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What are the two-year health outcomes among hospitalized patients with COVID-19 in China?

The ongoing coronavirus 2019 (COVID-19) pandemic, caused by the rapid outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has claimed more than 6.52 million lives worldwide. The emergence of SARS-CoV-2 variants due to genetic mutations has prolonged the epidemic. Some SARS-CoV-2 variants, such as Omicron and Delta, are more transmissible and virulent than the ancestral strain.

Study: 2-year health outcomes in hospitalized COVID-19 survivors in China. Image Credit: Hananeko_Studio / Shutterstock


Although most COVID-19 patients recover from acute infection, some have long-term health conditions associated with cognitive, physical and psychological problems, significantly affecting their quality of life. Thus, it is important to conduct regular follow-up of COVID-19 patients who have been discharged from hospitals. These studies will help understand the course of the symptom burden as well as the long-term health outcomes associated with SARS-CoV-2 infection.

Previous research revealed that COVID-19 patients who required treatment in an intensive care unit (ICU) continued to experience physical, mental or cognitive symptoms even a year after they were discharged from hospital. Understanding how long symptoms associated with COVID-19 last is imperative.

newly JAMA Network is open The study evaluated the dynamic trajectory of COVID-19 symptom burden as well as symptom persistence in those who survived SARS-CoV-2 infection for two years after hospital discharge.

about studying

In this longitudinal cohort study, scientists collected data on COVID-19 survivors released from Taikang Tongji and Huoshenshan hospitals. Both hospitals are located in Wuhan, China.

All participants were interviewed by telephone two years after their discharge from hospital. The second year follow-up study was conducted between 1 March 2022 and 6 April 2022.

Apart from the telephone interview, all participants also submitted a self-reported symptom questionnaire along with a COPD assessment test (CAT). Participants’ symptoms were scored as no problems, mild problems, moderate problems, or serious problems. Patients with at least persistent COVID-19 symptoms account for COVID for a long time.


A total of 370 patients, 19.8% of the study group, were found to have symptoms of COVID-19 two years after their discharge from hospital. 12.0% of the study group reported persistent symptoms, while 7.8% of patients experienced new or worsening symptoms of a reported level of mild symptoms in the first year of follow-up.

Some of the common symptoms that participants experienced were chest tightness, fatigue, shortness of breath, muscle pain, and anxiety. The majority of symptoms disappeared over time. Although shortness of breath lasted longer, it decreased after one year. The results of this study were in line with previous studies that revealed a downward trend in symptoms over time.

In this study, a higher risk of persistent symptoms was associated with ICU admission. In addition, COVID-19 infection in patients with cerebrovascular disease has been associated with the development of new symptoms. 6.2% of participants showed a CAT score of at least 10. The current study noted a higher risk of persistent symptoms in recovered COVID-19 patients who required ICU care during their hospital stay or had chronic liver disease.

Chronic liver disease has been identified as an important factor associated with the risk of persistent symptoms. In addition, a CAT score of 10 and above indicates a higher likelihood of experiencing symptoms of COVID-19 for prolonged periods.

Study restrictions

The authors highlighted several limitations, including the lack of an age-matched control group compatible with comorbidity. Because of this limitation, long-term symptoms of acute illness cannot be identified. Another drawback of the current study is the loss of participants, especially the elderly, during follow-up. The age distribution is an important aspect as it is considered an impact rate for post-COVID-19 symptoms.

The current study also used a self-report symptom questionnaire rather than diagnostic tools, reinforcing the risk of bias due to participant subjectivity. The number of symptoms considered in this study was small, considering the fact that more than a hundred symptoms associated with COVID-19 have been reported. The emergence of SARS-CoV-2 variants was endemic, which may alter virulence and long-term sequelae compared to the data analyzed in this study.


The current longitudinal cohort study, which included survivors of the emerging coronavirus two years after their release from hospitals, revealed the common long-lasting symptoms of fatigue, anxiety, chest tightness, shortness of breath and myalgia. Although most of these symptoms disappeared, the shortness of breath persisted at a low level over time. Severely infected COVID-19 patients who required admission to the intensive care unit were at an increased risk of persistent symptoms. This study provided insight into the dynamic course of health outcomes for COVID-19 survivors.