Here’s what we know so far about long-term symptoms of COVID-19

We are now very familiar with the common symptoms of COVID-19: fever, dry cough, and fatigue. Some people also experience aches and pains, a sore throat, and loss of taste and smell.

Victims with a mild illness can expect to improve after a few weeks. But there is mounting evidence that this is not the case, and COVID-19 can leave a lasting impression on its victims, not just the most severely affected or the elderly and frail.

It is not just an infection of the lungs.

On the surface, COVID-19 is a lung disease. The SARS-CoV-2 coronavirus infects the cells of the respiratory tract and can cause life-threatening pneumonia.

However, the full range of symptoms affects multiple parts of the body. An app that records daily symptoms developed at King’s College London has followed the progress of more than 4 million COVID-19 patients in the UK, Sweden, and the United States.

In addition to the well-described symptoms of fever, cough, and loss of smell, there are other effects, such as fatigue, rash, headache, abdominal pain, and diarrhea. People who develop more severe forms of the disease also report confusion, severe muscle aches, cough, and shortness of breath.

About 20% of people infected with COVID-19 require hospitalization to treat their pneumonia, and many need oxygen assistance. In about 5% of cases, pneumonia becomes so severe that patients are admitted to intensive care for respiratory support.

Activates the immune system.

People with severe COVID-19 appear to show an impaired immune response even in the early stages of the disease. They have fewer circulating immune cells, which cannot effectively control the virus, and instead suffer an exaggerated inflammatory response (the “cytokine storm”).

This is increasingly recognized as one of the main factors that makes the disease so severe in some patients. Suppressing this exaggerated response with the immunosuppressant dexamethasone remains the only treatment that reduces mortality rates in those requiring oxygen or intensive care.

Patients with severe COVID-19 describe a much more complex range of symptoms than would normally be seen with pneumonia alone. This can include brain inflammation (encephalitis), which causes confusion and decreased consciousness. Up to 6% of severe patients can suffer a stroke.

Pathology studies and autopsies of patients who died from COVID-19 reveal the expected characteristics of severe pneumonia or acute respiratory distress syndrome (ARDS), with extensive inflammation and scarring. ARDS occurs when there is sudden and widespread inflammation in the lungs, resulting in shortness of breath and bluish skin.

However, they also reveal that the virus appears to directly cause inflammation of small capillaries or blood vessels, not only in the lungs but in multiple organs, causing blood clots and damage to the kidneys and heart.

Persistent ‘deeply frustrating’ symptoms

Anyone with a serious illness would be expected to suffer lasting consequences. But COVID-19 appears to have persistent symptoms even in those with milder forms of the disease.

Social media is full of stories of survivors affected by ongoing symptoms. Support groups have emerged on Slack and Facebook that host thousands of people, some of whom still suffer more than 60 days after infection. They call themselves “long-term” or “long-term.”

One of the best known victims is Paul Garner, an infectious disease specialist at the Liverpool School of Tropical Medicine in the UK. He was infected in late March and his symptoms continue. In a blog post published by the British Medical Journal, he describes having: “… muggy head, upset stomach, tinnitus (ringing in the ears), pins and needles, difficulty breathing, dizziness, and arthritis in the hands.”

These symptoms have increased and decreased, but have not yet resolved. He says this is: “… deeply frustrating. Many people begin to doubt themselves … Their partners wonder if there is something psychologically wrong with them.”

So far, only one peer-reviewed study has reported results on the long-term symptoms of COVID-19 infection: a single group of 143 survivors from Rome. Most of them did not require hospitalization and all were evaluated at least 60 days after infection. They reported poorer quality of life in 44.1% of cases, including symptoms of persistent fatigue (53.1%), dyspnea (43.4%), joint pain (27.3%), and chest pain (21.7%).

While our experience with COVID-19 has only just begun, long-term symptoms after severe viral illness are not a new phenomenon. Influenza has long been associated with persistent symptoms, such as fatigue and muscle pain, even after the 1890 and 1918-19 pandemics.

The survival of severe viral pneumonia or ARDS, particularly after intensive care, is known to have long-lasting implications. Some survivors experience dyspnea and long-term fatigue as a result of damage to their lungs or other complications. Survivors may also experience depression (26–33%), anxiety (38–44%), or post-traumatic stress disorder (22–24%).

Long-term symptoms are a feature of other coronaviruses

Our experience with other coronaviruses should have warned us of these problems. The first SARS coronavirus and Middle East respiratory virus (MERS) caused serious illness in a higher proportion of patients than COVID-19, with a significant number of patients developing ARDS and requiring intensive care.

Canadian researchers followed survivors of the first SARS outbreak in Toronto. They found that sleep disorders, chronic fatigue, depression, and muscle aches were common. A third of survivors had to change their work and lifestyle, and only 14% had no long-term symptoms. Similarly, in a Korean group of MERS survivors, 48% still experienced chronic fatigue after 12 months.

The COVID-19 pandemic is still in its early days. Survivors with persistent symptoms, “long-distance carriers,” are clearly not uncommon, and their symptoms and concerns must be heard, studied, and understood. Clinical trials in the UK, Europe, and the United States are now recruiting to do this.

As with many aspects of COVID-19, we have much to learn and much work remains to be done.

This article is republished from The Conversation under a Creative Commons license. Read the original article.