Health outcomes and reinfection among COVID-19 survivors 4 years after hospital discharge in Wuhan, China: a cohort study

OBJECTIVES: To evaluate health outcomes and identify risk factors for reinfection and persistent symptoms among COVID-19 survivors 4 years after hospital discharge. DESIGN: Longitudinal cohort study. SETTING: Two hospitals in Wuhan, China. PARTICIPANTS: 1076 COVID-19 survivors discharged from hospital. OUTCOME MEASURES: Self-reported symptom questionnaire, Chronic Obstructive Pulmonary Disease Assessment Test, Hospital Anxiety and Depression Scale and Checklist Individual Strength (CIS) fatigue subscale. Long covid was defined according to WHO criteria. RESULTS: Median age was 58 years and 50.2% were male. Reinfection during December 2022-April 2023 occurred in 36.1%; 21 developed pneumonia and 14 required hospitalisation. At least 12 months after reinfection, 12.1% reported sequelae compared with 46.9% after the initial infection. At 4 years, 16.7% reported long covid symptoms, commonly fatigue, chest tightness, cough and dyspnoea. In multivariable analysis, risk factors for abnormal fatigue (CIS ≥27) included age (OR 1.020, 95% CI 1.007 to 1.034; p=0.003), reinfection (OR 2.393, 95% CI 1.708 to 3.352; p<0.001), severe disease (OR 1.553, 95% CI 1.088 to 2.218; p=0.015) and tumour (OR 3.420, 95% CI 1.177 to 9.936; p=0.024). CONCLUSIONS: At 4 years post discharge, symptom burden was lower than at earlier follow-up time points for most survivors. Reinfection and older age were associated with persistent symptoms.