COVID-19 symptoms usually bring to mind flu-like symptoms, plus trouble breathing or losing your sense of taste. Many people can even get by with minimal impact on their lives even with an active infection. Some won’t have any symptoms at all.
But the long-term issues stemming from a COVID-19 infection can look quite different from those first couple of weeks, in keeping with the pattern seen with other viral infections. For patients who suffered from SARS, the impacts of even a short term illness sometimes lead to diminished exercise capacity or lung function that persisted years after being first diagnosed, and similar issues were spotted in MERS survivors.
Craig Spencer, the director of global health in emergency medicine at Columbia University, recounted his long-haul impacts of a 2014 Ebola encounter, which to this day, leaves him struggling with concentration and memory. “In discussions I’ve had with many COVID long-haulers, both in the ER and online, I’ve heard so many describe symptoms similar to what I experienced in the months after my illness,” he wrote on Twitter. “The fatigue, ‘brain fog’, and feeling better some days and worse the next.”
But there is a major difference between these illnesses and COVID-19: the scope. MERS, SARS, and Ebola infected thousands of people each. Over the past six months or so, around six million people in the US alone have received a positive COVID-19 test. With all of the politics and false controversy surrounding testing, governmental agencies have failed to find the actual number of Americans who have had a COVID-19 infection.
In research done by the CDC at the end of July, over 30 percent of COVID-19 patients had not returned to normal health conditions two or three weeks after testing. Out of respondents between the ages of 18 and 34, who typically have milder cases of illness, one in four still hadn’t full recovered weeks after testing. Even some children were still feeling the infection take a toll on their health months after infection. And the symptoms were far-ranging, from depression to myocarditis.
Because there hasn’t been enough reliable, rapid testing, Spencer says it may be harder for some long-haulers to access necessary healthcare if they never officially received a positive test. “It will ultimately be hundreds of thousands of people who will suffer these symptoms of chronic or long COVID.”
Continued typical COVID-19 symptoms long after infection
One of the first signs of a long-haul COVID-19 infection is feeling like the infection never left your body, days or even months after you should’ve theoretically recovered. One study in JAMA found that in 179 Italian patients ranging from age 19 to 84, only around 12 percent had experienced “full recovery.” Over fifty percent still felt fatigued, and about 44 percent described a worsened quality of life. They also described other common symptoms that lingered, like cough, fever, chest pain, headaches, and occasional shortness of breath.
Another study in BMJ estimates that about 1 in 10 COVID-19 patients will feel unwell for more than three weeks, with a subset ranging into months. However, it’s still pretty mysterious as to who will have these impacts and why. The study cites weak antibody responses or inflammatory reactions as possible reasons for the virus to stick around a long time, but there’s no perfect formula for knowing how your body will react to the virus.
One of the more serious possible long-term repercussions of COVID-19 is heart damage. A study released in July of 100 COVID-19 patients showed that in most of those who had supposedly recovered two months prior were still showing cardiac problems, ranging from structural changes to biomarkers that indicate cardiac injury.
“The fact that 78% of ‘recovered’ [patients] had evidence of ongoing heart involvement means that the heart is involved in a majority of patients, even if Covid-19 illness does not scream out with the classical heart symptoms, such as anginal chest pain,” Valentina Puntmann, a University Hospital Frankfurt cardiologist and author of the study, told STAT News. She noted that many of the people tested were relatively young, recovered from the disease at home, and had no idea that anything was wrong with their hearts.
In several professional and college level athletes, cases of myocarditis (inflammation of the heart muscle) have popped up as COVID-19 cases have risen. This type of inflammation is caused by a viral infection, but it’s still challenging to know precisely how SARS-CoV-2 might cause myocarditis. Some autopsies have found inflammation in the heart’s blood vessels instead of muscle cells, which are where other infections tend to hit. Cardiologists are concerned that, even if COVID-19 generally causes only mild myocarditis, even that level of damage could lead to elevated risk of heart attack or failure in the future.
“It’s not difficult to imagine that in the future, clinical practitioners will ask a new patient, ‘Did you have COVID?” cardiologist Sam Mohiddin told Science.
COVID-19 is a respiratory virus, so perhaps it’s not shocking that some of the long-term issues would be in the respiratory system. One study from August shows that some long term recoveries from COVID-19 infections may include from chronic cough, fibrotic lung disease, bronchiectasis, and pulmonary vascular disease.
The worst cases of COVID-19 may increase a person’s risk for acute respiratory distress syndrome (ARDS) and sepsis, which, even when survived, both create lasting damage to the lungs and other organs. ARDS occurs when air sacs become filled with fluid leaking from the tiny blood vessels in the lungs, causing the lungs to fail. It requires the use of a ventilator and can leave lasting scars. Sepsis is the general term for when an infection triggers a life-threatening immune response in a person’s body, and can cause serious lasting tissue damage anywhere it reaches.
However, many lung injuries can heal, says Panagis Galiasatos, an expert on lung disease at Johns Hopkins Bayview Medical Center. “There’s the initial injury to the lungs, followed by scarring,” he said in a press release. “Over time, the tissue heals, but it can take three months to a year or more for a person’s lung function to return to pre-COVID-19 levels.”
Mount Sinai researchers found that out of nearly 4000 hospitalized COVID-19 patients, nearly half of them suffered from acute kidney injury, and 19 percent required dialysis. More than a third of patients who were discharged had not recovered to baseline kidney function when they left the hospital.
Like many of COVID-19′s impacts, the mechanism is still unknown. Johns Hopkins nephrologist C. John Sperati noted in a press release that it’s not known how many people who go through dialysis actually recover fully in just a normal illness, which makes it a “worrisome development” in COVID-19 patients. Survivors may end up with kidney complications down the road.
“We may be facing an epidemic of post-COVID-19 kidney disease, and that, in turn, could mean much greater numbers of patients who require kidney dialysis and even transplants,” said Girish Nadkarni, co-director of Mount Siani’s COVID Informatics Center, in a press release.
Neurologic and mental health
Brain fog might be one of the more minor neurologic symptoms that stick around long past supposed recovery. “Evidence shows that at least one-third of people who have COVID-19 experience neurological complications,” said Igor Koralnik, MD, chief of neuroinfectious diseases and global neurology at Northwestern Medicine, in a press release.
According to the BBC, more than 300 studies have shown strange neurological symptoms in COVID-19 patients, including mild symptoms like headaches, loss of smell and tingling sensation, or even drastic cases of aphasia (a speech disorder), strokes, and seizures.
The causes of these neurological problems could be a lack of oxygen to the brain due to respiratory problems during infection, a direct attack from the virus on brain cells or nerves, or an overreaction of the immune system, Koralnik noted. In some extreme cases, an intense immune response known as a cytokine storm that can occur in response to COVID-19 may penetrate the blood-brain barrier. This could lead to comas, seizures, and even death, according to Medscape. If SARS-CoV-2 can remain dormant in neurons for many years, there’s a serious chance that these patients will have long-term consequences, Majid Fotuhi, the medical director of NeuroGrow Brain Fitness Center, told Medscape.
Perhaps the most mysterious thing about these neurological symptoms may end up being that, without proper testing, we may never be able to link them back to the virus at all. This is especially true for patients who didn’t experience cold-like symptoms. Brain fog and confusion might be the only symptoms someone feels, which could keep them from going to get tested Robert Stevens, associate professor of anaesthesiology and critical care medicine at Johns Hopkins Medicine, told the BBC.
Beyond neurological issues, the anxiety and depression associated with having an intense infection can also take a severe toll on patients. Natalie Lambert, a health researcher at Indiana University School of Medicine, found after surveying over 1,500 “long-haulers” on Facebook that hundreds of respondents struggled with anxiety, concentration, and depression.
Even without physical symptoms, mental health consequences can take a serious toll on both survivors and anyone currently feeling overwhelmed by the state of the pandemic. For this symptom in particular, we all are at risk whether our bodies have been healthy or sick.