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A majority of survivors who left hospital following COVID-19 had not fully recovered five months after discharge and continued to experience negative impacts on their physical and mental health, as well as their ability to work, according to results released by a major national study into the longer-term effect of the COVID-19. The study also found that one in five of the participant population reached the threshold for a new disability. 

The PHOSP-COVID study involves a number of Oxford researchers across a range of disciplines. Professor Ling-Pei Ho, who leads the Ho Group at the Medical Research Council Human Immunology Unit (MRC HIU), is a respiratory consultant and specialist in respiratory immunology, and one of the leads for the PHOSP-COVID study in Oxford. 

These initial findings of the study, which is also supported by the NIHR oxford Biomedical Research Centre (BRC) and the NIHR Oxford Health BRC, were published on the medRxiv pre-print server.

The UK-wide study, which is led by the NIHR Leicester BRC, analysed 1,077 patients who were discharged from hospital between March and November 2020 following an episode of COVID-19.

Researchers found that each participant had an average of nine persistent symptoms. The ten most common symptoms reported were: muscle pain, fatigue, physical slowing down, impaired sleep quality, joint pain or swelling, limb weakness, breathlessness, pain, short-term memory loss, and slowed thinking.

Patients were also assessed for mental health. The study reports that over 25 per cent of participants had clinically significant symptoms of anxiety and depression and 12 per cent had symptoms of post-traumatic stress disorder (PTSD) at their five-month follow-up.

Of the 67.5 per cent of participants who were working before COVID, 17.8 per cent were no longer working, and nearly 20 per cent experienced a health-related change in their occupational status.

Those who experience more persistent symptoms tend to be middle-aged, white, female, with at least two comorbidities, such as diabetes, lung or heart disease. Cognitive impairment, also referred to as ‘brain fog’, occurs as a predominant symptom in a sub-set of patients who tend to be older and male.

A biological marker associated with inflammation, C-Reactive Protein (CRP), is elevated in all but the most mild of post-hospital cases

Professor Ho, said: “These findings are a clear message that COVID-19 leaves the majority of hospitalised patients with symptoms and mental health issues.

“Persistently elevated CRP, a marker of inflammation, suggests a relationship between these issues and leftover biological effects from the infection. There is still a lot to understand and unpick in the coming months. PHOSP-COVID and other studies linked to it, such as the C-MORE Study, will continue to investigate.

“These studies were very long and involved, and it’s important to acknowledge the patients’ engagement, without which these findings would not have been possible. I am also keen to recognise the contribution of Prof Naj Rahman, Director of the Respiratory Trials Unit and  the large team of clinicians, research nurses, physiotherapists and researchers in the Respiratory, Mental Health and the MRC Human Immunology Unit.”

Professor Ho is one of three academics leading the study in Oxford; the others are Professor John Geddes, Director of the NIHR Oxford Health BRC and a professor of psychiatry, and Professor Stefan Neubauer, the Oxford BRC Theme Lead for Imaging.

The NIHR Oxford BRC’s Director, Prof Helen McShane, said: “This has been a very huge effort from a strong team in Oxford, led by Professors Ho, Neubauer and Geddes, who have contributed to the national leadership and impetus of this study. PHOSP-COVID provides a clear indication that further research is required over the coming months and years to better understand the long-term impact of COVID-19 on individuals and groups of patients.”

Professor Chris Whitty, Chief Medical Officer and co-lead for the NIHR, said: “We are in the foothills of our understanding of long-term effects of COVID. This research provides useful information on the debilitating effects of COVID some people are living with months after being hospitalised. It is important that we work out what exactly the various elements of what is currently termed ‘Long Covid’ are so we can target actions to prevent and treat people suffering with long term effects.

Read the full press release.