One-Year Recovery Among Survivors of Prolonged Severe COVID-19: A National Multicenter Cohort.

Objectives: Understanding the long-term effects of severe COVID-19 illness on survivors is essential for effective pandemic recovery planning. Therefore, we investigated impairments among hospitalized adults discharged to long-term acute care hospitals (LTACHs) for prolonged severe COVID-19 illness who survived 1 year.
Design: The Recovery After Transfer to an LTACH for COVID-19 (RAFT COVID) study was a national, multicenter, prospective longitudinal cohort study.
Setting and Patients: We included hospitalized English-speaking adults transferred to one of nine LTACHs in the United States between March 2020 and February 2021 and completed a survey.
Interventions: None.
Measurements and Main Results: Validated instruments for impairments and free response questions about recovering. Among 282 potentially eligible participants who provided permission to be contacted, 156 (55.3%) participated (median age, 65; 38.5% female; 61.3% in good prior health; median length of stay of 57 d; 77% mechanically ventilated for a median of 26 d; 42% had a tracheostomy). Approximately two-thirds (64%) had a persistent impairment, including physical (57%), respiratory (49%; 19% on supplemental oxygen), psychiatric (24%), and cognitive impairments (15%). Nearly half (47%) had two or more impairment types. Participants also experienced persistent debility from hospital-acquired complications, including mononeuropathies and pressure ulcers. Participants described protracted recovery, attributing improvements to exercise/rehabilitation, support, and time. While considered life-altering with 78.7% not returning to their usual health, participants expressed gratitude for recovering; 99% returned home and 60% of previously employed individuals returned to work.
Conclusions: Nearly two-thirds of survivors of among the most prolonged severe COVID-19 illness had persistent impairments at 1 year that resembled post-intensive care syndrome after critical illness plus debility from hospital-acquired complications.
Competing Interests: Dr. Makam’s institution received funding from the University of California, San Francisco Research Evaluation and Allocation Committee Carson and Hampton Research Funds and the National Association of Long Term Hospitals (NALTH). Drs. Makam’s and Covinsky’s institutions received funding from the National Institute on Aging. Drs. Makam, Ely, Jackson, and Convinsky received support for article research from the National Institutes of Health. Dr. Prettyman disclosed that he is President of the NALTH. Dr. Espejo’s institution received funding from the Donaghue Foundation. Dr. Votto received funding from the NALTH; he disclosed that he is the Chief Medical Officer of NALTH. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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