What is the long-term impact of COVID-19 on the Health-Related Quality of Life of individuals with mild symptoms (or non-hospitalised): A rapid review

The COVID-19 morbidities model has been widely used since 2020 to support Test and Trace and assess the cost-effectiveness of the COVID-19 vaccination programme. The current iteration of the Long COVID model covers several morbidities associated with COVID-19, which are essential to plan for elective care in the future and identify which services to prioritise. However, there are uncertainties in the model around the long-term health-related quality of life (HRQoL) impact of COVID-19, which is primarily based on data for severe COVID disease or hospitalised patients at present. The COVID-19 morbidities model requires updating to address gaps and reflect the latest HRQoL evidence. The aim of this rapid review was to provide updated HRQoL evidence for the COVID-19 morbidities model to better support decision-making in relation to COVID-19 policy. Thirteen primary studies were identified. People who had an initial mild COVID-19 illness or were not treated in hospital can have a decreased HRQoL post-COVID. However, the extent, severity, and duration of this is not consistent. The evidence on the long-term impact of a mild COVID-19 infection on HRQoL is uncertain. Implications for policy and practice include: O_LIAn initial mild COVID-19 illness can lead to a reduction in HRQoL and impaired mental health, but there is evidence indicating that patients can show significant recovery up to normal levels after one year. C_LIO_LIEmployers should be aware that employees may have prolonged experiences of impaired mental health, including anxiety, depression, and fatigue, following COVID-19 disease, even if their initial disease was mild (not hospitalised). C_LIO_LIPublic health agencies should make patients with mild COVID-19 disease aware of the potential for ongoing symptoms and ways to mitigate and manage them through raised awareness and education. C_LIO_LIHealth Boards should review their provision of long-COVID services in relation to the extent of impacts identified. C_LIO_LIBetter quality studies that report longitudinal follow-up data on HRQoL for a representative cohort of patients who have had mild COVID-19 are required. C_LI Funding statementThe Bangor Institute for Health and Medical Research, Bangor University was funded for this work by the Wales Covid-19 Evidence Centre, itself funded by Health & Care Research Wales on behalf of Welsh Government. Rapid Review DetailsO_ST_ABSReview conducted byC_ST_ABSBangor Institute for Health and Medical Research Rapid Review Team Review TeamO_LIDr Llinos Haf Spencer, l.spencer@bangor.ac.uk C_LIO_LIDr Annie Hendry, a.hendry@bangor.ac.uk C_LIO_LIMr Abraham Makanjuola, a.makanjuola@bangor.ac.uk C_LIO_LIMr Jacob Davies, j.davies@bangor.ac.uk C_LIO_LIMiss Kalpa Pisavadia, kalpa.pisavadia@bangor.ac.uk C_LIO_LIProfessor Dyfrig Hughes, d.a.hughes@bangor.ac.uk C_LIO_LIProfessor Deb Fitzsimmons, d.fitzsimmons@swansea.ac.uk C_LIO_LIProfessor Clare Wilkinson, c.wilkinson@bangor.ac.uk C_LIO_LIProfessor Rhiannon Tudor Edwards, r.t.edwards@bangor.ac.uk C_LI Review submitted to the WCEC inJuly 2022 Rapid Review report issued by the WCEC inAugust 2022 WCEC TeamAdrian Edwards, Ruth Lewis, Alison Cooper and Micaela Gal involved in drafting, Topline Summary, editing etc. This review should be cited asRR00040. Wales COVID-19 Evidence Centre. What is the long-term impact of COVID-19 on the Health-Related Quality of Life of individuals with mild symptoms (or non-hospitalised): A rapid review. July 2022. This report can be downloaded herehttps://healthandcareresearchwales.org/wales-covid-19-evidence-centre-report-library DisclaimerThe views expressed in this publication are those of the authors, not necessarily Health and Care Research Wales. The WCEC and authors of this work declare that they have no conflict of interest. TOPLINE SUMMARYO_ST_ABSWhat is a Rapid Review?C_ST_ABSOur rapid reviews use a variation of the systematic review approach, abbreviating or omitting some components to generate the evidence to inform stakeholders promptly whilst maintaining attention to bias. They follow the methodological recommendations and minimum standards for conducting and reporting rapid reviews, including a structured protocol, systematic search, screening, data extraction, critical appraisal, and evidence synthesis to answer a specific question and identify key research gaps. They take 1-2 months, depending on the breadth and complexity of the research topic/ question(s), extent of the evidence base, and type of analysis required for synthesis. Who is this summary for?The Department of Health and Social Care (DHSC), who have previously created a COVID-19 morbidities model to support the COVID-19 pandemic response. It will also inform Welsh Government policy through work conducted by the Technical Advisory Cell. Background / Aim of Rapid ReviewThe COVID-19 morbidities model has been widely used since 2020 to support Test and Trace and assess the cost-effectiveness of the COVID-19 vaccination programme. The current iteration of the Long COVID model covers several morbidities associated with COVID-19, which are essential to plan for elective care in the future and identify which services to prioritise. However, there are uncertainties in the model around the long-term health-related quality of life (HRQoL) impact of COVID-19, which is primarily based on data for severe COVID disease or hospitalised patients at present. The COVID-19 morbidities model requires updating to address gaps and reflect the latest HRQoL evidence. The aim of this Rapid Review was to provide updated HRQoL evidence for the COVID-19 morbidities model to better support decision-making in relation to COVID-19 policy. The latest edition of the model was published by the DHSC team in December 2020. The review focused on studies reporting on the long-term impact on HRQoL of patients who had experienced mild symptoms or were not treated in hospital. Inclusion was limited to studies that used validated HRQoL measures, which can be mapped onto EuroQol Quality of Life Measure - 5 dimensions (EQ-5D) and conducted in OECD countries. Two existing systematic reviews were used to identify relevant primary studies published before January 2021, with new searches focusing on the period between January 2021 to June 2022. Key FindingsThirteen primary studies were identified. Extent of the evidence baseO_LIMost studies (n=8) were cross-sectional surveys or reported on HRQoL outcomes at a single time point post-COVID (n=2). Only three studies (one of which was a case report) provided longitudinal follow-up data, which included changes from baseline or reported data at multiple time points. C_LIO_LIOnly two studies reported on HRQoL beyond six months follow-up: One study reported data at three months, six months, and twelve months follow-up and one study measured outcomes at six to eleven months. Five studies measured HRQoL at three months post COVID-19, one at four months, and one at five months. Three studies reported data at two months or less post COVID-19. C_LIO_LITwo studies (one was a case report) focused solely on patients with mild infection, whilst the remaining eleven studies also included patients with moderate or severe/critical COVID-19 illness. Three studies included participants categorised as non-hospitalised or hospitalised patients. twelve studies recruited patients attending outpatients or health care settings; one study recruited a general Swedish population who had a previous COVID-19 infection. C_LIO_LIThe studies were conducted in Turkey (n=2), Denmark (n=1), Sweden (n=1), USA (n=2), Chile (n=1), Ukraine (n=1), Mexico (n=1), Austria (n=2), and The Netherlands (n=2). No UK-based studies were identified. C_LI Recency of the evidence baseO_LIThree studies published in 2022 were conducted in 2021 (Akova & Gedikli, 2022; Bileviciute-Ljungar et al., 2022; Tanriverdi et al., 2022). C_LI Summary of resultsO_LIPeople who had an initial mild COVID-19 illness or were not treated in hospital can have a decreased HRQoL post-COVID. However, the extent, severity, and duration of this is not consistent. C_LI Best evidence availableO_LIHan et al., (2022) recruited outpatients who had mild initial COVID-19 disease and measured HRQoL at six to eleven months follow-up; 436/2092 (21%) outpatients responded to the survey. The findings indicated that the burden of persistent symptoms was significantly associated with poorer long-term health status, poorer quality of life, and psychological distress. C_LIO_LISiegerink et al., (2021) measured HRQoL at three months, six months, and twelve months follow-up, and recruited patients presenting at hospital with COVID-19, a proportion of whom were not hospitalised. At three months follow-up, 22% (n=9) of the non-hospitalised group reported abnormal Hospital Anxiety and Depression Scale (HADS) scores (cut-off at 16). After six months, this decreased to 16% (for n=4), and 14.8% at twelve months (n=4). C_LIO_LILabarca et al., (2021) reported a change from baseline in percentage satisfaction with HRQoL. They found 50% of the (n=18) mild (non-hospitalised) COVID-19 patients reported an individual change in HRQoL, categorised as a change of [≥] 10% on a Visual Analogue Scale (VAS) at four months follow-up. C_LI Policy ImplicationsO_LIAn initial mild COVID-19 illness can lead to a reduction in HRQoL and impaired mental health, but there is evidence indicating that patients can show significant recovery up to normal levels after one year. C_LIO_LIEmployers should be aware that employees may have prolonged experiences of impaired mental health, including anxiety, depression, and fatigue, following COVID-19 disease, even if their initial disease was mild (not hospitalised). C_LIO_LIPublic health agencies should make patients with mild COVID-19 disease aware of the potential for ongoing symptoms and ways to mitigate and manage them through raised awareness and education. C_LIO_LIHealth Boards should review their provision of long-COVID services in relation to the extent of impacts identified. C_LIO_LIBetter quality studies that report longitudinal follow-up data on HRQoL for a representative cohort of patients who have had mild COVID-19 are required. C_LI Strength of EvidenceO_LIThe evidence on the long-term impact of a mild COVID-19 infection on HRQoL is uncertain. C_LI