Many of the individuals released to long-term acute care facilities suffered from conditions that lasted for over a year.

Researchers at UC San Francisco studied COVID-19 patients in the United States who survived some of the longest and most harrowing battles with the virus. They discovered that approximately two-thirds of these survivors continued to experience a range of physical, psychiatric, and cognitive issues up to a year afterward.

The study, which was recently published in the journal Critical Care Medicine, reveals the life-altering impact of SARS-CoV-2 on these individuals, the majority of whom had to be placed on mechanical ventilators for an average of one month.

Too sick to be discharged to a skilled nursing home or rehabilitation facility, these patients were transferred instead to special hospitals known as long-term acute care hospitals (LTACHs). These hospitals specialize in weaning patients off ventilators and providing rehabilitation care, and they were a crucial part of the pandemic response.

Among the 156 study participants, 64% reported having a persistent impairment after one year, including physical (57%), respiratory (49%), psychiatric (24%), and cognitive (15%). Nearly half, or 47%, had more than one type of problem. And 19% continued to need supplemental oxygen.

The long-term follow-up helps to outline the extent of the medical problems experienced by those who became seriously ill with COVID early in the pandemic.

“We have millions of survivors of the most severe and prolonged COVID illness globally,” said the study’s first author, Anil N. Makam, MD, MAS, an associate professor of medicine at UCSF. “Our study is important to understand their recovery and long-term impairments, and to provide a nuanced understanding of their life-changing experience.”

Disabilities from long-term hospital stays

Researchers recruited 156 people who had been transferred for COVID to one of nine LTACHs in Nebraska, Texas, Georgia, Kentucky, and Connecticut between March 2020 and February 2021. They questioned them by telephone or online a year after their hospitalization. The average total length of stay in the hospital and the LTACH for the group was about two months. Their average age was 65, and most said they had been healthy before getting COVID.

In addition to their lingering ailments from COVID, the participants also had persistent problems from their long hospital stays, including painful bedsores and nerve damage that limited the use of their arms or legs.

“Many of the participants we interviewed were most bothered by these complications, so preventing these from happening in the first place is key to recovery,” Makam said.

Although 79% said they had not returned to their usual health, 99% had returned home, and 60% of those who had previously been employed said they had gone back to work.

They were overwhelmingly grateful to have survived, often describing their survival as a “miracle.” But their recovery took longer than expected.

The results underscore that it is normal to for someone who has survived such severe illness to have persistent health problems.

“The long-lasting impairments we observed are common to survivors of any prolonged critical illness, and not specific to COVID, and are best addressed through multidisciplinary rehabilitation,” Makam said.

Reference: “One-Year Recovery Among Survivors of Prolonged Severe COVID-19: A National Multicenter Cohort” by Anil N. Makam, Judith Burnfield, Ed Prettyman, Oanh Kieu Nguyen, Nancy Wu, Edie Espejo, Cinthia Blat, W. John Boscardin, E. Wesley Ely, James C. Jackson, Kenneth E Covinsky and John Votto, 10 April 2024, Critical Care Medicine.
DOI: 10.1097/CCM.0000000000006258

The work was supported by grants from the National Institutes of Health/National Institute on Aging (K23AG052603), the UCSF Research Evaluation and Allocation Committee (Carson and Hampton Research Funds), and the National Association of Long Term Hospitals. The authors had no conflicts of interest to disclose.