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Health services should learn long-term lessons of earlier coronavirus outbreaks

June 09, 2020

Patients recovering from COVID-19 could suffer significant long-term effects, according to research into the experiences of people hospitalised by previous coronavirus outbreaks.

Researchers at the universities of Leeds, Manchester and Hull have for the first time collated evidence on physical, psychological and social impacts among patients who fell victim to Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) - two previous viral infection outbreaks similar to the current COVID-19 pandemic.

These previous outbreaks resulted in respiratory and exercise capacity problems in the first six months after hospitalisation, mental health problems including post-traumatic stress disorder, anxiety and depression in up to a third of survivors at six months and beyond. Quality of life for one third of survivors was impaired even 12 months after discharge from hospital.

Publishing their findings in the Journal of Rehabilitation Medicine, the researchers warn that rehabilitation clinicians and services should anticipate similar health problems in survivors of COVID-19.

Dr Manoj Sivan, an Associate Clinical Professor and Consultant in Rehabilitation Medicine at the University of Leeds' Institute of Rheumatic and Musculoskeletal Medicine, was lead clinician on this research.

He said: "COVID-19 is a new illness and the acute phase has already been devastating for people in many countries across the globe.

"While we have all rightly been busy creating capacity in acute service and saving lives, we must not forget those being discharged from the hospitals. We don't really know the long-term health problems these survivors face in the recovery phase of this pandemic.

"We do though have the two previous coronavirus outbreaks to learn from. This research gives us a rough idea of the rehabilitation needs in the first year after discharge. This allows us to prepare and plan services to meet their needs and work towards the best possible care for these patients in the community."

Co-author Dr Stephen Halpin, Senior Research Fellow and Consultant in Rehabilitation Medicine at Leeds is, like Dr Sivan, also a member of the University of Manchester's Division of Neuroscience and Experimental Psychology.

He said: "This highlights the importance of developing strong follow-up multidisciplinary rehabilitation services and has directly informed our management of COVID-19 patients in Leeds."

Co-author Dr Abayomi Salawu is Honorary Senior Lecturer at Hull York Medical School and Consultant in Rehabilitation Medicine at Hull University Teaching Hospitals NHS Trust.

He said: "Considering the novel nature of COVID-19,?we can only guess what the impact in the medium to long term on the survivors will be. However, we do know that patients who required ICU input for more than two weeks are likely to have ongoing rehabilitation needs irrespective of the diagnosis.

"This work has enabled us to develop a unique comprehensive follow-up and rehabilitation pathway. This has been designed despite current prevailing circumstances that have had significant impact on what services can be provided by the rehabilitation therapy teams in the community.

"It is anticipated that when we subsequently do a service evaluation of this follow-up pathway that we have created across Yorkshire for patients with COVID-19, we will be able to add more evidence to the expanding knowledge base in managing it."

The authors identified almost 1,200 previous international studies into the harmful long-term clinical outcomes for survivors of SARS and MERS coronavirus infections after hospitalisation or intensive care unit admission. They carried out a systematic review of 28 of those studies - the majority of which related to SARS cases; 23 were included in their meta-analysis.

The researchers cautioned: "At this stage it is not possible to conclude whether the long-term outcomes identified in SARS and MERS patients will also occur in COVID-19 survivors.

"However, as SARS and MERS belong to the same family of virus as COVID-19, and the clinical features are looking identical, including severe respiratory distress and intensive care admission in severe cases, the long-term picture is likely to be similar with COVID-19.

"Rehabilitation clinicians and services should plan ahead for timely follow-up, screening and interventions to enable best possible recovery and quality of life for these individuals."

Acute multidisciplinary rehabilitation while in hospital, post-acute rehabilitation in rehabilitation or respiratory units once discharged from hospital, and long-term rehabilitation interventions in the community are all recommended to optimise physical, psychological and functional recovery for those recovering from coronavirus.

Ideal multidisciplinary rehabilitation teams must include physiotherapists, occupational therapists, psychologists, speech and language therapists, dietitians, and physicians in rehabilitation medicine - with links to acute respiratory and intensive care teams and relevant community rehabilitation teams.

The authors also recommend that further research should be carried out into COVID-19 survivors, focusing on capturing lung function abnormalities, exercise capacity, psychological and cognitive impairments and, ultimately, quality of life.
Further information

The paper, "Long-term clinical outcomes in survivors of severe acute respiratory syndrome and Middle East respiratory syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis", is published in the Journal of Rehabilitation Medicine (DOI: 10.2340/16501977-2694).

Authors: Hassaan Ahmed1 and Kajal Patel1, Darren Greenwood2, Stephen Halpin 2,7, Penny Lewthwaite4, Abayomi Salawu5, Lorna Eyre6, Andrew Breen6, Rory O'Connor3,7, Anthony Jones7 and Manoj Sivan3,7.

1School of Medicine, University of Manchester, Manchester, 2School of Medicine and Leeds Institute for Data Analytics, University of Leeds, 3Academic Department of Rehabilitation Medicine, University of Leeds and National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS trust, 4Department of Infectious Diseases, Leeds Teaching Hospitals NHS Trust, Leeds, 5Department of Rehabilitation Medicine, Hull University Teaching Hospitals NHS Trust, Hull, 6Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds, and 7Division of Neuroscience and Experimental Psychology, University of Manchester.

For additional information or to arrange interviews please contact the media relations team at the University of Leeds via

University of Leeds

The University of Leeds is one of the largest higher education institutions in the UK, with more than 38,000 students from more than 150 different countries, and a member of the Russell Group of research-intensive universities. The University plays a significant role in the Turing, Rosalind Franklin and Royce Institutes.

We are a top ten university for research and impact power in the UK, according to the 2014 Research Excellence Framework, and are in the top 100 of the QS World University Rankings 2020.

The University was awarded a Gold rating by the Government's Teaching Excellence Framework in 2017, recognising its 'consistently outstanding' teaching and learning provision. Twenty-six of our academics have been awarded National Teaching Fellowships - more than any other institution in England, Northern Ireland and Wales - reflecting the excellence of our teaching.

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University of Manchester

The University of Manchester, a member of the prestigious Russell Group, is the UK's largest single-site university with 38,600 students and is consistently ranked among the world's elite for graduate employability. The University?is also one of the country's major research institutions, rated fifth in the UK in terms of 'research power' (REF 2014). World class research is carried out across a diverse range of fields including cancer, advanced materials, addressing global inequalities, energy and industrial biotechnology. No fewer than 25 Nobel laureates have either worked or studied here. It is the only UK university to have social responsibility among its core strategic objectives, with staff and students alike dedicated to making a positive difference in communities around the world. Manchester is ranked 35th in the world in the Academic Ranking of World Universities 2016 and 5th in the UK. The University had an annual income of almost £1 billion in 2015/16.

Hull York Medical School

Hull York Medical School (HYMS) is a partnership between the two well-established Universities of Hull and York. Since opening in 2003, the School?has become known as one of the UK's most welcoming and inclusive medical schools with a reputation for innovative, inspiring, exciting and rigorous medical education. Our students graduate as excellent thinkers,?evidence based?practitioners and patient-centred communicators who are thoroughly prepared for clinical practice.

Hull York Medical School?researchers conduct world-class research, much of this is interdisciplinary, spanning traditional subject boundaries and reaching out into other departments within the Universities of Hull and York. Our research spans those issues which are of critical importance to the country and the NHS including primary care, mental health, palliative care, public health and other applied clinical areas and in some key translational biomedical areas in thrombosis, haemostasis and metabolism, and immunology and infection. Research undertaken has attracted significant grants and funding including from Marie Curie (£118,682 to improve the care of those with chronic lung conditions), the Wolfson Foundation (£500,000 to help create a world-leading centre for research into palliative care), Cancer Research UK (£343,000 to understand emergency presentation of lung and colorectal cancer) and from the British Heart Foundation (£900,000 to pursue cardiovascular and metabolic research). We strive for excellence in our research with 85% considered world-leading or internationally excellent (REF 2014). ?

University of Leeds

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