What We Know (And Don’t Know) About Long COVID

By Devin Partida, Editor-in-Chief, ReHack.com
Twitter: @rehackmagazine

Most people who get sick with the COVID-19 virus get better after a week or two. However, more severe cases require hospitalization and linger for much longer. Others notice their symptoms go away for a while and reappear after one or more months.

This phenomenon is now commonly referred to as long COVID — and while we have some information, there’s still so much we don’t know. Every case seems to be different, with a handful of possible overlapping symptoms like long-term fatigue and mental health issues. In addition to medical consequences, patients may experience financial hardship and other social effects of long COVID. Therefore, doctors must highly individualize every treatment plan, targeting the specific complaints and needs of each patient.

Types of Long COVID

Patients experiencing long COVID symptoms tend to fall into one of three categories. The first never got over their initial bout of the virus and continue to experience fatigue and other complications. The next group had temporary relief, only to have a reoccurrence of symptoms a month or more later. The last cohort were those who spent an extended amount of time in the ICU and are experiencing related long-term mental and physical symptoms.

Effects on Physical Health

The initial virus — as well as long COVID — can affect nearly every one of a patient’s organ systems, decreasing their ability to perform daily living and work tasks as capably as before. These are some common ones to watch out for.

1. Lungs
The road to recovery is long and arduous for those who suffered lung damage from COVID-19. These patients will need months to years of breathing exercises, treatments and therapy. They’ve likely suffered virus-specific strains of pneumonia or bronchitis — and some experienced acute respiratory distress syndrome.

Scarring builds up in the lungs due to these and other conditions, making it difficult for patients to breathe and keep up with mildly strenuous activity. Patients can recover, but scientists are still unaware of all the long-term repercussions. Researchers in the UK plan to analyze the potential genetic changes of lung cells following infection and damage.

One study has been examining patients with long COVID still experiencing breathing difficulty. They’ve noticed CT results typically come back normal, suggesting no physical problem. However, new testing with xenon MRI shows lowered gas transfer across participants. A reduced ability to deliver oxygen into the bloodstream might be a potential reason for long COVID breathing difficulties, though their research still needs more time.

2. Heart
Long COVID effects on heart health seem to directly correlate with the severity of the reaction to the initial strain of the virus. Those who had an asymptomatic to mild experience have fewer long-term heart complications than those who needed hospitalization for the condition.

COVID-19 typically affects the heart muscle through secondary effects rather than attacking it directly. One primary cause of myocardial injury and a predictor of future cardiovascular issues is cytokine storms brought on by an inflammatory response to the virus. Preexisting conditions like heart disease and obesity further exacerbate the initial damage.

People who contract COVID-19 are at a higher risk of developing a range of conditions, including dysrhythmias, pericarditis, myocarditis and heart failure. There’s enough evidence to suggest considering past COVID-19 exposure as a risk factor for cardiovascular disease.

3. Brain
Some of the most common complaints of patients with COVID-19 are fatigue, brain fog, insomnia, headaches and decreased concentration. These symptoms are among the most prevalent in self-reported long COVID patients as well.

One longitudinal study studied patients’ symptoms a few months after the virus and again three to six months later. They found 80% were experiencing neurological symptoms that affected their quality of life. At the follow-up, one-third had complete relief, but a majority of the other two-thirds were seeing some improvements.

Doctors still aren’t sure why the virus has such long-term neurological effects, but longitudinal studies such as this one will continue to monitor patient outcomes to learn all they can.

In recent news, researchers have noticed a change in the brain’s white matter and spinal fluid in patients who experienced COVID-19. At first, they were concerned that virus replication was causing damage.

However, autopsy reports show no remains of the virus in cerebral spinal fluid or brain tissue. Some possible causes for continued neurological symptoms are damaged blood vessels, low oxygenation or inflammatory damage where the immune system causes changes to the brain and spinal cord.

Effects on Mental Health

No one has come out of this pandemic mentally unscathed, but those who experienced the initial virus and self-report long COVID symptoms may be the most at-risk for mental health issues.

Patients with more severe cases of the virus and long-term stays in the hospital or ICU have a likelihood of experiencing post-intensive care syndrome. The extreme isolation of COVID-19 patients exacerbates this multi-faceted phenomenon. In the long-term, there’s a tendency toward hallucinations and feelings of paranoia that persist in the form of PTSD.

Patients who experience long COVID symptoms affecting their quality of life are also at high risk for anxiety and depression. The inability to participate in activities they once enjoyed can lead to social isolation.

Also, these extended symptoms can lead to job loss, increasing worries about financial stability and personal capability. Even those who avoided contracting the virus altogether can suffer mental health issues due to job loss, social isolation and loss of loved ones.

The Biochemical Problem

Despite all the self-reported symptoms and worsening physical and mental health conditions, there seems to be very little biochemical evidence of long COVID. A recent study examined cohorts of patients who had the initial virus and were experiencing long COVID symptoms and subjects who had never contracted it. They found almost no significant differences in the extensive medical exams conducted on both groups.

However, other studies have found multiple biochemical signs of immune response activity. One team studied data from patients with various levels of neuropathic long COVID symptoms, determining the possible cause of infection-triggered immune dysregulation.

Another study found patients with long COVID had continually high activated innate immune cells and exceptionally high type I IFN and type III IFN. These elevated inflammatory reactions can continue up to eight months after the initial infection.

Taking Preventative Measures Against Long COVID

While the vaccine can help lower the risk of long COVID by 15% and reduce the likelihood of lung disorders and blood clots by 49% and 56%, it still isn’t a perfect preventative measure. The self-reported symptoms of long COVID also don’t seem drastically different between those who had mild forms or asymptomatic reactions to the virus from those who had severe bouts.

Overall, the only way for patients to ensure they don’t experience long COVID is to avoid the virus in the first place. Using preventative measures like social distancing where possible, wearing a mask in public places and washing hands will be the most effective.