Long-Term Effects of COVID-19

It has only been a few months since COVID-19 began sickening people in China before spreading across the world so it is difficult to know what the long-term effects of infection might be.  Some health experts are looking at similar acute respiratory illnesses like SARS to obtain some insights into lasting effects. These could include diminished lung function that could cause shortness of breath, weakness and disability.

There is also the possibility that there are lasting emotional and cognitive conditions. Many people who must enter an intensive care unit like severely ill COVID-19 patients must often deal with anxiety, depression and even post-traumatic stress disorder.  Cognitive problems may include diminished memory, decreased attention and loss of mental acuity.

Physical Effects of COVID-19

It is difficult to determine the exact mechanisms that the SARS-CoV-2 virus uses on the human body at this time, but the ongoing research has shed considerable light on this new and novel illness. There are many similarities with other coronaviruses, but there are some significant differences that have made COVID-19 particularly difficult to manage.

First of all, SARS-CoV-2 is transmitted from person to person via respiratory droplets like the common cold—another coronavirus—or influenza. These other viruses however curtail their lethality and stealth; in other words, they allow more of their human hosts to survive in order to maintain their own survival. Furthermore, these common illnesses also produce an immune response with coughing, sneezing or fever almost immediately upon infection, but SARS-CoV-2 may not elicit such a response for days or at all.

This is believed to occur because SARS-CoV-2 initially resides in the nose and throat. Here it enters cells and quietly replicates. Only later does it move to the lungs where the virus attacks the oxygen-collecting cells called alveoli. As the alveoli become inflamed, they lose their ability to gather oxygen.  This loss of lung function is why so many COVID-19 patients require ventilators.

This compromised lung function may cause other systemic issues like kidney, heart or brain dysfunction. This is especially problematic for people already struggling with chronic conditions like diabetes or heart disease. These underlying conditions may help explain why some COVID-19 patients fully recover while others become chronically health-compromised.

Although it is a bit early to tell, many patients are complaining of post-viral fatigue syndrome in which there is weakness, headaches or eye strain.  Symptoms may come and go, but exercise may initiate return of symptoms. In most cases, these symptoms resolve on their own, but if it persists it could become chronic fatigue syndrome which can be debilitating.

Following the SARS outbreak that sickened 8,000 people, 27 percent of the survivors suffered from chronic fatigue syndrome years after the initial infection. If this model holds up for COVID-19 which could infect 50 to 70 percent of the U.S. population, then millions could be housebound for years.

This fatigue may be related to heart damage that the SARS-CoV-2 virus may induce. One study found that almost 19 percent of COVID-19 patients that were hospitalized exhibited signs of heart damage, while another study of Wuhan coronavirus patients found signs of inflammation of heart tissue that may lead to scarring and heart failure in at least 12 percent of patients.

In addition to heart damage, long term lung damage also appears to be a likely outcome. A Chinese study found “ground-glass opacities” or tissue damage in the lungs of 77 percent of patients. This could make even routine activities like climbing stairs difficult. It is uncertain whether this kind of lung damage is permanent, but about a third of SARS and MERS patients suffered long term lung damage.

Fatigue is not the only long-term health issue following COVID-19 infection. One study found that many patients experienced fatigue, muddied thinking, chills and sleep problems. The study reported that only 20 percent of seriously ill patients were symptom-free 50 days after infection. Studies of similar illnesses like Epstein-Barr, Ross River and Q fever found that up to 12 percent of severely infected never regained full health.

Mental Effects of Severe COVID-18 Infection

It is, of course, difficult to precisely ascertain the mental symptoms of such a serious illness as COVID-19 while still in the midst of a pandemic. Natural responses such as fear and stress can produce psychological conditions that may not be directly related to a viral infection. It is only with great care that physicians can distinguish cognitive symptoms directly as a result of COVID-19.

New evidence reveals that SARS-CoV-2 produces neurological conditions like headaches, dizziness, loss of smell and taste, and fainting. There is also mounting evidence that there could be long-term issues like diminished concentration and memory. 

As the closest analogues for COVID-19, SARS and MERS has been analyzed for clues into the psychological and cognitive long-term effects. One meta-study of SARS and MERS patients that followed from up to 60 days to 12 years after infection found that there were many long-term symptoms including

  • Confusion
  • Depression
  • Anxiety
  • Impaired memory
  • Insomnia

Among SARS patients on steroids, about 0.7 percent suffered from mania or psychosis. This study also found that 76 percent of patients had returned to their jobs within 3 years.

The conclusion of the meta-study was that most people who are infected with SARS-CoV-2 are unlikely to experience mental health or cognitive issues following recovery. However, due to the novel nature of COVID-19, it is incumbent upon clinicians to be alert to potential long-term psychological issues.

The authors of the meta-study also warn that many of the individual studies do not meet the standards of a rigorous scientific investigation and the results may not be reliable. Furthermore, it should be noted that many COVID-19 patients that recover must return to a world still grappling with the pandemic.  That includes recommended self-isolation, limited social support networks, and destabilizing financial insecurity. 

These and other related issues can diminish psychological health and contribute to many of the mental health problems common to patients recovering from serious illnesses. It will probably take years of study to unwind all of these threads and establish the most common long-term health effects of this pandemic.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

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