A few months ago, a young athlete came to my clinic, where I am an infectious disease physician and immunology researcher at COVID-19. He felt tired all the time and, what was important to him, was having a hard time doing mountain biking. Three months earlier, he had tested positive for COVID-19. He’s the kind of person you expect to have a few days with mild symptoms before you fully recover. But when he entered my clinic, he was still showing symptoms of COVID-19 and he was unable to mountain bike to the level he was able to before.
Tens of millions of Americans were infected and survived COVID-19. Fortunately, many survivors return to normal health within two weeks of becoming ill, but for some survivors of COVID-19 – including my patient – the symptoms can persist for months. These survivors are sometimes called long-haulers, and the disease process is called “long COVID” or post-acute COVID-19 syndrome. A long-hauler is anyone who has continued with symptoms after an initial attack of COVID-19.
Numerous studies in the past few months have shown that about 1 in 3 people with COVID-19 will experience symptoms that last longer than the normal two weeks. These symptoms affect not only people who were very ill and hospitalized with COVID-19, but also those with milder cases.
The long COVID is similar to the COVID-19
Many long-haulers experience the same symptoms they experienced during their initial struggle with COVID-19, such as fatigue, cognitive impairment (or brain fog), difficulty breathing, headaches, difficulty exercising, depression, difficulty sleeping and loss of taste or smell. In my experience, patients’ symptoms appear to be less severe than when they were initially ill.
Some long-distance vehicles also develop new symptoms. This can vary widely from person to person, and there are reports of everything from hair loss to tachycardia and anxiety.
Despite persistent symptoms, SARS-CoV-2 – the virus itself – is not detectable in most long-distance vehicles. And without an active infection, they cannot spread the virus to others.
Who are the long-haulers?
Patients who have been hospitalized for COVID-19 are the most likely to have persistent long-term symptoms.
In a study published in July 2020, Italian researchers followed 147 patients who had been hospitalized for COVID-19 and found that 87% still had symptoms 60 days after they were discharged from the hospital. A more recent study, published in January, found that 76% of COVID-19 patients hospitalized in Wuhan, China, still had symptoms six months after becoming ill.
This Wuhan study was particularly interesting because the researchers used objective measures to assess people who reported persistent symptoms. The people in the study still reported persistent breathing problems six months after falling ill. When the researchers performed CT scans to look at patients’ lungs, many of the radiographs showed spots called ground-glass opacities. This probably represents inflammation where SARS-CoV-2 caused viral pneumonia. In addition, people in this study who had severe COVID-19 were unable to walk as fast as those whose illnesses were less severe – these lung problems reduced the amount of oxygen that was passing from their lungs into the bloodstream. And remember, all of this was measured six months after infection.
Other researchers have found similar objective health effects. One study found evidence of ongoing viral pneumonia three months after patients left the hospital. Another study of 100 German patients with COVID-19 found that 60% had inflammation of the heart two to three months after the initial infection. These German patients were relatively young and healthy – the average age was 49, and many did not need to be hospitalized when they had COVID-19.
The most ill patients with COVID-19 are not the only ones suffering from prolonged COVID. Patients who had a milder initial case that did not result in hospitalization may also experience persistent symptoms.
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According to a recent survey by the Centers for Disease Control and Prevention, 35% of outpatients who had mild cases of COVID-19 did not return to their initial health status 14 to 21 days after the onset of symptoms. And that didn’t just happen with older people or with latent health problems. Twenty percent of previously healthy individuals aged 18 to 34 years had continuous symptoms. Overall, research shows that up to a third of individuals who have had COVID-19 and have not been hospitalized will continue to experience symptoms until three months later.
To put these numbers into context, only 10% of people who contracted the flu are still sick after 14 days.
Long-term symptoms, long-term effects
The medical community still does not know how long these symptoms will persist or why they occur.
According to recent research that has not yet been peer-reviewed, many long-haulers cannot return to work or perform normal activities due to brain fog, pain or debilitating fatigue. Before my patient fell ill, he rode up a mountain in our Colorado city almost every day. It took him four months to recover to the point that he could climb it again.
SARS-CoV-2 hurts people in more ways than the medical community originally recognized. At Colorado State University, my colleagues and I are studying long-distance vehicles and exploring whether immune system imbalances play a role in the disease process. Our team and many others are working diligently to identify long-haulers, to better understand why symptoms persist and, most importantly, to find out how the medical community can help.
This article was republished from The Conversation, a nonprofit news site dedicated to sharing ideas from academic experts. It was written by: Stephanie LaVergne, Colorado State University.
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Stephanie LaVergne does not work for, consult, own shares or receive funding from any company or organization that would benefit from this article and has not disclosed relevant affiliations other than her academic appointment.