With input from Dr Monica Vasudev

1109:  COVID-19: Long-term effects

1. COVID-19 symptoms can sometimes persist for months.
2. Most patients recover completely within a few weeks. However, some of them, even those who had mild disease, continue to experience symptoms after their initial recovery.
3. Older people and those with several serious medical conditions have the greatest odds of having lingering COVID-19 symptoms.
4. The most common signs include: Fatigue, cough, shortness of breath, headache.
5. Heart.Imaging tests done months after recovery from COVID-19 have revealed long-term damage to the heart muscle, even among those who experienced mild COVID-19 symptoms. This may heighten the risk of heart failure or other heart complications later on.
6. Lungs. There can be long-term damage to the alveoli in the lungs. The resulting scar tissue can cause long-term breathing problems and fibrosis.
7. Brain. Even in young people, this viral disease can cause strokes, seizures and Guillain-Barre syndrome. COVID-19 may also heighten the risk of developing Parkinsons disease and Alzheimers disease.
8. While large clots can cause heart attacks and strokes, much of the heart damage that is caused by COVID-19 is considered to occur as a result of very small clots that block tiny blood vessels (capillaries) in the heart muscle.
9. Other organs affected by blood clots include the lungs, legs, liver and kidneys. 
10. COVID-19 also has the potential to weaken blood vessels, thus contributing to lasting problems with the liver and kidneys.
11. ICU experience can make a person more likely to develop post-traumatic stress syndrome, depression and anxiety.
12. Many people may develop chronic fatigue syndrome.

[Mayo Clinic]

13. As per WHO, recovery time appears to be around two weeks for mild infections and three to six weeks for severe disease.
14. In a survey of 350 patients with COVID-19 in the United States, 39% of those who had been hospitalized reported a return to baseline health by 14 to 21 days following diagnosis.

[Tenforde MW, Billig Rose E, Lindsell CJ, Shapiro NI, Files DC, Gibbs KW, Prekker ME, Steingrub JS, Smithline HA, Gong MN, Aboodi MS, Exline MC, Henning DJ, Wilson JG, Khan A, Qadir N, Stubblefield WB, Patel MM, Self WH, Feldstein LR, CDC COVID-19 Response Team. Characteristics of Adult Outpatients and Inpatients with COVID-19 - 11 Academic Medical Centers, United States, March-May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(26):841.]

15. In a study including 143 patients who were hospitalized for COVID-19, only 13% were reported to be symptom free after a mean of 60 days following disease onset The most common persistent symptoms included fatigue (53%), dyspnea (43%), joint pain (27%), and chest pain (22%). None of the patients had fever or features concerning for acute illness.

Persistent severe illness with weeks of fever and pneumonia associated with underlying immunosuppression has also been reported.

[Uptodate]

16. In a survey of 292 patients diagnosed with COVID-19 in the outpatient setting, only 65% reported a return to baseline health by 14 to 21 days after diagnosis. Those returning to baseline health did so in a median of 7 days following diagnosis. Symptoms most likely to persist beyond 14 to 21 days included cough (43%) and fatigue (35%). Fever and chills persisted in 3% and 4%, only.

[Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020.]

16. Some recovered patients have persistently or recurrently positive nucleic acid amplification tests. While recurrent infection or reinfection cannot be definitively ruled out, there is evidence to state that these are unlikely.

[Uptodate]

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA