse financial outcomes before and after COVID‐19 infection

“…In a recent national survey of COVID-19 survivors who had been hospitalized, half reported that their hospitalization had been a strain on their finances and 23% reported having used all or most of their savings. 2,3 Research examining patients' out-of-pocket costs for COVID-19 hospitalization and postdischarge care have also found that some patients experience a significant burden of out-of-pocket spending for their care. [4][5][6] However, objective measurements of patients' financial outcomes after COVID-19 infection and hospitalization have not yet been examined, particularly studies that can distinguish the impacts of individuals' COVID-19 infection from broader economic disruptions during the pandemic.…”