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Nearly 6.5 per cent of those who were hospitalised with COVID-19 died a year later, says a study by the Indian Council of Medical Research (ICMR) as part of an effort to map the long-term impacts of the pandemic on public health. While this finding is comparable to data from across the world, the ICMR study also shows that 17 per cent of the participants experienced post COVID-19 conditions such as lethargy, breathlessness, cognitive abnormalities like difficulty in remembering or concentrating and brain fog.
The study included patients who were hospitalised since September 2020 — meaning the infections were likely to have happened with the original, Delta or Omicron variants. Besides, it looks at outcomes only in those who were hospitalised with moderate to severe disease.
What were the major findings of the study?
The study was based on the data of 14,419 patients across 31 hospitals. It found that 6.5 per cent of those hospitalised with COVID-19 died during the following year and 17.1 per cent of them experienced long-term symptoms. Importantly, the study also found that people were nearly three times more likely to die if they experienced post-Covid-19 complications.
The study puts in a caveat that the exact definition by WHO (World Health Organisation) or the US CDC (Centers for Disease Control) on long COVID could not be used as they came out after patient enrolment had already begun. The ICMR study defines post COVID-19 conditions as a new onset of fatigue, breathlessness or cognitive abnormalities such as difficulties in remembering, concentrating and brain fog. The study further shows that even a single dose of the vaccine before the infection reduced the number of deaths in the one-year period by 60 per cent.
Who was at a higher risk of mortality?
The other factors that increased the risk of death later in the year after a COVID-19 infection and hospitalisation were comorbidities, age and gender. The study found that people with one comorbid condition were more than nine times likely to die during the year following the infection. Men were 1.3 times more likely to die and those above the age of 60 years 2.6 times more at risk of mortality, according to the data.
However, children between the ages of 0 and 18 years were at a 5.6 times higher risk of death between the first follow-up at four weeks and the follow-up at the one-year mark. This risk reduces to 1.7 fold when the four weeks immediately after hospitalisation is considered, meaning more children died later in the year. “Our earlier reports have shown that comorbidities among admitted children are more severe, such as malignancies, kidney disorders, haematological disorders and others. This could be hypothesized as one of the reasons for the higher odds of death among these children,” the study said.
With comorbidity increasing the likelihood of death the most, a former scientist from ICMR previously associated with the study, said: “This clearly shows that comorbidities are an important risk factor. So, people with any comorbidities, especially conditions such as liver cirrhosis and chronic kidney disease, must take all precautions because they are likely to get severe disease and following complications. They must stay in touch with their doctors and monitor their conditions well.”
Could people infected with the newer, milder variants, experiencing just upper respiratory symptoms, also get long Covid and have a higher risk of death after it?
Dr Suranjit Chatterjee, senior consultant of internal medicine at Indraprastha Apollo Hospital, New Delhi, who is not associated with the study, said: “From the evidence that we have seen so far, long Covid may happen even in people who have had bouts of mild COVID-19. But the symptoms do improve with some therapy and pills.”
However, he said, long Covid was perhaps being over-diagnosed. “Any symptom for which a cause cannot be determined is attributed to previous COVID-19 infection. There is a need to look at alternative causes for any symptoms reported by patients and to specify exactly what should be considered long Covid and what should not.”
The ICMR scientists themselves say that their study should not be extrapolated for a larger number of people who have had mild COVID-19. “This 6.5 per cent mortality rate will not be applicable to those who had or at present have a simple upper respiratory infection and are ambulatory (are able to walk),” they said.
With new variants like Eris and Pirola raising concerns, what precautions should people keep in mind?
Dr Chatterjee says that the good thing about COVID-19 was that it taught people to mask up, maintain respiratory hygiene, and wash hands regularly. “This drill should continue even now, especially when people are in crowded areas. These habits can protect not only against COVID-19 but also other respiratory infection.” He adds that it is especially important for people over the age of 60 years and those with co-morbidities to follow these habits whenever there is a surge in infections. He says that his clinic has started reporting a few cases of COVID-19 again but not too many. And, the hospitalisations have not gone up.
Should people, especially those at risk of severe disease, take a precaution dose?
Dr Chatterjee says that at the moment there is no need to take additional doses of the vaccine as the disease remains mild — just upper respiratory symptoms such as cough and cold — in most people.
“We have to wait and see how the disease evolves. Even then, we cannot continue vaccinating with older vaccines. There is a need for newer generation of vaccines. And even then, I would recommend shots only if the disease pattern changes and only to people living with comorbidities and those at the extremes of ages, just like we do for other flu vaccines,” he adds.
