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Dr Amitava Banerjee, consultant cardiologist, University College London Hospitals, reflects on the latest Office for National Statistics, UCL, Barts, and University of Leicester research on post-COVID syndrome in individuals discharged from hospital published in The BMJ.
What were your findings?
We’ve done a study in 48,000 people who’ve been hospitalised with Coronavirus in England, and followed them up over a mean time of about 4 months. And what we find is that in those who’ve been discharged, firstly, there is a high mortality rate of about 1 in 8, there is a high hospital readmission rate of about 3 in 10, and there’s also a high incidence of new chronic diseases – diabetes, major cardiovascular events, chronic kidney disease, and liver disease. Secondly, we show that this, when matched to a control population by age, by sex, and then general risk factors in the general population, this is a much higher risk.
And so I think overall, what this shows is that this is very far from a benign condition. We’ve focused a lot in terms of our coverage, our resource, our clinical services, on the acute events, but we also have to be aware that multi-organ impairment is an issue here. And so there’s even more reason to think about keeping the infection rate down at population level.
Were you surprised by the extent of long COVID?
I’m a cardiologist in my clinical role, and by the summer of last year, I was definitely seeing patients just in my general inpatient and outpatient activities, who were complaining of heart rhythm problems, of myocarditis, and cardiac complications. And I’ve managed people who are in hospital acutely with coronavirus so I’ve seen the organ impairment. I was surprised by the mortality rate in people who are discharged, in their hospital readmission rate, and the extent at four months of organ impairment outside of the lungs.
If you go back to the first reports from Wuhan, we’ve very much thought of this as a pulmonary disease, as a respiratory disease, and clearly, this is a multi-system disease, or at least with multi-system complications.
Your study advances what we know. What don’t we know at the moment?
There’s still a lot that we don’t know. Firstly, in the hospitalised group, we need to know more about who are the most high-risk people, who we need to monitor more closely when we discharge them from hospital, how long we need to monitor them for, which scans do we need to do, and how frequently, for example. We don’t have any specific treatments for long COVID yet. So all of those.
We don’t know the impact of vaccination in the trials on long COVID and on the organ complications here. In the non-hospitalised people who’ve had coronavirus infection, I would say that there’s even more unknowns. We have shown in a separate study, the COVERSCAN study, that there is likely to be mild organ impairment across the heart, the kidneys, the lungs, the liver, but how that progresses over time, we don’t know.
Is there enough follow-up in place after discharge?
In the UK, the Government announced at the end of 2020, the establishment of dedicated post-COVID clinic services for assessment of these patients. I think the challenges that already the health system and health professionals are swamped by, firstly, the direct effects in the acute setting of the pandemic, and secondly, there are non-COVID services which have been indirectly affected – whether it’s cancelled surgeries, cancelled clinic appointments, cancelled investigations, which we’re all catching up with. So the infrastructure, the staffing, the funding for these to be done equitably everywhere, is challenging. And so in the interim, I do, unfortunately, think that a lot is already being seen by general practitioners, but also by specialists like me in hospitals who’ve ended up seeing them outside of the standard referral route.
Is there anything positive that we can say about long COVID at this stage?
There’s been data to suggest that 13.7%, 14% of people who have had coronavirus infection have persistent symptoms beyond 12 weeks. I guess you can say it’s positive that 85% of people do recover by that time. I think it’s positive that most people don’t have lasting organ impairment. But I think the message is not a positive one, it’s a sobering one, that there is both an acute risk and a chronic risk with coronavirus.
So any suggestion that we should just live with the virus and not be concerned by rising population infection rates is really flawed. And we have enough evidence to say that clearly.
Créditos: Comité científico Covid