Inside the life of a COVID long-hauler who “fought like an animal” to make it out of the hospital after 299 days

OCTOBER 27, 2021 / 10:44 AM / CBS NEWS

The past year has seen some dramatic swings in America’s fight against COVID-19. But while the number of COVID cases are trending downward, some long-haulers are having a hard time recovering from the disease. 

Alex Castro of Sandy, Oregon, used to be able to swim, cook and hike, but now it takes every breath he has and baby steps, to just walk across his living room. 

At 44 years old, Castro is just a shell of the man he used to be. COVID caused him heart failure and ravaged his kidneys and lungs. 

He got infected with the coronavirus before there was a vaccine. His wife told CBS News’ David Begnaud they didn’t take the virus seriously. The couple thought it was just like the regular flu.  

Castro spent 299 days at Providence Portland Medical Center in Oregon — 108 of those days were spent on ECMO, which is a heart and lung bypass machine.   

Castro’s oldest son AJ said Castro would be walked with the ECMO “maybe two, three days a week” as blood was being pumped out of his body and back into it, doing the work of his heart and lungs as he walked. 

“The health care workers and the nurses and the doctors all in the ICU, they were a godsend. They literally saved my dad’s life,” AJ said. 

ICU nurse Levi Cole said Castro “fought like an animal” to make it out of the hospital and on the day the hospital took Castro off the ECMO machine, Cole crawled into bed with him. 

“I gave him a big hug and we were both laughing. I had tears in my eyes with pure joy. We all dragged him across the finish line, but he did it himself,” Cole said.  

Castro cannot remember half of the time he was in hospital, but he did remember Cole’s hug. He got emotional as he listened to what Cole told Begnaud. 

AJ is his dad’s primary caretaker during the day. He described to Begnaud what his life is like now. 

“I just turned up just the amount of oxygen that he’s getting through his nose,” AJ said. Castro is on oxygen around the clock and his doctor said he will be on it for the rest of his life. 

“Even like going to the bathroom, like walking with a walker with me to the bathroom, he’ll do pretty good and then it’ll literally just hit him out of nowhere,” AJ said. “He’s just super tired and he’s out of breath and he’ll take a seat wherever he is just to catch his breath again.” 

One walk to the bathroom and about 10 simple arm exercises during occupational therapy really tired Castro out.  

After a short nap, Castro went to physical therapy where he did some knee bends and breathing exercises.  

Everyone is constantly watching Castro’s oxygen saturation level, which dropped to 73 when Castro did some knee bends—95 to 100 are normal levels. 

Despite it all, Castro’s spirit seemed strong. He said yes to everything they asked him to do.  

“Just standing on his feet is probably a better exercise than walking for him,” one occupational therapist said. 

Castro standing on his own is a success in the eyes of his medical team. Castro once worked three jobs to support his family. He is now dependent on all of them. His wife and oldest daughter Mari now make most of the money. 

Mari manages the local Burger King where Castro used to work. He said he loved to work and wants to do it again but it is unclear if he ever will ever be able to. 

He’s been out of the hospital for 20 days and there are notable improvements daily. Castro has since received the COVID vaccine. Doctors believe he will likely need a lung transplant.  

The hospital didn’t disclose to CBS News what Castro’s bill will be after spending 299 days there. But they did say that whatever Castro’s insurance won’t pay, the hospital will take care of the rest.   His wife created a GoFundMe page to help pay for any additional expenses that might incur during his long recovery and to make up for Alex’s lost wages.

Short-term and Long-term Rates of Post-acute Sequelae of SARS-CoV-2 Infection: A Systematic Review

Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 InfectionA Systematic Review

Authors:Destin Groff, BA1Ashley Sun, BA1Anna E. Ssentongo, DrPH, MPH1,2et al

Key Points

Question  What are the short-term and long-term postacute sequelae of COVID-19 (PASC) infection?

Findings  In this systematic review of 57 studies comprising more than 250 000 survivors of COVID-19, most sequelae included mental health, pulmonary, and neurologic disorders, which were prevalent longer than 6 months after SARS-CoV-2 exposure.

Meaning  These findings suggest that long-term PASC must be factored into existing health care systems, especially in low- and middle-income countries.Abstract

Importance  Short-term and long-term persistent postacute sequelae of COVID-19 (PASC) have not been systematically evaluated. The incidence and evolution of PASC are dependent on time from infection, organ systems and tissue affected, vaccination status, variant of the virus, and geographic region.

Objective  To estimate organ system–specific frequency and evolution of PASC.

Evidence Review  PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral databases were searched from December 2019 through March 2021. A total of 2100 studies were identified from databases and through cited references. Studies providing data on PASC in children and adults were included. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for abstracting data were followed and performed independently by 2 reviewers. Quality was assessed using the Newcastle-Ottawa Scale for cohort studies. The main outcome was frequency of PASC diagnosed by (1) laboratory investigation, (2) radiologic pathology, and (3) clinical signs and symptoms. PASC were classified by organ system, ie, neurologic; cardiovascular; respiratory; digestive; dermatologic; and ear, nose, and throat as well as mental health, constitutional symptoms, and functional mobility.

Findings  From a total of 2100 studies identified, 57 studies with 250 351 survivors of COVID-19 met inclusion criteria. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC was 54.0% (45.0%-69.0%; 13 studies) at 1 month (short-term), 55.0% (34.8%-65.5%; 38 studies) at 2 to 5 months (intermediate-term), and 54.0% (31.0%-67.0%; 9 studies) at 6 or more months (long-term). Most prevalent pulmonary sequelae, neurologic disorders, mental health disorders, functional mobility impairments, and general and constitutional symptoms were chest imaging abnormality (median [IQR], 62.2% [45.8%-76.5%]), difficulty concentrating (median [IQR], 23.8% [20.4%-25.9%]), generalized anxiety disorder (median [IQR], 29.6% [14.0%-44.0%]), general functional impairments (median [IQR], 44.0% [23.4%-62.6%]), and fatigue or muscle weakness (median [IQR], 37.5% [25.4%-54.5%]), respectively. Other frequently reported symptoms included cardiac, dermatologic, digestive, and ear, nose, and throat disorders.

Conclusions and Relevance  In this systematic review, more than half of COVID-19 survivors experienced PASC 6 months after recovery. The most common PASC involved functional mobility impairments, pulmonary abnormalities, and mental health disorders. These long-term PASC effects occur on a scale that could overwhelm existing health care capacity, particularly in low- and middle-income countries.Introduction

The global COVID-19 pandemic that began in late 2019 has caused more than 187 million infections and 4 million deaths as of July 10, 2021.1 Survivors experience long-lasting medical, psychological, and economic consequences, further increasing the disability-adjusted life years lost.2 Despite current vaccination efforts,3 the health consequences of COVID-19 remain urgent, with long-term multi-organ system impacts that are yet to be elucidated. With a variety of clinical presentations and degrees of severity in patients,4 there is a dire need to better understand the lasting and emergent effects of COVID-19.

Frequently reported residual effects from SARS-CoV-2 virus include fatigue, dyspnea, chest pain, persistent loss of taste and/or smell, cognitive changes, arthralgias, and decreased quality of life. Many of these symptoms may result from widespread neuropathological events occurring in major white matter bundle tracts, cortical gray matter, and subcortical gray matter.5 In a study conducted in the United States by Chopra et al,6 33% of patients had persistent symptoms at a 60-day follow-up after COVID-19 hospitalization. Similar trends have been observed in Europe.7 Furthermore, persistent symptoms (>6 weeks) have been reported in 19% of fully vaccinated individuals.8 However, as the pandemic emerged in 2019, most studies have been limited in the duration of observation, and there has yet to be a consolidation of these trends to portray an overarching evolution of these symptoms from short-term to long-term sequelae following COVID-19 infection.

To our knowledge, short-term and long-term sequelae of COVID-19 have not been systematically evaluated. In this paper, we synthesized the existing literature to estimate the overall and organ system–specific frequency of postacute sequelae of COVID-19 (PASC). We sorted studies into groups that focused on (1) postacute symptoms at 1-month after acute COVID-19 (short term), (2) persisting and new clinical manifestations between 2 and 5 months after infection (intermediate term), and (3) clinical manifestations that were present at least 6 months after COVID-19 (long term). These categorizations were based on literature reports proposing a framework that COVID-19 infection progresses from an acute infection lasting approximately 2 weeks into a postacute hyperinflammatory illness lasting approximately 4 weeks, until ultimately entering late sequelae.9,10 As we better understand the disease burden of PASC in COVID-19 survivors, we can develop precise treatment plans to improve clinical care in patients with COVID-19 who are at greatest risk of PASC and establish integrated, evidence-based clinical management for those affected.MethodsInformation Source and Search Strategy

The present study has been prospectively registered at PROSPERO (CRD42021239708) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.11 Databases were searched from December 2019 through March 2021, including PubMed (MEDLINE), Scopus, the World Health Organization Global Literature on Coronavirus Disease, and CoronaCentral. We manually searched the reference lists of included studies and other relevant documents to find additional studies. There were no limitations on country of publication or language. Non–English language articles were translated using the language translation services at the Penn State University Library. Predefined search terms included multiple combinations of the following: (COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV OR SARS nCoV2) AND (post-acute sequelae of SARS-COV-2 OR long COVID-19 OR post-COVID-19 syndrome). Studies obtained from the search were transferred into EndNote version 9.3.2 (Clarivate), and duplicates were removed.Eligibility and Inclusion Criteria

Studies were selected according to the following criteria: participants, adults and children with a previous COVID-19 infection; exposure, COVID-19; condition or outcome of interest, frequency of PASC; study design and context, randomized clinical trials, prospective and retrospective cohort studies, case series with at least 10 patients, and case-control studies. Inclusion criteria included the following: previous COVID-19 diagnosis and reported PASC frequencies.Data Extraction

Two investigators (D.G. and A.S.) screened titles and abstracts of all identified articles for eligibility. Full-text articles were screened from eligible studies. Disagreements were resolved by discussion with a third investigator (P.S.). The following information was extracted by 2 investigators (D.G. and A.S.) independently: year of publication, country and time frame of the study, sample size of survivors of COVID-19, number of participants with PASC, mean (SD) or median (IQR) age, percentage male, percentage hospitalized, outcome of interest, time zero (ie, from diagnosis of COVID-19 or hospital discharge), and measurement methods for outcome of interest.Study Quality Assessment

Two reviewers (D.G. and A.S.) independently assessed the quality of the included studies. The Newcastle-Ottawa Scale (NOS) was used for the quality assessment of the included studies.12 Based on the NOS criteria, we assigned a maximum of 4 stars for selection, 2 stars for comparability, and 3 stars for exposure and outcome assessment. Studies with fewer than 5 stars were considered low quality; 5 to 7 stars, moderate quality; and more than 7 stars, high quality.Definition of Short-term, Intermediate-term, and Long-term PASC

The primary outcome was the frequency of PASC, which was defined as the presence of at least 1 abnormality diagnosed by (1) laboratory investigation, (2) radiologic pathology, or (3) clinical signs and symptoms that was present at least 1 month after COVID-19 diagnosis or after discharge from the hospital. We defined short-term PASC as 1 month; intermediate-term, 2 to 5 months; and long-term, as 6 or more months after COVID-19 diagnosis or hospital discharge.Statistical Analysis

A narrative approach was used to describe the number of studies, proportion male, proportion hospitalized, median or mean age (by study), whether the study was conducted in low- and middle-income countries (median gross national income, ≤$12 535) or high-income countries (median gross national income, ≥$12 536). We did not conduct a meta-analysis due to high heterogeneity in the outcome of interest. We summarized PASC rates descriptively, reporting medians and IQRs. PASC frequencies were summarized as short term, intermediate term, or long term and by organ system. R package ggplot2 was used to display the boxplots.13 All statistical analyses were performed with R software version 3.6.2 (R Project for Statistical Computing).ResultsIdentified Studies

As shown in eFigure 1 in the Supplement, we identified a total of 2100 studies. After excluding the duplicates and studies that did not meet inclusion criteria after screening the title, abstract, or main text, a total of 57 studies were included, with 250 351 survivors of COVID-19 who were assessed for PASC at 30 days after acute COVID-19 infection and beyond. The mean (SD) age of survivors was 54.4 (8.9) years, 140 196 (56%) were male, and 197 777 (79%) were hospitalized during acute COVID-19. High-income countries contributed 45 studies (79%). Study-specific details are provided in the Table.6,7,1468Frequency of PASC

Displayed in Figure 1A is the distribution of studies by country and follow-up time from baseline. PASC frequencies were stratified and reported by 1 month (short-term),1426 2 to 5 months (intermediate-term),7,15,19,2747,4961,66,67 and 6 months (long-term)15,56,6267 from COVID-19 diagnosis or hospital discharge (Figure 1B). The median (IQR) proportion of COVID-19 survivors experiencing at least 1 PASC at 1 month was 54.0% (45.0%-69.0%; 13 studies); at 2-5 months, 55.0% (34.8%-65.5%; 38 studies); and at 6 or more months, 54.0% (31.0%- 67.0%; 9 studies). When stratified by World Bank income groups, median (IQR) PASC frequency was 54.6% (33.0%-68.3%; 45 studies) in high-income countries and 56.0% (43.5%-67.0%; 12 studies) for low- and middle-income countries (eFigure 2A in the Supplement). PASC rates were similar in studies with higher (≥60%) and lower (<60%) percentages of hospitalized patients (eFigure 2B in the Supplement). In addition, when stratified by study methodological score, the proportion of PASC were similar (eFigure 2C in the Supplement).Rates of Clinical Manifestations of PASC

A total of 38 clinical manifestations were assessed. We collapsed these clinical manifestations into categories of (1) organ systems, ie, neurologic, mental health, respiratory, cardiovascular, digestive, dermatologic, and ear, nose, and throat; (2) constitutional symptoms; and (3) functional mobility.Neurologic Symptoms

Various neurologic symptoms were reported (Figure 2A). These included headaches, memory deficits, difficulty concentrating, and cognitive impairment. Even though anosmia (loss of smell) and ageusia or dysgeusia (loss or distortion of taste) are often reported as part of ear nose and throat system, we chose to include them in the neurologic symptoms because they are a consequence of the effect of the virus on the cranial nerve 1 (olfactory nerve) for smell and cranial nerves VII (facial), IX (glossopharyngeal nerve), and X (vagal nerve) for taste. The most common neurocognitive symptoms were difficulty concentrating (4 studies; median [IQR], 23.8% [20.4%-25.9%]), memory deficits (4 studies; median [IQR], 18.6% [17.3%-22.9%]), cognitive impairment (7 studies; median [IQR], 17.1% [14.1%-30.5%]). Dysgeusia and anosmia were reported in 11% (18 studies; median [IQR], 11.2% [6.7%-18.9%]) and 13% (24 studies; median [IQR], 13.4% [7.9%-19.0%]) of the survivors, respectively. Overall, headache symptoms were reported in 8% (11 studies; median [IQR], 8.7% [1.9%-13.9%]) of COVID-19 survivors. However, disparities existed in headache symptoms by study, ranging from 0% in Bellan and colleagues58 to 18% in Zhao et al.49Mental Health Disorders

A variety of standardized instruments were used to assess mental health. These included the Patient Health Questionnaire (PHQ) 2 to screen for depression, the PHQ 9 to evaluate major depressive disorder, the General Anxiety Disorder 7 to assess generalized anxiety disorder, the Hospital Anxiety and Depression Scale to measure symptoms of anxiety and depression, and the PTSD Checklist of DSM-5 and the Impact of Events Scale to assess the presence and severity of posttraumatic stress disorder symptoms. The Pittsburgh Sleep Quality Index questionnaire was used to assess sleep quality and disturbances (Table). Depression or anxiety were reported in 9 studies, and the rates were consistent (Figure 2B). Approximately 1 in 3 COVID-19 survivors was diagnosed with generalized anxiety disorders (7 studies; median [IQR], 29.6% [14.0%-44.0%]), 1 in 4 with sleep disorders (10 studies; median [IQR], 27.0% [19.2%-30.3%]), 1 in 5 with depression (2 studies; median [IQR], 20.4% [19.2%-21.5%]), and 1 in 8 with posttraumatic stress disorder (9 studies; median [IQR], 13.3% [7.3%-25.1%]).Pulmonary Abnormalities

Pulmonary manifestations of PASC were assessed with pulmonary function tests (such as spirometry, diffusing capacity for carbon monoxide, and respiratory strength) and imaging modalities including chest radiograph, computed tomography scans, and magnetic resonance imaging. Dyspnea was mainly assessed with the Modified Medical Research Council Dyspnea Scale. Dyspnea was reported in 38 studies (median [IQR], 29.7%; [14.2%-37.0%]), and cough was reported in 26 studies (median [IQR], 13.1% [5.3%-22.6%]). Increased oxygen requirement was reported in nearly two-thirds of COVID-19 survivors (3 studies; median [IQR], 65.0% [39.3%-76.1%]). Other frequently reported sequelae included pulmonary diffusion abnormalities (4 studies; median [IQR], 30.3% [22.1%-38.5%]), ground glass opacification (7 studies; median [IQR], 23.1% [19.7%-43.0%]), restrictive patterns on spirometry (3 studies; median [IQR], 10.0% [6.1%-24.1%]), and lung fibrosis (5 studies; median [IQR], 7.0% [2.5%-17.7%]) (Figure 2C). Overall, chest imaging abnormalities were present in a median (IQR) of 62.2% (45.8%-76.5%) of survivors (4 studies).Functional Mobility Impairment

Three functional mobility impairments were assessed in this systematic review. They were impairment in general functioning (9 studies; median [IQR], 44.0% [23.4%-62.6%]), mobility decline (6 studies; median [IQR], 20.2% [14.9%-30.6%]), and reduced exercise tolerance (2 studies; median [IQR], 14.7% [10.6%-18.8%]) (Figure 2D).General and Constitutional Symptoms

Due to their subjective nature and self-reportage of symptoms (Table), general well-being and constitutional symptoms varied widely between studies. In this category, we noted 7 persisting symptoms among survivors of COVID-19 (Figure 2E). These included fatigue or muscle weakness, joint pain, muscle pain, flu-like symptoms, fever, general pain, and weight loss. Most commonly reported symptoms were joint pain (11 studies; median [IQR], 10.0% [6.1%-19.0%]), fatigue or muscle weakness (30 studies; median [IQR], 37.5% [25.4%-54.5%]), and flu-like symptoms (6 studies; median [IQR], 10.3% [4.5%-19.2%]). General pain (8 studies; median [IQR], 32.4% [22.3%-38.4%]), persistent fever (16 studies; median [IQR], 0.9% [0%-3.1%]), and muscle pain (13 studies; median [IQR], 12.7% [5.6%-21.3%]) were also frequently reported among survivors. Fever rates decreased as a function of time: by 60 days of follow-up, persistent fever rates reduced from 3% to 0% in studies by Carvalho-Schneider and colleagues.14 Except for Glück et al15 at a 1-month follow-up, the reported fever rates were less than 20%. The high fever rates reported in Glück et al15 can potentially be explained by unusually high anti–SARS-CoV-2 immunoglobulin G levels in their patient population of frontline health care workers, which was significantly associated with the severity of disease as reported by the authors. Fever rates for the subsequent follow-ups at 3, 5, and more than 6 months after diagnosis were all at 0% in the Glück study.15 Carvalho-Schneider et al14 reported a slight increase in unintentional weight loss (defined as a loss of more than or equal to 5% of body weight at baseline) from 9% to 12% at day 30 to day 60 of follow-up, respectively.Cardiovascular Disorders

Chest pain and palpitations were common cardiovascular manifestations in survivors of COVID-19 (Figure 3A). The median (IQR) frequency of chest pain and palpitation were 13.3% (8.8%-17.8%; 14 studies) and 9.3% (6.0%-10.8%; 5 studies), respectively. Other reported diagnoses, such as myocardial infarction and heart failure, were not as frequently reported in the literature.Gastrointestinal, Dermatologic, and Ear, Nose, and Throat Disorders

The overall rate of gastrointestinal disorders was 6% and included abdominal pain, decreased appetite, diarrhea, and vomiting (Figure 3B). Hair loss (4 studies; median [IQR], 20.8% [17.4%-23.4%]) and skin rash (3 studies; median [IQR], 2.8% [1.7%-5.6%]) constituted dermatologic disorders (Figure 3C). Finally, sore throat was a concern among 3% of COVID-19 survivors (6 studies; median [IQR], 3.3%, [2.9%-4.0%]) (Figure 3D).Discussion

In this systematic review, we evaluated the temporal progression of clinical abnormalities experienced by patients who recovered from an infection with SARS-CoV-2, starting with a mean of 30 days post–acute illness and beyond. The results suggest that rates of PASC are indeed common; 5 of 10 survivors of COVID-19 developed a broad array of pulmonary and extrapulmonary clinical manifestations, including nervous system and neurocognitive disorders, mental health disorders, cardiovascular disorders, gastrointestinal disorders, skin disorders, and signs and symptoms related to poor general well-being, including malaise, fatigue, musculoskeletal pain, and reduced quality of life. Short- and long-term rates of PASC were similar, highlighting the potential for pathological sequelae long after exposure to the SARS-CoV-2 virus.

The mechanisms underpinning the postacute and chronic manifestations of COVID-19 are not entirely understood. Nevertheless, these mechanisms can be grouped into the direct effect of the viral infection and the indirect effect on mental health due to posttraumatic stress, social isolation, and economic factors, such as loss of employment.69,70 Direct viral effects can be explained by several hypotheses, including persistent viremia due to immune fatigue and paresis,71 relapse or reinfection,72 hyperinflammatory immune response, cytokine- and hypoxia-induced injury,73 and autoimmunity74 as well as neurotropism using a transsynaptic spread mechanism,5 resulting in hypoxic- or hemorrhagic-driven neuronal apoptosis.75 Herein, widespread acute injury to cortical/subcortical and white matter fiber bundles may affect brain function and impede distal brain connectivity, respectively, manifesting in common symptoms, such as those identified in this review. These symptoms may include headache (ie, encephalopathy), cognitive deficits (ie, widespread neuropathological events), and smell and taste disorders (ie, acute injury to olfactory bulb).

At the forefront of clinical care for acute COVID-19 are multiple guidelines, recommendations, and best practices that have been disseminated and prioritized for prevention and management. However, no clear guidelines are currently available for postinfectious care or recovery, and there is a notable dearth of information on and strategies about how to assess and manage patients following their acute COVID-19 episode. This is in part due to a high degree of between-study heterogeneity in defining PASC. Indeed, this heterogeneity was evident the present study. We noted varying definitions of time zero, which included symptom onset, COVID-19 diagnosis, hospital admission, or hospital discharge. Furthermore, variations in the specific outcomes of interest and the outcome measurement tools existed, hindering us from pooling the data in a formal meta-analytic model. SARS-CoV-2 variant types and breakthrough infectivity rates among fully vaccinated individuals will likely modify the manifestations and incidence of PASC further.8

Our results indicate that clinical management of PASC will require a whole-patient perspective, including management tools like virtual rehabilitation platforms and chronic care for post–acute COVID-19 symptoms in conjunction with the management of preexisting76,77 or new comorbidities.78 One-stop multidisciplinary clinics are therefore recommended to avoid multiple referrals to different specialists and encourage comprehensive care. Based on our work and the recent systematic reviews by Nasserie and colleagues,79 these specialists should include respiratory physicians, cardiologists, neurologists, general physicians (from primary care or rehabilitation medicine), neuropsychologists or neuropsychiatrists, physiotherapists, occupational therapists, speech and language therapists, and dieticians.80

The clinical and public health implications of our findings are 2-fold. In addition to the life lost from acute COVID-19 illness, many individuals experience disability due to PASC, greatly exacerbating the disease burden.81 Such a burden is more than enough to overwhelm existing health care system capacities, particularly in resource-constrained settings. Second, predictive models of postacute and chronic COVID-19 sequalae using clinical and laboratory data obtained during the acute phase of COVID-19 are critically needed to inform effective strategies to mitigate or prevent PASC.Limitations

This study has limitations. First, there is no consensus on the definition of postacute COVID-19. PASC currently has many definitions, including (1) the presence of symptoms beyond 3 weeks from the initial onset of symptoms78; (2) symptoms that develop during or following an infection consistent with COVID-19, continue for more than 4 weeks, and are not explained by an alternative diagnosis80; and (3) signs and symptoms at 12 weeks after infection and beyond. This led to considerable heterogeneity in PASC definitions among the articles synthesized in this systematic review. Therefore, it was difficult to precisely compare the percentages of patients with abnormalities on follow-up visits between studies and to obtain a standardized understanding of patients’ long-term symptoms from COVID-19. Second, we were not able to stratify the risk of PASC by severity of initial illness (for example, community-based vs hospitalized vs required care in an intensive care unit vs required invasive life-sustaining measures) or by preexisting comorbidities, patient age, or other factors that may affect an individual patient’s risk of PASC. Third, the lack of standard reporting also created differences in how PASC sequelae were analyzed. Fourth, many studies investigated the prevalence of specific outcomes instead of reporting all symptoms present at various points post-COVID-19 infection. This limits the ability for a comprehensive, generalizable analysis of the long-term effects of COVID-19. Fifth, many studies included in this analysis were obtained from manual searching through references. This might suggest a need for improved database search terms for subsequent studies.Conclusions

These findings suggest that PASC is a multisystem disease, with high prevalence in both short-term and long-term periods. These long-term PASC effects occurred on a scale sufficient to overwhelm existing health care capacity, particularly in resource-constrained settings. Moving forward, clinicians may consider having a low threshold for PASC and must work toward a holistic clinical framework to deal with direct and indirect effects of SARS-CoV-2 sequalae.

More Than Half Of Covid-19 Patients Suffer From Long Haul Symptoms, Study Finds – Forbes

OCTOBER 13, 2021 

Topline

A study found that more than half of people who had Covid-19 experienced at least one long-haul symptom six months or more after their initial diagnosis, a rate that has the potential to “overwhelm existing health care capacity,” at a time when care systems are already bursting at the seams. 

Key Facts

Published Wednesday in the Journal of the American Medical Association, the statistical survey included results from 57 studies that encompassed over 250,000 people who had survived Covid-19 and found that 54% suffered at least one symptom one month after their diagnosis, 55% did between two and five months after, and 54% did at six months or more. 

The most common symptoms were wide ranging and included chest imaging abnormalities, difficulty concentrating, generalized anxiety disorder, functional impairments and fatigue or muscle weakness. 

Issues with the heart, digestive system, and ear, nose, and throat were also frequently reported.

Big Number

44,615,612. That’s how many coronavirus cases the United States has seen since the start of the pandemic as of press time, according to Johns Hopkins University.

Tangent

Being vaccinated may not have an effect on someone’s risk of developing long Covid. According to a New England Journal of Medicine study quoted in the JAMA survey, 19% of people who have been fully vaccinated still experienced symptoms six weeks after initial infection.

Key Background

Long-hauler syndrome can be one of the most debilitating effects for people who survive Covid-19 infection. The Centers for Disease Control and Prevention define long Covid as “a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected.” People who did not experience symptoms from their Covid-19 bout can still experience post-infection symptoms, according to the CDC. A study published by the group last month found that one-third of people were dealing with symptoms two months after being infected. The organization said that more research is needed to understand who gets these symptoms and why they last so long. 

Further Reading

Long Covid Affecting One Third Of People After Covid-19 Coronavirus Infection, CDC MMWR Study Finds (Forbes) 

ADA Protections And Long-Haul Covid: What You Should Know (Forbes)

Six Months As A Covid Long-Hauler: Unending Symptoms, Many Unknowns (Forbes)

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Over half of those diagnosed will develop ‘long COVID’

Authors:1by John Anderer OCTOBER 14, 202

A disturbingly high percentage of people who recover from symptomatic COVID-19 continue to struggle with lingering “long COVID” symptoms for months after the fact. It’s been a worrying trend since the beginning of the coronavirus pandemic. Now, researchers from Penn State report that over half of the 236 million people with COVID-19 worldwide since the pandemic began since will indeed experience long COVID symptoms.

Study authors warn that governments, doctors, and health care organizations should all prepare themselves for an ever-increasing number of long COVID patients in need of treatment for a variety of physical or psychological symptoms. According to the new report, both adults and children may experience several potential health issues for as long as six months post-recovery.

The team analyzed a total of 57 prior studies focusing on COVID-19 patients during this project, encompassing 250,351 unvaccinated adults and children with COVID-19 between December 2019 and March 2021. Among that entire group, 79 percent ended up needing hospitalization for their infection. Most of those hospital patients lived in high-income nations with an average age of 54 years-old. Researchers assessed each person’s post-COVID health on three occasions: one month after recovery, two to five months afterward, and six or more months later.

Overall, one in two patients dealt with long COVID symptoms. In the vast majority of cases, these symptoms interfered with the individual’s mobility, organ function, or well-being. Most long COVID symptoms persisted for at least six months.

More specifically, over half of all patients reported experiencing weight loss, fatigue, fever, or pain. Another one in five lost mobility and close to one in four had a harder time concentrating after COVID-19. Troublingly, doctors diagnosed close to one in three patients with generalized anxiety disorder after recovering.

Long COVID can continue to affect the lungs and heart

COVID-19 is notorious for attacking the lungs. Six in 10 patients displayed chest imaging abnormalities while over a quarter reported difficulty breathing. As far as heart issues, the most common long COVID complaints were increased chest pain and more frequent heart palpitations. Another 20 percent reported hair loss or the development of a rash. Many others dealt with stomach problems like diarrhea, stomach pain, and lack of appetite.

“These findings confirm what many health care workers and COVID-19 survivors have been claiming, namely, that adverse health effects from COVID-19 can linger,” says co-lead investigator Vernon Chinchilli, chair of the Department of Public Health Sciences, in a university release. “Although previous studies have examined the prevalence of long COVID symptoms among patients, this study examined a larger population, including people in high-, middle- and low-income countries, and examined many more symptoms. Therefore, we believe our findings are quite robust given the available data.”

“The burden of poor health in COVID-19 survivors is overwhelming,” adds co-lead investigator Dr. Paddy Ssentongo, assistant professor at the Penn State Center for Neural Engineering. “Among these are the mental health disorders. One’s battle with COVID doesn’t end with recovery from the acute infection. Vaccination is our best ally to prevent getting sick from COVID-19 and to reduce the chance of long-COVID even in the presence of a breakthrough infection.”

What’s causing these lingering symptoms?

Unfortunately, scientists are still uncertain as to what exactly is causing long COVID. The immune system entering “overdrive,” lingering infection, increased production of autoantibodies, and reinfection are all possibilities at this point. Since SARS-CoV-2 is capable of entering the nervous system, symptoms including loss of taste or smell, memory decline, and concentration issues are all common among COVID-19 survivors.

“Our study was not designed to confirm COVID-19 as the sole cause of these symptoms. It is plausible that symptoms reported by patients in some of the studies examined were due to some other causes,” Dr. Ssentongo notes.

Study authors add early intervention and treatment is going to be essential to helping long COVID patients maintain a certain quality of life. Doctors should be prepared for an influx of new patients complaining of issues they had never experienced prior to COVID and, at this point in the pandemic, health care facilities should be prepared to identify and treat long COVID symptoms.

“Since survivors may not have the energy or resources to go back and forth to their health care providers, one-stop clinics will be critical to effectively and efficiently manage patients with long COVID,” Dr. Ssentongo concludes. “Such clinics could reduce medical costs and optimize access to care, especially in populations with historically larger health care disparities.”

At least one long-term symptom seen in 37% of COVID-19 patients -study

by Reuters Wednesday, 29 September 2021 11:06 GMT

Sept 29 (Reuters) – At least one long-term COVID-19 symptom was found in 37% of patients three to six months after they were infected by the virus, a large study from Oxford University and the National Institute for Health Research showed on Wednesday.

The most common symptoms included breathing problems, fatigue, pain and anxiety, Oxford University said, after investigating symptoms in over 270,000 people recovering from COVID-19.

The symptoms were more frequent among people who had been previously hospitalised with COVID-19 and were slightly more common among women, according to the study.

The study did not provide any detailed causes of long-COVID symptoms, their severity, or how long they could last.

It, however, said older people and men had more breathing difficulties and cognitive problems, whereas young people and women had more headaches, abdominal symptoms and anxiety or depression.

“We need to identify the mechanisms underlying the diverse symptoms that can affect survivors,” said Oxford University professor Paul Harrison, who headed the study.

“This information will be essential if the long-term health consequences of COVID-19 are to be prevented or treated effectively,” Harrison added. (

They’re called mild cases. But people with breakthrough covid can still feel pretty sick.

Authors: Fenit Nirappil The Washington Post Aug. 31, 2021

Andrew Kinsey knew that even after being vaccinated against the coronavirus, there was a chance he could still fall ill with covid-19.

He just never expected to feel this lousy from a case doctors call mild.

For nearly a week, Kinsey felt like he had been “run over by a truck.” He struggled to walk a few steps and to stay awake through episodes of the TV show “Doomsday Preppers.” He returned to work last Monday as a corporate litigator but needs midday naps.

“The vaccine appears to have worked to protect my lungs, so that kept me from having life-threatening symptoms, but at the same time, a so-called mild course can be . . . sort of the sickest I’ve ever been in my life,” said Kinsey, who is 38 and lives with his wife and three children in Pennsylvania. “It’s important for people to know that what they picture in their head of a bad cold isn’t necessarily what will actually happen even if they get a mild course.”

Kinsey and other vaccinated people who develop breakthrough cases of covid-19, the illness caused by the virus, are learning a mild case may not seem so mild to the person enduring the infection. Those cases can be as modest as a few days of sniffles, but, in other circumstances, can spawn debilitating headaches and fatigue. Symptoms can persist longer than the usual cold.

But public health authorities and scientists stress that research overwhelmingly shows that coronavirus vaccines are keeping people out of the hospital and that most breakthrough cases are mild or moderate.

Seven vaccinated people who ended up sicker than they expected shared their stories and said they did not want to cast doubt on vaccines – because they believe their outcome would have been much worse had they not been inoculated. Instead, they said they want to help fellow vaccinated people weigh their risks as they decide when to wear a mask and whether to attend a wedding or travel for vacation. They also do not want people to assume a mild case is trivial.

Kinsey is re-examining how he weighs risk this upcoming school year after his family’s battle with the virus. He’s not sure how he and his wife, Lisa, who is also vaccinated, were exposed. They are generally cautious and wear masks to protect their daughter Sarah, who is too young for vaccines at age 8 and has significant medical issues.

Sarah also contracted the virus and was hospitalized for nearly two weeks, later mostly recovering while her vaccinated siblings stayed healthy. For at least several months, the family expects to have protection from natural and vaccine-induced antibodies. But Kinsey says his experience was a reminder of the urgency of paying close attention to the changing understanding of the virus.

Matt Longman, who is 41 and lives in Tucson, Ariz., said he had a 103-degree fever, experienced aches in his elbows and toes like he had never encountered before and could not stop shaking even after wrapping himself in three blankets. Longman fears he would have ended up in the hospital had he not been vaccinated, especially because his immune system is weakened from migraine treatments.

Study examines the effects of COVID-19 on human kidney cells

Date: June 10, 2021Source:American Society of Nephrology

Summary:

The virus that causes COVID-19 can infect and replicate in human kidney cells, but this does not typically lead to cell death. Kidney cells that already have features of injury may be more easily infected and develop additional injury.

Researchers have studied human kidney cells in the lab to examine the effects of COVID-19 on kidney health. The findings appear in an upcoming issue of JASN.

Many individuals who develop COVID-19 also experience kidney damage, but it’s unclear if this is a direct result of viral infection or a consequence of another condition or the body’s response to the infection. To investigate, a team led by Benjamin Dekel, MD, PhD (Sheba Medical Center, in Israel) cultivated human kidney cells in lab dishes and infected them with the virus that causes COVID-19.

The researchers found that although the virus that causes COVID-19 could enter, infect, and replicate in human adult kidney cells, this did not typically lead to cell death. Prior to infection, the cells contained high levels of interferon signaling molecules, and the infection stimulated an inflammatory response that increased these molecules. In contrast, infection of kidney cells deficient in such molecules resulted in cell death, suggesting a protective effect.

The cells in these experiments were grown as a three-dimensional spheroid that imitates the healthy kidney or as a two-dimensional layer that mimics the cells of an acutely injured kidney. Cells that mimicked an acutely injured kidney were more prone to infection and additional injury but not cell death.

“The data indicate that it is unlikely that the virus is a primary cause of acute kidney injury seen in COVID-19 patients. It implies that if such injury takes place in the kidney by any cause, the virus might jump on the wagon to intensify it. Therefore, if we’re able to limit the common scenario of acute kidney injury in the first place, then there might be the possibility to minimize potential damage caused by the virus,” Dr. Dekel explained.

Study co-authors from the Sheba Medical Center and the Israel Institute for Biological Research include Dorit Omer, PhD, Oren Pleniceanu, MD, PhD, Yehudit Gnatek, MSc, Michael Namestnikov, Osnat Cohen-Zontag, PhD, Sanja Goldberg, PhD, Yehudit Eden Friedman, MD, Nehemya Friedman, PhD, Michal Mandelboim, PhD, Einat B. Vitner, PhD, Hagit Achdout, PhD, Roy Avraham, PhD, Eran Zahavy, PhD, Tomer Israely, PhD, and Haim Mayan, MD.

Disclosures: Dr. Dekel is a co-founder and shareholder at KidneyCure Ltd.make a difference: sponsored opportunity


Story Source:

Materials provided by American Society of NephrologyNote: Content may be edited for style and length.

Another Hidden Covid Risk: Lingering Kidney Problems

September 1, 2021in News

Since the beginning of the pandemic, doctors have found that people who become very ill with Covid-19 often experience kidney problems, not just the lung impairments that are the hallmark of the illness.

Now, a large study suggests that kidney issues can last for months after patients recover from the initial infection, and may lead to a serious lifelong reduction of kidney function in some patients.

The study, published Wednesday in the Journal of the American Society of Nephrology, found that the sicker Covid patients were initially, the more likely they were to experience lingering kidney damage.

But even people with less severe initial infections could be vulnerable.

“You see really, across the board, a higher risk of a bunch of important kidney-associated events,” said Dr. F. Perry Wilson, a nephrologist and associate professor of medicine at Yale, who was not involved in the study. “And what was particularly striking to me was that these persisted.”

Kidneys play a vital role in the body, clearing toxins and excess fluid from the blood, helping maintain a healthy blood pressure, and keeping a balance of electrolytes and other important substances. When the kidneys are not working properly or efficiently, fluids build up, leading to swelling, high blood pressure, weakened bones and other problems.

The heart, lungs, central nervous system and immune system can become impaired. In end-stage kidney disease, dialysis or an organ transplant may become necessary. The condition can be fatal.

The new study, based on records of patients in the Department of Veterans Affairs health system, analyzed data from 89,216 people who tested positive for the coronavirus between March 1, 2020, and March 15, 2021, as well as data from 1,637,467 people who were not Covid patients.

Between one and six months after becoming infected, Covid survivors were about 35 percent more likely than non-Covid patients to have kidney damage or substantial declines in kidney function, said Dr. Ziyad Al-Aly, chief of the research and development service at the V.A. St. Louis Health Care System and senior author of the study.

“People who have survived the first 30 days of Covid are at risk of developing kidney disease,” Dr. Al-Aly, a nephrologist, said.

Because many people with reduced kidney function do not experience pain or other symptoms, “what’s really important is that people realize that the risk is there and that physicians caring for post-Covid patients really pay attention to kidney function and disease,” he said.

The two sets of patients in the study differed, in that members of one group had all been infected with Covid and members of the other group may have had a variety of other health conditions. Experts cautioned that there were limitations to the comparisons.

The researchers tried to minimize the differences with detailed analyses that adjusted for a long list of demographic characteristics, pre-existing health conditions, medication usage and whether people were in nursing homes.

Another limitation is that patients in the V.A. study were largely male and white, with a median age of 68, so it is unclear how generalizable the results are.

One strength of the research, experts said, is that it involves over 1.7 million patients with detailed electronic medical records, making it the largest study so far on Covid-related kidney problems.

While the results most likely would not apply to all Covid patients, they show that for those in the study, “there’s a pretty notable impact on kidney health in survivors of Covid-19 over the long term, particularly those who were very sick during their acute illness,” said Dr. C. John Sperati, a nephrologist and associate professor of medicine at Johns Hopkins, who was not involved in the study.

Other researchers have found similar patterns, “so this is not the only study suggesting that these events are transpiring after Covid-19 infection,” he added.

He and other experts said that if even a small percentage of the millions of Covid survivors in the United States developed lasting kidney problems, the impact on health care would be great.

To assess kidney function, the research team evaluated levels of creatinine, a waste product that kidneys are supposed to clear from the body, as well as a measure of how well the kidneys filter the blood called the estimated glomerular filtration rate.

Healthy adults gradually lose kidney function over time, about 1 percent or less a year, starting in their 30s or 40s, Dr. Wilson said. Serious illnesses and infections can cause more profound or permanent loss of function that may lead to chronic kidney disease or end-stage kidney disease.

The new study found that 4,757 Covid survivors had lost at least 30 percent of kidney function in the year after their infection, Dr. Al-Aly said.

That is equivalent to roughly “30 years of kidney function decline,” Dr. Wilson said.

Covid patients were 25 percent more likely to reach that level of decline than people who had not had the illness, the study found.

Smaller numbers of Covid survivors had steeper declines. But Covid patients were 44 percent more likely than non-Covid patients to lose at least 40 percent of kidney function and 62 percent more likely to lose at least 50 percent.

End-stage kidney disease, which occurs when at least 85 percent of kidney function is lost, was detected in 220 Covid patients, Dr. Al-Aly said. Covid survivors were nearly three times as likely to receive the diagnosis as patients without Covid, the study found.

Dr. Al-Aly and his colleagues also looked at a type of sudden renal failure called acute kidney injury, which other studies have found in up to half of hospitalized Covid patients. The condition can heal without causing long-term loss of kidney function.

But the V.A. study found that months after their infection, 2,812 Covid survivors suffered acute kidney injury, nearly twice the rate in non-Covid patients, Dr. Al-Aly said.

Dr. Wilson said the new data supported results of a study of 1,612 patients that he and colleagues conducted that found that Covid patients with acute kidney injury had significantly worse kidney function in the months after leaving the hospital than people with acute kidney injuries from other medical conditions.

In the new study, researchers did not directly compare Covid survivors with people infected with other viruses, like the flu, making it hard to know “are you really any sicker than if you just had another bad infection,” Dr. Sperati said.

In a previous study by Dr. Al-Aly’s team, however, which looked at many post-Covid health issues, including kidney problems, people hospitalized with Covid-19 were at significantly greater risk of developing long-term health problems in virtually every medical category, including cardiovascular, metabolic and gastrointestinal conditions, than were people hospitalized with the flu.

Every type of kidney impairment measured in the new study was much more common in Covid patients who were sicker initially — those in intensive care or who experienced acute kidney injury in the hospital.

People who were less ill during their Covid hospitalization were less likely to have lingering kidney problems, but still considerably more likely than non-Covid patients.

“People who are at highest risk are the people who really had it bad to start with,” Dr. Al-Aly said. “But really, no one is spared the risk.”

The study also found that even Covid patients who never needed hospitalization had slightly higher risk of kidney trouble than the general V.A. patient population. But the risk seemed so small, Dr. Sperati said, that “I don’t know that I would hang my hat on” those results.

Dr. Wilson noted that some Covid patients who did not need hospitalization were nonetheless quite ill, needing to stay in bed for days. He said it’s possible that those were the ones who developed long-term kidney dysfunction, rather than people at the mildest end of the Covid spectrum.

Doctors are unsure why Covid can cause kidney damage. Kidneys might be especially sensitive to surges of inflammation or immune system activation, or blood-clotting problems often seen in Covid patients may disturb kidney function, experts said.

Dr. Sperati said Covid patients in the hospital seemed to have greater need for dialysis, and more protein and blood in their urine, than patients hospitalized with other severe illnesses.

“Covid is probably a little more of a kidney-toxic virus,” Dr. Wilson said. “I do think that the Covid syndrome has some long-term adverse effects on the kidney.”

The post Another Hidden Covid Risk: Lingering Kidney Problems appeared first on New York Times.

Should vaccinated people worry about long Covid?

Here’s what we know about long Covid — with some hope for the future.

Authors: By German Lopez  Aug 30, 2021, 8:30am EDT

Over the past few months, experts and officials have tried to prepare the world for a future in which Covid-19 is here to stay. They predict the vaccines will by and large defang the virus. There will still be a few cases of serious illness and death, but the coronavirus will be reduced to the level of a seasonal flu — a disease we’d be much better off without, but mild enough we won’t shut down society to fight it.

But this optimistic vision has always left open a big question: What about long Covid?

Covid-19 is most known for causing acute illness, from a cough and fever to hospitalization and death. But in some cases it seems to cause longer-term complications, including breathing difficulties, fatigue, and brain fog, though the effects vary from person to person. While Covid-19 typically resolves in the span of weeks, long Covid can last at least months after an infection.

“Without treatment, we’ve seen individuals who got sick in February or March of 2020 and are still sick and still extremely debilitated,” David Putrino, who’s treated long Covid patients at the Mount Sinai Health System in New York, told me.

These long-term complications aren’t unique to the coronavirus; other viruses, including seasonal flu, cause long-term symptoms too, sometimes similar ones. But as more people have been infected by the coronavirus, and more have subsequently developed long Covid, the long-term problems have received more attention.

So even in the context of a post-vaccine world, does long Covid makes the coronavirus too dangerous to live with? Can the world really treat Covid-19 like a flu-level illness if it’s causing debilitating long-term problems for many?

The truth is there’s still a lot about long Covid we simply don’t know. We don’t know what causes it, or why some people seem to develop long Covid symptoms while others don’t. We don’t know with much precision how often long Covid occurs. We don’t know how variants of the virus, including delta, have altered the risk. We don’t even know if all the cases believed to be long Covid are actually caused by the coronavirus.

Nor do we know much about breakthrough cases among vaccinated people leading to long Covid, though we know there have been some cases. But the vaccines very likely help to prevent long Covid by reducing both the likelihood of infection and severity of illness, both of which are associated with long-term complications. “If you’re not getting infected with Covid, you’re not going to get long Covid,” Putrino said.

The uncertainty makes it difficult to make any kind of sweeping declarations about long Covid. Based on my conversations with experts, the best we can say goes something like this: Long Covid is relatively rare, especially among vaccinated people. And it will likely become rarer over time, especially as more people get vaccinated and the population in general develops stronger immune defenses against the coronavirus.

“The hope is that over time as more variants emerge, as we keep getting more booster vaccinations, [and] as our body becomes more accustomed to producing antibodies to this virus type, we’re going to see cases of long Covid reducing — to the point where it’s not really a thing anymore,” Putrino said. But he cautioned, “This is conjecture. We don’t know for sure.”

It’s helpful, then, to view long Covid through two lenses: what the outlook is right now, in August 2021, and what it might look like in a few months or years. How worried you should be today if you’re vaccinated depends, like many things in the pandemic, on your own risk tolerance. But in the long term, there are some hopeful signs.

What long Covid looks like now

There are some things about long Covid we do know. It’s a real medical problem, although its symptoms, severity, and duration vary from person to person. These symptoms aren’t permanent in all cases — potentially not any of them — but they can last for a year or more. And some treatments, part of a nascent and growing field of medicine, can potentially cut down the symptoms’ severity and duration.

Most cases of Covid-19 don’t lead to long Covid. The limited data so far suggests 10 to 25 percent of adults infected with Covid-19 might develop long Covid (although experts advise a lot of caution in interpreting those numbers since the data here isn’t of great quality).

While we don’t know what causes long Covid, there are some theories — all speculative for now. One possibility is that lingering reservoirs of the virus or fragments of it continue to wreak havoc in the body. Another is that long Covid is part of the body’s healing process after fighting off the coronavirus. Yet another is that, because the SARS-CoV-2 virus is novel to humans, it can lead to a long-lasting overreaction by the immune system.

A major unknown is if all the detected long Covid cases are even caused by the coronavirus, given that some of the people who present long-term symptoms test negative for Covid-19 and related antibodies. Experts don’t deny that the symptoms are real and should be treated, but it’s also possible psychosocial circumstances or other pathogens could be behind some cases.“THE PROBLEM IS THAT WE KNOW VERY LITTLE ABOUT HOW FREQUENTLY BREAKTHROUGH INFECTIONS LEAD TO LONG COVID” —AKIKO IWASAKI

Many viruses, like seasonal flu, can cause long-hauler symptoms. One study in Pathogens suggested some long Covid cases may be due to reactivations of the Epstein-Barr virus that causes mononucleosis. (When I was in high school, I lost months to fatigue due to recurring mono.) So some people showing up at the doctor’s office with long Covid could have “long flu,” mono, or another disease entirely. “It’s hard to say,” Putrino acknowledged.

Long Covid remains a unique threat right now for two reasons: There’s still a lot of coronavirus out there, as the country deals with a recent surge driven by the delta variant. And compared to pathogens like the flu, fewer people have immune defenses built up against the virus, likely boosting the chances of developing Covid-19 and then long Covid compared to the risk of suffering long-term complications from the flu.

The good news: These risks can be mitigated with vaccines.

The vaccines cut the chances of getting infected by the coronavirus in the first place. To the extent long Covid cases are caused by the virus, that means fewer cases of long Covid. The delta variant and waning efficacy have complicated this, increasing the risk someone is infected with the virus even after vaccination — potentially necessitating booster shots. But the vaccines still offer some protection against the risk of any infection.

The vaccines also offer protection against severe disease. This protection has so far held up against the delta variant and despite concerns about waning efficacy: Multiple studies have found the vaccines are still around 90 percent effective against hospitalization or worse, both during delta’s spread and months after the shots are administered. A recent study from the Centers for Disease Control and Prevention found unvaccinated people are 29 times as likely to be hospitalized with Covid-19 than fully vaccinated people.

That’s important because long Covid also seems much more likely to develop in people who had severe cases of Covid-19. A study analyzing private health care claims, by the nonprofit FAIR Health, found that hospitalized Covid-19 patients were almost twice as likely as patients who weren’t hospitalized but were symptomatic to develop “post-Covid conditions.” Patients without symptoms were even less likely to develop longer-term conditions than those with symptoms, although it did happen in some cases.

So to the extent that the vaccines make you less likely to get sick in the first place, and much less likely to get severely ill if you do get sick, they reduce your chance of getting long Covid. If you do get sick, though, there’s a lot we don’t know.

Some breakthrough infections can lead to long Covid, as one New England Journal of Medicine study tracking Israeli health care workers found. But that study also found the overall prevalence was low: Among nearly 1,500 fully vaccinated health care workers who were exposed to the coronavirus or had related symptoms, just seven, of 39 breakthrough infections, reported persistent symptoms after more than six weeks.

Still, that’s one estimate from a small study looking at a somewhat narrow time period. “The problem is that we know very little about how frequently breakthrough infections lead to long Covid,” Akiko Iwasaki, an immunologist at the Yale School of Medicine, told me.

Perhaps the best that can be said is the vaccines likely help, probably significantly, but it’s unclear just how much. Given that, and the spread of the delta variant, some experts say it makes sense for those worried about long Covid to remain cautious and mitigate exposure even after getting the vaccine (through, say, masking), at least for now.

What long Covid might look like in the future

Moving forward, there are some reasons to be hopeful about long Covid.

For one, the Covid-19 pandemic will end. Through vaccination, natural infection, or both, the population will continue to build immunity against the coronavirus. Over time, this buildup will turn into a bulwark against SARS-CoV-2 — one that may not stop the virus from spreading entirely (experts expect the virus will instead become endemic, meaning it will still circulate as illnesses like colds and the flu do), but will at least reduce the number of infections and especially cut down on the most severe outcomes, like hospitalization and death.

Those population-level defenses will mean fewer infections and less severe illness, both of which will translate to fewer cases of long Covid over time.

Putrino offered an optimistic, albeit speculative, possibility: If long Covid is caused by an overreaction from an undeveloped immune system to a novel coronavirus, then the steady buildup of immunity and continued exposure to the virus over time could help reduce the risk of long Covid. In that case, the remaining incidents of Covid-19 as the virus turns endemic may be less likely to lead to long Covid.

“We need to focus on being a little more patient,” Putrino argued. “A year and a half feels like a long time. But in terms of how long it takes for our bodies to change and adapt to things, it’s a very short amount of time.”

We’ll also hopefully learn much more about long Covid going forward. That may help with prevention, such as techniques or treatments to stop Covid-19 from leading to long Covid. It could also help with the treatment of long Covid, potentially reducing its severity or duration. (Developing such treatments, though, will require taking long Covid seriously — something medical and research communities haven’t done in the past with “long haulers” dealing with other diseases.)

Over time, a waning pandemic and the reduced risk of getting Covid-19 could help us live with the virus, including with the possibility of long Covid. Just like people have learned to live with the flu and the severe outcomes it can cause (including long-term health complications and tens of thousands of deaths a year in the US), so too will people learn to live with a Covid-19 that’s weakened by the vaccines and natural immunity.

As is true with the flu or anything else in life, different individuals have different risk tolerances. Some people may choose to go out less during periods in which cases rise, continue to wear masks, or seek out booster shots. Others may decide the low chances of complications after they get a vaccine, if they even decide to get the shot, are tolerable enough to continue living as normal, even when cases rise within their community. Many will fall in between.

“Some people will do everything possible to prevent their risk, and other people will not worry as much,” Céline Gounder, an epidemiologist at New York University, told me. “It’s going to depend on the person.”

So the solution to long Covid may look a lot like the other scary, uncertain things about the pandemic, from variants to breakthrough cases: There’s no perfect option, but the best we can do is get as many people vaccinated as possible to defang the coronavirus — and greatly reduce the risk of long Covid — even if it’s never truly eliminated.

Long COVID’s daunting toll seen in study of pandemic’s earliest patients

Authors: Melissa Healy   6 hrs ago

COVID-19 patients in Wuhan were among the pandemic’s first victims, and a comprehensive new study finds that a year after shaking the coronavirus, survivors were more likely than their uninfected peers to suffer from mobility problems, pain or discomfort, anxiety and depression.

detailed accounting of 1,276 people hospitalized for COVID-19 in the pandemic’s opening months reveals that a full year later, almost half continued to report at least one lingering health problem that is now considered a symptom of “long COVID.”

One out of five said they had continued fatigue and/or muscle weakness, and 17% said they were still experiencing sleep difficulties. Just over one in four said they were suffering anxiety or depression in the wake of their bout with the SARS-CoV-2 virus.

For the growing number of patients who identify themselves as COVID “long haulers,” the new accounting offers cause for optimism — and concern. The period from six to 12 months after infection brought improvement for many. But most patients struggling with symptoms at the six-month mark were not yet well six months later.

The findings, catalogued by a team of Chinese researchers, were published late Thursday in the medical journal Lancet.

“This is not good news,” said David Putrino, a rehabilitation specialist who works with COVID long haulers at Mount Sinai Hospital in New York. “If you run the numbers here, about one-third of the group that had persistent symptoms are getting better after 12 months, while two-thirds are not.”

Putrino also called the findings a “wake-up call” to public health officials that even when the pandemic is over — a distant enough prospect in the midst of a fourth wave of infections — its downstream consequences will not be.

“We’re going to need resources for many years to come to deal with these patients,” he said.

There will be a lot of them. More than 87,000 COVID-19 patients are being hospitalized each day in the United States, and 2.7 million have receiving hospital care in the past year alone.

The half who contend with persistent symptoms will show up in doctors’ offices with clusters of vague and perplexing complaints including brain fog, heart palpitations, pain and exhaustion. And despite emerging evidence that time and specialized treatment can help many to improve, few will have the wherewithal to spend months in intensive rehabilitation for their symptoms, Putrino said.

An editorial published alongside the new study noted that only 0.4% of COVID long haulers are receiving rehabilitative treatment for their symptoms.

Even as scientists puzzle over the common biological mechanisms of long COVID’s diverse symptoms, healthcare providers “must acknowledge and validate the toll of the persistent symptoms of long COVID on patients, and health systems need to be prepared to meet individualised, patient-oriented goals, with an appropriately trained workforce,” Lancet’s editors wrote.

The new research also offered some glimmers of hope.

When the study’s COVID-19 patients were examined at six months, 68% said they had at least one of 15 symptoms considered hallmarks of long COVID, which is also known as Post-Acute Sequelae of COVID, or PASC. At one year, 49% were still afflicted by at least one of those symptoms.

The proportion of patients with ongoing muscle weakness and fatigue dropped from 52% to 20% during that time. Patients experiencing loss of smell dropped from 11% to 4%, and those afflicted with sleep problems fell from 27% to 17%. The 22% who reported hair loss at six months dwindled to 11% a full year out.

At the same time, the numbers of patients reporting breathing difficulties saw a slight increase, rising from 26% at six months to 30% after a year. Likewise, patients who reported new depression or anxiety increased from 23% to 26% during that period.

Study co-author Xiaoying Gu from the China-Japan Friendship Hospital in Beijing said the slight uptick in anxiety and depression was, like all of long COVID’s symptoms, hard to explain.

The psychiatric symptoms “could be caused by a biological process linked to the virus infection itself, or the body’s immune response to it,” he said. “Or they could be linked to reduced social contact, loneliness, incomplete recovery of physical health or loss of employment associated with illness.”

Patients who required mechanical ventilation were more likely than those with less severe illness to have measurable lung impairment and abnormal chest X-rays at both six and 12 months.

But in the tally of more subjective long COVID symptoms, the difference between the most severely ill and those who required no supplemental oxygen at all was very small.

That finding underscores the fact that even patients who are only mildly ill are at risk of developing a range of persistent symptoms.

Of the study population’s 479 patients who held jobs when the pandemic struck, 88% had returned to work a year after their illness. Most of the 57 who did not return said they either could not or were unwilling to do the tasks required of them.

The findings from the Wuhan patients also tracked with the widespread observation that persistent post-COVID infection symptoms are more common in women than in men. Women who had been hospitalized for COVID-19 were twice as likely as their male counterparts to report depression or anxiety 12 months later. In addition, they were close to three times as likely to show evidence of impaired lung function, and 43% more likely to report symptoms of fatigue and muscle weakness.

All of the study’s participants were treated at a single hospital in Wuhan, where reports of a mysterious new form of pneumonia first surfaced in December 2019. The researchers followed a large group of patients sickened in the first five months that the outbreak.

That makes the Lancet report one of the earliest and largest accounts of lingering COVID-19 symptoms to be tallied and vetted by other researchers, and the only one to compare such patients to a group of uninfected peers matched on a wide range of demographic and health attributes.

One thing is already clear, the journal editors noted: “Long COVID is a modern medical challenge of the first order.”

This story originally appeared in Los Angeles Times.