Post-COVID syndrome: Heart, lungs and clotting

Now that we’re a year into the COVID-19 pandemic, we’re beginning to have an understanding of the lasting long-term effects the disease has.

Prolonged symptoms have colloquially been called long COVID, and those who are experiencing these symptoms are colloquially called long haulers.

Long COVID may also be referred to as long-term COVID, chronic COVID, or post COVID syndrome, as no official term has been established yet.It’s important to remember research on COVID-19 and its prolonged effects on the body have only just begun, and to date we cannot draw any firm conclusions on the long-term effects of the disease.

The studies we highlight here represent only initial findings, and should be taken with a grain of salt.To begin, we are discovering that long-term complications from COVID-19 are fairly common.

In October of 2020, the United Kingdom’s National Institute for Health Research announced 10 to 20% of people who contracted COVID-19 continue to have symptoms or complications of COVID-19 one month after diagnosis.

One study in Italy suggested 87% of patients infected with COVID-19 continued to have persistent symptoms 60 days after their initial symptoms began.With the rising number of people experiencing long-term COVID-19 symptoms, the British National Institute for Health and Care Excellence, also called NICE, has categorized three unique stages of COVID-19 recovery.

The acute COVID-19 stage is the period of recovery within 4 weeks after diagnosis. The ongoing COVID-19 stage lasts 4 to 12 weeks after diagnosis, and the long COVID stage lasts over 12 weeks after diagnosis.

Fatigue is the most common symptom that appears to continue to persist after COVID-19 infection. A study in Ireland found over half of all patients continued to have persistent symptoms of fatigue 10 weeks after initial diagnosis, regardless of how severe their initial symptoms were.Cardiopulmonary issues such as shortness of breath, cough, and chest pain are also common.

A study in the United Kingdom found 60% of patients admitted to general medicine floors and 72% of intensive care patients had continuing shortness of breath 4 to 8 weeks after hospital discharge.

Similarly a Chinese study found over 50% of patients performed worse on spirometry pulmonary function tests 30 days after discharge from the hospital.

A German group used an MRI on a number of COVID-19 patients and found 78% of them had some sort of cardiac issue potentially caused by the disease around 2 to 3 months after diagnosis, with 60% of patients showing myocardial inflammation.Common neurological issues 3 months after diagnosis appear to be headaches, sensory loss including vision, hearing, taste, smell, and numbness, mobility challenges, memory loss, tremors, and cognitive impairment.It’s not clear if these symptoms are a continuation of the initial COVID-19 infection, or if they are related to an entirely new, yet separate, post-COVID-19 syndrome that we have only begun to uncover.

There are, however, a few hypotheses that have been proposed which could be contributing to the prolongation of COVID-19 symptoms.

Some people’s immune systems may respond to COVID-19 more strongly than others. Weaker immune responses to COVID-19 might lead to symptoms lasting several months instead of several weeks.

Weak immune response can be caused by advanced age, pre-existing health conditions that impact the immune system such as HIV, or possibly immunomodulating drugs such as steroids.On the other hand, some people’s immune response may be too strong.

Their immune systems may become too aggressive in trying to fight COVID-19, and as a result may cause cellular damage to other organs, leading to acute respiratory distress syndrome and systemic inflammatory response syndrome.

There has been some evidence that severe cases of COVID-19 have been in part caused by a sudden and massive release of cytokines, called a cytokine storm, leading to significant tissue inflammation and organ damage.

It’s for this reason that COVID-19 treatments for severe cases focus on immunosuppressive drugs such as glucocorticoids and anti-inflammatories.Reinfection with COVID-19 may also explain persistent symptoms of the disease.Overall, it is unclear why so many people continue to experience COVID-19 symptoms beyond the acute phase of the illness, and we may not have a clear understanding of this for a few years.While the cause of these continuing COVID-19 symptoms remains a mystery, and there are no COVID-19 specific treatment recommendations after acute infection, healthcare providers can focus their attention on treating the symptoms patients experience.Treating chronic fatigue is difficult.

Healthcare providers should try to identify anything that may be causing fatigue, such as disrupted sleep caused by anxiety, depression, or pain.

Patients should also be encouraged to remain physically active as much as possible, both to keep patients awake during the day, and improve sleep at night.

The United Kingdom National Health Service has created an easy to remember mnemonic patients can use to help cope with fatigue called the “four-P” method: planning, pacing, prioritizing, and positioning.

Patients should plan their day around times of day when they have the most energy, pace themselves while doing tasks, deprioritize tasks that are less important to do in their daily lives, and position items and activities to be easy to reach and use, such as using a shower seat and shower handle when freshening up.For patients who continue to experience cardiopulmonary symptoms such as shortness of breath, cough, and chest pain, healthcare providers should run diagnostic tests to look for possible causes.

For shortness of breath, patients should be given breathing exercises to increase pulmonary function, and given supplemental oxygen if they consistently are unable to maintain adequate peripheral oxygen saturation.

Patients experiencing persistent non-productive cough should consider over-the-counter cough suppressants. Patients with chest pain caused by costochondritis may benefit from NSAIDs, or inhaled bronchodilators if bronchospasm is the cause of discomfort.In summary, there is growing evidence that patients infected with COVID-19 will likely have prolonged symptoms from the disease months after their original diagnosis.