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Long-term impact of COVID-19 severity on health-related quality of life

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A health worker vaccinating a UNICEF staff against COVI-19

A RECENT study conducted on the residents of Amsterdam, the Netherlands, describes that people with mild coronavirus disease 2019 (COVID-19) experience better health-related quality of life after one year of disease onset than those with moderate or severe COVID-19. The study has been published in the journal BMC Medicine.

   The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has severely impacted the physical and mental health of affected people worldwide. A significant proportion of COVID-19-affected people have been found to have long-term health consequences even one year after the initial diagnosis.

   Studies investigating the health-related quality of life among COVID-19 patients have mostly observed poor physical, mental, and social functioning among participants after disease onset. In contrast, a few studies have documented satisfactory physical and functional recovery among participants. However, these studies have been conducted on hospitalized patients with severe COVID-19.

Background

   In the current study, scientists have explored the impact of mild, moderate, and severe COVID-19 on the physical, mental, and social functioning (health-related quality of life) of patients after 1 and 12 months of disease onset. They have also evaluated the impact of pandemic-related control measures on health-related quality of life.

Study design

   The study was conducted on adults in Amsterdam, the Netherlands, who had laboratory-confirmed COVID-19 with a range of severity (mild, moderate, or severe). The Medical Outcomes Study Short Form 36-item health survey was performed to assess health-related quality of life at one month and 12 months post-disease onset.

  The survey comprised 36 items specifically focusing on eight different domains, including physical, social, and emotional functioning, mental health, amount of energy and pain, and general health perceptions.

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Impact of COVID-19 severity on health-related quality of life 

   A total of 269 participants completed the survey on health-related quality of life.

  Considering disease severity, participants with mild COVID-19 exhibited a significantly better health-related quality of life than those with moderate or severe COVID-19. However, the level of health status was significantly higher at 12 months than at month one post-disease onset.

   Considering migration status, Dutch-origin participants had significantly better health quality on the domains of physical and social functioning and energy and pain levels than those with a migration background from high-income or low/middle-income countries. On the domains of general and mental health, Dutch-origin participants and those from low/middle-income countries had significantly higher quality of life than the participants from high-income countries.

   Participants with three or more high-risk comorbidities had the worst health-related quality of life than those with less than three comorbidities. Specifically, immunosuppression and psychiatric illness had the highest impact on physical functioning and general health, respectively.

   Health-related quality of life assessed among participants at month one post-disease onset revealed a significant deviation from the population-level reference standards. The highest and lowest deviation was observed for social functioning and body pain, respectively.

   Regarding general health, participants with mild COVID-19 were within reference standards. In contrast, participants with moderate or severe COVID-19 had significantly lower health quality.

   Health-related quality of life assessed at month 12 revealed that participants with mild disease have physical, emotional, and social functioning, energy level, and general health status similar to the reference standards. However, no such improvement in health quality was observed for participants with moderate or severe COVID-19.

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Impact of pandemic-related restrictions on health-related quality of life

   Participants who completed the survey during the period of pandemic-related restrictions reported less impairment in mental health and less limitation in social and physical functioning than those who completed the survey during the period of no restrictions. 

Study significance The study demonstrates that people with mild COVID-19 are capable of regaining normal levels of physical, social, and emotional functioning one year after the initial disease diagnosis. However, people with initial moderate or severe COVID-19 experience a deterioration in health-related quality of life even one year after the disease onset.

  People with a migration background or with a higher number of high-risk comorbidities are more susceptible to experiencing deterioration in health-related quality of life.

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