Those who are discharged from hospital after suffering from Covid 19 are often far from healthy. Researchers have now recorded how often and for what reasons Covid 19 patients have to be re-admitted or die after they are discharged from the hospital. Accordingly, the risk of relapse is highest within the first ten days after discharge – higher than in patients treated for heart failure or pneumonia during the same period.
A Covid 19 infection leads to long-term complications in some people. For example, those affected suffer from shortness of breath, fatigue, difficulty concentrating and chest pain. Discharge from the hospital often does not mean that those affected have fully recovered. So far, however, there is little data on the long-term course of patients who were treated with Covid-19 in hospital.
Dangerous aftermath
A team led by John Donnelly from the University of Michigan has now evaluated the proportion of Covid 19 patients who have to be re-admitted or die within two months of being discharged from the hospital. To do this, the researchers used data from 132 hospitals for American veterans. Of 2179 Covid-19 patients treated in one of these hospitals between March 1 and June 1, 2020, 1775 survived and were able to return home. Within two months of their discharge, 354 of them were hospitalized again (19.9 percent) and 162 died (9.1 percent) – either with or without further hospitalization. Overall, 27 percent of patients relapsed within the first two months, leading to re-hospitalization or death.
The most common causes for this were renewed health problems with Covid-19 in almost a third, sepsis developed in 8.5 percent, pneumonia or heart failure in 3.1 percent each. 22.6 percent of those who were re-admitted had to be treated in the intensive care unit because of their complaints. According to the researchers, the greatest risk factor for such complications is age: both re-hospitalizations and post-discharge deaths were most common in people over 65 years of age.
Increased risk within the first ten days
For comparison, Donnelly and colleagues also collected data from veterans of a similar age structure who were treated for heart failure or non-Covid-19 pneumonia during the same period. Based on two months after their discharge from hospital, these people were at a higher risk than Covid-19 patients of having to go to hospital again or of dying. However, within the first ten days after discharge, the Covid-19 patients were the most likely to be readmitted or to die.
“The first week or two after discharge is a risky period for any patient,” says Donnelly. “But when comparing the long-term course of Covid-19 patients and other seriously ill patients, we found that the risk in Covid-19 patients is even higher than usual.” According to Donnelly, the results indicate an acute need for action, to better care for patients given the high risk: “How can we design better discharge plans for these patients? How can we adapt our communication and post-hospital care to their needs? And how can we help your supervisors to prepare and cope with the situation? “
Further surveys planned
Donnelly’s colleague Theodore Iwashyna adds: “Unfortunately, our study shows once again that you are not simply healthy after having overcome Covid 19 disease. For many patients, Covid-19 causes a number of problems that are just as serious as any other serious medical condition. But our health system and research are not designed enough to help these patients recover from Covid-19 for days, weeks and months. “
The validity of the study is limited by the fact that it only included veterans, 95 percent of whom were male. The researchers chose this data because it was the quickest available. “It is likely that the picture in the private health sector will be very similar,” says Iwashyna. In future studies, the researchers want to include data from other hospitals as well as make comparisons with other diseases. In view of the widespread false claim that Covid-19 is no more dangerous than the flu, they want to provide data, for example, on how the long-term course of patients with Covid-19 and the flu differs.
Source: John Donnelly (University of Michigan) et al., JAMA, doi: 10.1001 / jama.2020.21465