A study published in the Lancet has found that out of more than 70,000 adults in the UK hospitalised with severe COVID-19 disease, half developed at least one health complication during their hospitalisation, while almost one in three participants died.
The peer-reviewed observational study, published on 17 July, showed that the complications that occurred in 50% of all participants, are likely to have important short- and long-term impacts for patients, healthcare utilisation, healthcare system preparedness, and wider society.
The most common complications included renal, complex respiratory, and systemic complications. Some also developed cardiovascular, neurological, and gastrointestinal and liver complications. These complications are different from long COVID symptoms in patients with COVID-19 who were not hospitalised.
Thomas Drake, co-author from the University of Edinburgh said: “Our research looked at a wide range of complications, and found that short-term damage to several organs is extremely common in those treated in hospital for COVID-19.”
Even though men and those over 60 years old were most likely affected, the complications and poor functional outcomes were common in even younger, previously healthy individuals. More than a quarter of those aged 19-29 and more than one-third of those aged 30-39 experienced a complication.
Joint senior author Ewen Harrison from the University of Edinburgh said that patients in hospitals with COVID-19 frequently had complications despite being in younger age groups and not having pre-existing health conditions.
“These complications could affect any organ, but particularly the kidney, heart and lungs. Those with complications had poorer health on discharge from hospital, and some will have long-term consequences,” he said.
The researchers highlighted that complication rates following COVID-19 are high, and these complications often affect people’s ability to look after themselves. The study found that 13% of participants aged 19-29 and 17% of those aged 30-39 were unable to look after themselves once discharged from the hospital.
Joint senior author of the study, Calum Semple from the University of Liverpool, said that this work “contradicts” current narratives that COVID-19 is only dangerous in people with existing co-morbidities and the elderly.
“Dispelling and contributing to the scientific debate around such narratives has become increasingly important. Disease severity at admission is a predictor of complications even in younger adults, so prevention of complications requires a primary prevention strategy, meaning vaccination,” he said.
Health and social care systems challenged by COVID-19 complications
The authors warn that policymakers must consider the risk of complications for those who survive COVID-19, not just mortality when making decisions around easing restrictions.
Aya Riad, a joint co-author from the University of Edinburgh, said that “just focussing on death from COVID-19 is likely to underestimate the true impact, particularly in younger people who are more likely to survive severe COVID-19.”
It is predicted that COVID-19 complications are likely to cause significant challenges for individuals and for the health and social care system in the coming years.
Large amounts of health and social care resources will be required, such as the adequate provision of staffing and equipment – for example, provision of follow-up clinics for those who have sustained in-hospital complications such as acute kidney injury or respiratory tract infection.
Harrison said that this review can inform healthcare systems and policymaker responses to the impacts of COVID-19. “Our results can also inform public health messaging on the risk COVID-19 poses to younger otherwise healthy people at a population level, particularly in terms of the importance of vaccination for this group,” he added.
The study looked at cases between 17 January and 4 August, 2020 before vaccines were widely available, and new variants of the virus had not arisen.
[Edited by Josie Le Blond]