key: cord-0958845-qtsj4wox
authors: Quinn, Kieran L.; Bell, Chaim M.
title: Pandemic health consequences: Grasping the long COVID tail
date: 2022-01-25
journal: PLoS Med
DOI: 10.1371/journal.pmed.1003891
sha: b61ef6cdf9aaa6212173af805ab28126fdb25c80
doc_id: 958845
cord_uid: qtsj4wox

nan

to be rehospitalized or die from mental health or cognitive-related causes, especially if they had preexisting dementia, compared to those hospitalized with influenza.

Initial hospitalization with COVID-19 represents a crucial touch point within the healthcare system. The study by Bhaskaran and colleagues sheds important light on the health service needs of patients who survive hospitalization for COVID-19. It further helps disentangle the effects of hospitalization from respiratory viral infection on important outcomes. The current work builds on similar findings from a recent study of 47,780 hospitalized adults with COVID-19 who survived to discharge with a mean follow-up of 140 days [8] . In that study, rates of hospital readmission and mortality were 3.5 and 7.7 times greater in the previously hospitalized group of COVID-19 patients, compared to general population controls, respectively. Other studies from the United States and China followed patients hospitalized for COVID-19 and reported lower 60-day and 1-year rehospitalization rates ranging from 13% to 19.9%. However, these studies did not account for the competing risk of death as was done in the current study [9] [10] [11] .

There were also noteworthy limitations of Bhaskaran and colleagues' study. First, causespecific outcomes among adults with COVID-19 may be artificially higher than those with influenza due to availability bias. Put simply, patients and providers may be much more aware of COVID-19 and its complications, including those related to return to hospital, than might be the case for those with pneumonia or even confirmed influenza. Second, the study used administrative data from primary care. While 98% of the population in England are registered with a general practice (thereby minimizing selection biases due to health-seeking behaviors), there are some geographical differences in the use of the OpenSAFELY platform, which may introduce the potential for selection bias. Third, this study was conducted in a high-income nation with substantial resources to support patients following infection with COVID-19. The generalizability of these findings to middle-and low-income nations, or those with limited resources, is unknown.

The study by Bhaskaran and colleagues has clear applications to healthcare resource planning and policy in the care of individuals who survive COVID-19. This suggests a substantial added burden on global healthcare systems. It further builds on our evolving knowledge of the post-COVID-19 condition and its lingering impacts, including on many previously healthy adults in their prime years of productivity. Still, a wealth of research is required to develop prediction tools to proactively identify and support the healthcare needs of survivors, including end-of-life care, develop new strategies to prevent and treat the post-COVID-19 condition, and encourage interprofessional teams to provide longitudinal care through innovative health policy interventions.

Early pandemic public messaging strategies focused on flattening the peak of the acute COVID-19 infection curve to preserve healthcare system capacity and its ability to deliver high-quality care. These efforts were generally successful. To preserve ongoing system capacity and provide high-quality patient care, the long COVID tail does not require further flattening, but rather demands new clinical and health policy strategies to address its potential for longterm suffering. Here, we must recognize that the head of the pandemic often demands our immediate attention, but we must not ignore its long and deadly tail.

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As Their Numbers Grow, COVID-19 "Long Haulers

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