When Symptoms of COVID-19 Don't Go Away

Judy Londa, a 55-year-old Brooklynite who had traveled on the subway earlier this year to teach art at a Manhattan public school, developed symptoms of COVID-19 two days before she suddenly dropped out of personal school in mid-March.
Londa said she had been very ill for two weeks, with "intense chest tightness that felt like a car was parked on it and barely able to go from room to room." However, she stayed out of the hospital and consulted FaceTime for regular consultations with her doctor, an infectious disease specialist.
By May she felt well enough to stroll around the neighborhood and gradually increase the distance she walked. She expected a full recovery. But now, more than six months after her illness, even walking up a short hill can be exhausting, and she wonders if she will ever feel like the athletic, energetic, healthy woman she was before the novel Coronavirus turned her life into a life roller coaster of recurring illness despite no signs of active infection.
"I'll feel better and be able to run a mile or more and do yoga for about five days, then I'll be flat again for another five days," Londa said. “On and off like a switch, the same symptoms keep repeating - a feeling like cement is pressing on my chest, chills, cough, sore throat, dry mouth, tingling in my arm, an irregular heartbeat. I'm about to fall asleep and suddenly gasp like I'm drowning and have to get up and leave. It's really, really depressing. "
COVID-19 has also burdened her with health problems she has never had before: prediabetes, high cholesterol, high blood pressure, and premature ventricular contractions - a heartbeat caused by extra beats in one of the heart's pumping chambers. Upon checking with COVID-19 survivors on Facebook, she found that others shared her persistent, recurring symptoms. Londa has been doing pretty well for the past 10 days but has taught remotely to save energy.
At the start of the pandemic, doctors were necessarily focused on tackling the acute effects of COVID-19 and saving lives. Research is currently ongoing to assess the long-term effects and ways to prevent and treat persistent symptoms. There is growing concern that the pandemic will result in "a significant increase in the number of people suffering from permanent illnesses and disabilities," reported Nature.
In a September comment in The Lancet, an international team of infectious disease specialists admitted that “we don't know what to say to our patients when they ask about the progression and prognosis of their ongoing symptoms.” Among the many unknowns, who they quoted: "Does Acute COVID-19 Cause Diabetes? Or other metabolic disorders? Will patients develop interstitial lung disease? "
They also wondered "what symptoms could be explained by the anxiety caused by a new illness and isolation, and what symptoms are secondary to a complicated form of COVID-19." At present, the unknowns about the long-term consequences of this potentially devastating viral infection are far more numerous than the known.
One fact is already known: a person doesn't have to have had a serious illness to develop symptoms that last for months and, as time will tell, possibly years. Even some people with mild COVID-19 infections will continue to experience symptoms long after they have recovered from the acute illness.
The range of reported symptoms is wide. These include unusual tiredness from physical or mental activity, brain fog, temperature irregularities, skin rashes, memory problems, and insomnia. According to Dr. Dayna McCarthy, rehabilitation specialist at the Mount Sinai Center for Post-COVID Care, has unbalanced the body's immune response to the coronavirus, the nervous system.
The ongoing effects on those who survived another serious coronavirus disease, SARS, are not very encouraging. As the Mayo Clinic reported, "Many people who have recovered from SARS have developed chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that is made worse with physical or mental activity, but not with rest improves. " The same may apply to people who have had COVID-19. "
The COVID-19 virus can damage the lungs, heart, and brain, increasing the risk of persistent health problems. According to the Mayo experts, "Imaging tests done months after recovering from COVID-19 showed permanent damage to the heart muscle, even in people with only mild COVID-19 symptoms." The disease can cause very small blood clots, which Block capillaries in the heart and permanently injure the heart muscle. The disease can also weaken blood vessels and injure the kidneys and liver.
COVID-19 can scar the tiny air sacs of the lungs and cause long-term breathing difficulties, even if the scars partially heal. This effect on lung function ended the life of 107-year-old Marilee Shapiro Asher, a celebrated Washington, DC artist who remained professionally active until COVID-19 put her on the floor in the spring. She recovered from the acute infection during five days in the hospital and died a few months later from viral damage to her lungs that made her fragile and filled her air sacs with fluid.
For SARS, a 15-year patient follow-up showed that most lung repair occurred within two years, but some mild lung effects persisted indefinitely in more than a third of recovered SARS patients.
Brain-related effects of active COVID-19 infection can include strokes, seizures, and a temporary paralysis called Guillain-Barré syndrome. Many COVID-19 patients lose their sense of smell and taste during acute illness, but for some this neurological effect persisted months after they otherwise recovered. And the question remains whether the viral infection also increases the risk of developing neurological problems such as Parkinson's or Alzheimer's later.
People seriously ill with COVID-19, especially those who have been isolated in intensive care for weeks or more, with or without a ventilator, may develop symptoms of post-traumatic stress syndrome and persistent problems with anxiety and depression. Your emotional trauma can repeatedly cause nightmares and the fear of being alone and even going to sleep.
In fact, Londa said it was impossible to know how many of her recurring symptoms, or their severity, were due to unresolved anxiety stemming from the acute illness or fears that she might never be the person again she was before COVID-19.
A study of 179 recovered COVID-19 patients in Italy found a "deteriorated quality of life" of 44.1% months later, with a high proportion reporting persistent fatigue, shortness of breath, joint pain and chest pain. In McCarthy's experience, however, patients feel better after COVID-19, although symptoms tend to increase and decrease and improvement "is slow". She suggests that patients do things in smaller doses and not push themselves to live like they did before COVID-19, which can make their problems worse.
This article originally appeared in the New York Times.

© 2020 The New York Times Company

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