Well-Being Georgia

in partnership with

Augusta University of Health

COVID-19 Impact on Georgia Latest Articles

November 16, 2020

“Long COVID” Frustrates Patients and Puzzles Researchers

“Long COVID” Frustrates Patients and Puzzles Researchers

Updated on October 16, 2020 at 4:30pm EDT.

Before Russell Frisby, a lawyer in the Washington, D.C. area, contracted COVID-19, he was healthy except for mild, well-controlled asthma, with an active lifestyle that included golf. After a five-day hospitalization with the infection in March, he is now marking his sixth month of persistent symptoms.

At its peak, the illness wore away at his spirits.

“You’re sick. You don’t think you’re making any progress. You don’t know when it’s going to end or what it’s going to mean for your life,” Frisby recalls.

He’s not alone.

Researchers are searching for answers
While mild symptomatic cases of coronavirus infection may result in full recovery in about two weeks, some COVID-19 survivors, like Frisby, are ill for months.

Post-acute or chronic COVID-19, sometimes called “long COVID,” can saddle people with a number of symptoms that can drag on after the worst of the acute illness ends. These include ongoing fever, irregular heartbeat, cough, joint pain, “brain fog” and difficulty thinking, vertigo, ongoing anosmia (loss of the sense of smell) and skin rash.

The most common post-COVID symptoms seem to be trouble breathing and fatigue that can be debilitating. Some survivors sustain damage to the heart, lungs, kidneys and brain, and in some cases have new diagnoses, including high blood pressure.

“The virus is something that can have a prolonged impact on people’s quality of life, people’s ability to return to work and people’s ability to do the activities they always wanted to do,” says Sarath Raju, MD, MPH, a specialist in pulmonary medicine who is treating Frisby at the Johns Hopkins Post-Acute COVID-19 Team (PACT)—a multidisciplinary medical clinic treating COVID-19 survivors with ongoing medical needs related to the virus.

Not quite a year into the pandemic, these problems remain poorly understood.

Estimates of the prevalence of “long COVID” range from as low as 10 percent to as high as 87 percent of survivors, depending on the group of patients studied.

Authorities have not even agreed on how to define post-acute COVID-19 yet. One proposed definition includes symptoms lasting more than 3 weeks, while chronic COVID-19 has been defined as more than 12 weeks of symptoms.

Researchers are trying to understand the risk factors not only for severe COVID requiring ICU care, Dr. Raju says, but also for “a course that involves prolonged symptoms and a prolonged recovery” after a relatively mild initial illness.

There is precedent for the phenomenon, and early hints at an explanation. The novel coronavirus’s cousin—the coronavirus that causes SARS—is one of several viruses that have been linked to persistent symptoms, potentially due to long-term inflammation. And SARS-CoV-2, the coronavirus that causes COVID-19, targets the ACE2 receptor, which studs many cell types in the body and offers entry into multiple organs. Organ damage could contribute to ongoing symptoms.

Post-acute or chronic COVID-19 also bears a resemblance to myalgic encephalomyelitis, commonly known as chronic fatigue syndrome (ME/CFS). This disorder causes debilitating fatigue and has been linked to dysfunction in mitochondria—the cell’s powerhouses—and to immune system malfunction. Some ME/CFS cases have been linked to recent viral infection. Something similar could be going on with COVID-19 survivors.

Finding a path to recovery
When Frisby first experienced coronavirus infection, he developed asthma symptoms that didn’t respond to his usual treatments. After several days, he developed a fever, cough and trouble breathing. He spent five days in the hospital with COVID-19, though he did not need to be intubated.

About a week after going home from the hospital, Frisby again experienced what felt like a stubborn asthma flare. Though his repeat COVID-19 tests were negative, he needed multiple medications to manage his lung symptoms, including a nebulizer every few hours.

For months, Frisby says, “it was horrible.”

“You’re coughing, and you can barely move,” he says. “It’s not like you can do anything. You’re just there—you can barely get out of bed, and you’re feeling lousy, just overall.”

Some post-COVID patients develop new symptoms, Raju says. But others, like Frisby, experience worsened symptoms of preexisting well-controlled asthma—even after a relatively mild bout of COVID-19.

“We’ve seen patients who weren’t even hospitalized who still have residual shortness of breath,” Raju says. “It comes as a shock, I think, to still be dealing with these issues for a prolonged period of time.”

Reason for hope
It’s still uncertain what people recovering from “long COVID” may face long-term. Many wonder when, if ever, they can expect to resume their pre-illness level of function. Whether they are at higher risk for other chronic diseases is also unclear. And no one knows yet if having received certain treatments for severe COVID-19, such as monoclonal antibodies, render a person more or less likely to become a “long-hauler.”

In order to answer these and other questions, studies are underway that delve into the body’s reaction to the virus. Scientists will also follow survivors over time to learn as much as they can about the long-term effects of the disease.

Researchers have called for a multidisciplinary approach and a research focus at clinics like Raju’s that care for post-COVID patients.

Frisby, for his part, says he started to turn the corner in July. By September, he said, he felt “95 percent better,” noting that he still gets tired earlier in the evening. Beyond that, he says he’s doing okay.

Still, in the wake of his bout with COVID-19, Frisby now needs to take more asthma medications than he did before. And tests of his post-COVID lung function showed impairment, Raju said, which presents another mystery.

“His lung function may go back to normal over time,” Raju says. “But I think that’s still something we’re working to understand.”

Medically reviewed in October 2020.

Sources:
UpToDate from Wolters Kluwer. “Coronavirus disease 2019 (COVID-19): Clinical features.” Oct 6, 2020.
Science. “From ‘brain fog’ to heart damage, COVID-19’s lingering problems alarm scientists.” Jul 31, 2020.
del Rio C, Collins LF, Malani P. “Long-term Health Consequences of COVID-19.” JAMA. Published online October 05, 2020.
Nature. “The lasting misery of coronavirus long-haulers.” Sept 14. 2020.
Sweetman E, Kleffmann T, Edgar C, de Lange M, Vallings R, Tate W. “A SWATH-MS analysis of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction.” J Transl Med. 2020 Sep 24;18(1):365.
UpToDate.com. “Clinical features and diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome.” Sept 7, 2020.

Categories: