<p class="first" id="d8735863e141">The acute clinical manifestations of COVID-19 have
been well characterized1,2, but
the post-acute sequelae of this disease have not been comprehensively described. Here
we use the national healthcare databases of the US Department of Veterans Affairs
to systematically and comprehensively identify 6-month incident sequelae-including
diagnoses, medication use and laboratory abnormalities-in patients with COVID-19 who
survived for at least 30 days after diagnosis. We show that beyond the first 30 days
of illness, people with COVID-19 exhibit a higher risk of death and use of health
resources. Our high-dimensional approach identifies incident sequelae in the respiratory
system, as well as several other sequelae that include nervous system and neurocognitive
disorders, mental health disorders, metabolic disorders, cardiovascular disorders,
gastrointestinal disorders, malaise, fatigue, musculoskeletal pain and anaemia. We
show increased incident use of several therapeutic agents-including pain medications
(opioids and non-opioids) as well as antidepressant, anxiolytic, antihypertensive
and oral hypoglycaemic agents-as well as evidence of laboratory abnormalities in several
organ systems. Our analysis of an array of prespecified outcomes reveals a risk gradient
that increases according to the severity of the acute COVID-19 infection (that is,
whether patients were not hospitalized, hospitalized or admitted to intensive care).
Our findings show that a substantial burden of health loss that spans pulmonary and
several extrapulmonary organ systems is experienced by patients who survive after
the acute phase of COVID-19. These results will help to inform health system planning
and the development of multidisciplinary care strategies to reduce chronic health
loss among individuals with COVID-19.
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