“This isn’t patients saying, ‘I can’t run quite as far as I used to.’ This is them saying, ‘I can’t walk, I can’t cook, I can’t shower.’ The effects are devastating.”
C. Terri Hough, MD, co-lead author
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COVID-19: Even Short Hospitalizations Lead to Long COVID Symptoms, Financial Hardship
COVID-19 patients after just 5 days or less in the hospital report new or worsened symptoms, impaired daily function, and significant financial loss.
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A hospital stay as short as 5 days or even less for COVID-19 can have long-term impacts on health and financial security, according to early results from a National Heart, Lung, and Blood Institute (NHLBI)-funded study. The findings were published online August 18, 2021 in the Journal of Hospital Medicine.
The study, which is ongoing, is being conducted by the NHLBI Prevention and Early Treatment of Acute Lung Injury (PETAL) Network. Investigators have enrolled >1300 of a desired 1500 patients at 44 major US medical centers. This early analysis includes 253 patients who were hospitalized during the fall of 2020 through early 2021, during the COVID-19 pandemic’s so-called third wave. Conditions of study inclusion were no substantial pre-COVID-19 disability and a positive molecular test for SARS-CoV-2.
One-month surveys were administered to patients via phone by trained interviewers and interviews were completed at a median of 47 days after discharge.
Median respondent age was 60 years, 43.4% were women. Median length of stay was 5 days (interquartile range [IQR], 3 to 8). Of the 93.3% who were discharged home 15.4% had home care services and 77.9% did not.
Half report new, worsened cardiopulmonary symptoms
Investigator's preliminary analysis finds that close to 85% (84.2%) of people hospitalized for COVID said that they were not back to their pre-COVID lives one-month post-discharge. When asked, on a scale of 0-100 how close to being all the way back to pre-COVID condition, the median response was 80 (IQR, 64-95). More than 15% (16.8%) reported a level of ≤50. Each additional week in hospital length of stay was associated with a 7.5-point lower response to the question (95% CI, –11.2 to –3.8).
“These people have substantially worse problems after hospitalization than clinicians would have expected,” said study co-lead author Theodore Iwashyna, MD, PhD, professor of internal medicine, division of Internal Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Michigan, in a Michigan Medicine statement.
More than half (56.5%) reported at least 1 new or worsened cardiopulmonary symptom after their COVID-19 hospitalization, a finding consistent with other studies of “long COVID,” authors point out. The most common cardiopulmonary symptom was cough, reported by 23.2% of patients. Women were twice as likely as men to report any new cardiopulmonary symptoms.
New limitations on ADLs
The researchers also report that at 1 month after hospitalization, 52.8% of patients had new limitations in activities of daily living (ADL) or instrumental ADL (IADL); all had 0 to 3 limitations before their COVID-19 hospitalization. Indeed, 25.2% reported ≥3 new health-related limitations in ADL or IADL compared to their pre-COVID-19 baseline.
Authors found that new limitations were common among patients discharged to home without home health services. The number of new cardiopulmonary symptoms explained 11.2% of the variance in the number of new limitations in ADL, a Spearman rank correlation of 0.30 (P < .0001).
More than 3 in 4 COVID-19 patients reported new or worsened cardiopulmonary symptoms or new health-related limitations in activities of daily living at 1 month—only 24.5% patients reported neither.
“This isn’t patients saying, ‘I can’t run quite as far as I used to.’ This is them saying, ‘I can’t walk, I can’t cook, I can’t shower.’ The effects are devastating,” said co-lead author C. Terri Hough, MD, professor of medicine and chief, Division of Pulmonary and Critical Care Medicine Oregon Health & Science University in the statement. “Unfortunately, we saw this even among patients with quite short hospital stays.”
Financial fallout
Financial consequences also were widespread, the authors write. Nearly one-quarter (23%) of patients said they had used up their savings, 20% had to either change their job or became unemployed, and close to 40% required a loved one to miss work to provide care.
Iwashyna et al say they suspect one major risk factor at this stage of the study and analysis: a lack of follow-up healthcare services. Three-quarters (73%) of patients reporting a disability had not received skilled home care following their hospitalization, even when other hospital services had resumed. “Somewhere the ball is being dropped. One month later, these patients need services and are not getting them,” said Iwashyna in the statement.
In conclusion, the authors state their “data suggest a broad range of new problems among survivors of COVID-19 hospitalization” and that the problems do not appear well correlated with each other. This, in turn, suggests “there may be multiple phenotypes of post-acute sequelae after COVID-19 hospitalization,” although to what extent the differences are mediated by differences in myriad other factors is not clear.
"The degree of financial stress, savings loss, and job dislocation reported here suggests these patients will face substantial challenges in guiding their own recovery in the absence of a dedicated set of services.”
Reference: Iwashyna TJ, Kamphuis LA, Gundel SJ, et al. Continuing cardiopulmonary symptoms, disability, and financial toxicity 1 month after hospitalization for third-wave COVID-19: early results from a US nationwide cohort. J Hosp Med. Published online August 18, 2021. DOI: 10.12788/jhm.3660
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