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Risk of death from COVID-19 lessens, but infection still can cause issues 3 years later.
The study also shows that patients hospitalized within 30 days after infection face 29% higher death risk in 3rd year compared with those not infected.
New findings on long COVID — long-term effects on health experienced by many who have had
The good news: The increased risk of death diminishes significantly one year after a
Up to 10% of people infected with the virus experience long COVID, according to federal data.
Al-Aly’s prior research has documented COVID-19’s damage to nearly every human organ, contributing to diseases and conditions affecting the lungs, heart, brain, and the body’s blood, musculoskeletal and gastrointestinal (GI) systems.
Such studies with longer follow-up are limited, said Al-Aly, a nephrologist who treats patients at the Washington University-affiliated John J. Cochran Veterans Hospital in midtown St. Louis. “Addressing this knowledge gap is critical to enhance our understanding of long COVID and will help inform care for people suffering from long COVID.”
Al-Aly and his team analyzed millions of de-identified medical records in a database maintained by the U.S. Department of Veterans Affairs, the nation’s largest integrated health-care system. The study included more than 114,000 veterans with mild COVID-19 who did not require hospitalization; more than 20,000 hospitalized COVID-19 patients; and 5.2 million veterans with no COVID-19 diagnosis. Patients were enrolled in the study from March 1, 2020, to December 31, 2020, and followed for at least three years, until December 31, 2023. Patients included people of diverse ages, races and sexes; statistical modeling ensured parity in representation.
Health Risks in Non-Hospitalized Patients
In the third year after infection, COVID-19 patients who had been hospitalized experienced a 34% elevated health risk across all organ systems compared with people who did not have COVID. That number is down from a 182% increased risk one year after a COVID infection and a 57% risk two years after.
Among nonhospitalized patients, researchers found a 5% increased risk in suffering from long COVID in the third year after infection. This translates into 41 more health problems per 1,000 persons – a small but not trivial burden. The long-term health effects in the third year primarily affected the GI, pulmonary and neurological systems. By comparison, the risk was increased by 23% one year after infection and increased by 16% two years after.
Comparison With Other Major Health Conditions
In the analysis, researchers also measured and compared the number of healthy life-years lost due to COVID-19. They found that among the non-hospitalized, at three years after infection, COVID-19 had contributed to 10 lost years of healthy life per 1,000 persons. By comparison, three years post-infection, those hospitalized for COVID-19 had experienced 90 lost years of healthy life per 1,000 persons.
For context, in the U.S., heart disease and cancer each cause about 50 lost years of healthy life per 1,000 persons, while stroke contributes to 10 lost years of healthy life per 1,000 persons.
“That a mild SARS-CoV-2 infection can lead to new health problems three years down the road is a sobering finding,” said Al-Aly, who is also director of the Clinical Epidemiology Center at the VA St. Louis Health Care System, and head of the research and development service. “The problem is even worse for people with severe SARS-CoV-2 infection. It is very concerning that the burden of disease among hospitalized individuals is astronomically higher.”
“COVID-19 is a serious threat to the long-term health and well-being of people and it should not be trivialized,” he said.
Ongoing Research and Future Considerations
The extended trajectory for long COVID may change as researchers incorporate data from years beyond 2020. At that time, vaccines and antivirals had not been developed. Similarly, Al-Aly’s analysis does not consider subsequent variants such as omicron or delta.
“Even three years out, you might have forgotten about COVID-19, but COVID hasn’t forgotten about you,” Al-Aly said. “People might think they’re out of the woods, because they had the virus and did not experience health problems. But three years after infection, the virus could still be wreaking havoc and causing disease or illness in the gut, lungs or brain.”
Reference: “Risk of death from COVID-19 lessens, but infection still can cause issues 3 years later” 30 May 2024, Nature Medicine.
DOI: 10.1038/s41591-024-02987-8
Funding: U.S. Department of Veterans Affairs