First 10 Days After Hospital Discharge Especially Risky for COVID Survivors

TUESDAY, Dec. 22, 2020 (HealthDay News) -- Being discharged from the hospital following a serious bout of COVID-19 is far from a clean bill of health, new research warns, and the risk of rehospitalization or death peaks early.

In the study, more than one-quarter of such patients ended up back in the hospital or died in the weeks after discharge. The researchers tracked almost 2,200 U.S. veterans discharged at 132 VA hospitals this past spring and summer. All had been hospitalized for COVID-19, and their post-hospital experience was compared with 5,300 peers who had been released following hospitalization for either non-COVID-related pneumonia or heart failure.

The findings showed that COVID-19 patients were 40% to 60% more likely to be rehospitalized or die within 10 days following discharge compared with the other patients.

In absolute terms, 9% of the discharged COVID-19 patients ended up dying within two months, while one-fifth ended up rehospitalized.

"We found a very high rate of readmission or death among COVID-19 patients surviving to discharge within the first 60 days after leaving the hospital," said study author John Donnelly. He's a research investigator in the department of learning health sciences at the University of Michigan, in Ann Arbor.

While the COVID-19 patients fared better two months out than the heart failure or pneumonia patients, the big concern appears to be "a period of extremely high risk within the first 10 days after discharge," Donnelly explained.

"This pattern was somewhat surprising as we might have expected consistently worse outcomes for COVID-19 patients out to 60 days. But that was not the case," he said.

So what's going on? "COVID-19 patients who were readmitted or died within 60 days tended to be older," said Donnelly. Other factors "might drive outcomes after discharge, but nothing beyond age stood out in our results," he noted.

The study was published online Dec. 14 in the Journal of the American Medical Association.

Almost all of the veterans in the study were men (95%) and about half were Black. Among the COVID-19 patients, nearly one-third had been in an intensive care unit (ICU) when first hospitalized, and 13% had been placed on a ventilator. In all, just over 80% survived their initial stay.

Following discharge, nearly one-quarter of those who were readmitted to the hospital ended up in the ICU, and 7% required ventilators.

Donnelly emphasized that the vast majority of coronavirus patients have either no symptoms or symptoms that can be managed at home. "And we would expect outcomes to be much more favorable for individuals who tested positive for COVID-19 but did not present with symptoms that were severe enough to merit hospitalization," he added.

But for those who do, are there ways to minimize risk during the immediate post-discharge period?

Donnelly said the study was "not able to address the question of whether readmissions after COVID-19 are preventable or not, and it is difficult to give a blanket recommendation for all patients."

But his team suggested that post-discharge vigilance is definitely called for. "And when in doubt, getting in contact with a physician for guidance on the most appropriate treatment would help patients and loved ones to best decide whether [rehospitalization] makes sense or not," Donnelly advised.

In New York City, a good place to turn to is the Post-COVID Recovery Center at Northwell Health's Staten Island University Hospital (SIUH). Established this past September, its director is Dr. Thomas Gut, an associate chair of medicine at SIUH.

"We set up a place specifically for COVID patients looking for further care after discharge because there really was no resource for patients who are no longer sick enough to be in the hospital, but their primary care doc perhaps isn't familiar enough with an illness that we're really just learning about as we go," Gut explained.

"Of course, not everyone is going to be able to access a center like ours," he noted. "But I would say that COVID patients who are out of the hospital are right to be concerned by any lingering or worsening of symptoms, like persistent fatigue or brain fog. Because we do know that during this 10-day period, you're at high risk for the kinds of things -- like heart attacks and strokes -- that you normally would not see with other types of viral infections, which suggests that COVID may inflict long-term damage to the heart, lungs or brain."

Gut's bottom line: "If your situation seems to be getting worse after discharge, in any measurable amount, you do need to seek medical care again."

More information

There's more on COVID-19 symptoms at the U.S. Centers for Disease Control and Prevention.

SOURCES: John Donnelly, PhD, research investigator, department of learning health sciences, University of Michigan, Ann Arbor; Thomas Gut, DO, associate chair, medicine, Northwell Health, Staten Island University Hospital, and director, SIUH Post-COVID Recovery Center, New York City; Journal of the American Medical Association, Dec. 14, 2020, online