The mystery of the COVID long-haulers

Long-haul COVID-19 is cropping up as another of the great mysteries of the coronavirus pandemic. It is a mystery because no one yet knows precisely why some people, including those who had only mild cases of COVID-19 and were not hospitalized, continue to feel lousy months after infection. Lest this virus scar a generation with lasting medical ailments and mental health wounds, there’s an urgent need to figure out what’s going on and why.

So far, the answers are murky. As Lenny Bernstein and Ben Guarino reported in The Washington Post recently, clinicians and researchers in the United States have yet to reach a consensus on a definition for long-haul COVID-19. They do not know how many people have it. Steven Deeks, an infectious-disease physician at the University of California at San Francisco, said the only thing certain is that an unknown proportion of those who get sick with the virus have long-term symptoms. “We know the questions,” he said. “We have no answers. Hard stop.”

The need for answers is underscored by a comprehensive new review of the problem led by researchers at New York-Presbyterian/Columbia University Irving Medical Center. They found that cell damage, inflammatory immune response, abnormal blood clotting and other complications can leave long-term symptoms such as chest pain, shortness of breath, “brain fog,” fatigue, joint pain and post-traumatic stress disorder. A multidisciplinary team of researchers conducted the review, examining reports from the United States, Europe and China, and publishing their conclusions March 22 in the journal Nature Medicine. They asserted, “It is paramount to establish an understanding of the healthcare issues” involved in long-haul COVID, and they call for dedicated clinics to cope with the problems.

Another just-published study from a special clinic for COVID patients established at Northwestern Memorial Hospital in Chicago studied long-term neurological symptoms in patients who were never hospitalized for COVID. The study included 100 patients with persisting problems, mostly women, from 21 states surveyed last year between May 13 and November 11, and found that 85 percent reported experiencing at least four neurological symptoms. The 10 most frequent symptoms were: nonspecific cognitive complaints, referred to as “brain fog” by patients; headache; numbness or tingling; dysgeusia, or dysfunction of the sense of taste; anosmia, or diminished sense of smell; myalgia, or muscle pain; dizziness; pain; blurred vision; and tinnitus, or a ringing sensation. Sen. Tim Kaine, D-Va., said at a Senate committee meeting March 18 that he was still feeling a nerve-tingling sensation nearly a year after getting the virus.

It is possible that some of the long-haul COVID is caused by lingering damage to the body that occurs during the acute phase of COVID-19 sickness, or by further aggravating conditions that existed previously, or by intense mental distress. The National Institutes of Health has launched an initiative with $1.15 billion in funding over four years to study the causes, treatment and prevention of long-haul COVID. The impact of this disease may be with us for a long time to come, and it is important to take seriously these signs of lingering — and debilitating — trouble.