‘Hundreds of thousands of people will need treatment for life’
Dr Ron Daniels is one of Britain’s leading intensive care doctors. A consultant at University Hospitals Birmingham NHS Foundation Trust, he was on the front line when the coronavirus pandemic first peaked and, with colleagues, saved many lives.
Like many doctors, Dr Daniels also caught a mild bout of the virus.
Even now, several months later, he can feel its impact. “The cough has gone but I’m still a bit breathless,” he says. “I routinely go up five or six flights of stairs at the hospital instead of taking the lift and I’m more breathless now than I normally would be. It’s not stopping me doing anything. It’s just noticeable.”
With the initial Covid-19 emergency now ebbing in several countries, doctors and scientists are turning their attention to the longer-term health impacts. The virus was only discovered six months ago and evidence remains thin, but it is already clear that doctors and health systems will be dealing with the fallout for decades to come.
How long can symptoms last, mental and physical?
The majority of people who catch Covid-19 suffer only very mild disease and it passes like a common cold or sore throat, causing no lasting damage.
But those, like Dr Daniels, who are harder hit but for whom the disease remains relatively mild, breathlessness, fatigue and muscle ache can last for a considerable time.
Early on in the crisis, researchers at King’s College London developed a Covid-19 app for people to record their symptoms daily. They report one in 10 people has symptoms lasting for eight to 10 weeks and say symptoms can fade, only to come bouncing back.
Prof Paul Garner, an expert in global health at Liverpool School of Tropical Medicine, suffered weeks of exhaustion after contacting what he suspects was Covid-19. “Sometimes I felt better and became optimistic,” he writes in the
“but then the next day I felt as though someone had hit me around the head with a cricket bat.”
Are there mental health impacts?
The World Health Organisation says the psychological impact of Covid-19 to date is best seen in “elevated rates of stress or anxiety”. “As new measures and impacts are introduced, especially quarantine and its effects on many people’s usual activities, routines or livelihoods, levels of loneliness, depression, harmful alcohol and drug use, and self-harm or suicidal behaviour are also expected to rise.”
Virologist Prof Peter Piot, director of the London School of Hygiene and Tropical Medicine, says: “The virus disappears, but its consequences linger for weeks.” Prof Piot became ill with Covid-19 in mid-March. His diary of his illness has done much to raise awareness of its long-term effects.
Prof Piot was admitted to hospital and remained breathless weeks later. Covid-19 also impacted his psyche. He writes: “Now I have felt the compelling presence of a virus in my body myself, I look at viruses differently. I realise this one will change my life, despite the confrontational experiences I’ve had with viruses before. I feel more vulnerable.”
What about those with severe disease?
The more severe the disease, the stronger its impact. For those who require mechanical ventilation to survive, Covid-19 is likely to be with them the rest of their lives. Doctors report a wide array of complications in such patients, from permanent lung scarring, to kidney, heart and even brain damage, septic shock, or an immune response that makes the blood more viscous and likely to clot, which can lead to heart attack and stroke. To assess the likely long-term impact in these cases, doctors have turned to studies of patients who had severe acute respiratory syndrome (SARS) in 2003 and others with acute respiratory distress syndrome (ARDS).
A Hong Kong study of SARS survivors showed one in two had much poorer exercise capacity and health status after two years. Only 78 per cent were able to return to full-time work one year after infection. Another study revealed 40 per cent of people recovering from SARS still had chronic fatigue symptoms three-and-ahalf years after being diagnosed.
The biggest study of ARDS survivors shows a similar pattern. It tracked 109 survivors of ARDS over five years, after discharge from intensive care. It concluded: “Exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of health care services are important legacies of severe lung injury.”
The precise long-term health impacts of Covid-19 will not be known for many years, but that they will be significant there can be little doubt.
As Prof Piot says: “Many people think Covid-19 kills one per cent of patients, and the rest get away with some flu-like symptoms. But the story gets more complicated – there will be hundreds of thousands of people worldwide, possibly more, who will need treatments such as renal dialysis for the rest of their lives.
“The more we learn about the coronavirus, the more questions arise.”
1 in 10
Covid-19 patients with symptoms that last for eight to 10 weeks, according to an app developed by King’s College London