The tragedy of the post-COVID “long haulers” – Harvard Health Blog

Suppose you suddenly have COVID-19. You get very sick for several weeks. When you wake up every morning you wonder if this could be your last day.

And then you start to turn the corner. Every day your worst symptoms – fever, terrible cough, shortness of breath – get a little better. You win, overcome a potentially fatal disease, and you no longer wonder if every day could be your last. In a week or two, you’ll be your old self.

But weeks go by, and even though the worst symptoms are gone, you are no longer your old self – not even close. You can’t take responsibility at home or at work: no energy. Even routine physical exertion, like vacuuming, leaves you exhausted. You hurt all over. You find it hard to concentrate on anything, even watching TV; you are unusually forgetful; you come across simple calculations. Your brain feels like it’s in a fog.

Your doctor congratulates you: the virus can no longer be detected in your body. It means you should feel good. But you don’t feel good.

The doctor suggests that perhaps the terrible experience of being sick with COVID-19 has left you a little depressed or a little PTSD. Maybe psychiatric treatment could help, because there is nothing wrong with you physically. You try the treatment, and it doesn’t help.

How common are persistent symptoms of COVID?

Tens of thousands of people in the United States have such persistent illness after COVID-19. In the United States, we call them post-COVID “long haul”. In the UK, they are said to be suffering from a “long COVID”.

Published studies (see here and here) and surveys by patient groups indicate that 50% to 80% of patients continue to have bothersome symptoms three months after the onset of COVID-19 – even after tests fail. detect more viruses in their body.

What persistent symptoms are common?

The most common symptoms are fatigue, body aches, shortness of breath, difficulty concentrating, inability to exercise, headaches and trouble sleeping. Since COVID-19 is a new disease that started with an outbreak in China in December 2019, we have no information on long-term cure rates.

Who is most likely to become a long hauler?

Currently, we cannot accurately predict who will become a long transporter. As a recent article in Science Note, people mildly affected by COVID-19 may still have persistent symptoms, and critically ill people may return to normal two months later. However, persistent symptoms are more likely to occur in people over 50, people with two or three chronic conditions, and people who have become very ill with COVID-19.

There is no formal definition of the term “post-COVID long-haul”. In my opinion, a reasonable definition would be anyone diagnosed with the coronavirus responsible for COVID-19, or very likely to have been infected with it, who has not returned to their pre-COVID level of health and function. -19 after six months.

Long-haul routes include two groups of people affected by the virus:

  • Those who sustain permanent damage to the lungs, heart, kidneys or brain that can affect their ability to function.
  • Those who continue to experience debilitating symptoms despite no detectable damage to these organs.

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, hypothesized that many members of the second group will develop a condition called myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS ). ME / CFS can be triggered by other infectious diseases – such as mononucleosis, Lyme disease, and severe acute respiratory syndrome (SARS), another coronavirus disease. The National Academy of Medicine estimates that there are one million to two million people in the United States with ME / CFS.

Dr Tedros Ghebreyesus, director of the World Health Organization, also expressed growing concern about chronic diseases that could follow as a result of COVID-19, including ME / CFS.

What could be causing the symptoms that plague long carriers?

Research is underway to test several theories. People with ME / CFS, and possibly long haul post-COVID, may have a low level of inflammation in the brain or decreased blood flow to the brain, or an autoimmune disease in which the body makes antibodies that attack the brain, or several of these abnormalities.

The bottom line

How many people can go long-haul? One can only guess. Currently, more than seven million Americans have been infected with the virus. It is not unthinkable that 50 million Americans will eventually become infected. If only 5% develop persistent symptoms, and if most of those with symptoms have ME / CFS, we would double the number of Americans with ME / CFS in the next two years. Most people who developed ME / CFS before COVID-19 remain ill for many decades. Only time will tell if this holds true for post-COVID cases of EM / CFS.

For this reason and many more, the pressure on America’s healthcare system and economy from the pandemic will not stop anytime soon, even as we develop and deploy a highly effective vaccine by the end of 2021. .

Virtually every healthcare professional I know believes the pandemic in the United States could and should have been better controlled than it was. Bad mistakes rarely lead to temporary damage.

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Jothi Venkat

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