Diverse Needs of Post-COVID-19 Patients Managed In or Out of Hospital

By Megan Brooks

January 14, 2022

NEW YORK (Reuters Health) - A large study from the UK shows that patients who recover from COVID-19, whether managed in or outside the hospital, often seek care from their primary-care provider for multiple lingering problems - and those problems may differ between the two groups.

The study provides "invaluable insights" into the healthcare-seeking behaviors of patients after COVID-19 and suggests that clinical practices "must adapt to meet patients' diverse needs" after COVID-19 managed at home or in the hospital, say the authors of an editorial published with the study in The BMJ.

"At the time we undertook this work most of the studies that had been done had been in people who had been hospitalized with COVID-19 and yet we know that this is only the tip of the iceberg; not everyone who has COVID-19 ends up in hospital and so we wanted to better understand how people who had COVID-19 but were managed in the community also fared after the disease," study investigator Dr. Jennifer Quint, with Imperial College London, told Reuters Health by email.

The study included more than 456,000 patients (median age, 61 years; 45% men) with COVID-19 between August 2020 and February 2021, with 18,059 admitted to the hospital and 437,943 managed in the community. The patients were followed for up to 9.2 months.

The researchers also included a negative control group of 38,511 people without COVID-19 and 21,803 patients with influenza before the pandemic.

Healthcare use in COVID-19 patients managed in the community increased by 18% compared with levels before the pandemic, "highlighting the need for adequate ongoing provision of care for this population," Dr. Quint and colleagues write in their paper.

Relative to the COVID-negative control and influenza cohorts, COVID-19 patients managed in the community had significantly higher GP consultation rates for multiple problems - most commonly loss of smell or taste (or both), venous thromboembolism, lung fibrosis and muscle pain.

Other issues in COVID-19 patients managed in the community included anxiety and depression, abdominal pain, diarrhea, general pain, nausea, chest tightness, and tinnitus that persisted throughout follow-up.

COVID-19 patients admitted to hospital also had significantly higher GP consultation rates for multiple problems, especially related to venous thromboembolism, renal failure, nausea and delirium.

Rates of primary-care consultations for fatigue, breathlessness and palpitations were similar between the two groups.

"Recognition of the different profiles of sequelae in each group and their dynamic nature is important in guiding appropriate care for patients after COVID-19 infection," Dr. Quint and colleagues write.

Editorialists Dr. Matthew Knight and Dr. Rama Vancheeswaran with West Hertfordshire Hospitals NHS Trust agree and say the "wide range" of healthcare requests from patients with COVID-19 "suggests the need for a holistic approach to care."

"The reductive focus of healthcare on diagnosis, pathology, technological advances - including virtual care - and specialized management of single organ systems will need to change in response to the diverse spectrum of post-acute symptoms reported by patients with COVID-19," they write.

"A more complex, holistic, and better informed response is required. Long COVID highlights the importance of a broader and deeper knowledge of patients' needs through primary care with multidisciplinary support - currently at odds with the increasingly complex investigations and healthcare pathways that distance clinicians and patients from each other," they add.

Dr. Knight and Dr. Vancheeswaran say it's important to note that this analysis describes a diverse symptom burden in mostly unvaccinated patients in the second wave of the pandemic characterized by pre-delta variants.

"An update of this study in the post-vaccine, delta (and omicron) world would be invaluable, and it should be a research priority," they add.

The study was supported by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre (BRC).

SOURCE: https://bit.ly/3qgBGNK and https://bit.ly/339YYvZ BMJ, online December 29, 2021.

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