Long-haul COVID-19 is a long-term cost of the pandemic that we’ve barely begun to calculate

The idea that COVID-19 can have long-term consequences is an idea doctors were reluctant to accept at first. But it shouldn’t have been. Back in 2010, researchers in Hong Kong took a look at people who contracted SARS during the 2003 outbreak. Almost all of them showed significant impairment of respiratory function seven years later, with an average functioning rate more than 20% lower than what should have been expected. These were not elderly patients, but mostly younger people, and many had not been most severely affected at the time of infection.

SARS-CoV-2 is closely related to SARS-CoV. Their names alone suggest that a close relationship and genetic analysis confirmed it several times. So it should come as no surprise that the two coronaviruses do not come off ‘clean’. They leave behind lingering damage that we are only now beginning to understand. In the case of SARS, the relatively small number of people affected made it possible to ignore the damage that the disease had caused to their lives. However, with so many people infected with COVID-19, the long-term effects of the disease can pose a huge long-term challenge to the healthcare system and the economy, as well as to those involved.

While the SARS study was limited to examining lung function, the real effects of COVID-19 (and likely SARS) extend far beyond the respiratory system. A new study by Northwestern Medicine found that 85% of long haul COVID-19 suffered from multiple neurological symptoms. The most common symptom is something called “brain fog,” which includes confused thinking and forgetting. A large number of patients have also reported headaches, numbness in parts of their body, muscle pain or weakness, and taste and smell disturbances. This last problem has not always been a total loss of those senses. In some cases, these were mixed signals, with things smelling and tasting unpleasant or just plain wrong. It was as if COVID-19 had rewired those senses. Wrong.

As The New York Times reports, a study from California found that nearly a third of former COVID-19 patients experienced symptoms such as shortness of breath, continuous cough, or abdominal pain. This included patients who were believed to be “asymptomatic” during the time they were actively infected with the SARS-CoV-2 virus. For some patients, symptoms did not appear until long after they should have been “cured” of any illness.

The wide variety of post-infection symptoms reflects the bewildering array of symptoms and systems affected during active infections. As Americans have learned over the past year, when it comes to COVID-19, all seems to be a symptom. And even when it seems like everything is fine… it could be a symptom, too.

Atlantic started reporting long haul COVID-19 last august, at a time when some officials (and media) seemed dismissive of the idea that an illness that was originally thought to be a respiratory infection could cause such a list of lingering illnesses. However, it has become clear that the inflammation and blood clots generated by COVID-19 can affect almost any part of the body. This realization required both a reassessment of what were high risk factors for the disease, and now it propels a fresh look at those who still fall ill weeks or months after infection.

In one follow-up article in early March, researchers interviewed by Atlantic came up with a new name for what might not work with many long-haul COVID-19s: dysautonomia. It is a condition where the systems that regulate the the autonomic nervous system has failed, which could explain another group of symptoms that some long haulers experience: high blood pressure, chills and periods of very rapid heart rate. But even dysautonomia is only a description of an effect. It is not a cause. A real understanding of what lies behind the symptoms of the lingering effects of COVID-19 and how best to treat them is yet to come.

What is clear is that the pandemic will leave a lingering social and economic cost that goes beyond the mere death toll. Of these 30 million infected, millions will have completely or partially debilitating symptoms for several months. Some, like SARS patients, could still function at levels well below their expected capacity years later. Some may never fully recover. This will represent both a long-term demand on the healthcare system and a long-term reduction in productivity, which – like everything about the events of the past year – may be unprecedented.

Although there is a strange sign of hope: as CNN reports, some of those expressing long-term symptoms apparently improved after receiving a COVID-19 vaccine. It’s unclear why waking up the immune system to fight this virus again should have any effect on people whose tests show no active viruses … but then the whole issue of long haul is poorly understood. And if it works for at least some people, then that’s a good thing.

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