Long road to recovery for some Covid-19 patients

Vaccinations against SARS-CoV-2 are already underway and we’re beginning to see light at the tip of the tunnel. However, many individuals who contract Covid-19 proceed to suffer from lingering unwanted effects because some people may take for much longer to get well from the disease than others. Many people have reported several persistent significant symptoms after overcoming the initial stages of Covid-19 illness. These symptoms could also be mild or severe and last more than 28 days and should include fatigue, shortness of breath, brain fog, chest pain or tightness, cough, sleep disturbances, fever, gastrointestinal symptoms, anxiety and depression (National Institutes of Health [NIH], 2021a). Scientists call this group of symptoms post-acute sequelae of SARS-CoV-2 infection (PASC) or “long COVID”. You may additionally have heard the terms “post-acute COVID-19,” “chronic COVID-19,” and “post-COVID syndrome,” and people affected by it are also known as “long-haulers.”

Let’s have a look at recovery from COVID-19, which has three general phases and only involves symptomatic recovery and never lively viral infection (Mikkelson and Abramoff, 2021):

• Acute COVID-19: symptoms last as long as 4 weeks after the onset of the disease.
• Ongoing symptomatic COVID-19: symptoms persist for 4 to 12 weeks after illness onset.
• Post-COVID-19: Symptoms that develop during or after COVID-19 last for 12 weeks or longer and usually are not attributed to some other illness or disease.

In addition to the symptoms listed above, less common physical unwanted effects include anosmia (lack of sense of smell), dysgeusia (changes in taste), joint pain, headache, xerostomia, rhinitis, lack of appetite, dizziness, muscle pain, alopecia, sweating and diarrhea ( Mikkelson and Abramoff, 2021 ). Symptoms akin to fever, chills and altered taste or smell disappear more quickly than others, normally inside two to 4 weeks. Persistent, debilitating illness akin to fatigue, shortness of breath, chest tightness, cognitive impairment and mental effects can last as long as three months or longer. The time to resolution of symptoms varies, but could also be significantly influenced by premorbid risk aspects in addition to the severity of the acute disease. Longer recovery periods have been reported in patients requiring hospitalization, older patients with pre-existing comorbidities, patients who developed medical complications akin to bacterial pneumonia or venous thromboembolism, and patients who had an extended stay in hospital or on a ward intensive care unit (ICU) ( Mikkelson and Abramoff, 2021 ). However, patients with less severe disease who haven’t been hospitalized also report prolonged, persistent symptoms.

We don’t yet know why some people fully get well from Covid-19 and others don’t. In December 2020, Congress appropriated $1.15 billion over 4 years to support NIH research. Scientists hope to reply several questions (NIH, 2021):

• What does recovery from SARS-CoV-2 appear like in specific populations?
• How many individuals will proceed to experience COVID-19 symptoms or develop recent symptoms after acute SARS-CoV-2 infection?
• What are the causes of persistent symptoms?
• Why are some people more vulnerable than others?
• Will SARS-CoV-2 infection increase the danger of other conditions, akin to chronic heart or brain diseases?

The full physical, mental and emotional impact of Covid-19 is not going to be fully understood for several years, but we do know that the pandemic has caused a profound increase in fear and anxiety. As health care providers, we must show compassion for those recovering from Covid-19. Listen to your patients, avoid dismissing their complaints, and show an additional ounce of empathy. It has been an exhausting and difficult 12 months for everybody. Until we’re all vaccinated and achieve herd immunity, we must proceed to wear masks, wash our hands and practice physical distancing to stop the spread of the virus.

Mikkelson, M. E., & Abramoff, B. (2021, April 2). COVID-19: Assessment and treatment of adults after acute viral illness. https://www.uptodate.com/contents/covid-19-evaluation-and-management-of-adults-following-acute-viral-illness

National Institutes of Health (2021, February 23). NIH Launches New Initiative to Study “Long COVID.” https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid