VA, CDC data suggest low-severity COVID-19 patients will need follow-up care

Clinicians and health systems will likely need to provide additional support to COVID-19 survivors, according to two studies outlining new and persistent care needs among patients who were never hospitalized for their initial infection. (Getty/Geber86)

Patients who were not initially hospitalized for treatment of their COVID-19 infection still face frequent health issues and require additional care in the months following diagnosis, according to a pair of studies published late last week.

The data suggest new diagnoses and an increase in healthcare demand across a range of specialties following the first month of acute COVID-19 illness among those with both low- and high-acuity cases.

As such, clinicians and health systems should be aware of—and be prepared to provide continued care for—the long-term needs of COVID-19 survivors, according to the studies by researchers affiliated with the Department of Veterans Affairs (VA) and the Centers for Disease Control and Prevention (CDC).

The first study (PDF), published Thursday in Nature, examined the records of more than 73,000 Veterans Health Administration (VHA) patients who were not hospitalized and survived at least 30 days after their COVID-19 diagnosis. To the authors’ knowledge, this represents the largest such study of post-acute COVID-19 conducted to date.

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Compared to the records of nearly 5 million other VHA patients without COVID-19, these patients had a higher risk of death and of additional outpatient care encounters. The study patients had a higher risk for numerous different conditions occurring across “almost every organ system,” the researchers wrote, as well as higher incident use of several classes of medications.

A complementary analysis conducted by the team found that several clinical risks were present among VHA COVID-19 patients who were not hospitalized or admitted to intensive care during the acute phase of their condition. The risk for those outcomes increased progressively with each tier of intensive care the patient required.  

“Beyond the first 30 days of illness, substantial burden of health loss—spanning pulmonary and several extrapulmonary organ systems—is experienced by survivors of the acute phase of COVID-19,” the researchers wrote. “Our results inform the global discussion on the post-acute manifestations of COVID-19; the findings provide a roadmap to inform health system planning and development of care strategies aimed at reducing chronic and permanent health loss and optimizing wellness among COVID-19 survivors.”

The second study, published Friday in the CDC’s Morbidity and Mortality Weekly Report, reviewed Kaiser Permanente Georgia’s records of 3,171 adults who had COVID-19 and were not hospitalized.

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During the window of 28 to 180 days after diagnosis, 69% of patients recorded one or more outpatient visits. Of note, those who had an outpatient visit were more often aged 50 years or older, women, non-Hispanic Black and had an underlying diagnosis compared to those without a recorded outpatient visit.

Sixty-eight percent of the patients had at least one of their visits for a new primary diagnosis, and 38% had a new specialist visit. COVID-19 and symptoms potentially related to COVID-19 were among the most common diagnoses for these new visits, with each becoming less common (although not eliminated entirely) as the days progressed.

The researchers wrote that they did not have a control group to compare the study results and that their data alone do not answer whether the volume of visits among the study group was greater than among peers without a diagnosis.

However, they did note that the mean number of visits among the patients exceeded that of a comparable group of non-hospitalized adults with influenza in Spain during 2009’s H1N1 pandemic. 

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“The presence of active COVID-19, symptoms of COVID-19 diagnoses and specialty referrals suggest that some non-hospitalized adults, including those with asymptomatic or mild acute illness, likely have continued health care needs months after diagnosis,” the researchers wrote. “Raising awareness among patients, clinicians and health systems about common new diagnoses and health needs, including specialist evaluation, after acute SARS-CoV-2 infection is important to understand the long-term effects of the illness.”

These two studies are the latest in a growing body of academic literature and data reviews that highlight lingering COVID-19 symptoms and other health needs among those recovering from acute COVID-19 infection.

Due to a wide range of systems within the body reported to be affected, providers like RWJBarnabas Health and Mount Sinai Health System have launched multidisciplinary programs dedicated to addressing COVID-19 patients’ long-term health needs over the past year.