The study, published in the Journal of the Royal Society of Medicine last month, analyzed 536 long-COVID patients still reporting extreme shortness of breath, cognitive dysfunction, and poor health-related quality of life an average of six months after contracting COVID-19.
Among them, 32 percent were health care workers and 13 percent had been hospitalized when initially diagnosed with COVID-19. Their median age was 45, and 73 percent were women.
More than 60 percent of patients were found to have some degree of organ impairment at six months, although most showed only “mild” impairment, and that figure remained essentially unchanged a year after the diagnosis.
The study found that 29 percent of patients showed damage to multiple organs at six months, and 27 percent did after a year.
Jason Maley, assistant professor of medicine at Harvard Medical School and the director of Beth Israel Deaconess Medical Center’s Long COVID Clinic, said the study’s findings can help show the consequences of the disease beyond patients’ reported symptoms and may be useful in developing preventative measures against long COVID.
“This is one piece, but an important one,” Maley said.
He said organ impairment is not necessarily tied to symptoms, even if they exist in the same part of the body, but the new research could be expanded upon by testing whether treating organ damage also helps address long-COVID symptoms.
While signs of organ damage persisted, the average number of symptoms that patients reported dropped from 10 to 3 between six months and a year after developing COVID-19, the study found.
In that period, the share of patients reporting extreme shortness of breath fell from 38 percent to 30 percent, those showing cognitive dysfunction fell from 48 percent to 38 percent, and those reporting poor health-related quality of life fell from 57 percent to 45 percent.
Jai Marathe, assistant professor of infectious diseases at the Boston University Chobanian and Avedisian School of Medicine and the founding director of Boston Medical Center’s Long COVID Clinic, said that timeline matches what she has seen in her patients, who tend to report recovery 12 to 14 months after developing symptoms.
“It’s reassuring to see that it lines up with what we already know,” Marathe said. “The authors were able to pick up different findings that did not necessarily correspond with the symptoms, but maybe in the future you could use this for predicting who might be at risk for developing long COVID.”
Marathe said the study provides useful data on possibly confounding factors in long COVID, but noted that participants may have had organ impairment prior to contracting COVID-19.
The study’s authors note that they “did not have history and imaging prior to the pandemic and so it is difficult to determine if COVID-19/long COVID caused impairment.”
Marathe said the study authors were able to relate fatty livers to shortness of breath “but, truly, that is the only finding that they could relate to the symptoms.”
“The rest of the MRI findings did not jibe well with what symptoms may be described by the participants,” Marathe said.
Shira Doron, chief infection control officer for Tufts Medicine, noted that the study — which surveyed patients primarily from England’s first wave of COVID-19 and did not distinguish between vaccinated and unvaccinated patients — analyzed an early form of the disease, “not the COVID that people are acquiring today.” She added that participants were self-selected for prolonged symptoms and filtered to study only those with organ damage.
“That is a very small subpopulation,” Doron said. “That’s not the vast majority of people who have had COVID, which is almost everybody.”
Doron said “long COVID” is a blanket diagnosis, which includes fatigue, loss of taste and smell, breathlessness, and other symptoms, which likely have distinct physiological mechanisms and may require different treatments.
“I don’t have a great solution to this messy problem,” she said. “I think we need to break it down into its smallest parts ... stop lumping these patients with different symptoms together.”
In an e-mail, Francesca Beaudoin, the director of Brown University’s Long COVID Initiative, wrote that the study does little to advance researchers’ understanding of long COVID or its treatment. Incidental findings, such as minor organ damage, on imaging tests are relatively normal, she wrote, and not necessarily indicative of anything significant.
Among a control group of 92 people who had never contracted COVID-19, roughly 35 percent had damage to at least one organ and 11 percent had damage to at least two, the study found.
The study “might sound alarming on the surface,” but “doesn’t do much to advance our understanding of long COVID or the best treatments,” Beaudoin said.
“We are still in need of better tools to diagnose and more targeted treatments,” she wrote. “I am optimistic that we will make advances in this area though — there are a number of exciting trials underway.