The risks of ‘long Covid’ are devastating, especially to those with underlying health problems – it’s killing thousands

A new study shows that 30 percent of hospitalised Covid patients get readmitted within five months after being discharged – and that one in eight of them die.

The new paper by UK university researchers and government statisticians provides a sobering message that getting out of hospital may not be the end of matters for Covid-19 patients. Looking at patients who were discharged from hospital during the first wave in England, almost a third ended up back in hospital and one in eight died.

The study followed 47,780 people who had been in hospital in England with the virus and subsequently let out, amounting to 80 percent of those who had been hospitalised and survived in the study period (up to August 31, 2020).

The main results were that 29.4 percent of those discharged were readmitted to hospital at a later date and 12.3 percent died. An obvious question is whether these were old people who were going to get sick and die for other reasons anyway. The study found that those in hospital with Covid-19 were more likely to be aged 50 or over, male, living in a deprived area, be a former smoker, and overweight or obese; they were also more likely to be comorbid than the general population, with a higher prevalence of prior hospitalisation and all measured pre-existing conditions (most notably hypertension, cardiovascular problems, respiratory disease and diabetes).

When the patients were matched with similar people in the wider population who never had the disease, these post-Covid patients were 3.5 times more likely to be admitted to hospital and 7.7 times more likely to die.

Covid-19 is a particularly nasty disease, full stop, and is particularly deadly to those with underlying medical problems, in that it triggers the immune system to attack the patient's own organs. The phenomenon of the 'cytokine storm' received much attention early in the pandemic, as patients who seemed to be doing okay suddenly went into a catastrophic downturn as their immune systems ran out of control.

In December, a study from Yale University found that ‘autoantibodies’ were a major problem in Covid patients. As the Guardian reported: “The scientists compared immune responses in patients and uninfected people and discovered scores of aberrant antibodies in the former. These blocked antiviral defences, wiped out helpful immune cells, and attacked the body on multiple fronts, from the brain, blood vessels and liver to connective tissue and the gastrointestinal tract.”

The new research, led by Kamlesh Khunti, professor of primary care diabetes & vascular medicine at Leicester University, found something perhaps surprising: while those who were most seriously ill with Covid-19, those who needed intensive care, experienced greater rates of post-discharge respiratory disease and diabetes, rates of death, readmission and major adverse cardiovascular events (MACE) were worse in those who hadn't been in intensive care. In other words, it wasn't simply a case of people having the worst initial illnesses who had the worst longer-term outcomes.

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Perhaps similarly surprising, while it was people over 70 who were more likely to have problems after discharge, long Covid seemed to have a greater impact in those under 70 compared to their usual risk of disease (the mean age of those in the study was 65)

As this is an observational study, the old adage that 'correlation does not equal causation' applies. For example, as the paper notes, people who were already heading for problems like diabetes and heart disease may have been more likely to end up in hospital than those who are in better underlying health. 

The research also didn't look at those who weren't sick enough with Covid-19 to be admitted to hospital. Research published earlier this month suggests 12.4m people in England may have had Covid, of whom 300,000 have needed hospital treatment – roughly 2.5 percent. So overall, we're probably looking at about 0.75 percent of the population that has been readmitted thanks to long Covid. That said, there have been reports of multi-organ problems among non-hospitalised people, too, so there is little room for complacency. 

Another new study has concluded that how quickly a patient's immune system responds after infection with Covid plays a crucial role in determining the severity of the attack, and may play a part in its recurrence.

Researchers from Cambridge University studied 207 people who tested positive for the virus over a three-month period and found those with no symptoms or mild cases mounted a robust immune response soon after getting infected. But those needing hospitalisation had an impaired immune response, leading to a delayed and weakened attempt to fight the virus. 

The main message of these findings is that we urgently need to do more research on the full impact of post-Covid syndrome (PCS), both to improve treatment and to assess the future impacts on healthcare services.

One idea that would be worth pursuing is whether the damage is done during the time that people feel ill with Covid-19 or whether it continues after they appear to have recovered. If it is the latter, perhaps treatment to suppress these autoimmune effects needs to continue in some form for weeks or months afterwards.

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What is clear is that so-called 'long Covid' is more than just feeling unwell longer than you would expect. The impacts of the disease, particularly in the way it drives the immune system to damage organ tissues, can be very serious and some patients never get over them. At the very least, we need to have a way of monitoring patients with Covid-19 after they recover, so we can look out for these problems and plan for the extra demands they may make on health services.

It may also make us reconsider exactly how many people have died of Covid-19. If someone leaves hospital only to die weeks or months later because of organ damage caused by the disease, we should probably count those as Covid deaths, too. The headline measure at the moment is 'deaths from any cause within 28 days of a positive test.' That measure is likely to be ignoring some deaths that should be counted, and possibly includes some deaths that were from another cause entirely. Death certificates are better, but have their own problems. Getting a more accurate picture will be tricky, but it is still important.

Some will no doubt use this paper as further ammunition to promote lockdowns. But while it may change the balance between the benefits and costs of restrictions, the fact remains that the costs of lockdowns are still not being emphasised enough. The focus remains myopically on reducing the number of infections. But while some measures have a major impact at relatively low cost – like banning large, indoor gatherings or nagging us to avoid crowded spaces – some have quite small benefits and huge costs, like closing schools.

Above all, this new research emphasises once more the need to get on with vaccination programmes as quickly as possible. No stone must be left unturned to get everyone inoculated as soon as possible. Then we can leave this mess behind once and for all.

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