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Study investigating the long-term impact of moderate to severe COVID-19 finds that a large proportion of COVID-19 patients previously admitted to hospital continue to experience intrusive symptoms six months following infection.

Schematic drawing showing body with internal organs, surrounded by novel coronavirus particles.


Investigators from the Radcliffe Department of Medicine, University of Oxford had previously studied 58 patients recovering from COVID-19 to understand the short-medium term impact of COVID-19 on multiorgan health, cognition, mood symptoms and quality of life. This early study provided important insights into the burden of ongoing symptoms and multiorgan abnormalities on MRI in patients. However, what was not clear at the time was whether some of these abnormalities would persist in patients or explain the high burden of ongoing symptoms.


The latest study, published in the journal EClinicalMedicine, focussed on understanding the cause and trajectory of heart and lung abnormalities in patients. The C-MORE study investigators invited patients back for repeat assessments at 6 months from infection. Detailed information on the longitudinal trajectory of symptoms and MRI abnormalities were collected as part of this study.

Persistent symptoms

The investigators found that in many patients, previously described MRI abnormalities involving the heart and lungs were actually seen to improve. However, symptoms continued to persist in many individuals.

Even at 6 months from infection, more than half the patients who were previously hospitalised with COVID-19 described enduring symptoms of breathlessness, chest pain, dizziness, palpitations or loss of consciousness.

While cardiopulmonary exercise testing also showed some improvement, one in three patients was still unable to exercise to their fully predicted potential. Interestingly, this was not related to heart or lung health but was thought to be due to muscle-related impairment.


Dr Mark Philip Cassar, the first author of this paper said “The dissociation between persistent symptoms and objective measures of cardiac and lung health is concerning. This suggests that many patients who have symptoms will have no answers after extensive clinical investigations and that there will be some with abnormalities on lung function testing or MRI which may be silent and could cause symptoms in the future.

Dr Betty Raman, who leads the C-MORE study along with Professor Stefan Neubauer, said “Long COVID is a significant global health concern and is likely to affect millions of people for years to come."

Our study underscores the need for further research in this field to better understand the cause for ongoing symptoms in patients, but to also monitor those at risk of symptoms in the future.
- Dr Betty Raman


The C-MORE study is part of the national PHOSP-COVID consortium study, led by the University of Leicester, which is investigating the long-term effects of COVID-19 on 10,000 hospitalised patients across the UK to better understand main mechanisms that contribute to ongoing symptoms in patients. These efforts are pivotal for discovering new treatments for patients.

Read the full paper.