Long COVID (PASC)

By Suhani Khandelwal

Published 8:53 PM EST, Thurs April 22, 2021

Introduction

Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or chronic COVID syndrome (CCS) and long-haul COVID or Long COVID.

Recent studies have shown that COVID-19 has long term impacts on patients health, irrelevant of their age and medical history. For example, 35% of COVID symptomatic adults with a positive outpatient test reported that even 2–3 weeks later they had not returned to their original state of health. Furthermore, 20% of the subjects between 18 to 34 years who were in good health, confirmed that some of the symptoms were prolonged. The US Center for Disease Control and Prevention (CDC) lists fatigue, shortness of breath, joint and chest pain as some of the long-term symptoms of COVID-19. Coronavirus long-haulers have also reported cognitive impairment, depression and headaches.

The impact of SARS, however, continues as survivors’ exercise capacity and health status are significantly impaired for over 24 months. Another study revealed that 40% of people recovering from SARS still had chronic fatigue symptoms 3.5 years after being diagnosed. This may be because long COVID affects organs and can cause inflammation of the heart muscles, pulmonary issues, hair loss and skin rashes. However, we still do not know just how long these symptoms will persist or why they occur.

Reference Studies

At the Jin Yin-tan Hospital in Wuhan, over a span of 5 months, 1733 patients undertook a series of symptom questionnaires, physical examinations, and a six-minute walking test to study the long term impact of COVID. In it, 63% of subjects reported fatigue or muscle weakness and 26% had sleep difficulties. In addition, 23% of participants experienced anxiety or depression. Severely ill patients had significantly impaired pulmonary diffusion capacities, abnormal chest imaging manifestations, and had the longest recovery period. Furthermore, the decline of neutralising antibodies raises concern for severe acute respiratory syndrome coronavirus 2 re-infection.

As far as researchers know now, there is no one type of person who is more likely to suffer from long-term COVID-19 symptoms and issues, though some doctors say they are seeing far more females showing such symptoms. Ryan Hurt, an internist who leads post-COVID-19 syndrome research at the Mayo Clinic, said that even though only 10% of the approximately 20,000 COVID positive patients are considered long-haulers at the clinic, 60-80% of them are women.

Organ damage caused by COVID-19

Although COVID-19 is seen as a disease that primarily affects the lungs, it can damage many other organs, increasing the risk of long-term health problems. Organs that may be affected by COVID-19 include:

Heart- Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscles, even in people who only experienced mild COVID-19 symptoms. Increasing the risk of heart failure and other heart diseases in the future.
Lungs- The type of pneumonia often associated with COVID-19 can cause long-standing damage to the tiny air sacs (alveoli) in the lungs. The resulting scar tissue can lead to long-term breathing problems.
Brain- Strokes, seizures and Guillain-Barre syndrome, a condition that causes temporary paralysis, have also been associated with COVID. Increase the risk of developing Parkinson’s disease and Alzheimer’s disease.

Blood clots and blood vessel problems

COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from small clots blocking capillaries in the heart.

Other parts of the body affected by blood clots include the lungs, legs, liver and kidneys. COVID-19 can also weaken blood vessels and cause them to leak, contributing to potentially long-lasting problems with the liver and kidneys.

Problems with mood and fatigue

People who have severe symptoms of COVID-19 often have to be treated in a hospital’s intensive care unit and are often put on ventilators. Simply surviving this experience can make a person more likely to later develop post-traumatic stress syndrome, depression and anxiety.

Because it’s difficult to predict long-term outcomes from the new COVID-19 virus, scientists are looking at the long-term effects seen in related viruses, such as the virus that causes severe acute respiratory syndrome (SARS).

Many people who have recovered from SARS have gone on to develop chronic fatigue syndrome, a complex disorder characterized by extreme fatigue that worsens with physical or mental activity but doesn’t improve with rest. The same may be true for people who have had COVID-19.

Many long-term COVID-19 effects still unknown

Much is still unknown about how COVID-19 will affect people over time. However, researchers recommend that doctors closely monitor people who have had COVID-19 to see how their organs are functioning after recovery. Many large medical centres are opening specialized clinics to provide care for people who have persistent symptoms or related illnesses after they recover from COVID-19.

It’s important to remember that most people who have COVID-19 recover quickly. But the potentially long-lasting problems from COVID-19 make it even more important to reduce the spread of the disease by following precautions such as wearing masks, avoiding crowds and keeping hands clean.

Suhani Khandelwal, Youth Medical Journal 2021