‘Long COVID’ — Debilitating symptoms long after infection
Research: After two months, 27% experienced shortness of breath, chest pain, cough
The vast majority of COVID-19 symptoms aren’t dangerous, just discomforting.
Especially when they refuse to go away.
A spate of new studies about socalled “Long COVID” found that about one-quarter of people infected with the virus — even if their illness was mild or routine — suffer from persistent symptoms and impairment for months after recovery. If confirmed, the research suggests potential health problems for a significant number of the 30 million Americans known to have been infected.
In some baffling cases, their initial infection may have caused no illness at all, and they end up suffering from debilitating symptoms they had appeared to escape when they first contracted the virus.
“They have all these symptoms that are almost appearing out of nowhere,” said psychologist Jessie Borelli of UC Irvine, who was part of a research team that studied 1,407 people seen at University of California outpatient clinics.
The syndrome was recognized early on in the pandemic. But the new research details its prevalence.
More than two months after their infection, 27% of people experienced shortness of breath, chest pain, cough or abdominal pain, the team reported. Of these patients, nearly a third did not have symptoms during their ini
“We would expect them (patients) to have ongoing effects. But the effects that people are having just from having a mild infection — that is surprising. We didn’t really know the extent of the long-term issues that people who weren’t so sick would face.”
— Dr. Aruna Subramanian, clinical professor of medicine, Stanford
tial infection.
A similar pattern was seen in a new Stanford Health Care study of Bay Area patients who were never sick enough to need hospitalization. This research, published last month in the journal Clinical Infectious Diseases, found that three to four months after infection, 29% of people who returned for treatment reported fatigue; 21% reported shortness of breath; 24% reported loss of taste or smell; 17% reported muscle pain; and 16% reported memory problems. And many people in the study suffered from more than one of these symptoms.
“It didn’t matter if they had been hospitalized or not. Quite a few of them had just had mild infection,” said infectious disease expert Dr. Aruna Subramanian, a clinical professor of medicine at Stanford who led the trial.
A study of people diagnosed with “Long COVID” at New York City’s Icahn School of Medicine at Mount Sinai found that the most prevalent symptoms were fatigue, affecting 92% of people, followed by 74% reporting loss of concentration and memory; 68% reporting weakness; 65% reporting headache; and 64% reporting dizziness.
And like the other studies, people are affected regardless of the severity of their initial infection or prior health status, it reported.
It’s well known that hospitalization for COVID-19 treatment, especially if intensive care unit treatment is needed, can lead to profound persistent health problems. A study from China, published in The Lancet, found that, even six months later, 63% of discharged patients felt fatigue and muscle weakness.
But there’s no explanation — or treatment — for the common, persistent and sometimes fluctuating constellation of symptoms in these healthier patients.
“Early on, we focused on keeping people out of the ICU, getting people off the ventilator, keeping people alive. And these people — yes, we would expect them to have ongoing effects,” said Subramanian. “But the effects that people are having just from having a mild infection — that is surprising.
“We didn’t really know the extent of the longterm issues that people who weren’t so sick would face,” she said.
The UC study also found that symptoms tended to cluster together in five groups, categorized in pairs: chest pain-cough, shortness of breath-cough, anxiety-fast heartbeat, abdominal pain-nausea, and low back pain-joint pain.
It reported another pattern: People who experienced a certain symptom during their initial infection were more likely to report a related cluster of symptoms later on. For instance, someone who felt chest pain 10 days after infection was more likely to experience chest pain and cough two months later, said Borelli, associate professor in the Department of Psychological Science at UC Irvine. Her team’s study is published on the preprint site MedRxiv and has not finished undergoing peer review.
Spared from a potentially devastating disease, Millbrae’s Rick St. John felt fortunate after recovery from flu-like symptoms.
“I didn’t have fevers. I didn’t have a cough. I didn’t have the classic symptoms,” recalled St. John, a fit 49-year-old chemical engineer who was sickened last March during a work meeting with outof-town consultants. “It was like having the flu, for three weeks.”
But for months, he was plagued by periods of headaches, fatigue and nausea. Despite a lifetime of running and skiing, he also felt persistent shortness of breath.
“I was on a roller coaster. I’d feel a little better and start doing normal things, then I would feel really terrible for three to five days,” he said.
With a rigorous job directing digital sciences for a pharmaceutical company, he would work during the week but then collapse into bed on weekends. In August, he took a full month off work to focus on recovery.
Now, a year later, he is beginning to feel better. But he still takes care not overexert himself — and continues to experience regular headaches and bouts of mild nausea.
With burgeoning cases of COVID-19 throughout the country, there is growing concern about a new burden of ongoing health problems among people in the prime of their lives.
“We do not know yet the magnitude of the problem, but given the number of individuals of all ages who have been or will be infected with SARS-CoV-2, the public health impact could be profound,” said National Institutes of Health Director Dr. Francis S. Collins.
Researchers hope the new findings will bring more attention to the problem.
“Patients say that they are experiencing some difficulty getting their symptoms recognized by the medical professionals,” said Borelli. “It’s a situation where, medically, it’s difficult to figure out what’s going on.”