A significant proportion of post-COVID patients were still symptomatic after almost three years of contracting the virus, according to a study.
But the hospitalised cohort – the more severe patients – have improved. While some of their symptoms persisted, they did not get worse and were also “getting back to normal” from a psychological point of view.
The study, General well-being at long-term follow-up of COVID-19, was completed last summer but has not yet been published.
It aimed at determining the incidence of physical and psychological symptoms at long-term follow-up in subjects previously infected with COVID-19, as well as any abnormalities in blood investigations.
The long COVID syndrome is defined as persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks following the acute illness.
Co-authored by Caroline J. Magri, Stephen Fava, Rachel Anne Xuereb and other junior doctors at Mater Dei Hospital, it stemmed from the fact that while there was significant data on the effects on patients’ physical and psychological well-being at short-term follow-up, the long-term impact of the disease remained largely unknown.
Almost 1,000 patients, who contracted COVID-19 in 2020, pre-vaccination, and whose average age was now 49, were randomly selected and interviewed to assess persistence of symptoms and health-related quality of life.
The research showed that while the same number of patients still “felt worse than before” infection (21 per cent), there was a slight improvement when it came to an abnormal taste of food and loss of smell, compared to the first study.
Now, almost three years down the line, 10 per cent less patients suffered from an abnormal taste of food and 15 per cent less from a loss of sense of smell.
Fatigue levels remained the same at 25 per cent of the patients, a comparison of the studies showed.
Symptoms like shortness of breath persisted to the same extent three years on, while headaches got slightly worse, affecting 22 per cent of patients as opposed to 19 per cent.
But myalgia symptoms (muscle aches and pain) had risen from 15 per cent to 22 per cent with the passage of time, the comparison showed.
Patients who might still have long COVID are still supported through the various services and treatments available at primary healthcare
The most common symptoms were abnormal taste of food (41.8 per cent), loss of smell (40.8 per cent), fatigue (25.9 per cent), headache (22.4 per cent), shortness of breath (22.1 per cent) and muscle ache (21.8 per cent), according to the latest study.
Further studies needed for patients with heart injury
The biggest differences remained between hospitalised and non-hospitalised patients, said Magri, a cardiologist at Mater Dei.
On assessing hospitalised patients – six per cent of participants – compared to non-hospitalised patients, higher troponin levels were noted at long-term follow-up, suggesting underlying minor injury in the heart muscle.
Further studies were required to assess whether the injury in a subset of patients could result in some impaired heart function in future, Magri said.
Patients with persistent fatigue were found to have deranged blood investigations that could imply ongoing inflammation.
Likewise, subjects with persistent shortness of breath also indicated ongoing inflammation from their blood tests.
On the other hand, the standard psychological questionnaire revealed that hospitalised patients fared worse than their non-hospitalised counterparts only with respect to physical functioning.
Dwindling attendance at clinic
Long COVID clinics set up at Mater Dei Hospital have been reduced because referrals from GPs have dwindled, Magri said, although patients were still being seen.
The outlook was “OK” for most long COVID patients, she said, with some who manifested poor heart function having since stopped treatment.
Only four cases documented by clinicians at long COVID clinics in 2023, down from 39 registered in 2022, the health ministry said.
It put the decline down to the course of the global infection rates of COVID-19.
The decrease in the rates of swabbing directly led to a decrease in the diagnosis of long COVID, despite potentially still being relevant locally, the ministry explained.
“Despite this, patients who might still have long COVID (without the diagnosis due to the lack of a positive swab test) are still supported through the various services and treatments available at primary healthcare.”