Jump to content

Long COVID

From Wikipedia, the free encyclopedia

This is an old revision of this page, as edited by 79.76.129.65 (talk) at 11:07, 22 December 2020 (Removed tooth loss as symptom. Reference was anecdotal.). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Part of a series on the
COVID-19 pandemic
Scientifically accurate atomic model of the external structure of SARS-CoV-2. Each "ball" is an atom.
Scientifically accurate atomic model of the external structure of SARS-CoV-2. Each "ball" is an atom.
Timeline
2019
2020
2021
2022
2023
Locations
By country and territory
By conveyance
International response
National responses
Medical response
Vaccines
Current vaccines
Variants
Variants of concern
Other variants
Economic impact and recession
By country
By sport
Impacts
Long COVID
Society
Politics
virus icon COVID-19 portal

Long COVID, also known as chronic COVID syndrome (CCS) and long-haul COVID,[1][2][3] is the long-term sequelae of coronavirus disease 2019 (COVID-19). These symptoms persist after the usual convalescence period. These long-term symptoms include fatigue, headaches, shortness of breath, anosmia (loss of smell), muscle weakness, low fever, cognitive dysfunction (brain fog), and hair loss.

Somewhere between 10 and 20 percent of people who have been diagnosed with COVID-19 report experiencing a range of symptoms which last longer than a month. About 2%[4] of people have report having symptoms which last longer than 12 weeks, which is called post-COVID-19 syndrome. Sufferers of long COVID are often called long-haulers.

Studies are under way into various aspects of long COVID, but as of December 2020 it is too early to draw conclusions, although one study has suggested risk factors for developing the illness. Health systems in some countries or jurisdictions have been mobilised to deal with this group of patients by creating specialised clinics and providing advice.

As "Long COVID" can also arise in young, healthy people[5][6] and even professional athletes[7] even if acute disease only led to minor symptoms, preventing Coronavirus infection and mastering the pandemic through suited measures including social distancing[8], source control[9], personal protective equipment[10] and vaccination has the potential to contribute significantly to long term population health, beyond the survival benefit for the high risk population.

While "Long COVID" is observed after acute Covid-19, it has not been reported after Covid vaccination, with over 100'000 participants included in vaccine trials by December 2020[11][12][13].

Definitions

The British National Institute for Health and Care Excellence (NICE) divides COVID-19 into three clinical definitions:

  • acute COVID-19 for signs and symptoms during the first 4 weeks after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),
  • new or ongoing symptoms 4 weeks or more after the start of acute COVID-19, which is divided into:
    • ongoing symptomatic COVID-19 for effects from 4 to 12 weeks after onset, and
    • post-COVID-19 syndrome for effects that persist 12 or more weeks after onset.

NICE describes the term long COVID, which it uses "in addition to the clinical case definitions", as:[14]

commonly used to describe signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (12 weeks or more).

— National Institute of Health and Clinical Excellence

NICE defines post-COVID-19 syndrome as:[14]

Signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post‑COVID‑19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.

— National Institute of Health and Clinical Excellence

Description and incidence

As time passed, from the first reports of the disease in December 2019 through the spread of the COVID-19 pandemic into 2020, it started becoming clear that COVID-19 was a long-term illness for many people,[15][16] seen in people who had a mild or moderate initial infection[17] as well as those who were admitted to hospital with more severe infection.[18][19][20]

Some early studies suggest that between 1 in 5 and 1 in 10 people with COVID-19 will experience symptoms lasting longer than a month.[15][18] An early analysis by the United Kingdom's National Institute for Health Research suggests that ongoing long COVID symptoms may be due to four syndromes: permanent damage to the lungs and heart, post-intensive care syndrome, post-viral fatigue syndrome, and continuing COVID-19 symptoms.[21][22][15][23][24]A November 2020 study concluded that survivors of COVID-19 appear to be at increased risk of psychiatric sequelae[25] – 20% of those infected are diagnosed with a psychiatric disorder within 90 days, with anxiety, depression and insomnia being most common.[26]

A majority (up to 80%[27]) of those who were admitted to hospital with severe disease experience long-term problems including fatigue and shortness of breath (dyspnoea).[28][15][29] Patients with severe initial infection, particularly those who required mechanical ventilation to help breathing, are also likely to suffer from post-intensive care syndrome following recovery.[18]

As of December 2020 an estimated 200,000 people in the UK are suffering from Long Covid.[30]

Terminology

Long COVID is a patient-created term which was reportedly first used in May 2020 as a hashtag on Twitter by Elisa Perego.[31][32]

Sufferers are often referred to as long-haulers.[16][33][34][35][36][37][38][39]

Symptoms

Symptoms reported by people with long COVID include:[40][36][38]

  • Extreme fatigue
  • Long lasting cough
  • Muscle weakness
  • Low grade fever
  • Inability to concentrate (brain fog)
  • Memory lapses
  • Changes in mood, sometimes accompanied by depression and other mental health problems
  • Sleep difficulties
  • Headaches
  • Joint pain
  • Needle pains in arms and legs
  • Diarrhoea and bouts of vomiting
  • Loss of taste and smell
  • Sore throat and difficulties to swallow
  • New onset of diabetes and hypertension
  • Skin rash
  • Shortness of breath
  • Chest pains
  • Palpitations
  • Hair loss

Risk factors

According to a King's College London study reported on 21 October 2020 (but not yet peer-reviewed[4]) risk factors for long COVID may include:[41][42]

  • Age – particularly those aged over 50
  • Sex – being a woman (in the younger age group)
  • Excess weight
  • Asthma
  • Having more than five symptoms in the first week of COVID-19 infection (e.g. cough, fatigue, headache, diarrhoea, loss of sense of smell)

Studies

A number of studies are currently analysing the long-term effects of the virus on some individuals. A wide range of longer-term damage to other organs has been found, including the nervous system, and possibly kidneys, liver, and gastrointestinal tract. Symptoms such as decreased lung and cardiac function and decreased exercise capacity have frequently been recorded. In addition, a range of symptoms of as yet unknown aetiology, such as fatigue, joint pain, "brain fog", and fever, have led to comparisons with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), although distinct from such a diagnosis, which is dependent on other criteria. Doctors are hoping to find specific causes for the symptoms experienced by COVID-19 long-haulers, who are often young, previously fit and healthy people, as their treatment will differ depending on the aetiology, which could be lingering infection, autoimmune abnormalities, lung or heart damage, inflammation or other reasons.[43][44]

A study by King's College London found that an estimated 10 per cent of COVID-19 sufferers in the UK did not recover within three weeks, and about 250,000 people experienced symptoms for 30 days or more.[45]

Timeline

In April/May 2020, 143 patients who had been hospitalised in acute care were followed up in Rome, Italy, and 87.4% reported at least one persisting symptom, particularly fatigue and dyspnoea.[39][46]

The University of Leicester and the University Hospitals of Leicester NHS Trust are undertaking a major study into the long-term health effects of COVID-19 as of August 2020.[45][47][48]

On 1 September 2020 The Lancet Infectious Diseases published an article by 15 doctors summarising the most common complaints of people recovering from COVID-19, who had experienced different degrees of severity during the acute phase, seen in their clinical practice. They reported an observational study of 100 recovering/recovered patients published in July 2020,[49] which found that 78 of these patients had abnormal findings on cardiovascular MRI (median 71 days after diagnosis), and 36 of those experienced dyspnoea and unusual fatigue. While long-term sequelae of the disease were as yet unknown, the authors said that research into aspects of these long-term effects is needed, including prediction of which patients may suffer such effects, management of the acute phase which may help to avert the symptoms, phases of the immunological response in these patients, possible genetic determinants, and treatments for the symptoms.[40]

On 9 November 2020, a study found that the COVID-19 survivors had around a 18.1% chance of developing a psychiatric disorder within 90 days of COVID-19, while 5.8% of these patients were receiving a psychiatric diagnosis for the first time.[25] On 9 November 2020, Dr. Anthony Fauci said "Between 25% and 35% of COVID-19 patients have lingering symptoms such as fatigue, shortness of breath, muscle aches, sleep disturbances and 'brain fog'."[50]

Health system responses

Australia

In October 2020, a guide published by the Royal Australian College of General Practitioners (RACGP) says that ongoing post-COVID-19 infection symptoms such as fatigue, shortness of breath and chest pain will require management by GPs, in addition to the more severe conditions already documented.[27]

United Kingdom

In Britain, the National Health Service has set up specialist clinics for the treatment of long COVID.[51] The four Chief Medical Officers of the UK were warned of academic concern over long COVID on 21 September 2020 in a letter published in The BMJ and written by Trisha Greenhalgh.[52] The letter was signed by academics including David Hunter, Martin McKee, Susan Michie, Melinda Mills, Christina Pagel, Stephen Reicher, Gabriel Scally, Devi Sridhar, Charles Tannock, Yee Whye Teh, and Harry Burns, former CMO for Scotland.[52] In October 2020, NHS England's head Simon Stevens announced the NHS had committed £10 million to be spent that year on setting up long COVID clinics to assess patients' physical, cognitive, and psychological conditions and to provide specialist treatment. Future clinical guidelines were announced, with further research on 10,000 patients planned and a designated task-force to be set up, along with an online rehabilitation service[53] – "Your Covid Recovery".[54]

In December 2020, University College London Hospitals (UCLH) opened a second Long Covid clinic at the National Hospital for Neurology and Neurosurgery for patients with post-Covid neurological issues. The first clinic opened in May, primarily focused on respiratory problems, but both clinics also refer patients to other specialists where needed, including cardiologists, physiotherapists and psychiatrists.[55]

Public response

Multiple groups of long COVID sufferers have joined groups on social media sites that are either internationally based or on smaller geographical areas.[56][57] In many of these groups individuals post about frustrations with living with their symptoms and believed dismissal by medical professionals.[57]

See also

References

  1. ^ Baig, Abdul Mannan (23 October 2020). "Chronic COVID Syndrome: Need for an appropriate medical terminology for Long‐COVID and COVID Long‐Haulers". Journal of Medical Virology. doi:10.1002/jmv.26624. Retrieved 27 November 2020.
  2. ^ Staff (13 November 2020). "Long-Term Effects of COVID-19". Centers for Disease Control and Prevention. Retrieved 27 November 2020.{{cite news}}: CS1 maint: url-status (link)
  3. ^ "Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE". National Institute for Health and Care Excellence. 18 December 2020. Retrieved 18 December 2020.{{cite web}}: CS1 maint: url-status (link)
  4. ^ a b Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, Pujol JC, Klaser K, Antonelli M, Canas LS, Molteni E (21 October 2020). "Attributes and predictors of Long-COVID: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App" (Document). doi:10.1101/2020.10.19.20214494. {{cite document}}: Cite document requires |publisher= (help); Unknown parameter |s2cid= ignored (help); Unknown parameter |url= ignored (help)
  5. ^ Iacobucci, Gareth (17 November 2020). "Long covid: Damage to multiple organs presents in young, low risk patients". BMJ: m4470. doi:10.1136/bmj.m4470. ISSN 1756-1833.
  6. ^ Brito, Daniel; Meester, Scott; Yanamala, Naveena; Patel, Heenaben B.; Balcik, Brenden J.; Casaclang-Verzosa, Grace; Seetharam, Karthik; Riveros, Diego; Beto, Robert James; Balla, Sudarshan; Monseau, Aaron J. (2020-11). "High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19". JACC: Cardiovascular Imaging: S1936878X20309463. doi:10.1016/j.jcmg.2020.10.023. PMC 7641597. PMID 33223496. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  7. ^ "Dimitrov 'still suffering coronavirus symptoms'". BBC Sport. Retrieved 22 December 2020.
  8. ^ VoPham, Trang; Weaver, Matthew D; Hart, Jaime E; Ton, Mimi; White, Emily; Newcomb, Polly A (12 June 2020). "Effect of social distancing on COVID-19 incidence and mortality in the US". doi:10.1101/2020.06.10.20127589. PMC 7310657. PMID 32587998. {{cite journal}}: Cite journal requires |journal= (help)CS1 maint: PMC format (link)
  9. ^ Hunziker, Patrick (16 December 2020). "Minimizing exposure to respiratory droplets, 'jet riders' and aerosols in air-conditioned hospital rooms by a 'Shield-and-Sink' strategy". doi:10.1101/2020.12.08.20233056. {{cite journal}}: Cite journal requires |journal= (help)
  10. ^ Cook, T. M. (2020-07). "Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic – a narrative review". Anaesthesia. 75 (7): 920–927. doi:10.1111/anae.15071. ISSN 0003-2409. {{cite journal}}: Check date values in: |date= (help)
  11. ^ Polack, Fernando P.; Thomas, Stephen J.; Kitchin, Nicholas; Absalon, Judith; Gurtman, Alejandra; Lockhart, Stephen; Perez, John L.; Pérez Marc, Gonzalo; Moreira, Edson D.; Zerbini, Cristiano; Bailey, Ruth (10 December 2020). "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine". New England Journal of Medicine: NEJMoa2034577. doi:10.1056/NEJMoa2034577. ISSN 0028-4793. PMC 7745181. PMID 33301246.{{cite journal}}: CS1 maint: PMC format (link)
  12. ^ Anderson, Evan J.; Rouphael, Nadine G.; Widge, Alicia T.; Jackson, Lisa A.; Roberts, Paul C.; Makhene, Mamodikoe; Chappell, James D.; Denison, Mark R.; Stevens, Laura J.; Pruijssers, Andrea J.; McDermott, Adrian B. (17 December 2020). "Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults". New England Journal of Medicine. 383 (25): 2427–2438. doi:10.1056/NEJMoa2028436. ISSN 0028-4793. PMC 7556339. PMID 32991794.{{cite journal}}: CS1 maint: PMC format (link)
  13. ^ Mahase, Elisabeth (9 December 2020). "Covid-19: Oxford vaccine could be 59% effective against asymptomatic infections, analysis shows". BMJ: m4777. doi:10.1136/bmj.m4777. ISSN 1756-1833.
  14. ^ a b "Context | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE". National Institute for Health and Care Excellence. 18 December 2020. Retrieved 18 December 2020.{{cite web}}: CS1 maint: url-status (link)
  15. ^ a b c d "Living with Covid19. A dynamic review of the evidence around ongoing covid-19 symptoms (often called long covid)" (PDF). National Institute for Health Research. 15 October 2020. doi:10.3310/themedreview_41169. Archived (PDF) from the original on 18 October 2020.
  16. ^ a b Komaroff A (15 October 2020). "The tragedy of the post-COVID "long haulers"". Harvard Health. Harvard Health Publishing, Harvard Medical School. Retrieved 18 October 2020.
  17. ^ "Even Mild Cases Can Cause "COVID-19 Fog"". Columbia University Irving Medical Center. 21 September 2020. Retrieved 18 October 2020.
  18. ^ a b c Servick K (8 April 2020). "For survivors of severe COVID-19, beating the virus is just the beginning". Science. doi:10.1126/science.abc1486. ISSN 0036-8075.
  19. ^ Smith-Spark L (10 August 2020). "Adults may not be the only Covid 'long haulers.' Kids have symptoms months after falling ill". CNN. Retrieved 19 October 2020.
  20. ^ Tanner C (12 August 2020). "All we know so far about 'long haul' Covid – estimated to affect 600,000 people in the UK". inews. Retrieved 19 October 2020. i spoke to Professor Tim Spector of King's College London who developed the Covid-19 tracker app
  21. ^ Mahase E (October 2020). "Long covid could be four different syndromes, review suggests". BMJ. 371: m3981. doi:10.1136/bmj.m3981. PMID 33055076. S2CID 222348080.
  22. ^ "Coronavirus: Long Covid could be four different syndromes". BBC News. 15 October 2020. Retrieved 18 October 2020.{{cite news}}: CS1 maint: url-status (link)
  23. ^ Simpson F, Lokugamage A (16 October 2020). "Counting long covid in children". The BMJ. Retrieved 18 October 2020.
  24. ^ https://www.meaction.net/long-covid-me-understanding-the-connection/
  25. ^ a b Taquet M, Luciano S, Geddes JR, Harrison PJ (November 2020). "Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA". The Lancet. Psychiatry: S2215036620304624. doi:10.1016/S2215-0366(20)30462-4. PMID 33181098.
  26. ^ Kelland, Kate (9 November 2020). "One in five COVID-19 patients develop mental illness within 90 days - study". Reuters.
  27. ^ a b Fitzgerald B (14 October 2020). "Long-haul COVID-19 patients will need special treatment and extra support, according to new guide for GPs". ABC News. Australian Broadcasting Corporation). Retrieved 19 October 2020.
  28. ^ Ross JM, Seiler J, Meisner J, Tolentino L (1 September 2020). "Summary of COVID-19 Long Term Health Effects: Emerging evidence and Ongoing Investigation" (PDF). University of Washington. Retrieved 15 October 2020.
  29. ^ "How long does COVID-19 last?". UK COVID Symptom Study. 6 June 2020. Retrieved 15 October 2020.{{cite web}}: CS1 maint: url-status (link)
  30. ^ "Long Covid: I used to run, now I can walk 200 metres". BBC News. 19 December 2020. Retrieved 19 December 2020.
  31. ^ Perego E, Callard F, Stras L, Melville-Jóhannesson B, Pope R, Alwan NA (1 October 2020). "Why we need to keep using the patient made term "Long Covid"". The BMJ. Retrieved 18 October 2020.
  32. ^ Callard F, Perego E (October 2020). "How and why patients made Long Covid". Social Science & Medicine: 113426. doi:10.1016/j.socscimed.2020.113426. PMC 7539940. PMID 33199035.
  33. ^ Marshall M (September 2020). "The lasting misery of coronavirus long-haulers". Nature. 585 (7825): 339–341. doi:10.1038/d41586-020-02598-6. PMID 32929257. S2CID 221723168.
  34. ^ "Covid-19 Long Haulers: Meaning, Symptoms, Support Groups". Covid.us.org. 12 July 2020. Retrieved 19 October 2020.
  35. ^ "What are the long-term symptoms of COVID-19?". HMRI. 4 August 2020. Retrieved 19 October 2020.
  36. ^ a b "COVID-19 (coronavirus): Long-term effects". Mayo Clinic. 18 August 2020. Retrieved 19 October 2020.
  37. ^ Taylor T (31 July 2020). "COVID-19 long-term effects: People report ongoing fatigue, brain fog and breathlessness, so what's happening in the body?". ABC News. Australian Broadcasting Corporation. Retrieved 19 October 2020.
  38. ^ a b "What are the long-term health risks following COVID-19?". NewsGP. Royal Australian College of General Practitioners (RACGP). 24 June 2020. Retrieved 19 October 2020.
  39. ^ a b Carfì A, Bernabei R, Landi F (August 2020). "Persistent Symptoms in Patients After Acute COVID-19". JAMA. 324 (6): 603–605. doi:10.1001/jama.2020.12603. PMC 7349096. PMID 32644129. Retrieved 19 October 2020.
  40. ^ a b Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, et al. (October 2020). "Long-term consequences of COVID-19: research needs". The Lancet. Infectious Diseases. 20 (10): 1115–1117. doi:10.1016/S1473-3099(20)30701-5. PMC 7462626. PMID 32888409. Retrieved 19 October 2020.
  41. ^ Gallagher, James (21 October 2020). "Long Covid: Who is more likely to get it?". BBC. Retrieved 21 October 2020.
  42. ^ "New research identifies those most at risk from 'long COVID'". King's College London. 21 October 2020. Retrieved 22 October 2020.
  43. ^ Couzin-Frankel J (31 July 2020). "From 'brain fog' to heart damage, COVID-19's lingering problems alarm scientists". Science. Retrieved 19 October 2020.
  44. ^ Manke K (8 July 2020). "From lung scarring to heart damage, COVID-19 may leave lingering marks". Berkeley News. University of California at Berkeley. Retrieved 19 October 2020.
  45. ^ a b Morgan E, Elliott S (12 August 2020). "Long Covid: What is it, what are the symptoms and what help is there?". ITV News. Retrieved 19 October 2020.
  46. ^ Tancheva, Lyubka; Petralia, Maria Cristina; Miteva, Simona; Dragomanova, Stela; Solak, Ayten; Kalfin, Reni; Lazarova, Maria; Yarkov, Dobri; Ciurleo, Rosella; Cavalli, Eugenio; Bramanti, Alessia; Nicoletti, Ferdinando (1 November 2020). "Emerging Neurological and Psychobiological Aspects of COVID-19 Infection". Brain Sciences. 10 (11). doi:10.3390/brainsci10110852. PMID 33198412. Retrieved 21 December 2020.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  47. ^ "First patient joins UK's largest study into long terms effects of COVID-19". Leicester Biomedical Research Council. 13 August 2020. Retrieved 19 October 2020.{{cite web}}: CS1 maint: url-status (link)
  48. ^ "New national study on long-term health impacts of COVID-19 launched". University College London Hospitals. 7 July 2020. Retrieved 19 October 2020.{{cite web}}: CS1 maint: url-status (link)
  49. ^ Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. (July 2020). "Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)". JAMA Cardiology. doi:10.1001/jamacardio.2020.3557. PMC 7385689. PMID 32730619. Retrieved 19 October 2020.
  50. ^ "Fauci says Covid-19 symptoms last "well beyond what you'd expect" from a viral syndrome". CNN. 8 November 2020. Retrieved 11 November 2020.{{cite web}}: CS1 maint: url-status (link)
  51. ^ Cookson C (15 October 2020). "'Long Covid' symptoms can last for months". Financial Times. Retrieved 15 October 2020.
  52. ^ a b Greenhalgh, Trisha (21 September 2020). "Covid-19: An open letter to the UK's chief medical officers". The BMJ. Retrieved 19 October 2020.{{cite web}}: CS1 maint: url-status (link)
  53. ^ "NHS to offer 'long covid' sufferers help at specialist centres". NHS England. 7 October 2020. Retrieved 19 October 2020.
  54. ^ "Your COVID Recovery". Your COVID Recovery. Retrieved 19 October 2020.
  55. ^ "UCLH opens second 'long Covid' clinic for patients with neurological complications". University College London NHS Foundation Trust. Retrieved 19 December 2020.
  56. ^ Blazonis, Sarah (27 November 2020). "Facebook Group Created by Tampa Man Aims to Connect COVID-19 Long Haulers". www.baynews9.com. Retrieved 29 November 2020.{{cite web}}: CS1 maint: url-status (link)
  57. ^ a b Witvliet, Margot Gage (27 November 2020). "Here's how it feels when COVID-19 symptoms last for months". PBS NewsHour. Retrieved 29 November 2020.{{cite web}}: CS1 maint: url-status (link)

Further reading

Retrieved from "https://en.wikipedia.org/w/index.php?title=Long_COVID&oldid=995693163"