People with mild illness may expect improvement after a few weeks. But there is growing evidence that this is not the case, and COVID-19 can leave a lasting impression on those who suffer from it, not only on the most severely affected or in the elderly and frail.
It’s just a lung infection.
On the surface, COVID-19 is a lung disease. SARS-CoV-2 coronavirus infects airway cells and can lead to life-threatening pneumonia.
However, the complete diversity of symptoms affects various parts of the body. An application that records the symptoms that evolved at King’s College London followed the progression of more than four 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 effects that add to fatigue, rashes, headache, abdominal pain and diarrhea. People who expand the most severe bureaucracy of the disease also report confusion, severe muscle pain, coughing and shortness of breath.
About 20% of those infected with COVID-19 require hospitalization to treat their pneumonia, and many need assistance with oxygen. In about 5% of cases the pneumonia becomes so severe patients are admitted to intensive care for breathing support.
Activates the immune system
People with severe COVID-19 appear to have a modified immune reaction even in the early stages of the disease. They have fewer circulating immune cells, which do not heal the virus and instead suffer an exaggerated inflammatory reaction (the “cytokine storm”).
This is increasingly identified as one of the main points that make the disease so severe in some patients. Eliminating this overreaction with the dexamethasone immunosuppressant is the only remedy that reduces mortality rates in those who require oxygen healing or extensive care.
Patients with coVID-19 severe describe a much more complex variety of symptoms than would be seen with pneumonia alone. This can be accompanied by inflammation of the brain (encephalitis), which causes confusion and loss of consciousness. Up to 6% of severe people can have a stroke.
Pathology studies and autopsies of deceased COVID-19 patients reveal the expected characteristics of severe pneumonia or acute respiratory misery syndrome (EDS), with extensive inflammation and scarring. ERS occurs when there is widespread inflammation of the lungs, resulting in shortness of breath and bluish skin.
However, uniquely, they also reveal that the virus appears to cause direct inflammation of small capillaries or blood vessels, only in the lungs, but in various organs, resulting in blood clots and damage to the kidneys and heart.
Persistent ”deeply frustrating”
Anyone with a severe disease would be expected to suffer long-lasting consequences. But COVID-19 seems to have persistent symptoms even in those with milder forms of the illness.
Social media is full of stories of survivors suffering from persistent symptoms. Support teams have made the impression on Slack and Facebook, housing 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 most productive known patients is Paul Garner, an infectious disease specialist at Liverpool School of Tropical Medicine in the UK. It swells at the end of March and its symptoms persist. In a blog post published through the British Medical Journal, he describes having: “… abdominal pains, tinnitus (ringing in the ears), tingling, shortness of breath, dizziness and arthritis in the hands.”
These symptoms have increased and decreased but have not yet been resolved. He says it’s: “… deeply frustrating. Many other people are starting to doubt themselves… Their partners wonder if there’s anything with them.”
To date, only one peer-reviewed study has reported effects on the long-term symptoms of COVID-19 infection: an unwrified organization of 143 survivors in Rome. Most of them required hospitalization and all were evaluated at least 60 days after infection. They reported a deterioration in quality of life in 44.1% of cases, adding symptoms of persistent fatigue (53.1%), dyspnoea (43.4%), joint pain (27.3%) chest pain (21.7%).
While our delight with COVID-19 is just beginning, long-term symptoms following a serious viral disease are not a new phenomenon. Influenza has long been linked to persistent symptoms such as fatigue and muscle pain, which were added after the pandemics of 1890 and 1918-19.
Survival of severe viral pneumonia or LRA, especially after thorough care, is known to have long-term implications. Some survivors suffer from shortness of breath and prolonged fatigue due to lung injuries or other complications. Survivors would also possibly suffer from depression (26-33%), anxiety (38-44%) post-traumatic stress disorder (22-24%).
Long-term symptoms, a characteristic of coronaviruses.
Our delight with other coronaviruses has alerted us to those problems. The first SARS coronavirus and the Middle East respiratory virus (MERS) have caused serious illness in a greater proportion of other people with SARS than COVID-19, with a significant number of others coming with EDS and requiring thorough attention.
Canadian investigators followed the survivors of the first SARS outbreak in Toronto. They found that sleep disorders, chronic fatigue, depression and muscle pain were common. A third of the survivors had to replace their paintings and lifestyle, and 14% had no long-term symptoms. Similarly, in a Korean merS survivors’ organization, 48% continued to suffer from chronic fatigue after 12 months.
The COVID-19 pandemic is still in diapers. Survivors with persistent symptoms, “long-lasting” symptoms are obviously not unusual and their symptoms and considerations should be heard, studied and understood. Clinical trials in the UK, Europe and the United States are recently recruiting to do so.