Abstract
BackgroundThe COVID-19 global pandemic presents with waves of infection. International studies report key demographic and outcome differences with younger patients, lower co-morbidity and mortality reported amongst second wave patients.1 Less is known about observed differences, subsequent recovery and ‘Long covid’ development. We therefore sought to explore differences in clinical severity at 8–10 week follow-up for adult discharges following acute admission with COVID-19 during London’s first two waves.MethodsThis prospective observational cohort study compared in each wave the first 400 patients’ admission trajectory and recovery after discharge. We excluded hospital acquired cases and included unreachable patients with available admission records.ResultsGroups admitted between 27/2/2020 - 05/04/2020 (first wave) and 10/12/2020 - 08/02/2021 (second wave) demonstrated similar median age 61 years (IQR: 50 – 74 vs. 51 – 74); p = 0.59); and male sex (61.8% vs. 59.3%; p = 0.47); but higher BMI in second wave admissions (26.8 vs. 27.7 kg/m2; p = 0.015). Co-morbidity prevalence was similar, other than chronic kidney disease being more prevalent in first wave admissions (18% vs. 9.3%; p <0.0001).On admission, second wave patients demonstrated: higher Clinical Frailty Score, lower NEWS score with more patients deemed suitable for full treatment escalation. A significant number received more: novel agents, non-invasive treatment and less invasive ventilation (table 1). Length of stay was lower (5 vs. 8 days, p<0.0001).322 (first) vs. 365 participants (second wave) completed follow-up at 74 vs. 54 days; p<0.0001, post discharge. Second wave patients reported less mental health burden, greater self-reported recovery and symptom trajectory other than fatigue. A greater proportion had improved radiological changes. Many patients had not returned to work in both waves.Abstract P97 Table 1Demographics and clinical characteristics of participants at hospital admission and follow up for wave 1 and 2 admissions Wave 1 Wave 2 p-value N = 400 N = 400 Demographics and Lifestyle Age (years) (Median, IQR) 61 (50 -74) 61 (51 - 74) 0.59 Male gender (N,%) 247 (61.8%) 237 (59.3%) 0.47 Ethnicity (White) (N,%) 200 (50.0%) 195 (48.8%) 0.001* Smoking status – Never smoker (N,%) 215 (53.8%) 219 (54.8%) 0.58 BMI (kg/m2) (Median, IQR) 26.8 (24.1 - 29.4) 27.7 (24.3 - 31.6) 0.015 Underlying clinical status Clinical Frailty Score (Median, IQR) 2 (2, 4) N = 332 3 (2, 3) N = 384 0.001 Shielding Status (N,%)Extremely vulnerableHCP issued letter 32 (10.1%)23 (7.2%) 39 (11.2%)5 (1.4%) 0.001 Covid Admission Severity Parameters Total number of symptoms (Median, IQR) 4 (3 - 6) 3 (2 - 3) <0.0001 NEWS2 score (Median, IQR) 5 (2 - 7) N = 372 4 (3 - 6) N = 379 0.60 TEP status – For full escalation (N,%) 284/365 (77.8%) 361/400 (90.3%) <0.0001 Maximum respiratory support (N,%)CPAPNIV N= 37710 (2.7%)2 (0.5%) N = 40032 (8.0%)5 (1.3%) <0.0001 Received anti-viral or immunosuppressive drugs (N,%) 23/374 (6.2%) 127/400 (31.8%) <0.0001 ITU admission (N,%) 62/377 (16.5%) 43/400 (10.8%) 0.02 Intubation (N,%) 49/364 (13.5%) 19/400 (4.8%) <0.0001 Pulmonary Embolus (N,%) 22/360 (6.1%) 24/395 (6.1%) 0.98 Follow-up Outcomes N = 322 N = 365 Mental Health Outcomes PHQ2 score ≥ 3 (N,%) 47 (15.4%) 34 (9.9%) 0.04 TSQ score ≥ 5 (N,%) 44 (14.9%) 12 (3.3%) <0.0001 Physical Recovery and Symptoms Not returned to work (N,%) 76 (24.8%) 114 (33.6%) 0.03 Improved Sleep quality (N,%) 168 (61.5%) 265 (78.4%) <0.0001 Improved Fatigue (N,%) 241 (87.6%) 307 (88.7%) 0.91 Improved Cough (N,%) 194 (69.5%) 291 (84.8%) <0.0001 Improved Breathlessness (N,%) 213 (76.1%) 311 (89.6%) <0.0001 Total Number of Symptoms (Median, IQR) 1 (0 - 2) N=314 0 (0 – 1) N=364 Radiology outcomes (N,%)NormalisedSignificantly ImprovedNot significantly improvedWorsened N=309211 (68.3%)55 (17.8%)2 (0.7%)30 (9.7%) N=279187 (67.0%)65 (23.3%)13 (4.7%)14 (5.0%) <0.0001 *p value likely attributable to differences in unknown ethnicityConclusionThese data suggest second wave patients, although frailer, presented with fewer symptoms and experienced improved hospital admission trajectory. They demonstrated improved self-reported mental health and physical recovery outcomes despite earlier follow-up, possibly attributed to improved in-hospital treatment. Supporting recovery remains a clinical priority given many patients had not returned to work.ReferenceSaito S, et al. First and second COVID-19 waves in Japan: comparison of disease severity and characteristics. J Infect. 2021;82(4):84-123.