There’s the lingering COVID-19 virus, but a long cold and flu?
lingering symptoms from respiratory illness, wrote in an email. Even with other coronaviruses, explained Vivaldi, long-term symptoms such as fatigue and lung illness have been reported.
Vivaldi’s study, as well as another paper published in The Lancet, provide even more evidence of lingering symptoms and health consequences from illnesses other than COVID.
Vivaldi and her team examined a variety of symptoms and asked about the quality of life of more than 10,000 people aged 16 to 70-plus in the U.K., from March 2020 to October 2021, with a January 2021 follow-up survey. They found that while many participants who’d had COVID at any point during that period had a higher burden of lasting symptoms, so did those who’d had an acute respiratory infection, when compared to no infection at all.
“Our findings suggest that there may be long-lasting health impacts from other respiratory infections that are going unrecognized,” the authors wrote in the paper, published in October.
Symptoms differed between postacute COVID and respiratory illness, with some overlap. People with persistent respiratory symptoms experienced more coughing, memory and sleep problems, abdominal issues and more, compared to the non-illness group. Those with long COVID, by contrast, had more instances of a loss of taste or smell, hair loss, and more lightheadedness and dizziness.
Vivaldi was struck by the number of people who reached out after the paper’s publication, saying, “I’ve always avoided people who are sniffly, because if I get sick, it knocks me out for weeks.”
The U.K. study’s results also show a decreased quality of life score for those with post-acute respiratory symptoms. But that doesn’t mean the phenomenon is widely talked about, or socially acceptable.
“Patients in Western medicine have been ill-served by us when symptoms are hard to pin down,” said Crawford-Faucher. “These patients have not been believed for a long time.”
The misconception that COVID illness is “just like the flu,” and, by default, the flu alone is mild and largely harmless, made the rounds as COVID continued to kill people across the world. The second study, published in The Lancet in December, found the burden of COVID illness is statistically worse than that of the flu, and persistent flu was associated with a multitude of distinct negative, and at times chronic, health outcomes.
Looking at more than 81,000 people registered with the U.S. Department of Veterans Affairs and hospitalized either with COVID between March 2020 and June 2022 or with flu from October 2015 to February 2019, the study determined a higher burden of health loss and higher mortality rates for both illnesses. The absolute death rate was higher in the COVID group than in the flu group.
They also found that those hospitalized with COVID had a higher readmission rate to the intensive care unit compared to flu. This surprised Crawford-Faucher.
“I was not expecting that,” she said. “The study shows that it’s not just lingering symptoms. It highlights that you’re actually at a higher risk for other complications,” and, as she described it, more “badness.”
While those registered with the VA were mainly older white men, the sheer size of the study meant that researchers were able to look at the health records of thousands of people in their 20s and 30s, women and people of color. Participants ranged in age from 20 to 101, with the average age 60.
The U.K. study was also limited by its demographic scope: Participants were 93% white. Vivaldi said it’s a frustrating limitation, and a “genuine challenge” of a prospective study, which requires participant engagement.
Jessica Ericson, a pediatric infectious disease specialist at Penn State College of Medicine and Penn State Health, said she wasn’t surprised by the results of either study. She said she’s seen people who get the flu or other non-COVID respiratory infection develop persistent symptoms.
“These papers put numbers to that,” she said.
The VA study also found COVID had more of a widespread impact on the body, whereas persistent flu symptoms were more likely to be respiratory.
“When you’re sick with COVID or the flu, that’s literally the tip of the iceberg,” said Al-Aly, the senior author on the VA study.
So then why the rampant misinformation that SARS-CoV-2 is largely harmless, or that the flu is no big deal?
“We did a disservice early on in the pandemic when we focused so much on deaths and hospitalizations,” said Ericson. “People were thinking, ‘Well that’s not me, so I’m not going to worry about getting infected.’ But there are lots of things that can make your life less enjoyable that aren’t death.”
The VA study found that those hospitalized with flu were more likely to suffer later from heart problems such as a fast heartbeat, cough, shortness of breath and Type 1 diabetes.
Ericson said there’s still a problem of mistrust in the health care system. Crawford-Faucher, of AHN, said she’s noticed more parents coming in expressing skepticism about vaccines they haven’t previously questioned.
“It’s been really unfortunate,” she said.
New research on long COVID and lingering respiratory illnesses can raise awareness about links people might have otherwise missed. When Ericson sees patients come in with autoimmune symptoms, it prompts her to ask, “Did you have a virus recently? Were you sick?”
There’s evidence that the droves of people coming into clinics with long COVID symptoms has lessened. Experts think that’s due in part to vaccines.
“If you get immunized against COVID or the flu, you’re less likely to have a severe infection,” said Crawford-Faucher. “Long COVID seems to be more likely with severe infection. So one can make the argument that one way to prevent post-viral syndromes is to get vaccinated.”
Ericson reiterated the importance of additional public health measures: getting a flu shot, staying home when you’re sick, and not inviting over sick friends or relatives.
And while the pandemic continues to hold lasting impacts, from long COVID to widespread vaccine hesitancy, it’s also changed the way much of society thinks about illness.
“The silver lining of long COVID is that now we’re looking at this,” said Vivaldi. “The public health interest wasn’t there before. There’s a growing awareness that people can struggle to recover from respiratory illnesses.”
Al-Aly added that it’s not necessarily that scientists have uncovered a new phenomenon — lingering symptoms from viruses and other pathogens have existed for centuries.
“It’s kind of like when you have an earthquake, and you focus on the first two minutes, but you don’t tally up the damage after,” he said. “We conceptualize these viruses as acute. The reality is not different, it’s that our perspective has widened. Earthquakes have aftermaths.”