The Mysteries of Long-COVID

"Although the long-COVID phenomenon has been feared and discussed since the beginning of the pandemic, we observed that most health outcomes arising after a mild disease course remained for several months and returned to normal within the first year."

"When we started this study there was a lot of uncertainty regarding the long-term effects of the pandemic and there was a fear that a large proportion of infected individuals will have long-lasting symptoms and emergence of new morbidities."

Dr./Maytal Bivas-Benita and Barak Misrahi, Ki Research Institute, Israel

"There is a subset who remain asymptomatic [one year post-COVID infection, those aged 19 to 40 in particular]."

"Weakness, cognitive impairment, brain fog, shortness of breath -- these are the ones you keep hearing from patients."

Dr. Manali Mukherjee, immunologist, McMaster University

 

"The people I look after who are suffering with long-COVID have severe shortness of breath or severe weaknesses even beyond a  year that significantly impacts their ability to look after themselves and their families and to work."

"People are still questioning whether long-COVID is a 'real thing'. this kind of evidence continues to show that it is a real thing, and people need to be listened to and their experiences need to be validated and we desperately need to try to find a way to help them."

Dr. Kieran Quinn, general internal medicine, palliative care specialist, Sinai Health System, Toronto

Illustrative: A medical worker at Hadassah Hospital Ein Kerem in Jerusalem treats a patient in the coronavirus ward on December 27, 2021. (Olivier Fitoussi/Flash90)

Most symptoms of 'long-COVID' tend to clear within a year, a new study involving thousands of 'long-haulers' suggests, recently published in the British Medical Journal. According to the researchers involved in the study, this information may help ease the growing fears of long-lingering COVID infection effects. 

 

The researchers were "surprised to find only a small number of symptoms related to COVID remained for a year following infection, as well as the low number of individuals affected by them". "It's good news, with caution", responded immunologist Dr. Manali Mukherjee who had herself developed long-COVID following a SARS-CoV2 infection. She managed to recover from the ordeal, but it took 18 months before her system was cleared of the after-effects of COVID.

 

What the study also does is affirm the existence of long-COVID as a legitimate health phenomenon resulting from exposure to a COVID infection. A government of Canada survey, the Canadian     COVID-19 Antibody and Health Survey, found 15 percent of adults with confirmed or suspected COVID had experienced symptoms of long-COVID. Close to half, (47 percent) had symptoms persist for a year or longer, while 21 percent said "often or always" their symptoms limited day-to-day activities.

The Israeli researchers added that the precise definition of long-COVID, or "post-COVID condition" remains elusive -- a still-evolving issue. To the present, it has been defined as symptoms persisting, or new ones appearing, four weeks or so after infection with COVID, while others define it as the persistence of symptoms for a period of at least three months.

Reports of symptoms exceed 100 variants spanning every organ system -- from abdominal pain and hair loss, to problems in concentration. Long-COVID may be assumed to be less frequent at present than in early pre-vaccination days, Dr. Quinn had written with colleagues in a brief for the COVID-19
Science Table for Ontario a year ago. It still, however, poses "substantial health risks" with a heavy burden to the economy and to the health care system, they added.

Assumptions as to its cause remain only that; theories are that long-COVID is a result of persistent inflammation, or a hyper-stimulated immune response. The body's immune activation may go rogue, unleashing auto-antibodies that turn on its own tissues and proteins, once SARS-CoV-2 is cleared from the body. The possibility also suggests itself that tiny blood clots known as micro-clots could be blocking vessels throughout the body, the cause of symptoms such as shortage of breath and brain fog.

The Israeli study based its results on the scrutiny of electronic health records of 1.9 million people who took a COVID PCE test between March of 2020 and October 2021. The research method relied on compared 300,000 people who tested positive for SARS-CovV-2 not admitted to hospital in the month following a diagnosis of COVID, matching them to a similar number testing negative.

A list of 70 reported symptoms was studied, comparing the vaccinated to the unvaccinated, studying people at different time periods; one to six months after infection with COVID, and six to 2 months later. Those who tested positive had significantly higher risks of problems such as loss of smell and taste, concentration and memory problems, breathing difficulties, weakness, palpitations, cough, muscle aches and pains and dizziness throughout the year after a COVID diagnosis.

 

Chest pain, hair loss, cough and muscle aches and pains were seen to decrease following six months; concentration and memory problems peaked at four months, and then gradually declined, while weakness persisted throughout the year for people aged 19 to 60. 

"People describe it [fatigue, an unmentioned symptom in the study] as waking up with only ten percent battery in your smartphone [or] post exertional malaise [where] even seemingly simple physical or cognitive mental activities that use some energy can leave you with total energy deficit and depletion, for days afterwards."

Dr. Kieran Quinn

"Many people may not have come in [to report their experience of post-COVID symptoms making their lives miserable]."

"These records are based on who actually took the effort of coming in."

Dr, Manali Mukherjee

A new, large-scale study on long COVID out of Israel found various types of health issues reported after mild infections tend to clear up within the first year. But that's not the case for everyone. Vancouver resident Katy Mclean is still struggling with fatigue and other impacts after catching COVID back in September 2020. (Ben Nelms/CBC)