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HomeMedical Information Coping With a DiseaseA step into the unknown: Why even mild COVID-19 can mean to a long-haul to recovery

A step into the unknown: Why even mild COVID-19 can mean to a long-haul to recovery

By: Medix Team
A step into the unknown: Why even mild COVID-19 can mean to a long-haul to recovery

It isn’t just hospitalised patients who’re still experiencing debilitating symptoms months after falling ill.

When the World Health Organization (WHO) released its COVID-19 guidance in February, it said that recovery should take two weeks in mild cases and three to six weeks in severe ones. Since then, it’s become clear that the initial illness is only just the beginning for some people who are still suffering the after-effects months later.

 

Some were hospitalised and ended up on a ventilator. But many stayed home with what they thought were mild symptoms that have instead proven to be prolonged and ongoing. 

 

The sheer novelty of the pandemic means that searching for answers online quickly become a frustrating experience for COVID-19’s long-haulers, as they’re now known. Clinical research into the virus’s long-term effects is only just beginning. 

 

In the meantime, long-haulers formed online groups to log their “Long Covid” symptoms, share stories and swap advice. Some community groups, including the Body Politic COVID-19 Support Group on Slack and Survivor Corps on Facebook, have teamed up with academics to produce surveys that build public awareness about potential health complications.    

 

Governments are also starting to acknowledge the existence of Long Covid, not to mention the potential economic costs of a significant number of people ending up with lingering health issues. In late July, a paper by the US Centers for Disease Control and Prevention (CDC) revealed that 35% of 3,000 non-hospitalised COVID-19 sufferers were still suffering symptoms three weeks after testing positive.

 

The key question is whether this is normal after a viral infection? After all, flu can knock the afflicted out for weeks. The CDC’s answer is that 90% of flu patients typically recover in two weeks.

 

COVID-19 appears to have a more devastating health impact for a wider section of the population. That’s all the more concerning given that larger numbers of people are contracting it compared to a typical flu outbreak.

 

The CDC concludes that, “COVID-19 can result in prolonged illness even among young adults without underlying chronic medical conditions”. It advocates public health messaging targeting the young, given how many believe their age will protect them.

 

Medical experts hypothesize a number of reasons why COVID-19 is triggering health issues that may or may not turn into chronic conditions.

 

One school of thought suggests that residual pockets of the virus remain even after diagnosed patients are given the clinical all clear. This might explain why symptoms flare up again, sandwiching days, weeks or months of feeling back-to-normal.

 

Another school of thought believes that an over-sensitized immune system continues reacting to a virus that’s no longer there, inflaming and inflicting greater damage on the organs that had been originally infected. For what’s become clear is that COVID-19 is a multi-system disease, even if it is primarily known as a respiratory disease putting the lungs at risk.

 

This is in part because of the way it enters the human body. The virus’s distinctive protein spike penetrates and infects human cells by latching onto their angiotensin-converting enzyme 2 receptors  (ACE2).

 

These receptors are proteins attached to the surface of many cells across the body – in the lungs, brain, heart, blood vessels, digestive system, kidneys, liver and so on. Long-haulers are reporting health issues involving all of them.

 

In late July, America’s Indiana University School of Medicine and Survivor Corps released a non-peer reviewed survey of 1,567 long-haulers. They listed 50 ongoing symptoms as diverse as muscle twitching, hands and feet tingling, blurred vision, dry eyes, hair loss and dizziness.

 

Their most common symptoms, however, were the traditional post-viral trinity of fatigue, body aches and breathing difficulties. But in one piece of good news, a recent research report by the University of California’s Keck School of Medicine concludes that COVID-19 is less aggressive than SARS, which left 20% of sufferers with sustained lung damage.

 

A previous survey of Hong Kong-based SARS patients discovered that 40% still had chronic fatigue problems three years on from the disease. Will COVID-19 lead to an explosion in diagnoses of chronic fatigue syndrome (CFS), devastating sufferers ability to work or lead a normal life?

 

Some COVID-19 long-haulers are experiencing symptoms akin to post-exertional malaise (PEM), which leaves sufferers feeling worse than they did before after even minimal levels of exercise or mental exertion. PEM is considered a hallmark of CFS. 

 

Yet it’s important to note that CFS requires a specific diagnosis, whereas fatigue has many sources. This includes scarred lungs and cardiac impairment, which can both fade with time.

 

One recent German clinical study analysed COVID-19’s impact on the heart. Researchers selected 100 patients with an average age of 49 years old.

 

Their findings received widespread news coverage because the team discovered that even though 67 of the patients hadn’t been hospitalised, 76 of them had evidence of biomarkers signalling a cardiac injury similar to a heart attack.

 

However, caution is warranted. In a recent article, the British Heart Foundation pointed out that the German study was small-scale and non-randomised, the gold standard for clinical studies. What the patients were exhibiting may have been a short-term response to viral stress. The flu can have a similar impact.

 

Long-haulers are also reporting a myriad of brain and neurological issues including memory loss, hallucinations, headaches, dizziness and vertigo, plus tingling and twitching. John Geddes, professor of epidemiology at the University of Oxford, believes this is because of the way the virus gets into nerve cells.

 

Neurological complications are an offshoot of many viruses. One consequence of viral infections can be Guillain-Barre syndrome, which prompts the immune system to attack nerve cells’ protective coating.

 

David Putrino, director of rehabilitation for America’s Mount Sinai Health System, recently told reporters that COVID-19 could cause dysautonomia in 5% to 15% of COVID-19 patients too. This is a condition where the autonomic nervous system malfunctions and can cause an irregular heartbeat, breathing and blood pressure.

 

Another major reason why COVID-19 causes complications is because it can damage the lining of blood vessels, the endothelium. Back in April, the Lancet reported that a damaged endothelium risks blood clots that can trigger heart attacks and strokes.

 

Viruses, including COVID-19, are also considered a possible trigger for other conditions such as fibromyalgia, which causes chronic pain and tiredness.

 

Long-haulers are giving one very important message for the rest of the world. COVID-19 is a virus that everyone needs to take seriously.

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