Even as the COVID-19 pandemic continues to rage, the death rates due to this disease have decreased in many parts of the world. And yet many patients recover COVID-19 tend to have some complications, even if they have had a mild illness.
The concept of long-term COVID is rapidly gaining popularity because patients are not only prone to have prolonged or persistent symptoms even after acquiring two consecutive negatives. COVID-19 test results but also because rehospitalizations and deaths due to post-COVID complications continue to occur.
A new study appeared in JAMA suggests that the highest risk for a COVID-19 the health of a patient is likely to be in the 10-day period after discharge from the hospital, and therefore proper care and monitoring of the health status of patients is very important during this early phase of recovery.
Peak post-COVID lethal risks
The study was conducted by researchers based at the University of Michigan and Ann Arbor Health System on Veterans Affairs. Observing that there were limited data on the initial outcomes after hospitalization, the researchers began measuring the rate of readmission, reasons for readmission and mortality rate after hospitalization among the patients with COVID-19 .
To do this, they used a two-person approach:
First they collected data on hospitalization of veterans with COVID-19 of 132 VA hospitals. Patients admitted between March and June 2020 and discharged between March and July 2020 were included in this study.
Second, they identified veterans hospitalized during the same time periods due to non-COVID-related pneumonia and heart failure. The researchers focused on data on duration of hospitalization, use of intensive care unit (ICU), dependence on invasive mechanical ventilation, and need for vasopressors (drugs used to treat very low blood pressure).
They then measured the readmission and death risks up to 60 days after resignation in between COVID-19 survivors and also calculated the dangerous rates of readmission for 10, 20, 20-40 and 40-60 days after discharge.
Common reasons for readmission and death
The researchers collected data on 2,179 veteran hospitalizations for COVID-19 , of which 678 patients were treated in the ICU, 279 had to access mechanical ventilators, 307 received vasopressors and 1,775 survived the disease to finally be discharged. Among these survivors, 354 (19.9 percent) were readmitted, 162 (9.1 percent) died and 479 (27 percent) were observed as readmitted or died within 60 days of being discharged.
The most common reasons for readmission and death of survivors were COVID-19 reinfection, sepsis, pneumonia, and heart failure. At readmission, 22.6 percent of these patients had to be treated in hospitals, 7.1 percent were mechanically ventilated and 7.9 percent received vasopressors.
In the other cohort of veterans with non-COVID hospitalizations, 2,156 patients had pneumonia and 4,269 had heart failure, of which 97.8 percent and 98.3 percent survived, respectively, and were discharged after therapy. After excluding patients who died, the health outcomes of 1,799 patients with pneumonia and 3,505 with heart failure were compared with those who survived. COVID-19 and were discharged.
Comparing these two cohorts of surviving patients, the researchers found this COVID-19 survivors had lower rates of 60-day readmission or death compared with patients with pneumonia or heart failure. However, COVID-19 survivors had the highest rates of readmission and / or death within the first 10 days after discharge compared with these same patients.
Urgent need for critical care in the first 10 days after discharge
Although the forecast for COVID-19 survivors after discharge for the duration of 60 days do not appear as bad compared to patients of other potentially fatal causes of admission, the findings on the rates of readmission or death in the first 10 days suggest an increased risk of clinical damage during this period.
The researchers thus conclude that although their study has some limitations (both cohorts were primarily male and elderly, and therefore had higher risks of severe outcomes) public health surveillance and clinical care for the period of 10 days after discharge for all COVID-19 patients are key.
If the health systems and clinical trials on drugs, vaccines, etc. focus only on mortality during hospitalizations and do not consider this critical period posthospitalization, then they may underestimate the burden of COVID-19 and to obtain loss-making results to the detriment of the entire global population fighting the pandemic.
For more information, read our article on Post-COVID care.
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