'Long Haul' COVID Recovery Worse Than Cancer Rehab for Some: CDC

Damian McNamara

July 08, 2021

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Some people recovering from COVID-19 fare worse than current or previous cancer patients when referred to outpatient rehabilitation services, a new study from the CDC demonstrates.

People experiencing ongoing or "long-haul" symptoms after COVID-19 illness were more likely to report pain, challenges with physical activities, and "substantially worse health" compared with people needing rehabilitation because of cancer, lead author Jessica Rogers-Brown, PhD, and colleagues report.

The study was published online today in Morbidity and Mortality Weekly Report (MMWR).

"This study is very helpful to get to know about long-haul COVID symptoms and the need for rehab, despite several limitations, given the number of patients in this study," Yuriko Fukuta, MD, told Medscape Medical News.

Dr Yuriko Fukuta

"This article shows deconditioning due to post-COVID-19 is quite severe," said Fukuta, assistant professor of Medicine-Infectious Disease at Baylor College of Medicine in Houston. "It has been underrecognized. Rehab should be offered for post-COVID-19 patients and prevention is critical. Not getting COVID-19 means you do not need to be worried about post-COVID-19 at all."

The CDC investigators compared self-reported physical and mental health symptoms, physical endurance, and use of health services between 1295 outpatients recovering from COVID-19 and a control group of another 2395 outpatients rehabilitating from a previous or current cancer diagnosis who had not experienced COVID-19.

Researchers used electronic health record data from January 2020 to March 2021 in the Select Medical network of outpatient clinics. The study included patients from 36 states and the District of Columbia.

Compared with people referred for cancer rehabilitation, those with COVID-19 symptoms lasting beyond 4 weeks were 2.3 times more likely to report pain, 1.8 times more likely to report worse physical health, and 1.6 times more likely to report difficulty with physical activities, an adjusted odds ratio analysis reveals.

The COVID-19 rehabilitation group also performed significantly worse on a 6-minute walk test, suggesting less physical endurance than people recovering from cancer (P < .001). They also used more rehabilitation services overall than the control group.

The researchers suggest services tailored to the unique physical and mental health rehabilitation needs of the post-COVID-19 patient population could be warranted.

Dr Greg Vanichkachorn

"The information in the new report is congruent with what we have seen clinically. Here at Mayo Clinic, we have had the opportunity to work with hundreds of patients struggling to recover from their COVID-19 infection since the early spring of 2020," Greg Vanichkachorn, MD, MPH, told Medscape Medical News when asked to comment.

From the very beginning, patients have reported significant difficulties with physical ability, endurance, and daily function. "Unfortunately, these functional deficits were often overlooked with the presence of other symptoms such as shortness of breath and fever," he said.

"While the findings are not new per se, I am very happy to see the emphasis placed on functional deficits by this research," added Vanichkachorn, a family physician and founder of Mayo Clinic's COVID-19 Activity Rehabilitation Program.

The study does not suggest all people recovering with COVID-19 will fare worse than people recovering from cancer, the authors caution. They note, "These results should not be interpreted to mean that post–COVID-19 patients overall had poorer physical and mental health than patients with cancer.

"Instead, results indicate that post–COVID-19 patients specifically referred to a large physical rehabilitation network had poorer health measures than those referred for cancer, which indicates that some patients recovering from COVID-19 had substantial rehabilitation needs."

Unanswered questions remain. "I would like to know how post-COVID-19 patients improve with physical therapy in the next study," Fukuta said. "For example, do they improve more quickly than controls? Which kind of therapy is effective?"

MMWR. Published online July 8, 2021. Full text

Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter:  @MedReporter.

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