POST COVID-19 SYNDROME - HOW REAL IS LONG COVID?

Article Updated on 8 March 2023

This article is continuously updated.

Have you been infected with COVID-19? Are you still feeling tired or out of breath? Have trouble sleeping or difficulty concentrating? Or, are you perhaps in pain? If so, you may have Long COVID, and potential organ damage, as new research suggests.

Long COVID, or post-acute COVID-19 syndrome, is an illness that affects at least 10% of people who have had severe COVID-19 infections and may persist long after they recover from the novel coronavirus. Scientists estimate that at least 65 million people worldwide have Long COVID currently, with cases increasing daily.  

Post-acute COVID-19 syndrome can cause more than 200 symptoms and affects multiple organ systems. A recent study shows that over half of Long COVID patients have organ damage up to one year after being infected with the SARS-CoV-2 virus.   

Keep reading to learn more about persistent COVID-19, its symptoms, risk factors, what organs it can damage, and how to manage it.

What Is Long COVID?

Post-acute COVID-19 syndrome is when a patient continues experiencing symptoms from a coronavirus infection after initial recovery. It is also called Long COVID, persistent COVID, or post-COVID syndrome.

In most cases, a mild or moderate COVID-19 infection usually lasts up to two weeks. In some cases, however, patients may experience persistent health problems even after testing negative for the virus.    

Referred to as “Long haulers,” these patients have coronavirus symptoms that persist or return three months after first testing positive for COVID-19. A post-COVID condition may involve various lasting health problems that can go on for weeks, months, and even years.

Researchers also recently found that Long COVID can cause single or multiple organ damage over the course of a year after a COVID-19 infection.  

A similar post-viral syndrome was seen in the SARS epidemic (2003) and the MERS outbreak (2012), both caused by coronavirus infections. These observations strongly supported speculations that COVID-19 was no different.  

Long COVID is regarded as a disability under the Americans with Disabilities Act (ADA) as of July 2021.

What Are the Symptoms Of Long COVID?

Post-COVID symptoms might come and go and cannot be attributed to a different health condition. 

These symptoms include anxiety, trouble concentrating, insomnia, depression, stress, fatigue, breathlessness, and chest pain. Long COVID can be even more severe in some cases, irreversibly damaging some vital organs and leading to chronic diseases.

The symptoms of Long COVID can interfere with your daily functioning and affect different organ systems. People who experience persistent COVID symptoms commonly report:

General symptoms such as:

• Fatigue
• Fever
• Post-exertional malaise (symptoms getting worse even after minor physical or mental effort)

Respiratory symptoms such as:

• Cough
• Shortness of breath
• Persistent need for oxygen

Cardiac symptoms such as:

• Chest pain
• Heart palpitations (fast or pounding heartbeats)

Neurological symptoms such as:

• Headaches
• Sleep disturbance
• Brain fog (trouble thinking or concentrating)
• Lightheadedness
• Changes in taste and smell
• Depression or anxiety
• Post-traumatic Stress Disorder (PTSD) symptoms
• Paresthesia (pins and needles sensation)

Digestive symptoms such as:

• Diarrhea
• Stomach aches

Other symptoms:

• Joint pain
• Muscle weakness
• Hair loss
• Changes in the menstrual cycle
• Rashes

The frequency and prevalence of these symptoms are highly variable between studies. But overall, the most common symptoms are fatigue, anxiety, sleeping disorders, dyspnea, and chest pain.

Other complications and conditions can also develop after a coronavirus infection. These are usually called “sequelae” and are included within the spectrum of the post-acute COVID-19 syndrome. Sequelae of COVID-19 include: 

• Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
• Dysautonomia
• Venous thrombosis (VTE) and strokes
• Cardiovascular disease (heart disease)
• Cerebrovascular disease (conditions that affect blood flow and the blood vessels in the brain)
• Heart inflammation (myocarditis)
• Kidney injury
• Lung fibrosis
• Type 2 diabetes
• Thyroid disorders

These symptoms can last years and prevent people with Long COVID from returning to work efficiently. 

Does Long COVID Cause Organ Damage?

Although COVID-19 is a respiratory illness, the novel coronavirus can damage many organ systems.

A prospective study previously assessed the heart, lungs, liver, kidneys, pancreas, and spleen in 201 patients with persistent symptoms following recovery from acute SARS-CoV-2 infection.

The authors reported that  70% of those Long COVID patients had damage to at least one organ, and 29% had multi-organ damage.

The same group of researchers published a more recent 1-year follow-up study. The study included 536 patients with Long COVID.

Most patients (497) were ‘UK first wave’ (COVID-19 January–September 2020), and 39 were ‘second wave’ (COVID-19 after September 2020).

13% of the participants in the study had been hospitalized previously because of a COVID-19 infection, and 32% were healthcare workers. 

The mean age of patients was 45 years, and the median body mass index (BMI) was 25 kg/m2.

The authors found that 59% had single-organ damage, and 27% had multiple-organ damage one year after becoming infected with the novel coronavirus.

They also noted that patients with organ damage because of Long COVID were generally older and had higher BMI than patients without organ damage.

On the bright side, the most common Post-COVID symptoms improved at the 1-year follow-up, including:

• Fatigue (98% to 64%)
• Myalgia (89% to 35%)
• Shortness of breath (90% to 47%)
• Headache (85% to 34%)
• Chest pain (81% to 38%)
• Fever (73% to 2%)
• Cough (75% to 11%)
• Sore throat (71% to 11%)

Of 331 patients, 60 (18%) had resolved all symptoms at follow-up. 

However, this study raises concerns regarding Long-term organ damage following a COVID-19 infection. 

Who is At Risk Of Developing Post-COVID Syndrome?

Anyone who gets infected with the novel coronavirus might be at risk of developing persistent COVID, even patients with mild symptoms or none at all. 

Nevertheless, post-COVID conditions are more common in patients who experienced severe COVID-19 symptoms and unvaccinated individuals who contract the virus. 

People more likely to develop Long COVID are:

• Patients who experience more severe COVID-19 symptoms
• Patients who were hospitalized or entered an intensive care unit due to a COVID-19 infection
• Patients who required ventilation because of a COVID-19 infection
• Patients with health problems before a novel coronavirus infection
• Patients who develop multisystem inflammatory syndrome (MIS) before or during COVID-19 illness
• Female patients (females are more likely to have post-COVID anxiety and depression)
• Patients with a higher body mass index (BMI)
• Patients with type 2 diabetes
• Patients with Epstein-Barr virus (EBV) re-activation
• Patients with specific autoantibodies (antibodies that react with self-antigens)
• Patients with connective tissue disorders
• Patients with attention deficit hyperactivity disorder (ADHD)
• Patients with chronic urticaria (chronic hives)
• Patients with allergic rhinitis (inflammation of the inside of the nose caused by an allergen)
• Older patients
• Patients of Black, Asian, or Minority Ethnicity (BAME)
• Patients from lower income groups and those unable to recuperate well in the first several weeks after contracting COVID-19

It is clear now that organ transplant recipients and patients with pre-existing health conditions such as cardiovascular disease, chronic kidney disease (CKD), and diabetes mellitus are more likely to develop severe COVID-19.

It is still unclear whether these health problems also increase the risk of developing Long COVID. 

However, around a third of people with Long COVID do not have any identified pre-existing health conditions.

Although less common, long-term effects of COVID-19 can occur in children and adolescents.

Intensive care unit admission and Long COVID

Post-intensive care syndrome, or PICS, is a condition where a patient continues to experience health issues after they leave the intensive care unit (ICU).

These health problems may include muscle weakness, trouble with thinking and judgment, and PTSD symptoms.

Post-ICU syndrome is an independent syndrome that can cause physical, psychiatric, and mental disturbances. Since these overlap with Long COVID, the post-ICU syndrome could independently cause Long hauling COVID symptoms.   

How Common Is Long COVID?

Many studies report that most people recovering from a COVID-19 infection develop Long-COVID. Different reports from around the world cite different prevalence rates because the syndrome is still being heavily investigated. 

One study in Wuhan, China, estimated that 76% of patients suffer from at least one post-COVID symptom, with fatigue and muscular weakness being the most commonly reported (63%). Sleep difficulties and anxiety/depression were seen in 26% and 23% of patients, respectively.

A different study in Italy showed that almost 87.3% of patients had at least one post-COVID symptom 60 days after infection. The most common persistent symptoms were fatigue, dyspnea, joint pain, and chest pain. 

Another study done in the US found that 32.6% of patients had persistent symptoms two months after being infected with the coronavirus. 18.9% of patients even reported worse symptoms than before. In this study, dyspnea, cough, and loss of taste and smell were the most common post-acute COVID symptoms.

A more comprehensive global study examined the worldwide prevalence of post-COVID syndrome using a systematic review and meta-analysis. This study estimated that up to 95% of patients experienced one or more persistent COVID-19 symptoms, with fatigue and memory problems being the most commonly reported symptoms.

A recent multidisciplinary, population-based study in the Netherlands did something new that could give more accurate estimates.

The researchers identified common Long COVID symptoms that have been present before a SARS-CoV-2 infection and in people who never got the infection. 

They compared the symptom severity and prevalence before and after COVID-19 in participants with COVID-19 and in controls (people who never had the virus).

The authors concluded that only 12.7% of patients had persistent symptoms because of their COVID-19 infection.

There is still some discrepancy between studies. The numbers and reported Long corona symptoms differ depending on the criteria and goals of the authors. Nevertheless, combined, these studies give a more general idea of what post-acute COVID syndrome is as a whole.

What Causes Post-COVID Syndrome?

The COVID-19 virus has wreaked havoc worldwide, causing a devastating pandemic that brought the healthcare sector to its knees.  

SARS-CoV-2 attacks nearly every organ, causing acute and long-term damage, some of which is irreversible.

Doctors are not entirely sure what causes Long COVID-19. They believe there are likely multiple, potentially overlapping, causes of Long COVID.

They theorize that a continuous state of widespread inflammation could be what causes post-acute COVID syndrome. Persistent inflammation can affect each organ system in our body, causing a wide range of symptoms. So, Long COVID is the result of an interplay of several factors:    

• Persisting reservoirs of SARS-CoV-2 in tissues: Scientists could detect the spike antigen of COVID-19 virus in the tissue of patients with acute phase coronavirus disease up to 12 months after testing positive.
• Re-activation of other viruses: Researchers suspect immune dysregulation during COVID-19 infection could reactivate neurotropic viruses. These viruses include herpes and Epstein-Barr viruses (EBVs), among others, and could cause persistent symptoms.
• Continued inflammatory response: Inflammation itself affects our cognition and behavior. It causes fatigue and weakness and can damage different body parts. One study found that nearly 60% of patients had heart muscle inflammation (myocarditis) more than two months after COVID-19 infection.
• Sustained damage: The organ damage sustained during acute COVID-19 infection can persist for a long time, causing various symptoms. During an inflammatory response, endothelial and epithelial damage may occur due to the invasion of monocytes and neutrophils, which are recruited to fight off the invading pathogen. Consequently, lung tissue becomes damaged, resulting in acute respiratory distress syndrome (ARDS) and dyspnea after COVID. 
• Physiologic disruption: The SARS-CoV-2 virus disrupts many physiological processes, which can lead to serious aftermath. One example is the coagulation system – the novel coronavirus causes a persistent hypercoagulable state that puts patients at higher risk of developing emboli (blood clots).  
• Other factors: Medications and treatments used to combat the acute COVID-19 infection might play a role in later disturbances. One example is post-Intensive care syndrome.

Immobilization during disease, steroid use, and vitamin D deficiency because of COVID can contribute to bone demineralization. This condition causes bone pain and muscle weakness, which are common post-COVID symptoms. 

All these factors and more can combine to cause the Long COVID syndrome. 

Is There a Treatment For Long COVID?

Since post-acute COVID-19 syndrome is still new, there are no strict guidelines on how to treat it yet. There are currently no broadly effective treatments for Long COVID.

The best way to treat long-haul COVID-19 symptoms is by detecting them early. Several health authorities are already implementing screening algorithms in specific patient populations at high risk of developing Long COVID. Follow-up after 4-6 weeks with these patients can include a wide variety of tests, depending on their risk factors and disease course:

• Imaging studies (MRI to detect organ damage)
• Breathing studies (pulmonary function tests)
• Psychiatric evaluation
• Kidney tests
• Cardiac evaluation
• Evaluation of clotting risk

Based on these, your physician can recommend therapy, rehabilitation, medications, and follow-up testing to lead you safely to a full recovery.

Multidisciplinary clinics are emerging to support patients who have had COVID-19 in their recovery. Physical therapy, breathing exercises, and other treatment options can be helpful.

Moreover, several clinical trials are testing different drugs and interventional therapies that may be able to treat the symptoms of Long-haul COVID.

For example, researchers are investigating a novel immune-modulating drug for patients who developed postural orthostatic tachycardia syndrome (POTS) after a SARS-CoV-2 infection.

The drug lowers antibody levels by blocking antibody production and decreasing autoantibodies.

Final Word

Several studies confirm that symptoms can persist for up to one year in individuals with Long COVID. A more recent study now adds that three in five people with post-COVID-19 syndrome have damage in at least one organ, and one in four have damage in two or more organs.

This significantly impacts the quality of life and time off work in those patients, many of whom are health workers. That can become a major concern for individuals, healthcare sectors, and the economy.

The best treatment for Long COVID is the prevention of COVID-19 altogether. So, to avoid post-COVID-19 syndrome and potentially more dangerous outcomes, get your COVID-19 vaccine as soon as possible and take all the appropriate health precautions. 

To search for the best healthcare providers that offer either COVID-19 Treatment, or vaccines, please use the Mya Care search engine.

Sources:

• Post Acute Coronavirus (COVID-19) Syndrome - StatPearls - NCBI Bookshelf
• Long COVID: An overview - PMC
• Post-acute COVID-19 syndrome | Nature Medicine
• Long COVID after breakthrough SARS-CoV-2 infection | Nature Medicine
• Long COVID: major findings, mechanisms, and recommendations | Nature Reviews Microbiology

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