ST. LOUIS — People who have been infected with the COVID virus face a significantly increased risk of developing health issues like diabetes, blood clots, heart failure, lung conditions and disorders in the gastrointestinal and musculoskeletal systems — even two years after recovery, according to a new Washington University School of Medicine study.
“Some estimates show more than 90% of the U.S. population has been infected with COVID-19,†said Ziyad Al-Aly, chief of the research and development at the Veterans Affairs ºüÀêÊÓƵ Health Care System and clinical epidemiologist at Washington University. “Doctors need to realize that their patients could be at risk of these conditions, be it heart disease or lung problems or brain problems — they’re at risk.â€
Yan Xie, senior clinical epidemiologist at the VA and a researcher involved in the new study, said the current estimate of long COVID patients is around 65 million — and is only expected to grow.
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The researchers compared the health outcomes of more than 138,000 patients who had been infected with the virus to almost 6 million non-infected individuals. They tracked the development of more than 80 health conditions associated with long COVID across a two-year span using unnamed patient records from the VA.
“We’ve been doing research on long COVID since the beginning of the pandemic, trying to understand what long COVID is and the different manifestations,†Al-Aly said. “Most of the research on long COVID, including ours, previously focused on outcomes up to a year after the infection.
“There was really nothing at all looking at what happens to people at two years after the infection,†he said. “So we decided to take a look.â€
Hospitalized vs. non-hospitalized
In analyzing the infected patients’ health risks, Al-Aly said two major groups stood out: people who had been hospitalized with COVID and those who had not.
Those who had not been hospitalized within the first 30 days of infection still faced an increased risk of death six months after recovery, as well as a higher risk of hospitalization for about a year and a half. After two years, they still had a higher risk of diabetes, many GI conditions, fatigue, joint pain and more, compared with non-infected individuals.
Patients who had been hospitalized during their COVID infection fared even worse in the following years than the non-hospitalized.
“In the non-hospitalized group, risks remained elevated for several problems, for several organ systems,†Al-Aly said. “For the people who were hospitalized, the risk was ubiquitous across all organ systems. It really spans the gamut with respect to the organ systems that are affected.â€
Between both groups — hospitalized and non-hospitalized — the risks were highest immediately following infection and then gradually declined. However, even two years later, risks were still elevated for many conditions in the hospitalized patients. They had a heightened risk for 65% of the illnesses and conditions studied after two years, while non-hospitalized patients were only at a significantly increased risk for 35% of them.
Burden of the disease
In addition to examining these increased health risks, the researchers also found that these post-infection conditions led to a loss of about 80 healthy life years per 1,000 non-hospitalized patients and a staggering 643 lost years per 1,000 patients for those who had to be hospitalized.
That value — disability-adjusted life years — calculates the loss of a full year of health, either due to premature death or years living with a disability because of a disease or health condition. It’s calculated by population.
“There are hundreds of millions of people who have survived COVID-19 now,†said Dr. Adnan Qureshi, a professor of neurology at the University of Missouri in Columbia. “But it just seems like these survivors are not integrating back into the normal life. They still continue to have symptoms and signs that are causing a lot of disability.â€
Qureshi said he’s seen many of these issues manifest as neurological conditions, especially brain fog. He expects more mandatory screenings and follow-ups after COVID infection will be needed to reduce the burden of many lingering post-infection problems.
Similarly, Al-Aly said that in addition to finding treatments to manage long COVID, making use of current vaccines and developing new strategies to block transmission remain exceedingly important.
“A lot of these conditions are likely to impact people for a lifetime,†Al-Aly said. “Treatment trials for long COVID cannot come soon enough for the people who have already been impacted and are suffering from long COVID. We need to develop the tools, the treatments, through trials to be able to manage these conditions over the course of people’s lifetimes.â€
Al-Aly said the researchers already have plans to follow up with three-year, five-year and 10-year analyses much like this two-year review.
“This additional burden (of long COVID) is really adding a burden to the patient, to the health care system, and even to the whole world,†said Xie, the VA epidemiologist. “We really feel like understanding long COVID will lead us to have the correct steps to reduce the risk and would be a very important focus for public health.â€