People hospitalized for COVID-19 are often discharged in much worse shape than before their illness—underscoring the value of preventing severe cases with vaccination.

In a new study, researchers found that during the pandemic’s early months, almost half of COVID-19 patients discharged from their health system had some degree of “functional decline.”

That’s a broad category including people who needed further therapy for physical impairments, like muscle weakness and low fitness levels; assistance with walking or other daily activities; home oxygen; or speech therapy or special diets after being on a ventilator.

The researchers said it all highlights a vital point: Many people who survive severe COVID-19 still face a long recovery.

“Surviving is not the same as thriving,” said lead author Dr. Alecia Daunter. She is a rehabilitation specialist at the University of Michigan Health System, in Ann Arbor.

A year-and-a-half into the pandemic, she noted, many people still believe that death is the only bad outcome of COVID-19.

Younger people, whose risk of death is low, can mistakenly think they have “nothing to worry about,” Daunter said.

Many studies have documented long-term consequences of COVID-19, including the phenomenon dubbed “long COVID,” which causes lingering problems like poor fitness levels, profound fatigue and “brain fog”—even after a mild infection.

And while COVID-19 primarily affects the lungs, it can damage other organs, including the heart and brain.

Yet studies have not described the impact on hospitalized patients’ functioning, according to Daunter’s team.

So the researchers analyzed medical records from 288 COVID-19 patients discharged from their medical center between March and May 2020. Most patients—almost two-thirds—were able to go home, but 13% went to a rehabilitation or skilled nursing center for further care.

And close to half (45%) had some type of functional decline at the time of discharge, according to the report published online recently in PM&R: The Journal of Injury, Function and Rehabilitation.

One reason is that being sick in the hospital causes “deconditioning”—a decline in muscle strength and heart and breathing capacity that makes even daily routines difficult, Daunter said.

And people sick enough to land in the intensive care unit can leave with “post-ICU syndrome,” with issues ranging from deconditioning to impaired memory and thinking to post-traumatic stress, she explained.

Daunter stressed that patients in the study were not a uniformly elderly group: They ranged in age from 20 to 95, and were 66 years old, on average.

“We’re talking about a relatively young and healthy population,” she said.

All of the COVID-19 vaccines available in the United States are highly effective at preventing severe disease and hospitalization, Daunter pointed out. It’s important for younger people to be aware they can land in the hospital—and suffer the after-effects, she said.

Long-term effects are not, however, limited to hospital patients, said Dr. Ruwanthi Titano, a cardiologist who treats patients at the Center for Post-COVID Care at Mount Sinai, in New York City.

In fact, Titano said, most patients at the center had milder COVID-19 cases treated at home.

Researchers are working to understand the causes of long COVID, whether, for instance, it stems from runaway inflammation or an autoimmune reaction, she said.

But patients do show signs of what’s called autonomic nervous system dysfunction, Titano explained: Their heart rate and blood pressure can “skyrocket” from something as basic as slow walking.

Initially, doctors told such patients to give their bodies time to recover, just like after a bad flu.

“And that wasn’t unreasonable,” Titano noted.

Over time, though, it’s become apparent that some COVID-19 patients have lasting problems. And a growing number of medical centers are opening COVID clinics like Mount Sinai’s.

It remains to be seen how patients will ultimately fair. At this point, Titano said, there has been some success with gradual exercise therapy, starting at a very mild intensity then slowly progressing.

While functional decline may not be life-threatening, it does take a toll on quality of life, Titano said, keeping people out of work and unable to fully “rejoin the world.”

Titano echoed Daunter on the prevention message.

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