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The PHOSP-COVID Study


There has been a lot of recent media coverage on the PHOSP-COVID study as it has recently been released as a preprint - Physical, cognitive and mental health impacts of COVID-19 following hospitalisation: a multi-centre prospective cohort study. The PHOSP-COVID study is a national consortium, led by experts at the University Hospitals of Leicester NHS Trust. It is under the umbrella of the NIHR Leicester Biomedical Research Centre.


Its aim is to investigate the long terms impacts of COVID-19 on the health outcomes for patients who were hospitalised due to the virus.

For those of us suffering from Long Covid - despite a large majority of us not being admitted to hospital even though we fulfilled admission criteria but were unable to access medical care in the first wave - I think it is a small step in the right direction to getting Long Covid accepted by our doctors and the government.


The purpose of the study

As COVID-19 is a new disease, the study aimed to identify whether there are longer-term health problems of COVID-19 for those who were hospitalised.

The research team wanted to understand:

  • why some people recover more quickly than others

  • why some patients develop other health problems later on

  • which treatments received in hospital or afterwards were helpful

  • how we can improve care of patients after they have been discharged from hospital.

They also wanted to develop a data resource that other research teams could use to make the best use of the time, clinical information and samples participants provided.

They aimed to recruit individuals who were discharged from hospital following COVID-19 to study the short (0-6 months), medium (6-12 months) and long term (12 months +) effects of the disease.


How did they achieve this?

They used multi centres in the UK observing adults discharged from hospital with a clinical diagnosis of COVID-19. This involved an assessment between two- and seven-months later including detailed symptom, physiological and biochemical testing. They studied age, sex, ethnicity, body mass index (BMI), co-morbidities, and severity of acute illness as co-variates. They analysed the outcomes for breathlessness, fatigue, mental health, cognition and physical function.


What did they find?

They recruited 1077 patients discharged from hospital with a COVID-19 diagnosis in 2020. It is important to remember here that patients only had to be admitted. So those with Covid-19 who were kept in a few hours for observation and investigation right up to those who required ventilation in an ICU.

From their assessments undertaken an average of 5 months post discharge they found the following:

  • 64% male, 36% female

  • Average age 58 years

  • 69% white ethnicity

  • 27% mechanically ventilated

  • 50% had at least two co-morbidities - such as diabetes, heart disease etc.

At 5 months:

  • ONLY 29% felt fully recovered

  • 20% had a new disability

  • 19% experienced a health-related change in occupation- unable to do previous job


Factors associated with failure to recover were:

  1. Being female

  2. Being middle - aged

  3. Being white ethnicity

  4. Having two or more co-morbidities

  5. Having a more severe acute illness


The study identified four clusters with different severities of mental and physical health impairment:



And in these groups they determined what percentage felt fully recovered at 5 months:




As you see of those who were classified with "only" mild symptoms less than half felt fully recovered at 5 months.

However the most important conclusion from this research was the following_


"The magnitude of the persistent health burden was substantial and weakly related to acute severity."

Or in other words people who have had COVID-19 are still unwell many months later and it is NOT related to how sick they were in the acute illness.


The researcher's conclusions

They identified factors related to recovery from a hospital admission with COVID-19 and four different phenotypes relating to the severity of physical, mental, and cognitive health five months later.

"The implications for clinical care include the potential to stratify care and the need for a pro-active approach with wide-access to COVID-19 holistic clinical services".



References

Physical, cognitive and mental health impacts of COVID-19 following hospitalisation: a multi-centre prospective cohort study https://www.medrxiv.org/content/10.1101/2021.03.22.21254057v1

https://phosp.org/about/



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