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Extensive Loss of Health at Six Months in Survivors of COVID-19

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Most individuals with COVID-19 experience a full recovery. However, a significant minority do not and instead experience long-lasting symptoms, for which the etiology remains poorly understood. Therefore, Al-Aly and colleagues sought to comprehensively analyze the post-acute sequelae of COVID-19 using a high-dimensional approach.

The study included a cohort of 73,435 patients from the Veterans Health Administration (VHA) with COVID-19 who survived at least the first 30 days after a COVID-19 diagnosis and who were not hospitalized. These patients were compared to a control group of 4,990,835 VHA patients who did not have COVID-19 and were not hospitalized. More than 99.99% of standardized differences between the two groups were < 0.1 after adjustment, indicating that their baseline characteristics were similar. The investigators also evaluated the risk of death associated with 379 diagnoses (based on ICD-10 codes), 380 medication classes, and 62 laboratory tests beyond the first 30 days from COVID-19 diagnosis.

After the first 30 days of illness, COVID-19 survivors had a higher risk of dying (hazard ratio [HR], 1.59; range 1.46-1.73). The most commonly affected organ system for COVID-19 sequelae was the respiratory tract (28.51 per 1,000 COVID-19 patients at six months). There was an increased incidence of bronchodilator use (22.23 per 1,000 COVID-19 patients at six months), antitussive and expectorant use (12.83), anti-asthmatic use (8.87), and steroid use (7.65). An excess burden of nervous system disorders was found, including nervous system signs and symptoms (14.32 per 1,000 COVID-19 patients at six months) and headaches (4.10). Mental health problems were more frequent as well, including sleep-wake disorders (14.53 per 1,000 COVID-19 patients at six months), anxiety and fear-related disorders (5.42), and trauma and stress-related disorders (8.93). The led to an excess burden of incident use of antidepressants (7.83) and benzodiazepines, sedatives, and anxiolytics (22.23).

Many COVID-19 survivors had cardiovascular sequelae as...