Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: A systematic review and meta-analysis

Abstract

Severe acute respiratory syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are two previous viral infection outbreaks similar to the current COVID-19 pandemic. Studies that have looked at long-term health problems in survivors of these two outbreaks report reduced lung function and reduced ability to exercise in some survivors up to 6 months after discharge from hospital. Mental health problems including stress, anxiety and depression were observed in up to one-third of survivors at 6 months and beyond. The quality of life was observed to be low even 12 months after discharge from the hospital. Rehabilitation clinicians and services should anticipate similar health problems in survivors of COVID-19, investigate them accordingly and plan suitable and timely treatments to enable best possible recovery and quality of life for them. Objective: To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive care unit admission. Data sources: Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched. Study selection: Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included. Data extraction: Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge. Data synthesis: Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15-45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450-473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31-47%), depression (33%, 95% CI 20-50%) and anxiety (30%, 95% CI 10-61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge. Conclusion: Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar longterm outcomes in COVID-19 survivors.

Applying the WHO ICF Framework to the Outcome Measures Used in the Evaluation of Long-Term Clinical Outcomes in Coronavirus Outbreaks

“…Considering the widespread prevalence of COVID-19, the long-term complications of coronavirus infection in survivors will increase healthcare utilization significantly in the coming months. Previous outbreaks have shown that there is a broad spectrum of long-term complications of coronavirus infection which spans across all of the ICF components, with prevalence of respiratory compromise, exercise intolerance, psychological distress and reduced quality of life being considerably high several months following infection [5]. Deficits in different components do not necessarily translate into each other and there is no causal relationship between them [15].…”

Anticipate study protocol: Baseline profile and care outcomes of patients attending Mater Misericordiae University Hospital with COVID-19 infection

“…All of Ireland's population are susceptible to COVID-19 infection 5,6 . Patients present with fever, cough, dyspnoea, fatigue, with some developing acute respiratory distress syndrome, multi-organ damage and secondary infection 7,8 . Symptoms of COVID-19 infection vary between individuals, and according to disease severity 5,7,9 .…”

“…Patients present with fever, cough, dyspnoea, fatigue, with some developing acute respiratory distress syndrome, multi-organ damage and secondary infection 7,8 . Symptoms of COVID-19 infection vary between individuals, and according to disease severity 5,7,9 . Many are asymptomatic 10 , some show mild to moderate symptoms 5,7 although severe cases with acute respiratory distress syndrome, acute heart injury, and secondary bacterial infection have occurred 5,9 .…”

“…Symptoms of COVID-19 infection vary between individuals, and according to disease severity 5,7,9 . Many are asymptomatic 10 , some show mild to moderate symptoms 5,7 although severe cases with acute respiratory distress syndrome, acute heart injury, and secondary bacterial infection have occurred 5,9 . COVID-19 infection is linked to a range of blood, cellular, and genetic abnormalities 5,7 .…”

Prevalence of depression during the SARS, MERS, and COVID-19 pandemics

“…Increasing SRs during the SARS, MERS, and COVID-19 pandemics were focusing on depression. [ 11 , 17 – 24 ] However, the methodological quality of these SRs is unclear. Therefore, to evaluate and compare the normativity of report of SR, we conducted a comprehensive overview about prevalence of depression during the SARS, MERS, and COVID-19 pandemics.…”