The majority of patients admitted to an acute care hospital in Sydney with Covid-19 in March and April are still experiencing symptoms more than three months after being discharged.
The head of the infectious diseases department at St Vincent’s hospital, Associate Prof Gail Matthews, said most of the 170 cases that came through the hospital were linked to outbreaks associated with the Ruby Princess cruise ship and a backpackers hostel in Bondi. Of those, 94 had agreed to take part in the St Vincent’s Adapt study, undergoing tests every three months to see whether the virus was associated with any lasting effects in the body’s immune system, blood, lung, gut and brain functions.
“We’re just starting to see the first results,” Matthews said.
“So about a third of those patients still have symptoms now, and that’s three or four months after being infected. And actually, if you look at those 10% of cases who were admitted to the hospital – so the serious cases and those requiring intensive care – about 80% of those patients still have some symptoms.”
Matthews said while researchers were still analysing data from brain scans and antibody tests, the persisting symptoms being reported were similar across both the severe and mild cases. “The symptoms are pretty comparable in both groups, except in the hospital patients they happen more often,” she said. “So we’re talking mainly fatigue, which is a big one, we’re talking about some persistent feelings of chest discomfort, and some shortness of breath. And in the mild cases, the loss of smell is still persisting.”
Prof Gregory Dore, an infectious diseases physician at the hospital, said because reports from around the world seemed to suggest the fatality rate among those infected was around 1%, that “some people therefore think that well, 99% of people get out without any trouble”.
“Well, that’s absolutely not the case,” he said. “When you have 10% or more people hospitalised, when you have even more that are managing with the virus out in the community, a proportion of those people having ongoing, debilitating symptoms.
“This is a scary virus in the way it can affect people. There is a significant minority of people who have this ongoing – if you want to call it – syndrome of debilitating symptoms, so we’re sort of looking very closely at that group, both in terms of evaluating their quality of life and mental health fatigue, looking at the neurocognitive function, and then looking immunologically at whether there are any markers that would predict a symptom. So those are devastating symptoms.”
Reduced exercise tolerance was another common symptom, and the chest symptoms differed between patients. “So sometimes the chest heaviness, sometimes heart palpitations, sometimes a bit of difficulty, sort of catching their breath,” he said.
Dore said some people had dismissed these symptoms as being mainly psychologically driven, an ongoing effect of having experienced a new and concerning virus. “It’s been an incredibly anxious, uncertain time for individuals,” he said. “But I have no doubt that this syndrome has triggered, in a proportion of people, an abnormal immune response.”
Matthews said she tried to reassure patients that many infectious diseases, such as influenza, come with lasting symptoms, and that Covid-19 was not unique in that regard. It did not mean they were still infectious. But because the virus is still so new, she said it was difficult to know how long patients may experience the symptoms, and whether in some, the effects may be permanent.
“What we would say is ‘we’re confident it’s very likely you will make a full recovery’ because even in other viruses which cause post-viral syndromes there is usually a full recovery, but it may be more prolonged in this case. But we do have to be honest and say, ‘we don’t really know, and nobody in the world knows’.”
Despite treating a significant portion of New South Wales patients, there were no Covid-19 deaths at St Vincent’s hospital. With a significant level of community transmission now occurring in Victoria putting pressure on the health system there, and NSW health authorities monitoring a cluster so far limited to the Crossroads hotel in Casula, south-western Sydney, Matthews said she was confident hospitals in her state were well prepared to cope with whatever happened next with the novel virus. Even if clusters and outbreaks were proving difficult to predict.
“Certainly, it was very stressful at the beginning [of the pandemic] because we didn’t know anything,” she said. “We were sort of having to work it out as we go along. I think we all feel even if we do have a second wave or a big outbreak or whatever you want to call it coming again, now we are so much more prepared than we were in March, or in April.
“We have some treatments, we have remdesivir, we have our policies in place, we know how we’re going to manage the wards.
“We feel more comfortable now than we did. But of course, where that will all go wrong is if we’re suddenly overwhelmed. And that’s really what we don’t want.”