High dimensional characterization of post acute sequalae of COVID 19.
The acute clinical manifestations of COVID 19 are well characterized1,2; however, its post acute sequalae have not been comprehensively described. Here, we use the national healthcare databases of the US Department of Veterans Affairs to systematically and comprehensively identify 6 month incident sequalae including diagnoses, medication use, and laboratory abnormalities in 30 day survivors of COVID 19. We show that beyond the first 30 days of illness, people with COVID 19 exhibit higher risk of death and health resource utilization. Our high dimensional approach identifies incident sequalae in the respiratory system and several others including nervous system and neurocognitive disorders, mental health disorders, metabolic disorders, cardiovascular disorders, gastrointestinal disorders, malaise, fatigue, musculoskeletal pain, and anemia. We show increased incident use of several therapeutics including pain medications (opioids and non opioids) antidepressants, anxiolytics, antihypertensives, and oral hypoglycemics and evidence of laboratory abnormalities in multiple organ systems. Analysis of an array of pre specified outcomes reveals a risk gradient that increased across severity of the acute COVID 19 infection (non hospitalized, hospitalized, admitted to intensive care) The findings show that beyond the acute illness, substantial burden of health loss spanning pulmonary and several extrapulmonary organ systems is experienced by COVID 19 survivors. The results provide a roadmap to inform health system planning and development of multidisciplinary care strategies to reduce chronic health loss among COVID 19 survivors.
Nature