Long-Term Effects of COVID-19

If the threat of a weeks’ long illness isn’t quite enough to motivate you to take important precautions against COVID-19—including masking, distancing, washing hands, and socializing outdoors and only for short periods of time—perhaps the threat of a potentially years’ long illness is.

Scientific organizations all over the world are beginning to study the long-term effects of COVID-19. The data is still spotty and confusing. Not nearly enough work has been done to draw major conclusions, but a few trends are emerging. Here’s the latest:

The disease itself lasts a long time. A study published by the CDC says that even among youngest and healthiest patients, ages 18 – 34, a quarter said that they had not regained their health after 2 – 3 weeks. This recovery time is significantly longer than those for many other diseases we are familiar with, including severe colds and the flu, which typically last a week or two at most. For this reason, the line between people who have COVID-19 and the yet poorly defined post-viral syndrome is still unclear.

Ongoing symptoms are surprisingly common. Beyond self-identified patients joining online support groups for “longhaulers,” as they are known, in the thousands, researchers and even local primary care physicians are noticing instances of ongoing symptoms. One study estimated that 10 percent of patients experienced prolonged illness.

Initially, doctors believed COVID-19 was primarily a respiratory illness. Now it is clear that the virus and its aftershocks go beyond the lungs. The disease affects the heart and other organs. The CDC is working to understand the COVID-heart relationship. They are finding COVID patients with inflammation and damage to the heart muscle itself, known as myocarditis, and/or inflammation of the covering of the heart, known as pericarditis. Heart damage like this might also explain some frequently reported long-term symptoms like shortness of breath, chest pain, and heart palpitations. Fatigue, cough, and impaired memory and concentration are also commonly reported long-term symptoms.

While it’s most common for heart damage to affect older people with preexisting conditions or those who had a severe case of COVID, long-term illness can affect even those who had mild illness, including those who were not hospitalized. The CDC reports that the heart damage, in particular, may be present in younger people with milder symptoms, as well, but they would be difficult to diagnose without specialized imaging tests.

An additional example of the full-body nature of COVID relates to blood clots. They appear to be part of an immune response cascade and are difficult to treat, even with blood thinners. The clots cause minor issues, like skin rashes, and major ones—like deep vein thrombosis, pulmonary embolism, and stroke—especially among older male patients with risk factors. Clots in the lungs worsen the respiratory issues. Because the clotting issues seem to begin 8 – 9 days after symptoms first arise, physicians think they relate to an immune response to the disease.

Clearly more study is needed to help determine the lasting effects of COVID-19. What is certain so far is that the effects persist for many patients. This creates an even greater incentive to protect yourself and your family from contracting COVID-19. Wear a mask, distance from others, wash your hands, and socialize only outdoors and for short amounts of time.

Marie George, MD, FIDSA, of SVMC Infectious Disease, is an infectious disease specialist.