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April 23, 2021

Death risk increases sharply after Covid-19—even for patients who weren't hospitalized

Daily Briefing

    Even non-hospitalized Covid-19 patients face a significantly higher risk of death and chronic medical conditions in the six months after their infection, according to a study published in the journal Nature.

    Recovery clinics for Covid-19 long-haulers

    Study details

    For the study, researchers at Washington University in St. Louis used medical records from the Department of Veteran Affairs (VA) to compare the health outcomes of:

    • 73,435 people who had Covid-19 and weren't hospitalized for treatment;
    • 13,997 hospitalized influenza patients;
    • 13,654 hospitalized Covid-19 patients up to six months after they'd recovered from an acute case of Covid-19; and
    • Nearly 5 million people who didn't develop Covid-19 and weren't hospitalized.

    The researchers assessed the symptoms that non-hospitalized Covid-19 survivors experienced between one and six months after their coronavirus infections. According to the New York Times, the study is the largest yet to examine a broad range of health conditions among people who developed Covid-19.

    One limitation, however, is that the population examined in the study—which analyzed data from the Veterans Health Administration—is not representative of the American population. For example, among those in the study who had Covid-19 and weren't hospitalized, 88% were male and 70% were white, while 90% and 70% of those who didn't develop Covid-19 were male and white, respectively.

    A further limitation is that researchers couldn't determine whether the patients studied had pre-existing health conditions or whether their symptoms were the direct result of their coronavirus infections, pandemic-related stress, corollary effects of their medications, or other factors.

    Covid-19 survivors face higher risk of chronic conditions and death

    Overall, the researchers found people who had Covid-19 and weren't hospitalized still experienced health impacts from Covid-19 for months, and they faced a higher risk of death and chronic medical conditions than people who never developed Covid-19.

    The researchers found that, relative to people who never had Covid-19, non-hospitalized Covid-19 survivors had a 20% higher chance of requiring outpatient medical care within six months of their infections. Covid-19 survivors also experienced a range of long-term medical problems, from cardiovascular to gastrointestinal to neurological. Specifically, the researchers found that even non-hospitalized Covid-19 survivors were more likely than people who didn't have Covid-19 to require assistance for:

    • Anemia;
    • Fatigue;
    • Malaise;
    • Mental health problems;
    • Metabolic and cardiovascular disorders;
    • Musculo-skeletal pain;
    • Nervous system disorders; and
    • Respiratory conditions.

    According to the researchers, many medical problems identified in non-hospitalized Covid-19 survivors—including diabetes, kidney disease, and certain heart problems—could become chronic conditions that would require life-long treatment. 

    Further, the researchers found about 2.3% of people who had Covid-19 and weren't hospitalized died, a risk 60% higher than that of patients who had never experienced Covid-19.

    Among patients hospitalized for Covid-19, the risk of dying was significantly higher than for those hospitalized with influenza—about 51% higher, according to the researchers.

    Experts say the findings reveal the medical system's challenges in grappling with Covid-19's long-term effects, the Times reports.

    "We have hundreds of thousands of people with an unrecognized syndrome, and we are trying to learn about the immune response and how the virus changes that response and how the immune response can include all the organ systems in the body," said Eleftherios Mylonakis, chief of infectious diseases at Brown University's Warren Alpert Medical School and Lifespan hospitals, who wasn't involved in the study. "The health system is not made to deal with something like this."

    Where America's coronavirus epidemic stands

    The new findings come as new cases of the coronavirus remain high in the United States, though the daily number of newly reported cases appears to be declining as millions of Americans have been vaccinated.

    "We remain in a complicated stage," CDC Director Rochelle Walensky said during a briefing Monday. "On the one hand, more people in the United States are being vaccinated every single day at an accelerated pace. On the other hand, cases and hospitalizations are increasing in some areas of the country, and cases among young people who have not yet been vaccinated are also increasing."

    According to data compiled by the Times, the United States' average daily number of newly reported coronavirus cases over the past week was 61,901—down by 6% compared with the average from two weeks ago.

    The Times' data showed that, as of Friday morning, the rates of newly reported coronavirus cases were increasing in Puerto Rico, Guam, and 18 states. Those states are Alabama, Arkansas, Colorado, Delaware, Florida, Georgia, Kansas, Louisiana, Maine, Mississippi, Missouri, Nevada, New Mexico, North Carolina, Oregon, Texas, Washington, and West Virginia.

    In the remaining states and U.S. territories, rates are decreasing, according to the Times' analysis.

    Meanwhile, data shows Covid-19 hospitalizations are rising again. According to the Times' data, 45,710 Americans with Covid-19 were hospitalized on Thursday—up by 7% compared with the average from two weeks ago.

    According to the Times' data, 719 new deaths were linked to the coronavirus on Tuesday, down 2% compared with the average two weeks ago (Gale, Bloomberg, 4/22; Belluck, New York Times, 4/22; Wamsley, NPR, 4/22; Coleman, The Hill, 4/22; Al-Aly et al., Nature, 4/22; Baker/Witherspoon, Axios, 4/22; Joseph, STAT News, 4/23; New York Times, 4/23).

    Recovery clinics for Covid-19 long-haulers

    Download the case study

    Recovery Clinics for Covid-19 Long-haulers

    Several health systems have set up dedicated recovery clinics to help treat and coordinate care for long-haulers. This resource provides an overview of Covid-19 recovery clinic models pioneered by two early adopters—The University of Iowa Hospitals and Clinics and the University of Pennsylvania Medicine—and considerations for assessing whether it is a model you should pursue.

    Download now

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