Understanding Long COVID: Risks and Symptoms Explained
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Chapter 1: The Reality of Long Covid
Long Covid is a genuine and widespread issue that can arise even after mild cases of Covid-19. Take the experience of a friend, Arthur, as an example. He was vaccinated but unfortunately contracted Covid shortly before he could receive a booster. His symptoms included fever and extreme fatigue lasting about a week. Though his doctor categorized his case as "mild," he felt miserable, enduring intense fatigue that forced him to take nearly three months off from his accounting job. The brain fog made it nearly impossible for him to concentrate on tasks involving numbers. Eight months later, he still hasn’t fully recovered. His initial frustration stemmed from his doctor's disbelief in the severity of his symptoms and the lack of acknowledgment of his condition's impact.
Long Covid can manifest after what is deemed a mild infection and is often debilitating, as Arthur's account illustrates. Many individuals experience lingering symptoms that can last for weeks, months, or even longer. The underlying causes, apart from the Covid-19 infection, remain largely unclear, leading to a reactive approach to treatment.
Patients often refer to themselves as “Long Haulers,” while medical professionals commonly use the term “Long Covid.” The National Institutes of Health (NIH) is more specific, labeling it as “Post-acute Sequelae of Covid-19” (PASC).
Initially, Long Covid was thought to be rare, leading to confusion among healthcare providers who were uncertain whether the symptoms were truly connected to the prior infection or perhaps psychosomatic. In reality, it is a prevalent issue that can occur even after mild cases of Covid-19, presenting diverse symptoms which adds to the complexity of diagnosis.
The first video titled "Understanding Long COVID: What Every Patient Needs to Know" offers valuable insights into the condition, its symptoms, and impacts on daily life.
Section 1.1: Who is Affected by Long Covid?
Long Covid can occur after mild to moderate infections and can even affect those who were asymptomatic. This is distinct from individuals who faced severe cases that required hospitalization, as they typically experience significant damage to their organs. While these patients may develop new symptoms post-discharge, this discussion will focus on those who experienced milder infections.
How long do these symptoms persist? The duration remains uncertain, but they can last for several months and range from mildly annoying to severely incapacitating.
Section 1.2: Common Symptoms
The symptoms of Long Covid vary widely and can include fatigue, cognitive difficulties like brain fog, shortness of breath, sleep disturbances, and emotional issues such as anxiety and depression. Some symptoms previously deemed rare, such as tremors, are now reported in about 40% of those affected, while roughly 30% experience unusual vibrations. There are also reports of circulatory imbalances and various cardiovascular issues.
Emotional health is significantly impacted, with increased rates of anxiety and depression reported among those suffering from Long Covid. Moreover, there is evidence of mild cognitive impairment, particularly in older adults, resulting in subtle yet pervasive psychological and behavioral challenges.
In the second video "Who is most likely to suffer from long COVID?" we explore the demographics and risk factors associated with this condition.
Chapter 2: Understanding the Risks and Prevalence
Chronic fatigue is arguably the most prevalent symptom, with its intensity varying among individuals. Many report feeling exhausted and unable to perform even simple tasks without significant effort. This debilitating fatigue can last for weeks, months, or even over a year.
What exacerbates symptoms? For some, physical or mental exertion leads to a worsening of symptoms, a phenomenon now known as “post-exertional malaise.”
Do symptoms persist as they did during the initial infection? Not always. Symptoms may evolve, sometimes resurfacing or disappearing entirely, with patients experiencing cycles of improvement and relapse.
Who is most at risk? While anyone can develop Long Covid, studies indicate that women, older adults, and those with more severe symptoms at the time of initial infection are particularly vulnerable. Research suggests that an unhealthy gut microbiome may increase the risk, as could low levels of immunoglobulins and the presence of Coronavirus particles in the bloodstream.
How common is Long Covid? Estimates suggest that 10 to 30% of individuals with mild Covid develop Long Covid, possibly more. Asymptomatic individuals may also be at risk.
What about children? The incidence appears lower in children, estimated at 4 to 10%, although some reports indicate higher rates. Regardless of prevalence, the impact on affected children can be significant and distressing.
Does vaccination help prevent Long Covid? Unvaccinated individuals have the highest rates of Long Covid. Those who are vaccinated and experience breakthrough infections may still develop it, but at a lower rate. Vaccinated individuals who also receive boosters and then contract Covid have the lowest incidence. Nevertheless, the consequences can be severe for anyone who develops Long Covid, as seen in Arthur's ongoing struggles with fatigue and cognitive issues.
How long does Long Covid last? The duration varies widely, with some reporting symptoms lasting from weeks to over a year. In a survey involving approximately 3,762 participants, 91% reported symptoms persisting beyond 35 weeks. Among them, 86% experienced relapses triggered by physical or mental exertion. At the time of the survey, 46% required reduced work hours compared to their pre-infection status, while 23% had not returned to work since developing Long Covid. The survey concluded that many had not regained their previous functionality and continued to endure significant symptoms.
In conclusion, avoiding infection is crucial, and it’s evident that seeking to gain immunity through infection is unwise. In the next installment of this series, I will delve deeper into the cardiac implications of Long Covid following mild infections. I hope you'll join me for that discussion.
Stephen C Schimpff, MD, MACP, is a quasi-retired internist, professor of medicine, former CEO of the University of Maryland Medical Center, and author of "Longevity Decoded: The 7 Keys to Healthy Aging" as well as "BOOST: Boost Our Own Metabolism" co-authored with Dr. Harry Oken.