“I crossed the 4-month mark of being sick with COVID-19. I am young, & I was healthy. Dying is not the only thing to worry about. I still have a near-daily fever, loss of cognitive function, essential tremors, GI issues, severe headaches, heart rate of 150+, viral arthritis and much more,” says Hannah Davis on twitter.

Like Davis, there are many more people and healthcare workers suffering from the long-term effects of COVID-19. Communities of people from the US, United Kingdom and Europe have created online support groups to make sense of their prolonged symptoms and find solace in the solidarity.

From March to June, India was in peak crisis mode, where hospitals were filling up with acute cases and the ‘newness’ of this disease made everyone on edge. Cases are still on the rise, but with basic infrastructural needs like PPEs and ventilators and beds more streamlined, the initial panic has died down.

This also means that we are now seeing the long-term effects of the virus, and how recovery is not always the end of the battle. So while we cheer on India’s nearly 65 per cent recovered cases, the story doesn't end there.

COVID-19 ‘Long Haulers’

Long-COVID is being described as the long-lasting effects or prolonged symptoms in people who have recovered from the disease.

FIT spoke to Dr Suranjit Chatterjee, a senior consultant of internal medicine at Indraprastha Apollo Hospitals, who explained,

He adds that he is still seeing breathlessness in some patients who had a more severe infection and were among the early patients. “In patients who have had a moderate to a severe disease, it is especially not a 2-week disease.”

Dr Chatterjee explained that patients who tested negative for the disease and were discharged were often returning with complaints of headaches, persistent fevers and more. In fact, he was talking to me after just treating one such patient. “I was just with a patient who had to be hospitalised again since he had a persistent fever for one and a half months, and no other cause for fever has been found so far.”

Explaining the Long-term Symptoms

So what are the symptoms of so-called ‘long-COVID’ or the lingering impacts of the disease?

Mild symptoms:

• Persistent, low-grade fever of about 99/99.4 degrees
• Mild weakness
• Body ache
• Abnormal gastrointestinal problems like diarrhoea and constipation
• Mild cough
• Irritation in the throat

Severe symptoms:

• Severe breathlessness, especially in people who have lung issues
• Fibrosis of the lungs, especially in those who had severe lung issues or who had been on the ventilator for a long time
• Cardiac issues can be subtle or serious and exist on a spectrum like variable pulse rates, myocarditis or inflammation of the heart (subtle, moderate or severe) which can cause palpitations and mild to severe breathless where the cardiac functioning becomes sub-optimal
• Heart attacks (explained in detail below)
• Kidney issues, renal failure (rare)
• Liver issues
• Severe muscle weakness
• Neurological issues: People have presented with strokes; classical GB syndrome, encephalopathy of the brain which presents as drowsiness

Dr Chatterjee says that these major symptoms are less common, and are seen more in patients who have had a moderate to severe COVID-19 illness, and have co-morbidities. “Mild patients do have persistent fever. But the breathlessness, the cardiac issues, the significant muscle wasting is more in moderate to severe patients. Patients who have been on a ventilator for a long time or have involved a large part of their lung are more likely to have long-term effects of lung fibrosis as compared to a milder patient."

All in all, you can expect to take a month or two to recover. This also depends on how you first presented with the virus and if you have an asymptomatic or mild or moderate or severe form.

“We are 10 physicians in this hospital, and we are all seeing recovered patients come back with lasting symptoms. It is reasonably common.” For the patient, this can be understandably frustrating.

Additionally, the links between these symptoms and COVID-19 needs to be empirically determined with more longitudinal studies.

Dr Chatterjee also clarifies, “Patients often present with a heart attack, that is, they come with COVID-19 and one of their symptoms is a heart attack. And then, there are also cases where recovered patients are getting heart attacks. It is difficult to say if this is post-COVID or because of some other reason, it needs more confirmation in the months to come.”

Similarly, people also present with strokes and “post-COVID also we have seen nerve involvement,” says Dr Chatterjee, “which is called GB or Guillain-Barré syndrome.”

“Some patients are also testing positive again, but we cannot say it is re-infection without more evidence and data. It would be wrong to say that without ample testing,” says Dr Chatterjee.

Dr Sumit Ray, a critical care specialist at Delhi’s Holy Family Hospital, says a lot of these prolonged effects are the outcomes of battling a serious illness and often occur for other illnesses as well. For example, he says, “On an average, it takes 3 days for every day spent in the ICU to recover. ICU fatigue is a common, well-known phenomena where the body faces severe muscle weakness for some time.” He adds that the issue in COVID-19 seem to be more serious, but they also need more studies to confirm the link.

In a nutshell, the ‘newness’ of the novel coronavirus is making it impossible to jump to conclusions and create clear, causal links between symptoms and the virus.

Why is the Virus Staying for So Long?

"See, when there is an exaggerated immune response like a cytokine storm, then obviously it is affecting a few organs. There is inflammation happening, the blood becomes thick and there is a tendency to cause clots in the entire body,” says Dr Ray.

While a certain level of inflammation happens with all infections, it is more severe in COVID-19 cases. “The main issue with COVID-19 is the cytokine storm. It is very characteristic of the virus.”

But as to the WHY of the symptoms lingering, Dr Chatterjee says that so far it is just how the virus is acting, “but time and more biopsy reports will tell us if it is the inflammation, the clots, the viscosity of the blood or something else that is causing these longer effects.”

According to the BBC, a possible but less likely explanation is that the virus itself (and not a reaction to it) is lingering on like in Ebola.

Does this Happen With Other Serious Illnesses? Similarities With Other Coronaviruses

Often any long-term, serious illness can cause similar complications to other organs, especially when the body is under stress and in the ICU.

So what is unique about the long-term effects of COVID-19?

He says that while it has not taken healthcare workers entirely by surprise as viruses have behaved similarly in the past - like Chikungunya which initially was dismissed as nothing major and just causing joint pain and breathlessness.

“This virus is also teaching us a new lesson everyday. In the weeks to come we should know more about the lasting side-effects, which organs are being involved in the long-term also.”

For SARS as well, Canadian researchers found that long-term chronic fatigue, depression and muscle pains were common in 84 per cent of the patients. Then another study showed that 48 per cent of Korean group of MERS survivors also had chronic fatigue for after 12 months. Dr Ray adds that PTSD is a common side-effect of serious illnesses, but the links have to be cemented with more evidence.

We are playing catch-up to the virus, and so for now doctors are managing the patients who are coming in with the symptoms. “Time will tell us how fast they will recover also,” adds Dr Chatterjee.