Long COVID symptoms may actually increase over 2-3 years after being hospitalised with COVID-19, according to international researchers who say almost one in two of the participants they studied reported some form of brain function or psychological impairment. In the first of two papers on long COVID, the team tested the brain function and mental health of 475 people who had been hospitalised with COVID-19 over two to three years. The researchers say many symptoms the participants reported actually increased over the study period, with some reporting new symptoms over that time. In a second paper, international researchers, including a researcher with lived experience with long COVID, review the current evidence on what long COVID is and how to treat it. The researchers outline the complexity and variability of symptoms after COVID-19, and say while treatment of the condition has so far mostly involved treating the symptoms, there are various areas for future research that may be able to tackle the biological factors driving the condition.
Journal/conference: The Lancet Psychiatry
Organisation/s: University of Oxford, UK (Paper 1), Nuffield Department of Primary Care Health Sciences, UK (Paper 2)
Funder: Paper 1: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation,
MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research.
Paper 2: In the past 36 months, TG has held research grants from UK National
Institute for Health and Care Research, Balvi, Medical Research
Council, Health Data Research UK, and Research Council of Norway.
She is a Governing Body Fellow at Green Templeton College and a
Visitor at the Pitt Rivers Museum, University of Oxford, and was until
2022, a trustee of the Hilda Martindale Charitable Trust (an educational
hardship fund). MS has held research grants from National Institute for
Health and Care Research, Research England Policy Support Fund, and
the Engineering and Physical Sciences Research Council. He is the
Editor-in-Chief of the Oxford Handbook of Rehabilitation Medicine.
AP has received consulting fees and grants from the US National
Institutes of Health and is Chief Medical Officer of Blooming Magnolia
(a 501[c]3 non-profit organisation). JŽN acknowledges institutional
support from the endowed Bowman Professorship in Medical Science
that he holds at the University of Arizona. He holds or has held
research grants from the US National Institutes of Health. He holds US
patent number 11119103 (serological assays for SARS-CoV-2). TG and
MS were funded by the UK National Institute for Health and Care
Research (LOCOMOTION study), and JŽN by the US National
Institutes of Health.
Media release
From: The Lancet
The Lancet Psychiatry: Severity of depression, anxiety and fatigue may increase in some individuals up to three years post-hospitalisation with COVID-19 compared to six months after, study suggests     The severity of depression, anxiety, and fatigue in some people is significantly higher two to three years after hospitalisation with COVID-19 compared to six and/or 12 months after, with evidence of both worsening of existing symptoms and emergence of new symptoms, suggests a study of 475 participants from the PHOSP-COVID cohort. At two to three years post-hospitalisation, most participants reported at least mild symptoms of one or more of depression, anxiety, fatigue and cognitive decline (such as memory loss or trouble with language), with more than one in five reporting severe symptoms. Emergence of new symptoms were mostly seen among people who experienced some other symptoms at 6 months. The authors believe this might indicate a window of opportunity for early intervention on core symptoms to prevent the emergence of a more complex syndrome.  More than one in four participants reported having changed their occupation compared to before they had COVID-19, and the main reason given was poor health. The study, published in The Lancet Psychiatry, also found an association between occupation change and an increase in cognitive deficits, but not depression or anxiety. Authors say this suggests many people who changed occupation in the months and years after hospitalisation with COVID-19 did so because they could no longer meet the cognitive demands of their job rather than for lack of motivation, interest, or confidence.   Authors highlight several limitations in this study, including a low response rate (19.2% of the PHOSP cohort responded to this survey) meaning a risk of selection bias where those who replied may be more likely to have symptoms than those who did not respond. Additionally, as those in the PHOSP cohort were hospitalised with COVID-19, the study findings might not generalise to patients who were not hospitalised.-The Lancet: More research is needed to better understand, treat, and prevent long COVID, says Review    A new, interdisciplinary Review of long COVID (also known as post-COVID-19 condition) explores the different facets of this emerging condition –  from its epidemiology and clinical manifestations to lived experiences and current best practices for managing long COVID and priorities for future research. The authors acknowledge that there are many challenges and unknowns for clinicians and patients alike when managing long COVID, as uncertainties about how to define, diagnose, and manage the condition remain. However, the review, published in The Lancet, suggests the recent advances in clinical phenotyping, deep molecular profiling, and biomarker identification could lead to a more informed and personally tailored approach to clinical care, with suggestions for future research focused on clinical trials and studies exploring potential treatments, next-generation COVID vaccines, developing predictive biomarkers for people who are more likely to develop long COVID, and optimizing rehabilitation protocols and health services to provide better support for people diagnosed with long COVID.