Long-term health effects of COVID-19 in hospitalized and non-hospitalized patients

Introduction: On March 11, 2020, COVID-19 was declared a pandemic by the World Health Organization. The disease has had a major impact on public health and the global economy with more than 70 million people infected worldwide and more than 1.5 million mortalities. However, less is known about the long-term consequences of the disease. Objective: Evaluate the long-term health effects of COVID-19 on hospitalized and non-hospitalized subjects. Methods: We identified all patients who presented to the COVID-19 recovery clinic at the University of Texas Medical Branch (UTMB) in the period from March 16, 2020, to October 8, 2020. Data regarding persistent symptoms, patient health questionnaire (PHQ-9) score, generalized anxiety disorder (GAD- 7) questionnaire score and six-minute walk distance was collected. Comparisons between patients with a history of hospitalization for COVID-19 related symptoms and those who were not hospitalized were performed using Chi-square test or Fisher's exact test for categorical variables, and independent t-test for numeric values. Results: We identified a total of 93 patients who presented to the COVID-19 recovery clinic during the study period. Patients were predominantly females (69.9%), mean age was 52 years and the majority were white (58%). Obesity (body mass index ≥30) was present in 62% of subjects and 73% had at least one comorbidity. The most common noted comorbidities were hypertension (53.8%), asthma (29%) and diabetes (22.6%). The mean duration from positive COVID-19 test to clinic visit was 62 days (Table 1). Persistent fatigue, cough and dyspnea on exertion were reported by 60%, 57% and 56% of patients, respectively. The mean six-minute walk distance was 952 feet. Of the entire cohort, 46 (49.5%) were not hospitalized for COVID-19 related symptoms, these patients were younger (48 vs 56 years, P 0.006), and out of the comorbidities studied, obesity was less common (50% vs 74.4%, P 0.037) compared to those who were hospitalized. The mean six-minute walk distance was greater in the non-hospitalized cohort (1067 vs 841 feet, P 0.016) compared to those who were hospitalized. There was no difference between both groups in the prevalence of persistent symptoms, depression or anxiety. Conclusion: Persistent symptoms including fatigue, dyspnea, depression and anxiety were common in patients who recovered from COVID-19, regardless of their hospitalization history. Performance on the six-minute walk test was lower in patients who were hospitalized.