USAID-funded study finds individuals hospitalised with COVID-19 are at higher risk of diabetes, respiratory, and cardiovascular complications in following weeks

On 21 March 2023, icddr,b and Bangabandhu Sheikh Mujib Medical University (BSMMU) jointly organized a dissemination seminar titled “Long-Term Sequelae of COVID-19: A Longitudinal Follow-Up Study in Dhaka, Bangladesh.” The seminar also presented a guideline titled “Long COVID Clinical Management Guideline for Physicians”. The findings, based on the first five months of participant follow-ups, were recently published in The Lancet Regional Health Southeast Asia. The study was funded by the United States Agency for International Development (USAID) Alliance for Combating TB (ACTB) in Bangladesh activity. The first of its kind in Asia, the study revealed that COVID-19 survivors carry a high burden of long-term effects of COVID-19 infection, often described as post-COVID-19 syndrome (PCS) or long COVID.

Professor Dr Shohael Mahmud Arafat, Chairman, Department of Internal Medicine, BSMMU; Professor Dr Chowdhury Meshkat Ahmed, Department of Cardiology, BSMMU, and Dr Farzana Afroze, Associate Scientist, Nutrition and Clinical Service Division, icddr,b and the principal investigator of the study presented key findings at the event. The study was conducted at two COVID-19-designated hospitals in Dhaka, Bangladesh, between 15 December 2020 and 30 October 2021. The researchers recruited clinically recovered individuals older than 18 years with RT-PCR-confirmed COVID-19 who sought care from the study hospitals with or without hospitalisation. The 362 enrolled participants were given comprehensive in-person follow-ups at one, three and five-month post-recovery intervals to evaluate the presence or trajectories of PCS symptoms which include neurological, cardiac, respiratory outcomes, and mental health. The study participants will be followed up for 24 months.

The study revealed that COVID-19 survivors over the age of 60 are twice as likely to develop cardiovascular (hypertension, high pulse rate, edema), and neurological (peripheral neuropathy or numbness, tingling sensation, and pain in the hands and feet, taste, and smell abnormalities) complications when compared to the age group younger than 40 years. The long-term effects of the disease also seem to differ by gender - the prevalence of developing post-COVID complications was found to be 1.5 to 4 times higher in females than in males. Long-term complications in hospitalised patients and those needing intensive care were 2-3 times more likely than in non-hospitalized patients.

Hospitalised survivors with pre-existing diabetes had a 9 to 11 times higher possibility of having uncontrolled blood sugar with regular medication and hence required the administration of insulin therapy more often compared to those who did not require hospitalisation. The new occurrence of diabetes was 10 cases per 1,000 person - among hospitalised patients, compared to none in the non-hospitalised group. Similarly, the new occurrence of renal impairment (high creatinine and proteinuria) and the increased liver enzyme were considerably high among COVID-19 survivors.

Most complications decreased over time in both groups, however, shortness of breath, fast pulse rate, post-traumatic stress disorder, anxiety and depression did not decline significantly in the non-hospitalised group, even five months after recovery.

The results highlight the need for continuous follow-up and care of COVID-19 survivors. Older and hospitalised patients should be routinely monitored for cardiovascular complications, given their increased risk. The novel incidence of diabetes mellitus among hospitalised COVID-19 survivors is also particularly concerning as it could be significantly adding to the diabetes burden in the country.

Professor Dr Shohael Mahmud Arafat presented the clinical management guideline for Long-COVID for physicians, which was developed jointly by BSMMU and icddr,b. He noted that the absence of a proper guideline often causes challenges in treatment and rehabilitation of ambiguous long COVID complications. He hopes that the proposed guideline will help physicians to identify, act and maximise patient rehabilitation.

Dr Tahmeed Ahmed, Executive Director of icddr,b, stressed the importance of the study and said, “The research bears immense importance in understanding the long-term adverse effects of COVID-19 and its patterns. It has become evident from the findings that many of those affected by the disease are still at increased risk of certain health complications. The research will be a success when people who have been hospitalised due to COVID-19 will maintain regular monitoring of complications and address them accordingly.”

Professor Dr Md. Sharfuddin Ahmed, Vice-Chancellor of BSMMU, attended the seminar as special guest and appreciated the collaborative effort by scientists of icddr,b and BSMMU to understand and find solutions to long COVID complications. He also suggested some new research ideas in this regard. He said, “I hope that icddr,b and BSMMU will jointly play an important role in solving public health problems of the country through more such new and innovative researches.”

Professor Dr Nazmul Islam, Director, Disease Control, Directorate General of Health Services (DGHS), in his special guest address thanked the researchers and everyone involved. He specially thanked USAID for funding the research and hoped for their continued cooperation.

USAID’s Health Expert Dr Samina Choudhury also attended the seminar as a special guest and highlighted some of USAID support to the Government of Bangladesh in its effort to combat COVID-19 pandemic in her speech. She said, “More than two million people have suffered from COVID-19 in Bangladesh, but the patterns and burden of the prolong health complications were unknown. This study provides significant insights in this regard. Many thanks to icddr,b and BSMMU for taking the initiative.”

Physicians from different medical colleges, representatives from BSMMU, icddr,b and media also attended the seminar.