Long COVID: Symptoms persist for months in many survivors

Most people with Covid-19 recover within two weeks. Some, as reported in [30], with so-called Long Covid (symptoms lasting longer than three weeks), continue to experience excessive fatigue, breathlessness, headache, insomnia, muscle fatigue and pains, chest pains, persistent cough, intermittentfevers and brain fog.

It’s unclear why some people develop long Covid and others don’t, but four factors appear to increase the risk:^[37]

1. High levels of viral RNA early during an infection
   
2. The presence of certain autoantibodies 
3. The reactivation of Epstein-Barr virus 
4. Having Type 2 diabetes

The study finds about 10 per cent had symptoms for a month, with between 1.5 and 2 per cent after three months. The median age of those with Long Covid is 45, and women are more likely to be affected.

COVID-19 Symptoms Linger for Months for Many

Months after becoming ill, many COVID-19 patients still have symptoms, three studies confirm, and the more severe the initial infections, the higher the odds of persistent problems.  In [33], it describes a patient with such long COVID symptoms:

Kelly LaDue thought she was done with COVID-19 in the fall of 2020 after being tormented by the virus for a miserable couple of weeks.

"And then I started with really bad heart-racing with any exertion. It was weird," says LaDue, 54, of Ontario, N.Y. "Walking up the stairs, I'd have to sit down and rest. And I was short of breath. I had to rest after everything I did."

A year later, LaDue still feels like a wreck. She gets bad headaches and wakes up with pain all over her body on more days than not. She also experiences a sudden high-pitched whistling in her ears, bizarre phantom smells and vibrations in her legs. Her brain is so foggy most of the time that she had to quit her job as a nurse and is afraid to drive.

"These symptoms, they come and go," she says. "You think: 'It's gone.' You think: 'This is it. I'm getting better.' And then it'll just rear back up again."

The most common complaints found from 3 studies include:

• UK^[28,29]
• Post-viral fatigue
• Lasting organ damage
• Symptoms that fluctuate and move around body
• Spanish^[1]
• Shortness of breath
• Chest pain
• Palpitations
• Cough
• Physical weakness
• Psychological and cognitive disorders
• US^[2]
• Shortness of breath
• Pain with deep breaths
• Chest pain
• Heart palpitations
• Rapid heartbeat
• Confusion
• Memory loss
• Difficulty concentrating
• Dizziness
• Headache
• Impaired smell and taste
• Kidney functional decline^[35,36]

"Not caused by one thing"

So far there are more theories than clear answers for what's going on, and there is good reason to think the varied constellation of symptoms could have different causes in different people:^[33]

Maybe, in some, the virus is still hiding in the body somewhere, directly damaging nerves or other parts of the body. Maybe the chronic presence of the virus, or remnants of the virus, keeps the immune system kind of simmering at a low boil, causing the symptoms. Maybe the virus is gone but left the immune system out of whack, so it's now attacking the body. Or maybe there's another cause.

"It's still early days. But we believe that long COVID is not caused by one thing. That there are multiple diseases that are happening," says Akiko Iwasaki, a professor of immunobiology at Yale University who is studying long COVID-19.  Read [33] for more details.

References

1. Clinical and immunoserological status 12 weeks after infection with COVID-19: prospective observational study
2. Long-term COVID-19 symptoms in a large unselected population
3. The Tip of the Iceberg: Virologist David Ho (BS '74) Speaks About COVID-19
4. Even Mild Covid-19 Infections Can Make People Sick for Months
5. [WEBCAST REPLAY] COVID-19 Pandemic Update: Analysis From Neil Howe & Daryl Jones
6. Why U.S. hospitals see promise in plasma from new coronavirus patients
7. Virus May Spread Twice as Fast as Earlier Thought, Study Says
8. What Does Your Cough Say About Your Illness?
9. The COVID-19 vaccine development landscape
10. She spent 9 days in a coma and relearned how to walk. What this Covid-19 survivor wants protesters to know
11. If you’re hoping a vaccine is going to be a knight in shining armor saving the day, you may be in for a disappointment. SARSCOV2 is a highly contagious virus. A vaccine will need to induce durable high level immunity, but coronaviruses often don’t induce that kind of immunity (link)
12. Mutations map holds the key to bringing coronavirus under control
13. Virus Likely to Keep Coming Back Each Year, Say Top Chinese Scientists (Bloomberg)
• “The virus is heat sensitive, but that’s when it’s exposed to 56 degrees Celsius for 30 minutes and the weather is never going to get that hot,” said Wang Guiqiang, head of the infectious diseases department of Peking University First Hospital. “So globally, even during the summer, the chance of cases going down significantly is small.”
14. All the Covid-19 Symptoms You Didn’t Know About
15. Coronavirus: Can it affect eyesight?
16. What Troponin Tells Us About Myocardial Injury in COVID-19
• Clinicians then assess potential causes of troponin elevation, including hyperinflammation, which may respond to immunosuppressive therapy.
17. Strokes and mental state changes hint at how COVID-19 harms the brain
18. A family physician’s COVID story
19. A COVID-19 vaccine: 5 things that could go wrong
20. Studies detail conjunctivitis in kids, adults with COVID-19
21. A perspective on potential antibody-dependent enhancement of SARS-CoV-2
22. COVID-19 survivors suffer long term heart conditions
23. As evidence builds that COVID-19 can damage the heart, doctors are racing to understand it
24. Novel coronavirus survives 28 days on glass, currency, Australian researchers find
25. CDC Expands Covid Risk Warning to Include Overweight People
• Nearly 72% of American adults are overweight (25 < BMI < 30) or obese (BMI ≥ 30)
26. CDC Says Virus Can Spread Indoors in Air Beyond Six Feet
27. Covid may cause sudden, permanent hearing loss – UK study
• 16 of 121 patients admitted to hospital with Covid reported hearing problems about two months after discharge.
28. Long Covid: what we know so far
29. Living with Covid19
30. Long Covid casts a lasting shadow over workers
31. Interferon deficiency can lead to severe COVID
32. 'Brain fog' can linger with long-haul COVID-19, study says
33. New clues to the biology of long COVID are starting to emerge
34. Risk Factors for Covid-19
35. Kidney damage can result from coronavirus infection
• Kidney fibrosis, or scarring, is a serious long-term consequence that can occur virtually after any injury to the kidney and correlates with kidney function. Our work shows kidney scarring in COVID-19 patients, which provides an explanation why the virus might cause kidney functional decline as demonstrated in other studies
36. Kidney Outcomes in Long COVID
37. How Long Covid Exhausts the Body 
38. Multimodal Molecular Imaging Reveals Tissue-Based T Cell Activation and Viral RNA Persistence for Up to 2 Years Following COVID-19
39. Study details immune cells vital to success of vaccines against coronavirus
40. Study identifies shared molecular mechanisms across SARS-CoV-2 variants that allow virus to thrive despite vaccination
• Similar to treatment regimens for HIV, we believe the future approach to managing pandemics will require a drug combination cocktail.
• Here, this could include a combination of vaccines and antiviral innovations to target the virus. Specifically, combination therapy approaches to target the adaptive immune response (e.g., vaccines, antibody treatments) and another inhibiting viral innate immune antagonist proteins (e.g., Orf6 and Orf9b) or activating the innate immune response, could be the most effective. Perhaps with this approach, we may be able to get ahead of viruses before they reach pandemic levels.
41. Impact of SARS-CoV-2 ORF6 and its variant polymorphisms on host responses and viral pathogenesis
• Impact of SARS-CoV-2 ORF6 and its variant polymorphisms on host responses and viral pathogenesis