Many Pandemic Survivors Now Are Plagued With ‘Long COVID’ Issues

Even when COVID-19 cases fall and the pandemic is declared over, pharmacists and other healthcare professionals will be dealing with the aftermath for years, if not decades, according to a new study. Researchers focused on “long COVID” and lingering health effects, even when the initial infection was mild. Here are more details.

LOUIS – More than a year into the COVID-19 pandemic, the extended burden on nation’s healthcare system is just becoming clear.

Many COVID-19 survivors, including those who had what appeared to be mild cases, are grappling with a range of health problems months after symptoms should have resolved.

Research led by Washington University Medical School and the Veterans Affairs (VA) Saint Louis Health Care System is touted as the largest comprehensive study of long COVID-19 to this point. Findings, published in the journal Nature, revealed that COVID-19 survivors in the VA health system -- including those never sick enough to be hospitalized -- have an increased risk of death in the six months following diagnosis of the virus.

Study authors say the significance goes far beyond veterans, however, and underscores the extensive burden everywhere of long-term complications from COVID-19.

"Our study demonstrates that up to six months after diagnosis, the risk of death following even a mild case of COVID-19 is not trivial and increases with disease severity," said senior author Ziyad Al-Aly, MD, of Washington University and the VA. "It is not an exaggeration to say that long COVID-19 -- the long-term health consequences of COVID-19 -- is America's next big health crisis. Given that more than 30 million Americans have been infected with this virus and given that the burden of long COVID-19 is substantial, the lingering effects of this disease will reverberate for many years and even decades."

The study cohort included 73,435 users of the Veteran Health Administration (VHA) with COVID-19 who survived at least the first 30 days after novel coronavirus diagnosis and were not hospitalized, and 4,990,835 VHA users who did not have COVID-19 and were not hospitalized. 

Here are some of the “post-acute sequalae identified in the study:

The broad range included:

  • Respiratory system: persistent cough, shortness of breath and low oxygen levels in the blood.
  • Nervous system: stroke, headaches, memory problems and problems with senses of taste and smell.
  • Mental health: anxiety, depression, sleep problems and substance abuse.
  • Metabolism: new onset of diabetes, obesity and high cholesterol.
  • Cardiovascular system: acute coronary disease, heart failure, heart palpitations and irregular heart rhythms.
  • Gastrointestinal system: constipation, diarrhea and acid reflux.
  • Kidney: acute kidney injury and chronic kidney disease that can, in severe cases, require dialysis.
  • Coagulation regulation: blood clots in the legs and lungs.
  • Skin: rash and hair loss.
  • Musculoskeletal system: joint pain and muscle weakness.
  • General health: malaise, fatigue and anemia.

In addition to the higher risk of death, recovered COVID-19 patients in the first 30 days of illness also have higher health resource utilization because of those problems, the authors point out. Medication use also is increased, they add, noting,

“We show increased incident use of several therapeutics including pain medications (opioids and non-opioids), antidepressants, anxiolytics, antihypertensives, and oral hypoglycemics and evidence of laboratory abnormalities in multiple organ systems,” the study adds.

After getting through the initial infection and the first 30 days of illness, COVID-19 survivors had a nearly 60% increased risk of death over the following six months compared with the general population, the authors report. In fact, at six months, excess deaths among all COVID-19 survivors were estimated at eight people per 1,000 patients. Among patients who were ill enough to be hospitalized with COVID-19 and who survived beyond the first 30 days of illness, there were 29 excess deaths per 1,000 patients over the following six months.

"These later deaths due to long-term complications of the infection are not necessarily recorded as deaths due to COVID-19," Al-Aly said. "As far as total pandemic death toll, these numbers suggest that the deaths we're counting due to the immediate viral infection are only the tip of the iceberg."

Go Back