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An the beginning of the pandemic we were told that Covid-19 was a respiratory disease from which most people would recover in two to three weeks, but it is increasingly clear that there may be tens of thousands of people, if not hundreds of thousands, who have had symptoms months after becoming infected.
Now, the National Institute for Health Research (NIHR) has published a report suggesting that “prolonged Covid” may not be just one syndrome, but up to four different ones, which some patients may experience simultaneously. This is what we know now:
Variety of symptoms
The durable Covid subtypes identified by the NIHR included patients who experienced the sequelae of intensive care; those with post-viral fatigue; people with lasting organic damage; and those with fluctuating symptoms that move through the body.
“We believe that the term protracted Covid is being used as a whole for more than one syndrome, possibly up to four, and that the lack of distinction between these syndromes may explain the challenges people have in being believed and accessing services,” Said Dr. Elaine Maxwell, lead author of the report, which was based on patient experiences and the latest published research. However, Professor Danny Altmann, an immunologist at Imperial College London, cautioned that reducing long-term Covid to just four syndromes might be too simplistic.
Recovering from ICU
Hospital discharge is often just the beginning of a long recovery process. Many Covid-19 patients who have survived a period in intensive care are too weak to sit up unaided or lift their arms from the bed, and some may even have difficulty speaking or swallowing. They can also be affected by depression or post-traumatic stress disorder. However, severe and long-lasting symptoms were not limited to this group.
Post-viral fatigue
Many Covid “long haul carriers” report fatigue, muscle pain, and difficulty concentrating. The extent to which this overlaps with chronic fatigue syndrome is being investigated. CFS has previously been linked to Epstein-Barr virus infection and Q fever. Studies of people who were infected during the 2003 Sars outbreak also indicated that about a third of them had a reduced tolerance to exercise for many months, even though her lungs seemed healthy.
Lasting organ damage
Continual shortness of breath, coughing, or a racing pulse can be symptoms of long-lasting damage to the lungs or heart, although this is not necessarily permanent. Lung damage appears particularly prevalent among patients who required hospital treatment for Covid-19. A recent study found that six weeks after leaving the hospital, about half of the patients were still experiencing shortness of breath, falling to 39% at 12 weeks. Meanwhile, about a third of hospitalized patients suffer heart damage, but those with seemingly mild infections can also be affected.
A separate study of 100 patients, many of whom had relatively mild symptoms when they were infected in March, revealed that 78 of them showed abnormal structural changes in their hearts on an MRI. However, these changes did not necessarily cause symptoms and may go away over time. Ongoing problems with the liver and skin have also been reported.
Symptoms that fluctuate and move around the body.
Perhaps the strangest group of Covid carriers are those with fluctuating symptoms. A common theme is that symptoms arise in one physiological system and then subside, only for symptoms to arise in a different system, according to the NIHR report. This fits in with the results of a survey of members of a Covid support group that found that 70% experienced fluctuations in the type of symptoms and 89% in the intensity of their symptoms. Although the underlying mechanism has yet to be proven, such symptoms could coincide with an altered immune system, Altmann said.
All ages affected
Estimates have suggested that 10% of Covid patients experience symptoms lasting more than three weeks, and around one in 50 will remain ill within three months. The NIHR report said that long-lasting symptoms had been seen in all age groups, including children, but unpublished results from the Covid Symptom Study suggest that women and older people may be at higher risk. “Above the age of 18, the risk of symptoms lasting more than a month appears to increase with age,” said Professor Tim Spector, professor of genetic epidemiology at King’s College London who is leading the study.
A particularly under-studied group is nursing home residents. “What we’ve heard from front-line staff is that there is a group of patients who maybe seemed to be recovering and then relapsed,” said Professor Karen Spilsbury, chair of research in nursing at the University of Leeds, who has been study the impact of Covid-19 on nursing home residents. Their strength and stamina appeared to suffer, while Covid may have accelerated the rate of cognitive decline in people with dementia.
