Researchers say their findings may have certain limitations as they are prone to both underestimation and overestimation due to considerable loss of participants to follow-up
Hospitalised patients with COVID-19 experience a variety of illnesses after discharge that may persist until 12 months post-discharge, a new study that followed up with former COVID-19 patients part of the Indian National Clinical Registry for COVID-19 during three waves of the pandemic found.
Among the 8,042 participants who were followed up at 30-60 days post-discharge, dyspnoea, fatigue, and mental health issues were reported among 18.6 per cent, 10.5 per cent, and 9.3 per cent respectively. The prevalence dropped to 11.9 per cent, 6.6 per cent, and 9 per cent, respectively, at a 1-year follow-up in 2,192 participants.
Of the diagnosed patients having dyspnoea and mental health issues, 10.1 per cent and 6.9 per cent respectively, had required treatment at the intensive care unit.
The study was led by the Clinical Studies and Trials Unit, Indian Council of Medical Research (ICMR), with observational data collected from 31 hospitals across India from September 2020 to October 2022.
‘Post-COVID syndrome’ is defined as the signs and symptoms that develop during or after an infection consistent with COVID-19 that may not be attributable to other causes and persist for more than 12 weeks, according to the Union Ministry of Health & Family Welfare. The reasons could be multifactorial, including pre-existing comorbidities and the severity of the disease.
“Other common issues reported were weakness of limbs, body aches, joint pain, cough, headache, vomiting, chest pain, fever, and loss of taste or smell which ranged from 1% to 6.7% during the first follow-up and 0.1-4.5% at the 1-year follow-up post-discharge,” the study published in the British Medical Journal said.
When the mortality rate was ascertained, 4.3 per cent of the patients had passed 60 days after discharge, with the highest death rate observed in the patient cohort during the third wave dominated by the omicron variant at 6.4 per cent. The researchers attributed this finding to better follow-up after the third wave as the omicron variant was the least severe.
Admittedly, they say their findings may have certain limitations as they are prone to both underestimation and overestimation due to considerable loss of participants to follow-up. Deaths post-COVID-19 may not necessarily be due to the disease itself and investigating that was beyond the scope of the study without controls.
Only 16 per cent of patients who died had been vaccinated, as compared with nearly 50 per cent among those who had survived, reinforcing the findings of previous studies.
Among those who died, a significantly higher proportion were above 60 years of age and had at least one comorbidity, and had required ICU admission during their original hospital stay as compared with survivors, the researchers wrote.
“A definitive cause of death was available in only 137 patients; the majority had died owing to cardiac causes that included heart failure and myocardial infarction,” the study said.
“Respiratory failure and sepsis/septic shock caused death among 26 and 15 participants, respectively. Stroke, pre-existing malignancy, chronic kidney disease, and mucormycosis were reported to be a cause of death for three, three, one, and one patients, respectively,” the study added.
The study has not categorised different forms of mental health despite a considerable number of survivors reporting suffering from mental health issues. However, according to the World Health Organization, there was an uptick of 25 per cent in global incidences of anxiety and stress during the pandemic’s first year.
“The reasons for the mental health issues could be many including fear of death, loneliness due to isolation, the stress of being admitted to the hospital, grief due to personal loss, and even monetary loss during the pandemic,” the researchers explained.
“In order to cater to these issues, we suggest that psychiatric care in terms of counseling, medication, and further functional linkages with peer groups and helplines would be quintessential. The GOI has recently announced the launch of the National Tele-Mental Health Program (NTMHP), which would have linkages with various levels of medical institutions,” the researchers recommended.
Tele-Mental Health Assistance and a Nationally Actionable Plan were announced for States to provide 24/7 telemental health services, which could be linked to COVID-19 clinics, the researchers suggested.
When data was compared between three waves of the pandemic, it was found that dyspnoea, mental health issues, and fatigue were highest among patients admitted during the second wave.
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