As the severity of the new coronavirus became more clear this year, we were all (understandably) focused on the immediate situation. We focused on the most prominent symptoms, the infection and mortality rates, and the range of severity among different populations. Now, in these later months of the pandemic, we need to turn our attention to the long-term effects for some patients. That's the topic of this week's Healthcare Triage.

[Healthcare Triage intro]

Should you contract the novel coronavirus and eventually recover, as most have done, you're basically in the clear for a bit. Right? That seems to be the general attitude. But we and many others are here to say, not so fast. 

It's possible that some people aren't fully recovering from the virus. This idea has been in the periphery for a while, especially because other coronaviruses are known to have lasting health effects, but incoming data are pushing it to a more central focus and raising concern even for those who did not have a severe case of the disease. 

While it is far too early to understand just how long "long-term" symptoms last, a researcher in Healthcare Triage's own backyard is on top of it. Dr. Natalie Lambert, at Indiana University, is studying COVID-19's "long haulers", individuals who have reported suffering from symptoms for weeks or even months after being diagnosed with the virus. Dr. Lambert teamed up with Survivor Corps, a grassroots movement in the United States dedicated to connecting those affected with COVID-19 with the medical and academic researchers working to understand the disease.

Beyond the extended length of symptoms in those individuals, some of those symptoms are surprising on their own. In a recently released survey report, researchers described now-familiar symptoms listed by the CDC such as loss of smell or damage to major organs like the heart or lungs, but also currently less recognized symptoms such as hair loss and brain fog.

Similarly, long-term symptoms were recently reported by researchers from Italy after assembling 179 patients who had been discharged from the hospital following recovery from the virus. At approximately 60 days after symptoms had begun, only 12.6% of patients reported being symptom-free, whereas 32% had 1-2 lingering symptoms and 55% has three or more. The most commonly reported long-term symptoms were fatigue and labored breathing.

A study published in JAMA Cardiology this July found that in a group of 100 German COVID-19 patients, 60 of them still had inflammation of the heart when imaged a mean of 71 days after testing positive. 36 patients reported general exhaustion and shortness of breath that was not present prior to contracting the virus. In contrast to the previous study, the majority of these patients had cases that did not require hospitalization, meaning long-term symptoms are not definitively linked to severe disease only.

Other work has suggested that an association between the virus and long-term neurological effects, including inflammation of the central nervous system (that means the brain and spinal cord), stroke, and neuropsychiatric illnesses such as delirium.

Data from the COVID Symptom Study, which gathers information from millions of people who submit it via the study's app, currently suggests that somewhere between 10 to 15% of people don't recover within a couple weeks. 

It's still way too early to know if a subset of COVID-19 patients will go on to endorse some level of chronic illness, and if so, which patients are most at risk. We'll need a lot more time to conduct a lot more studies with a lot more people before we can provide any clear answers. The data certainly aren't ruling it out, though, which is all the more reason to resist getting overly comfortable this early in the game.

Hey, did you enjoy this episode? You might enjoy this previous episode on convalescent plasma! We'd also really like it if you'd like and subscribe down below, and go on over to patreon.com/healthcaretriage, where you can help support the show even during a pandemic! We'd like to really thank our Research Associates: James Glasgow, Joe Sevits, Josh Gister, and Michael Chinn, and of course, our Surgeon Admiral Sam.