Research on long-COVID and the extended outcomes on lung function were featured at the British Thoracic Society Winter Meeting, with a review of the most important papers on the long-term sequelae from the year’s most important story.

In one study published in Thorax in December, researchers prospectively assessed the 12-week respiratory outcomes for patients previously hospitalised with COVID-19. They found that at least one pulmonary function variable was abnormal in 58% of a 60-patient cohort. Further, the bulk of the patients (88%) had abnormal imaging on chest CT scans.

The study found a strong association between the number of days patients required oxygen supplementation during the acute phase of the illness and both diffusion capacity of the lung for carbon monoxide and total CT score.

“We’re showing that we may be able to have key risk factors to predict longer term outcomes in these patients, hopefully to guide future guidelines,” said Dr Aditi Shah, of the University of British Columbia in Vancouver, who led the study and presented during the BTS Winter Meeting session.

Lasting symptoms, multidisciplinary approach

In another Thorax study of hospitalised patients, researchers led by Dr Swapna Mandal of the Royal Free London NHS Foundation Trust, conducted a cross-sectional analysis of 384 patients a median of 54 days after discharge.

“Whilst in many patients we saw an improvement in their symptomatology and their biomarkers, it was clear that many had ongoing symptoms, and long-COVID does exist,” she said.

More than two-thirds of the cohort (69%) had fatigue at follow-up, more than half had persistent breathlessness (53%), and many still had cough (34%). There was also evidence of depression seen in 14% of the cohort.

“It was very clear to us.. that we needed an MDT [multidisciplinary team] approach to managing these patients, with clear clinical pathways to be able to refer patients to other specialties,” Dr Mandal said. “What is still unclear, however, is what the trajectory of recovery in these patients is.”

One other featured study echoed these results, with 74% of previously hospitalised patients showing persistent symptoms at an 8- to 12-week follow-up visit. Clinically significant abnormalities in chest radiographs, exercise tests, blood tests, and spirometry were seen in 35% of that cohort.

Dr Shaney Barratt, of North Bristol NHS Trust, who presented those results, agreed with Dr Mandal: “There is a widespread persistence of symptoms and poor health status, and this really supports the holistic approach in the follow up of patients,” she said.

While most long-term follow-up has focussed on hospitalised patients, one other featured study examined outcomes in patients with milder cases of COVID-19 who did not require hospitalisation.

That study, conducted in Norway and led by Knut Stavem, of Akershus University Hospital, found that more than half of respondents to a survey reported no symptoms between 1.5 and 6 months after infection (53% of women and 67% of men). Still, even among these non-hospitalised patients, 16% reported dyspnoea, 12% still had disturbance to smell, and 10% had disturbance to taste.

“As the pandemic progresses we really need to know what the longer term consequences are,” said Prof Gisli Jenkins, of the University of Nottingham and one of the Thorax joint editors in chief, who co-chaired the session.

A personal reflection on long-COVID

The point was hammered home with a final presentation from Dr Jeffrey Siegelman, an emergency physician at Emory University School of Medicine in Atlanta. In November 2020, he wrote a reflection for JAMA on his own experience as a COVID-19 long hauler, and he recounted some of the challenges and lessons during the BTS Winter Meeting session.

His acute COVID-19 case was generally mild, with low-grade fever and other standard symptoms. The fever lingered for weeks, however, and he stayed isolated in his basement, away from his family.

Even after that period, other symptoms persisted. “I could do anything I wanted to – I could bound up the stairs, even walk a mile, but I would pay for it later,” he said. His headaches continued, and cognitive exertion also took a lasting toll. This continued for months, and Dr Siegelman said it led to profound feelings of isolation, and even guilt.

“Guilt that my colleagues are working for me, guilt that I’m not sharing my burden of the household, and that I can’t be the father that I’ve been for my kids, playing soccer on a Sunday afternoon or interacting in the ways that I have,” he said. “It is very hard to ask for help, especially as a physician. Ours is a profession of selflessness and action, and for these many months I’ve instead been in a position of dependent inaction.”

In the months since, with the help of a variety of medications and other therapy, he has improved.

“The experience has changed my perspective on patients with chronic illness,” Dr Siegelman said. “I challenge those of you listening today, the next time you treat someone with symptoms suggestive of a mild illness, it may not be mild to them.”