[dropcap]F[/dropcap]or many, COVID-19 evokes images of a week-long flu-like illness, or a debilitating hospital stay, attached to ventilators. There’s nothing in between. Though it might be easy to imagine the latter having long-term effects, a large portion of those who contract the virus are experiencing coronavirus symptoms that don’t go away for months. According to A July 24 report from the U.S. Centers for Disease Control and Prevention (CDC), out of around 300 non-hospitalised but symptomatic patients, 35% continued to experience symptoms like coughing, shortness of breath and fatigue three weeks later.
And, sure, three weeks doesn’t seem that long, but then there’s also a percentage of people who struggle with the same symptoms for far, far longer. In fact, a growing body of evidence is showing that a large subset of patients suffer for months, not weeks. A JAMA report coming out of Italy in June 2020 found that 87% of patients hospitalised for acute COVID-19 were still battling symptoms 2 months after diagnosis.
What is “Long-Haul” COVID-19?
Jamie Ducharme, writing for Time, tells of a 28-year old mother of two from Caldwell, Idaho who’s still been struggling with coronavirus symptoms that don’t go away, even months after infection. Prior to falling ill, Kayla Brim juggled homeschooling her kids with her job as a makeup artist. “Now, she suffers daily from shortness of breath, exhaustion, excruciating headaches, brain fog, neuropathy, high blood pressure and loss of taste and smell,” writes Ducharme. “She feels like ‘a little old lady,’ completely knocked out by simple tasks like making lunch for her children”.
This has been dubbed “long-haul COVID-19”, and it can happen to anyone – even the younger age groups who feel they aren’t at risk. People in their twenties are becoming unable to perform simple every day tasks. For any individual, that’s beyond inconvenient – it’s terrifying. For the nations whose workforces are going to have to suffer the effects of that, it’s devastating. Particularly so in a country like South Africa, which has been seeing its GDP contract by a shocking 16% at a quarter-on-quarter rate, or one like the US, who has seen millions of infections already.
“If even 10% of the more than 5 million (and counting) confirmed COVID-19 patients in the U.S. suffer symptoms that last this long, half a million people are already or could soon become chronically ill for the foreseeable future,” says Ducharme.
What kind of coronavirus symptoms don’t go away?
Long-Haul COVID-19 is becoming akin to a disability, hindering patients’ ability to work –and as a result earn the pay checks they need to treat their ongoing symptoms – or to care for families that depend on them. It’s placing an extra burden on healthcare facilities that wasn’t foreseen when the pandemic started, or even when countries began flattening their infection curves.
Experts still seem unsure as to why, unlike a flu or a common cold, these symptoms persist for so long. This is made even more puzzling by the fact that symptoms can vary so widely from person to person. Over one hundred distinct symptoms have been reported, and they run the gamut from anxiety and foggy thinking to muscle cramps, fatigue to breathing problems. A JAMA Cardiology study from July suggests many recently recovered patients have persistent heart abnormalities and kidney damage.
Writing for Science, Jennifer Couzin-Frankel explains why COVID-19 is so good at attacking out vital organs, and leaving them damaged: “Like a key fitting neatly into a lock, SARS-CoV-2 uses a spike protein on its surface to latch onto cells’ ACE2 receptors. The lungs, heart, gut, kidneys, blood vessels, and nervous system, among other tissues, carry ACE2 on their cells’ surfaces—and thus, are vulnerable to COVID-19. The virus can also induce a dramatic inflammatory reaction, including in the brain.”
That’s scary enough. But because we still know so little about this disease, there is a growing fear that some of these side-effects may be permanent.
And that concern doesn’t come without precedent. Rony Shimony, a cardiologist at Mount Sinai Hospital in New York, told Time that After the 1918 Spanish flu 50% to 60% of patients still suffered from symptoms and after-effects four whole years later. He expects COVID-19 might behave similarly, leaving patients with coronavirus symptoms that don’t go away for ages.
The lungs, in particular, could be at risk of long-term damage. The two previous coronaviruses that caused severe outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome devastated the lungs of those it infected. According to Couzin-Frankel, “One study of health care workers with SARS in 2003 found that those with lung lesions 1 year after infection still had them after 15 years”.
This means it’s expected that many who contract this virus, whether they develop serious symptoms or not, can be expected to have decreased exercise capacity, scarring of the lungs, and decreased general lung function going forward, though it does seem, thankfully, to a lesser effect than from SARS.
But, as we’ve mentioned, the lungs are not the only vital organs at risk. A June paper in Heart Rhythm raises concern about the enzyme troponin, which was found to be elevated in 20% to 30% of hospitalised COVID-19 patients – and signifies cardiac damage. “Acute cardiac injury in patients hospitalised with COVID-19 is associated with higher morbidity and mortality,” states the report.”Patients with ostensibly recovered cardiac function may still be at risk of cardiomyopathy and cardiac arrhythmias.”
“We’re now beginning to understand the impact on the brain, on the heart, on the lungs, on the kidneys,” says Shimony. “This particular infection is involving all the body. We need to really take time to understand further the impact on it. And it really causes us to be more cautious about what’s coming ahead.”
How can we prevent this?
The fact that there aren’t any indicators before the fact of who will become a long-hauler and who won’t is particularly terrifying. According to Ducharme, “without clear answers about what happens next, all doctors can offer the public is yet another plea to take coronavirus seriously—because right now, the only surefire way not to become a long-hauler is to not get COVID-19 at all”.
In light of the emerging evidence that this virus is not just a flu (coupled with the fact that patients don’t build up permanent immunity to it) it’s becoming increasingly important to prevent its spread entirely. People are becoming lax, and resigning themselves to the idea that “it’s inevitable that I’m going to get it” – but it need not be that way. Why accept that as fact, when it might leave you debilitated for months, years, or even the rest of your life?
After contracting COVID-19, you might feel off for two days, or you might be left with coronavirus symptoms for months, that get in the way of your attempts to adjust to the “new normal”. There’s no way of knowing how this disease could affect you or your family members in the long term, so it seems short-sighted, and even asinine, to take the risk.
“This is a disease that can leave people disabled for years to come, or a lifetime,” Shimony says. “The impact it has on a family, psychologically, financially, et cetera, that’s an impact for the country. So we have to build up prevention. We have to listen to the experts. Wear the mask and the social distancing.”