National Post (National Edition)
We're not talking about a dozen people, we're talking about tens of millions of people who could be saying a year from now they still don't feel like they're back to normal.
— NEUROSCIENTIST DR. ADRIAN OWEN ON THE LONGTERM EFFECTS OF COVID-19,
Iused to be able to fall asleep quickly and sleep well. That all changed last November, when I got COVID-19. It took a week of chills, aching muscles, a nasty cough and a sore throat before I started to feel like myself again — except for one very noticeable difference: I was struggling to fall asleep. And when I finally did, I'd wake up every half-hour. At first, I thought it was from being anxious about returning to work. Or perhaps I was still getting over the virus. But days dragged into weeks. And today, months after the original symptoms appeared, I still can't get a good night's rest.
It's no surprise that people haven't been sleeping well during the pandemic — whether they have had the virus or not — a phenomenon that has become known as COVID-somnia. A Greek study found nearly 40 per cent of people are experiencing difficulty sleeping. And in a survey of more than 5,500 Canadians, half showed signs of serious problems.
So has the virus directly impacted my ability to sleep, or did getting sick make me anxious, causing me to join the countless others who haven't had COVID-19, yet still can't seem to get any shuteye? The answer is unclear, but what I can say with certainty is that, before I tested positive, I was sleeping fine. Plus, I know what it's like to be kept awake by nerves, and this is different. It's like I'm stuck in a haze, desperate to fall asleep but unable to.
Research has shown lack of sleep can affect both physical and mental well-being. A 2018 study found that not getting enough sleep can impair cognition, specifically our ability to make decisions. But insomnia isn't the only thing the virus survivors struggle with.
For COVID long-haulers, some of the symptoms include fatigue, headaches, shortness of breath, brain fog and muscle aches. Some talk about not being able to return to work and struggling to do simple tasks. And while it's still unclear how many of the 89 million people worldwide who have recovered from COVID-19 are experiencing long-hauler symptoms, research out of the U.K. estimates that 10 per cent of people have symptoms more than three weeks after infection. A German study concluded that of 100 patients who recovered from COVID-19, 60 per cent had heart inflammation up to three months later. Another study found more than 70 per cent of nearly 2,000 COVID-19 patients in Wuhan still had symptoms six months after getting sick.
Still, as we near the oneyear anniversary of the pandemic, it's not surprising there is not much research looking at symptoms beyond a few months, or studies that are able to tease apart more severe COVID cases and the complicated factors that could be behind some of these lingering symptoms.
Neuroscientist Dr. Adrian Owen is co-leading the COVID-19 Brain Study, a global study on how the virus affects cognition and long-term COVID trajectory and who is most at risk of having persistent symptoms. Data is still preliminary, but a pattern seems to be emerging.
“People do have cognitive impairments, there's no question about it,” Owen says, “and they're actually quite extensive across the board.”
Some research suggests age and severity of illness have an effect. But Owen says there's a good chance that younger people who weren't hospitalized — like me — may face symptoms for at least several months after infection.
“Based on our preliminary data, it looks like the worse your COVID is, the worse your problems seem to be,” he says. “But you can be on the other end of the spectrum and be relatively asymptomatic and still suffer cognitive deficits at least in the first few months, although we don't know about the long term just yet.”
Dr. Renée Janssen is seeing the impact of long-haul COVID up close.
As a clinician at St. Paul's Hospital Post COVID-19 Recovery Clinic in Vancouver, Janssen has seen all kinds of symptoms, from brain fog to severe rashes to fatigue. The fatigue is one of the more common symptoms and goes hand in hand with insomnia.
“We see people in the clinic and their tests come back normal, yet they still feel fatigued and short of breath, so it's tough,” Janssen says. “Part of our work is to validate patients by saying yes, your symptoms are real even though we can't capture them on an X-ray.”
I've been told my experience with sleep post-COVID is anecdotal and doesn't hold any real value. And while pandemic science continues to evolve — we don't have much long-term data yet — it seems clear that at least some people continue to suffer long after initial infection.
Dr. Angela Cheung is co-leading the Canadian COVID-19 Prospective Cohort Study to determine short- and long-term outcomes of patients with COVID-19. Based on her clinical experience, Cheung says most people who reach the three-month mark postCOVID start feeling better (at the time of our conversation, she gently reminded me that I'm just about to hit this mark, and the fact that I'm sleeping better lately is a good sign I'll shake the insomnia eventually).
Cheung says for many people, a return to normal is all about pacing.
“You can't just jump from zero to 10 — if you were sick and not doing anything that's a zero, and previously you were able to do a 10 but you need to work toward this,” she says.
Cheung is part of a team who recently published a study comparing COVID-19 to the flu, and found COVID is more likely to result in hospitalization and death. Cheung says this means it's not surprising that the typical COVID-19 recovery period is longer than the typical flu recovery period.
It does remain somewhat of a mystery how this virus is causing a wide array of symptoms and it's important to distinguish between what the virus is directly causing — what it's triggering the body to do — and what it has indirectly caused by plunging us into this stressful pandemic world.
Recent research suggests the virus can signal the body to attack itself and cause inflammation, leading to muscle soreness. Other research has shown organ abnormalities and changes in regions of the brain after infection. It's also possible that lingering symptoms are repercussions of infection, similar to concussion, where you aren't constantly hitting your head, but the initial insult causes ongoing symptoms like headaches and dizziness as your body tries to heal.
Owen says it's important to grasp the magnitude of these long-term symptoms now.
“If someone has been in the ICU on a ventilator, and a year from now, they go to their employer and say, `I'm still not back to normal,' the employer will probably not worry about whether that's reasonable or not,” he says. “But what about people like you? Is it going to be reasonable in a year from now to say to your employer, `I'm sorry, but I'm still not back to normal?' As a society, we really need to understand this because we're not talking about a dozen people, we're talking about tens of millions of people who could be saying a year from now they still don't feel like they're back to normal.”