Two years after being hospitalized with COVID-19, survivors of the virus are still not back at the same level of health as those who never caught it, according to a new study.

And half of those patients are still experiencing at least one virus-related symptom, suggesting that long COVID might end up affecting patients for even longer than anticipated. The most commonly described symptoms were either fatigue or muscle weakness.

The research, published last week in the scientific journal, follows 1,192 patients who were hospitalized with COVID-19 in Jin Yin-tan hospital in Wuhan, China between early January 2020 and late May 2020.

Since the research looks at participants infected at the very start of the pandemic, it represents some of the longest data we have on the lasting effects of COVID-19, shedding more light on how this pandemic could leave huge swathes of the population with lingering issues for years.

“Our findings indicate that for a certain proportion of hospitalized COVID-19 survivors, while they may have cleared the initial infection, more than two years is needed to recover fully from COVID-19,†Bin Cao, vice president of the China-Japan Friendship Hospital and lead author of the study,

“Ongoing follow-up of COVID-19 survivors, particularly those with symptoms of long COVID, is essential to understand the longer course of the illness, as is further exploration of the benefits of rehabilitation programmes for recovery. There is a clear need to provide continued support to a significant proportion of people who’ve had COVID-19, and to understand how vaccines, emerging treatments, and variants affect long-term health outcomes.â€

This is not the first time data from this cohort has been released — researchers released patient outcomes in 2021, which looked at their health at the six-month and one-year marks.

All of the outcomes were compared to a control group who never got COVID-19 that had been age, gender and comorbidity matched to the study’s patient cohort. The median age of the 1,192 patients was 57 years, and there were slightly less women, at 46 per cent.

In order to assess the patients’ health at followups, the majority of which were done in person, researchers included a physical examination, six-minute walking test and laboratory tests as well as surveys relating to symptoms, quality of life, mental health and other aspects of their life in the period after they had recovered from COVID-19 and were cleared to leave the hospital.

TIME DOES HELP …

In general, the health of those who survive COVID-19 improves with time, the data shows. The percentage of patients who reported experiencing anxiety or depression dropped from 23 per cent at six months to 12 per cent at two years.

While 14 per cent of participants had difficulty walking in the six-minute test at the six-month follow-up, that number decreased to eight per cent at the two-year mark.

After two years, 89 per cent of COVID-19 survivors who had a job prior to the pandemic had returned to that original work.

And in terms of long COVID, around 68 per cent of patients were dealing with at least one lingering symptom of COVID-19 at the six-month mark as opposed to 55 per cent two years after contracting the virus.

… BUT COVID-19 HAS A LINGERING TOLL FOR MANY

The results still point to long COVID affecting a high number of people for longer than originally expected.

Of the lingering symptoms that patients described experiencing, the most common were either fatigue or muscle weakness, with 31 per cent reporting that they experienced one or both. On top of that, although patients improved with time, they still reported having worse mental and physical health overall than the general population.

“COVID-19 survivors still had more prevalent symptoms and more problems in pain or discomfort, as well as anxiety or depression, at two years than did controls,†the study stated.

A little under a third of the participants also reported sleep difficulties two years after contracting COVID-19, compared to just 14 per cent of the general population represented by the control group.

COVID-19 survivors reported pain or discomfort at more than four times the rate of the control group, and were more than twice as likely to report anxiety or depression.

And those with long COVID needed to utilize healthcare more often even two years after having the virus. Around 26 per cent of those who were still experiencing at least one virus-related symptom reported a recent outpatient clinic visit compared to 11 per cent of participants without long COVID.

“To the best of our knowledge, this is the longest longitudinal cohort study of individuals who had survived hospitalisation with COVID-19,†the study stated. "Long COVID symptoms at two years were related to decreased quality of life, lower exercise capacity, abnormal mental health, and increased use of health care after discharge.â€

Numerous studies have come out recently attempting to quantify long COVID’s impact on patients’ bodies and minds. One study published in early May found that the cognitive impact of long COVID in those assessed six months after their acute illness was the equivalent of aging 20 years.

Researchers in this new study say that even more research is going to be needed to understand how to combat this.

“The negative effect on quality of life, exercise capacity, and health-care utilization highlights the importance of studying the pathogenesis of long COVID and promoting the exploration of targeted treatment to manage or alleviate the condition,†the study stated.

There are several limitations to the study, such as the fact that all of the patients were sourced through a single hospital. Some who were originally part of the cohort did not return for the one-year and second-year followup, and it’s unknown if their presence would have confirmed the long COVID percentages or if they dropped out due to not having symptoms to report.

As the study looks at those who contracted COVID-19 at the beginning of the pandemic, its results may not be able to be applied to those who contracted later variants of the virus, highlighting the importance of tracking and studying long COVID in more patients across the globe.

“The COVID-19 survivors had not returned to the same health status as the general population two years after acute infection, so ongoing follow-up is needed to characterise the protracted natural history of long COVID; we plan to conduct yearly follow-ups in this cohort,†the authors wrote in the study.

“The value of rehabilitation programmes in mitigating the effects of long COVID and in accelerating recovery requires further exploration.â€