Long COVID: What Do We Know?

In two years of the pandemic, millions of people survived the infection but have experienced debilitating symptoms lingering for months. 

While most people with Covid recover within four weeks, about 5% still experience symptoms three months later, often described as long Covid.

In all the discussion about ‘opening up’, this is a significant and inconvenient topic.  But one which, adopting a measured approach, has potentially significant consequences for our health system and for individuals when thinking about our individual COVID-19 risk tolerances.

For public policy, it raises questions about whether our ability to ‘cope’ with a new COVID-19 normal is a function of our ability to deal with acute COVID-19 patients in hospital, or should be measured by the aggregate cost that COVID-19 (including long covid) may place on our health system over time.

And in terms of assessing the costs of COVID-19 infections to individuals, is the published data on deaths from or with COVID-19 an adequate and accurate measure of the long-term cost to individuals from lingering damage to their health?

This article provides some additional insights about long covid, in an effort to promote a greater understanding of this phenomenon amongst those who may not have had any direct or indirect exposure to persons experiencing long covid.   

The Diagnosis 

While COVID-19 is a respiratory pathogen, research is showing it can trigger disorders in other organs and systems of the body.

Long Covid is more like a chronic illness with a wide variety of symptoms, many of which are not explainable using conventional lab tests. Difficulties in detecting the illness have led some doctors to dismiss patients, or to misdiagnose their symptoms as psychosomatic. But researchers looking more deeply at long Covid patients have found visible dysfunction throughout the body.

Long Covid, as described by the World Health Organization, is defined as symptoms of Covid that last for at least two months after infection, and which cannot be explained by an alternative diagnosis. These symptoms include fatigue, shortness of breath, cognitive dysfunction but also others that generally have an impact on everyday functioning. Symptoms may also fluctuate or relapse over time.

Impact on Immune System 

Recent studies such as ‘Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection’ and Markers of Immune Activation and Inflammation in Individuals With Postacute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection, suggests COVID-19 can have an impact on the immune system many months after the virus is contracted. 

Some researchers have even found that the covid-19 infection can persist throughout the human body and brain in tissues for many months.

A New York Times article by Josh Keller that dove deep into the subject of long covid also stated that “Ongoing studies are trying to determine if these viral reservoirs cause inflammation in surrounding tissues, which could lead to brain fog, gastrointestinal problems and other symptoms.” 

Impact on Circulatory System

In an article for Johns Hopkins Medicine, cardiologist Wendy Susan Post, M.D., M.S stated that many long covid patients may struggle with heart problems

She said There are several reasons for this. The cells in the heart have angiotensin converting enzyme-2 (ACE-2) receptors where the coronavirus attaches before entering cells. Heart damage can also be due to high levels of inflammation circulating in the body. As the body’s immune system fights off the virus, the inflammatory process can damage some healthy tissues, including the heart.

Coronavirus infection also affects the inner surfaces of veins and arteries, which can cause blood vessel inflammation, damage to very small vessels and blood clots, all of which can compromise blood flow to the heart or other parts of the body. Severe COVID-19 is a disease that affects endothelial cells, which form the lining of the blood vessels.

In another study, patients with long-lasting Covid symptoms had unexpected responses to riding a bike. Despite having apparently normal hearts and lungs, their muscles were only able to extract a portion of the normal amount of oxygen from small blood vessels as they pedaled, markedly reducing their exercise capacity. 

Impact on Nervous System 

Cognitive Rehab: One Patient’s Painstaking Path Through Long Covid Therapyis the story of Samantha Lewis, who has struggled with brain fog and other lingering symptoms for more than a year since being infected by the virus. 

It paints a difficult picture that suggests that even people with mild cases of Covid are subject to some risk of sustaining cognitive impairments, including reduced attention, memory and word-finding. 

According to Dr. Avindra Nath, the clinical director of the National Institute of Neurological Disorders and Stroke, “Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered a respiratory pathogen, myriad neurologic complications – including confusion, stroke, and neuromuscular disorders – manifest during acute COVID-19. 

Furthermore, maladies such as impaired concentration, headache, sensory disturbances, depression, and even psychosis may persist for months after infection, as part of a constellation of symptoms now called long Covid. 

Even young people with mild initial disease can develop acute COVID-19 and long Covid neuropsychiatric syndromes. The pathophysiological mechanisms are not well understood, although evidence primarily implicates immune dysfunction, including nonspecific neuroinflammation and antineural autoimmune dysregulation.” 

Impact on Respiratory System 

Tae Chung, M.D., a specialist in neurology and physical medicine and rehabilitation; Megan Hosey, Ph.D., an expert in rehabilitation psychology,; Arun Venkatesan, M.D., Ph.D., a specialist in neurology; Amanda Morrow, M.D., an expert in pediatric rehabilitation medicine; and Emily Brigham, M.D., M.P.H., who specializes in lung disease and critical care, discuss long-term COVID-19 in an article by Johns Hopkins Medicine

“A bad case of COVID-19 can produce scarring and other permanent problems in the lungs, but even mild infections can cause persistent shortness of breath — getting winded easily after even light exertion.

Lung recovery after COVID-19 is possible, but takes time. Experts say it can take months for a person’s lung function to return to pre-COVID-19 levels. Breathing exercises and respiratory therapy can help.”

The New York Times article quotes a study that used specialized M.R.I. scans by a team of British researchers. They found preliminary evidence of lung damage in a small group of long Covid patients who had never been hospitalized. Detailed scans of their lung function indicated that most of the patients took up oxygen less efficiently than healthy people did, even if the structure of their lungs appeared to be normal.

In Conclusion 

How long is “long covid” and how concerned should we be about it?

The answer to these questions is still unknown. 

There is much research to be done in order to understand what causes it, how deeply and for how long it impacts the lives of patients and which patients are at most risk.

Why some people experience no symptoms or have mild systems that fully recover quickly, and others experience life-threatening organ damage or lasting disability is a question for our time. 

How likely is long covid with each type of COVID-19 variant?

The quicker we can definitively answer these questions the better.  The need for well-devised multidisciplinary recovery plans for those who suffer from long covid is cannot wait.

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