Trajectory, healthcare utilisation and recovery in 3590 individuals with long covid: a 4-year prospective cohort analysis, 2025, Prashar et al

[rvallee]

Trajectory, healthcare utilisation and recovery in 3590 individuals with long covid: a 4-year prospective cohort analysis
BMJ Open: https://bmjopen.bmj.com/content/16/1/e103884

Spoiler: Authors

Jai Prashar1,2, Toby Hillman1, http://orcid.org/0000-0003-2732-4497Emma C Wall1,3,4, Amanpreet Sarna1, Emma Mi5, Robert Bell1, Jagdeep Sahota1, Michael Zandi6, Patricia McNamara1, Rebecca Livingston1, Rebecca Gore1, Catherine Lunken1, http://orcid.org/0009-0008-9789-8131Elena Bax1, Rachel Nyam1, http://orcid.org/0000-0002-4263-2474Amir Masood Rafie Manzelat1, Lyth Hishmeh7, Emily Attree8, Stephen Cone1, http://orcid.org/0000-0001-8741-3411Amitava Banerjee1,9, Melissa Heightman10

Abstract​

Objective To characterise long-term trajectory of recovery in individuals with long covid.

Design Prospective cohort.

Setting Single-centre, specialist post-COVID service (London, UK).

Participants Individuals aged ≥18 years with long covid (hospitalised and non-hospitalised) from April 2020 to March 2024.

Main outcome measures Routine, prospectively collected data on symptoms, quality of life (including Fatigue Assessment Scale (FAS) and EuroQol 5 Dimensions (EQ-5D), return to work status and healthcare utilisation (investigations, outpatient and emergency attendances). The primary outcome was recovery by self-reported >75% of ‘best health’ (EQ-5D Visual Analogue Scale) and was assessed using Cox proportional hazards regression models over 4 years. Linked National Health Service England registry data provided secondary care healthcare utilisation and expenditure.

Results We included 3590 individuals (63.3% female, 73.5% non-hospitalised, median age 50.0 years, 71.9% with ≥2 doses of COVID-19 vaccination), who were followed up for a median of 136 (0–346) days since first assessment and 502 (251–825) days since symptom onset. At first assessment, 33.2% of employed individuals were unable to work. Dominant symptoms were fatigue (78.7%), breathlessness (68.1%) and brain fog (53.5%). 33.4% of individuals recovered to >75% of best health prior to clinic discharge (recovery occurred median 202 (94–468) days from symptom onset). Vaccinated individuals were more likely to recover faster (pre: HR 2.93 (2.00–4.28) and post: HR 1.34 (1.05–1.71) COVID-19 infection), whereas recovery hazard was inversely associated with FAS (HR 0.37 (0.33–0.42)), myalgia (HR 0.59 (0.45–0.76)) and dysautonomic symptoms (HR 0.46 (0.34–0.62)). There was high secondary care healthcare utilisation (both emergency and outpatient care). Annual inpatient and outpatient expenditure was significantly lower in hospitalised individuals while under the service. When compared with the prereferral period, emergency department attendances were reduced in non-hospitalised patients with long covid, but outpatient costs increased.

Conclusions In the largest long covid cohort from a single specialist post-COVID service to date, only one-third of individuals under follow-up achieved satisfactory recovery. Fatigue severity and COVID-19 vaccination at presentation, even after initial COVID-19 infection, was associated with long covid recovery. Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness. Research and clinical services should emphasise these factors as the strongest predictors of non-recovery.

 

[rvallee]

Ongoing service provision for this and other post-viral conditions is necessary to support care, progress treatment options and provide capacity for future pandemic preparedness.

This was a Long Covid clinic. It did none of that. What is needed is competent services working in a coherent system that aims to do those things, ties with research and works on international collaboration with a strategic approach because doing the same thing over and over again will not achieve a damn thing. This is not it. Those numbers are shamefully bad because they got it all wrong, can't even get anything competent off the ground, still pushing their failed ideology.

The threshold of 75% is obviously artificially low. Obviously full recovery means 100%, while 90% would be a somewhat reasonable concession even though it should then speak of a partial recovery, and is likely closer to what patients would find acceptable, which they'd know if they had asked. The whole thing where they can play around with "does 100% really mean 100%?" is so ridiculous. Recovery means 100%, if it's less than that and you have no concept for it then you're the problem here. They set the bar lower so that they can report false data but even with that they get very low numbers.

I tried looking at the supplementary material but it doesn't seem like it includes any data showing the distribution of recovery, so there only appears to be their binary (75%+ yes/no) binary definition. Unless I got it wrong, it's even more deceitful than that because the 75% is asking about the best patients have felt, while the average score is even lower (65% if I got it correctly). This is so damn cynical and dishonest.

This is not a problem with the provisioning of services, it's a problem of this being the wrong kind of service. Plus, as they note throughout the paper, the patients at their clinic still used other health care services. What the hell kind of clown service does that even look like, then?

Recovery rates were low with significant healthcare utilisation, both within and outside the LC service.

There are important clinical implications. First, LC is a multisystem disorder,31 which often requires multidisciplinary input for effective care.

And how do you know that it requires "multidisciplinary input for effective care" when no one knows what effective care is? Because your service is clearly not. You first have to actually do the work and you haven't, have been content waiting for this to die out, for the "psychosocial fad" to fall out of fashion.

This work also suggests that fatigue—a symptom without known pathogenesis or established management in LC—is central to the extent and duration of morbidity in LC, supported by other work.38 There is some suggestion that rehabilitative interventions may offer benefit,43 although the direct impact of multidisciplinary care on long-term fatigue remains poorly elucidated.

No, there literally is no such "suggestion", we know for a fact that this doesn't work because it's been the main approach the whole time and for decades before that. This whole system is ridiculous. This clinic is literally that, they report failure, and they still think it's smart to do the same thing and expect different results.

 

[rvallee]

Also despite literally describing the main problem as essentially being ME/CFS ("Certain symptoms may be key prognostic markers, including severity of fatigue, dysautonomia, myalgia and brain fog"), they make zero mention of ME/CFS or PEM, have not even assessed it even though they very likely must have heard it constantly from patients.

 

[Utsikt]

a 4-year prospective cohort analysis

who were followed up for a median of 136 (0–346) days since first assessment

So it’s not a four year cohort study then.

 

[SNT Gatchaman]

ME/CFS does get a single mention.

Our analysis of EQ-5D VAS severity of long covid is comparable to scores seen in myalgic encephalomyelitis/chronic fatigue syndrome and worse than in some cohorts with chronic conditions such as heart failure and chronic obstructive pulmonary disease.