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Severe COVID survivors face long-term impairments

A team of scientists led by the University of California, San Francisco (UCSF) has examined cases of COVID-19 patients across the United States who endured some of the most extended and severe bouts with the virus. The study revealed that about two-thirds of severe COVID survivors still faced physical, psychiatric, and cognitive challenges up to a year later. 

The findings highlight the enduring effects of SARS-CoV-2, especially among those who required mechanical ventilation for roughly a month on average.

Long-term impairments of severe COVID survivors 

These individuals were transferred to long-term acute care hospitals (LTACHs), specialized for weaning patients off ventilators and providing rehabilitation, playing a vital role during the pandemic

Among the 156 study participants, 64% reported persistent impairments after one year, including physical (57%), respiratory (49%), psychiatric (24%), and cognitive (15%) issues, with nearly half (47%) facing more than one type of problem, and 19% still requiring supplemental oxygen.

“We have millions of survivors of the most severe and prolonged COVID illness globally,” said lead author Anil N. Makam, an associate professor of medicine at UCSF. “Our study is important to understand their recovery and long-term impairments, and to provide a nuanced understanding of their life-changing experience.”

Focus of the study

The scientists enrolled 156 individuals who had been transferred for COVID-19 to nine LTACHs in Nebraska, Texas, Georgia, Kentucky, and Connecticut between March 2020 and February 2021. The participants, who were interviewed via telephone or online a year after their hospitalization, had an average hospital and LTACH stay of about two months. 

Lingering ailments and complications 

Despite the majority being in good health before COVID-19, they faced lingering ailments from the virus and complications due to prolonged hospital stays, such as bedsores and nerve damage, which significantly impacted their quality of life.

Although 79% continued to experience long COVID symptoms, 99% had gone back home, and 60% of those previously working had resumed employment. The gratitude for survival was widespread, often described as a “miracle,” though the path to recovery was longer than anticipated.

Survivors of any prolonged critical illness 

“The long-lasting impairments we observed are common to survivors of any prolonged critical illness, and not specific to COVID, and are best addressed through multidisciplinary rehabilitation,” Makam explained, indicating how widespread are persistent health problems for individuals recovering from such severe illnesses. 

The findings not only shed light on the long-term consequences faced by survivors but also call for a broad, multidisciplinary approach to rehabilitation, acknowledging the complexity of their recovery journey.


Prolonged COVID-19 symptoms, often referred to as “long COVID,” describe a range of lingering effects that some people experience after their initial recovery from COVID-19. These symptoms can last weeks, months, or even longer after the acute phase of the illness has passed. The condition can affect anyone who has had COVID-19, regardless of the severity of their initial infection.


Long COVID encompasses a wide array of symptoms, which can fluctuate and change over time and can affect any system in the body. The most commonly reported symptoms include fatigue, shortness of breath, cough, joint pain, and chest pain. 

Additionally, many people experience neurological symptoms such as headache, sleep disturbances, a pins-and-needles feeling, changes in smell or taste, memory problems, and difficulty concentrating, often referred to as “brain fog.”

Some individuals also report experiencing heart palpitations, dizziness, worsening of symptoms after physical or mental activities, muscle pain or headache, and a variety of gastrointestinal symptoms. Depression and anxiety have also been noted as part of the constellation of symptoms that can persist.

Cause of long COVID

The exact cause of long COVID is still under investigation, but several theories suggest it could be due to the immune system’s prolonged response to the virus, residual virus in the body, or damage caused by the initial infection.


The management of long COVID is multidisciplinary, involving primary care, specialist referrals as needed (such as to cardiologists, pulmonologists, neurologists, and mental health professionals), and supportive therapies tailored to the individual’s symptoms. Given the variety of symptoms and the potential for them to impact daily functioning, treatment plans are highly individualized.

The study is published in the journal Critical Care Medicine.


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