A “Long COVID” Story
Unfortunately, once a COVID-19 active infection subsides it may only be the beginning of a long, arduous, and incomplete return to normal life
by Sheryll Mangahas and Adam Grossman
Upon entering year 3 of the coronavirus disease 2019 (COVID-19) pandemic, the number of COVID-19 cases in the US has reached 77 million1. This is certainly an underestimate of the true number of people who have experienced COVID-19. Unfortunately, once a COVID-19 active infection subsides it may only be the beginning of a long, arduous, and incomplete return to normal life because of post-viral sequelae.
Within the medical community, post-viral illnesses have been known for quite some time. Other common viruses, including influenza, enterovirus, and Epstein-Barr virus, are known to have health repercussions after acute infection. These include chronic fatigue and neurological disorders. The recognition that post-viral sequelae of COVID-19 could last a long time has turned a relatively obscure field of research into a predominant topic.
Recent studies suggest that around 10% of COVID-19 patients experience post-acute sequelae of SARS-CoV-2 (PASC), more commonly called “long COVID”, effects that last weeks or months after their initial infection. The symptoms of PASC have a wide range of severity and have been observed in a multitude of organ systems. Common symptoms include fatigue, memory issues, gastrointestinal disturbances, altered sleep patterns, and continued trouble with breathing. Other reported symptoms of PASC include development of muscle weakness, joint pain, altered heart function, kidney disease, and overactive bladder. Often people with PASC must contend with their inability to resume their pre-COVID-19 life due to their limitations, sometimes leading to anxiety and depression.
Clinics have sprung up around the US to help people experiencing PASC try to find a way back to their pre-COVID-19 life. These clinics may provide oxygen therapy to help relieve breathing difficulties. Interestingly, COVID-19 causes some people to adopt shallow breathing during infection to prevent spasms of coughing so the clinics can help them re-learn to take a normal breath. They also may impart techniques to help with newfound memory limitations. The majority of PASC patients recover at least partially, but some cannot return to full-time work and others may have permanent partial or full disability.
The NIH launched Researching COVID to Enhance Recovery (RECOVER) in February 2021 to provide $1.1 billion over 4 years to gather information on patients upon recovery of COVID-19 and follow their health in the coming years. Since there is presently no way to predict who will develop PASC, the study will also follow asymptomatic COVID-19 patients to try to decipher why they did not develop symptoms. A thorough understanding of PASC will hopefully lead to a way to prevent something similar from occurring in future viral infections.
Before the appearance of SARS-CoV-2, severe acute respiratory syndrome coronavirus (SARS-CoV) caused a large outbreak in 2003 and Middle East respiratory syndrome (MERS) has had several outbreaks since it first appeared in 2012. Recovered patients from these viral infections also experienced effects long past their infections. The reported symptoms include severe fatigue and shortness of breath which have also been observed in PASC. These patients had a decreased quality of life along with increased medical costs2. The global scale of the current pandemic suggests that PASC could become another global health crisis on the heels of the pandemic, with costs that could be unprecedented. To the extent that employers are held liable for their employees’ SARS-CoV-2 infections this could also turn into a significant cost to the insurance industry.