Over Half of Early COVID-19 Patients in the Hospital Had Symptoms Two Years Later

There’s still a lot we don’t know about long COVID, which when people infected with COVID-19 continue to experience symptoms long after their infection disappears, including mental fog, fatigue, dizziness, and shortness of breath. They can last weeks, months, or even years after the person first tests positive for the virus.

Doctors estimate that anywhere from a quarter to a third of COVID-19 patients become “long-haulers” and individuals that aren’t vaccinated tend to be more at risk of developing long-term symptoms. But a new study shows that over half of patients hospitalized with COVID-19 early in the pandemic still had symptoms two years later.

The Longest of Long-Haulers

The study, recently published in the Lancet, found that 55% of patients still had at least one COVID-19 symptom two years later, and 68% had symptoms six months after infection.

Researchers from China-Japan Friendship Hospital looked at the records of 1,192 people who had been hospitalized at Jin Yin-tan Hospital in Wuhan, China, and were discharged between January and May 2020. The authors checked in with the participants six months, 12 months, and two years after they were discharged to see if they still had symptoms. The patients also received regular medical evaluations, including pulmonary function tests, CT scans, and six-minute walk tests.

The results show that most patients were generally in poorer health after two years. Many said they suffered from pain, fatigue, depression, anxiety, and had trouble sleeping. Patients who had higher-level respiratory support while hospitalized had more lung problems than others in the long term.

Patients with symptoms also said they went to the doctor more often now than they did before the pandemic. They also reported having a lower quality of life. Most of them had returned to work but it’s not clear in what capacity or if they had taken on as much work as they did before the infection.

Co-author Dr. Bin Cao of China-Japan Friendship Hospital says this study should encourage more providers to ask follow-up questions to their patients after they test positive for COVID-19.

“There is a clear need to provide continued support to a significant proportion of people who’ve had COVID-19 and to understand how vaccines, emerging treatments, and variants affect long-term health outcomes,” Cao said.

However, the study comes with some limitations. The researchers didn’t compare the results to patients that were hospitalized for non-COVID-19 reasons. Instead, they compared the group to residents living in the community that had never tested positive for COVID-19. This group also had health issues two years later, but only at around half the rate of those with long COVID.

The study also focuses on patients from just one hospital, so the results may not apply to all COVID-19 patients. Another factor to consider is the patient’s length of stay. Patients with COVID-19 early in the pandemic typically stayed in the hospital longer than they do now, which may account for their lasting symptoms. It’s also not clear if the original strain of the virus made these patients sicker compared to those that were infected with the delta or omicron strains of the virus.

The study also didn’t account for whether the person had gotten vaccinated.

Dr. Devang Sanghavi, a critical care specialist at the Mayo Clinic in Jacksonville, Florida, would like to see more studies on long COVID with an emphasis on vaccination status.

“The only thing I know that I can safely offer long COVID patients is vaccination,” said Sanghavi, who was not involved in the study. “When we compare non-vaccinated patients to vaccinated patients and see the incidence of symptoms of long COVID, vaccinated patients have less severe symptoms and less commonly have long COVID.”

Sanghavi says the study should motivate the government to research the effects of long COVID. He believes there could be millions of Americans living with lingering symptoms, but the CDC doesn’t keep track of the number of cases like it does for COVID-19.

“Right now, these patients sometimes seem to be an afterthought,” Sanghavi said. “The study points out potentially how many people will need help. I don’t know if you’ve tried to get an appointment for primary care visit, but it takes potentially weeks or even months in many places. And that’s just for a simple wellness check — forget about long COVID. That’s a lot longer.”

He added that providers also need to learn how to properly treat patients suffering from lingering symptoms. “Our health-care system is not prepared for the kind of influx of patients that this condition will bring,” he said.

Dr. Kristine Erlandson, an associate professor of medicine and infectious disease specialist at the University of Colorado, is recruiting long-haulers for another study on the long-term effects of COVID-19. She said the results line up with what she’s seen in her own work.

“This is similar to what we hear patients in the U.S. saying, that they’re still experiencing symptoms at two years out, particularly in that first spate of patients in the pandemic. We’ve been hearing this anecdotally, so it’s always nice to see things published,” said Erlandson, who was not involved in the study.

She also pointed out that some patients start to get better after 12 months but then get worse after two years.

“I think these long studies are interesting to see it’s not a progressive improvement. People are kind of fluctuating in terms of their improvements,” she said. It can also have a dramatic effect on a person’s quality of life.

“Unless they have some kind of treatments, I do worry that it is going to have some long-term impact on disability and in function for some patients,” she said.