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COVID-19 Long-Haulers

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While most people who catch COVID-19 have a relatively straightforward recovery, there is a group of people who are struggling with the long-term side-effects of the disease.

Early on, patients with both mild and severe Covid-19 report various symptoms, including a loss of breath capacity. Now, after recovering from the infection, some of them are reporting new symptoms, including chronic fatigue and ‘brain fog’. This group has gone on to be dubbed; The long-haulers.

With the current crisis just months old, no one really knows how far into the future symptoms will endure, and whether COVID-19 will prompt an onset of chronic, long-term side-effects. But one thing is for sure, we need to take the long-term health effects of COVID-19 very seriously.

The Long Haul

Even people who were never sick enough to go to a hospital, much less lie in an ICU bed with a ventilator, have started to report feeling something as ill-defined as “Covid fog” or as frightening as numbed limbs. Many have been unable to carry on with their healthy lives due to exhaustion, fumbling for words, or laid low by depression, anxiety, or PTSD.

Most people who contract COVID-19 have textbook symptoms; a fever and cough, followed by shortness of breath, chest pain, and extreme fatigue. For some, the symptoms ebb and flow without ever going away. The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and even the brain.

Some doctors are also watching for a syndrome called demyelination, in which the protective coating of nerve cells is attacked by the immune system when there is inflammation in the brain. As in the autoimmune disease, multiple sclerosis, this can cause weakness, numbness, and tingling. It can also disrupt how people think, in some cases spurring psychosis and hallucinations.

The likelihood of a patient developing these kinds of persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for varying lengths of time.

Data from a COVID symptom study, which uses an app into which millions of people in the U.S, U.K, and Sweden have recorded their symptoms, suggest that 10% to 15% of people—including some “mild” cases—don’t recover quickly. Another study from Italy found that 87% of patients in a cohort hospitalised for acute COVID-19 were still struggling two months later.

For Götz Martin Richter, a radiologist at the Klinikum Stuttgart in Germany, what’s especially striking is that just as the illness’ acute symptoms vary unpredictably, so, too, do those that linger. Richter refers to two patients he treated: a middle-aged man who experienced mild pneumonia from COVID-19, and an older woman already suffering from chronic leukaemia and arterial disease, who almost died from the virus and had to be resuscitated. Three months later, the man with the mild case “falls asleep all day long and cannot work,” Richter says. The woman has minimal lung damage and feels excellent.

What can the side-effects be?

The sheer breadth of complications linked to COVID-19 is mind-boggling. Some of the most commonly reported side-effects are;

  1. Brain fog - Difficulty thinking can occur after acute COVID-19infection. The virus may damage brain cells, and inflammation in the brain or body may also cause neurologic complications. Other viral infections can also lead to brain fog.
  2. Shortness of breath - Doctors are eyeing lung and heart complications, including scarring. Patients who become critically ill with COVID-19seem more likely to have lingering shortness of breath, but those with mild cases are also at risk.
  3. Heart arrhythmia - The virus can harm the heart, and doctors are concerned about long-term damage. How the heart heals after COVID-19 could help determine whether a patient develops an irregular heartbeat.
  4. Hypertension - Some patients have high blood pressure after an acute infection, even when cases were relatively mild, and people were previously healthy, possibly because the virus targets blood vessels and heart cells.

Based on experience with other viruses, doctors can “extrapolate and anticipate” potential long-term effects of COVID-19. Like COVID-19, some other viruses, such as Epstein-Barr, can damage heart tissue, for example.

“What we’re experiencing is an epidemic of severe illness, so, therefore, there is an epidemic of chronic illness that follows it.” Michael Marks, an infectious disease specialist at the London School of Hygiene & Tropical Medicine

Many doctors also fear the virus will induce extensive, permanent lung damage in many survivors because two other coronaviruses, the viruses that cause the first severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome, can devastate the lungs. One study of health care workers with SARS in 2003 found that those with lung lesions one year after infection still had them after 15 years.

What’s next?

By now, it is clear that many people with COVID-19 severe enough to put them in a hospital face a long recovery. The virus ravages the heart, for example, in multiple ways. Direct invasion of heart cells can damage or destroy them. Massive inflammation can affect cardiac function. The virus can blunt the role of ACE2 receptors, which typically help protect heart cells and degrade angiotensin II, a hormone that increases blood pressure. 

“Stress on the body from fighting the virus can prompt release of adrenaline and epinephrine, which can also have a deleterious effect on the heart” Raul Mitrani, a cardiac electrophysiologist at the University of Miami.

Many people with heart complications post–COVID-19 had preexisting conditions, most commonly diabetes and hypertension. It is thought that COVID-19, tips them into more hazardous terrain or accelerates the onset of heart problems that, absent the coronavirus, might have developed later.

But other patients are affected without apparent risk factors: A recent paper in JAMA Cardiology found that 78 of 100 people diagnosed with COVID-19 had cardiac abnormalities when their heart was imaged on average ten weeks later, most often inflammation in heart muscle. Many of the participants in that study were previously healthy, and some even caught the virus while on ski trips, according to the authors.

Severe lung scarring appears less common than feared. Scarring seems most likely to accompany underlying lung disease, hypertension, obesity, and other conditions. Lung damage is also seen in people who spend weeks on a ventilator. Experts suspect that, as with harm to the heart, previously healthy people are not exempt from the virus’ long-term effects on the lungs, though their risk is likely lower.

Then there’s the nervous system, a worrying target. Severe complications seem relatively rare but aren’t limited to those whom the virus renders critically ill. Doctors are starting to report patients with neurologic complications; many had been hospitalised during their acute infection, but not always for long—and for some, neurologic problems were their most debilitating symptom and the reason for the hospital admission. Several were struggling to recover from encephalitis. Others had inflammation in their brain’s white matter, which helps transmit electrical signals.

Separately, doctors are starting to see a class of patients who struggle to think clearly. Some neurologists and patients describe the phenomenon as “brain fog.” It’s mostly a mystery, though one theory suggests it’s similar to “post-viral fatigue related to inflammation in the body.”

The most bedevilling and common lingering symptom seems to be fatigue, but researchers caution against calling it chronic fatigue syndrome. That’s a specific diagnosis. You might have fibrosis in the lungs, and that will make you feel fatigued; you might have impaired heart function, and that will make you feel fatigued.

Summary

Trying to trace symptoms to their source is critical to understanding and ultimately managing them. Many physicians fear the societal impact of even uncommon complications, including in the millions of people never hospitalised. When you consider how many people are getting the disease, it’s a big problem.

Although scientists hope they’ll learn how to avert chronic symptoms and help patients currently suffering, this latest chapter in the COVID-19 chronicle has been sobering. The message many researchers want to impart: Don’t underestimate the force of this virus—the stakes are high.

At Vala we are committed to helping people who have suffered from COVID-19 with their long-term recovery. If you would like to speak to one of our team about your lingering symptoms, book an appointment today and we will discuss a long-term recovery strategy with you.

Further Reading and Sources

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