Long after being cleared of COVID-19, patients are still experiencing its lingering symptoms, blurring the concept of “recovery.”
One weekend early into 2021, Alwyn Mancio, 27, went out to hang out with his friends. Everything seemed fine until a few days later, three of them started developing symptoms of COVID-19. Alarmed, Mancio monitored himself for similar symptoms and isolated himself just in case. Not too long after, he developed a cold, and things gradually progressed from there.
Colds are listed as a less common symptom of COVID-19, so Mancio did not immediately suspect himself to have contracted the disease. However, seven days after the suspected date of exposure to a SARS-CoV-2-positive individual, Mancio started losing his senses of taste and smell. He also developed difficulty in breathing. When this happened, Mancio knew what had to be done: He got tested for the novel coronavirus on March 10.
“My doctor just told me . . . by the time that I [reach] my 14th day of isolation, and if I don’t [experience] symptoms anymore, it should be okay already,” he tells COMMONER. But Mancio decided to stay in isolation for another week after.
According to available research, around 88 to 95 percent of patients with a mild case or who are asymptomatic no longer yield replication-competent virus 10 to 15 days after the manifestation of symptoms. However, this does not equate to complete recovery for the patients. Rather, it only confirms that they can no longer transmit the virus to other people as the virus load in their bodies is no longer high enough to be transmitted.
But even after a month of “recovery,” Mancio reveals that he has yet to have his senses of taste and smell back to 100 percent. Doing strenuous physical activities such as exercising also now proves to be a challenge for the 27-year-old, despite having an active lifestyle prior to contracting COVID-19. Most notably, he still finds it hard to catch his breath the way he used to before getting ill.
As of writing, more than 174.5 million people have recovered out of the 191.69 million recorded cases of COVID-19 globally. But it seems the struggle does not have a definite end for some of those who have gotten through the disease. Like Alwyn, a population of COVID-19 survivors continue to exhibit symptoms weeks after recovery, even after testing negative for the virus. This is now what scientists believe to be the “post-COVID condition,” or what is simply called “long COVID.”
What We Know about “Long COVID”
According to the World Health Organization (WHO), there is no formal definition for long COVID yet. Dr. Marylouise McLaws, an epidemiologist from the University of South Wales, clarifies that WHO indicates that long COVID is “a clinical diagnosis with a history of COVID-19 with a failure to fully recover.” What is known is that this condition can last from a few weeks to months after getting infected; whether it can last for years is still unknown. In addition, anyone who contracts the disease has a chance of experiencing long COVID — regardless of the severity of their case.
Among the symptoms that individuals with long COVID may have are tiredness or fatigue; difficulty thinking or concentrating, sometimes referred to as brain fog; headache; loss of taste, smell, or both; dizziness; heart palpitations; chest pain; difficulty breathing or shortness of breath; cough; joint or muscle pain; depression or anxiety; and fever.
According to the Centers for Disease Control and Prevention (CDC), the aforementioned symptoms are not all that may occur. Multiorgan effects may also be observed, which is when most, if not all, body systems may be affected — including heart, lung, kidney, skin, and brain functions. This may come in the form of a multisystem inflammatory syndrome (MIS) or autoimmune conditions.
The CDC defines MIS as the condition wherein different bodily systems can become swollen. Autoimmune conditions, on the other hand, take place when the immune system mistakenly attacks healthy cells of the body, which may also cause painful swelling in the affected body parts. In other words, long COVID could be a number of different disorders blended into one, further aggravated by a prior COVID-19 infection.
How long multiorgan effects can last and whether or not they may cause further complications remain unknown.
What Studies Show
When asked about current literature in the medical field on the topic, McLaws discloses that scientists currently “do not have a definitive answer” why patients who have seemingly recovered from COVID-19 experience long COVID afterward.
“One hypothesis in the literature is that it may be associated with persistent viral load as a result of a weakened immune system,” she explains. Scientists from the CDC, however, speculate that long-term effects such as “persistent and significant impairment of exercise capacity and health status” over 24 months may be expected, if long COVID is indeed similar to what happened to those diagnosed with severe acute respiratory syndrome (SARS).
In a preliminary study by the United Kingdom Office of National Statistics, 13.7 percent of the respondents who tested positive for COVID-19 still reported symptoms even after 12 weeks or longer after recovery. That means approximately 1 in 10 people who were infected with SARS-CoV-2 go on to experience long COVID.
Meanwhile, a study from the United States found that around one-third of people who test positive for the virus do not go back to their usual state of health even after three to six weeks since diagnosis. Another United States study published in February of this year gathered respondents via an online survey between August and November 2020. Following the trend, 30 percent of the 234 respondents reported having COVID-19 symptoms even after nine months since diagnosis.
McLaws states that while long COVID is not a new postviral phenomenon as this has also been observed in patients diagnosed with SARS, Middle East Respiratory Syndrome (MERS), and chronic fatigue syndrome, available data remains inconclusive. One study found that pulmonary function, exercise capacity, and health status continued to be significantly impaired among SARS recoverees even after 24 months. Among the respondents, 29.6 percent of healthcare workers (HCWs) and 7.1 percent of non-HCWs were not able to return to work even after two years since infection. Meanwhile, findings of the study by Lam et al. revealed that 40 percent of SARS recoverees continued to struggle with chronic fatigue even three and a half years after being diagnosed.
According to McLaws, there has not been any agreed standardized treatment regime for long COVID in current literature. However, WHO does recommend separate treatments for the numerous complications from COVID-19, such as the management of hypertension, kidney disease, heart disease, and other comorbidities. “Other [suggested aspects for] support [are] mental health, social, and financial impacts of chronic illness,” she furthers.
What Should We Expect?
The world’s understanding of long COVID remains very limited. As of yet, not enough is known about how long the postviral phenomenon lasts or for how to actually recover from it. In fact, there is still no determined indicator of a patient’s likelihood to get long COVID.
However, what has been confirmed is that long COVID should not be confused with reinfection with the virus. Reinfection with SARS-CoV-2 seems to be rare, but the CDC warns that these may increase over time as patients will be more susceptible due to weaker immunity and exposure to virus variants and infectious cases. Reinfection may be verified via genomic sequencing — the process of analyzing one’s DNA taken from blood — if the patient had sequencing when first diagnosed, McLaws adds.
A Medicinal Matter
Currently, a number of medicines are being tested to treat some, but not all, effects of long COVID. In Massachusetts, biotechnology company PureTech Health has started a clinical trial for deupirfenidone, an anti-inflammatory and antifibrotic (i.e., that which blocks or prevents tissue scarrin) drug. Meanwhile in the United Kingdom, they have launched a study called HEAL-COVID. Participants in the study composed of those hospitalized due to COVID-19 are given one of two drugs after being discharged: apixaban, an anticoagulant drug that helps delay or prevent possible blood clotting and atorvastatin, an anti-inflammatory medicine. The National Institutes of Health in the United States have also funded a trial that would try to treat those wild mild cases of COVID-19 with existing drugs.
In the case of vaccines, scientists still do not know if they could prevent the occurence of long COVID. Another survey in the United Kingdom gathered 900 respondents experiencing long COVID to monitor their well-being after their first dose of the vaccine. While 57 percent saw an improvement in their symptoms, 24 percent reported no change and a total of 19 percent reported a deterioration in their health status. The study, however, is not yet peer-reviewed as of June.
Experts reiterate, however, that vaccination will definitely prevent death and severe illness due to the disease.
It is best to note that taking into account what happens next is just as crucial as recovering from the disease. But while progress has been made in answering some questions, many are still left unanswered. Especially for Mancio and the population experiencing long COVID, the most important question right now is: “When — and how — do we get better?”
“The knowledge on long COVID is being improved all the time,” McLaws affirms. While this may not be the response people are expecting, there is assurance that efforts to unshroud the mystery of long COVID are continuous, and scientists remain driven to provide the world with much needed answers.
This article was written by our contributor, Dab Castañeda, with research from Carli Buendia.
Dab Castañeda is a Manufacturing Engineering and Management student at De La Salle University-Manila. When he’s not occupied with working on spreadsheets for his clothes and meal plans, he likes to daydream about a life that could have been.
