Vaccinations against SARS-CoV-2 are well underway and we are beginning to glimpse the light at the end of the tunnel. However, many people who contracted COVID-19 disease continue to suffer from lingering side effects as the recovery following illness may take much longer for some individuals than others. A number of people have reported several ongoing significant symptoms after they have overcome the initial phases of COVID-19. These symptoms can be mild or severe, lasting for more than 28 days, and may include fatigue, dyspnea, “brain fog,” chest pain or tightness, cough, sleep disorders, fevers, gastrointestinal symptoms, anxiety, and depression (National Institutes of Health [NIH], 2021a). Researchers refer to this cluster of symptoms as Post-Acute Sequelae of SARS-CoV-2 infection (PASC) or “long COVID.” You may have also seen the terms “post-acute COVID-19,” “chronic COVID-19,” and “post-COVID syndrome” and the individuals suffering from it are often referred to as “long haulers.”
Let’s take a look at COVID-19 recovery which spans three general phases and involves symptomatic recuperation only, not active viral infection (Mikkelson & Abramoff, 2021):
- Acute COVID-19: symptoms last for up to 4 weeks following the onset of illness.
- Ongoing symptomatic COVID-19: symptoms last between 4 to 12 weeks following the onset of illness.
- Post-COVID-19: symptoms that develop during or after COVID-19, continue for 12 weeks or longer, not attributed to any other illness or disease.
In addition to the symptoms mentioned above, less common physical side effects include anosmia (loss of smell), dysgeusia (altered taste), joint pain, headache, sicca syndrome, rhinitis, poor appetite, dizziness, myalgias, alopecia, sweating and diarrhea (Mikkelson & Abramoff, 2021). Symptoms such as fever, chills and altered taste or smell, resolve more rapidly than others, typically within two to four weeks. Persistent debilitating illness such as fatigue, dyspnea, chest tightness, cognitive impairments, and psychological effects can last up to three months or longer. The length of time to symptom resolution varies but may be significantly impacted by premorbid risk factors as well as the severity of the acute illness. Lengthier recovery periods have been reported in patients who required hospitalization, older patients with preexisting comorbidities, patients who experienced medical complications such as bacterial pneumonia, or venous thromboembolism, and patients who had a prolonged stay in the hospital or intensive care unit (ICU) (Mikkelson & Abramoff, 2021). However, patients with less severe disease that were not hospitalized are also reporting prolonged persistent symptoms.
We don’t yet know why some individuals recover completely from COVID-19 illness and others don’t. Last December 2020, Congress allocated $1.15 billion in funding over four years to support NIH research. The scientists hope to answer several questions (NIH, 2021):
- How does recovery from SARS-CoV-2 vary across the population?
- How many people will continue to experience symptoms of COVID-19, or develop new symptoms, after acute SARS-CoV-2 infection?
- What are the underlying causes of sustained symptoms?
- Why are some people more vulnerable than others?
- Will SARS-CoV-2 infection increase the risk of other conditions such as chronic heart or brain disorders?
The full physical, mental and emotional impact of COVID-19 will not be completely understood for several years but we do know that the pandemic has caused a profound increase in fear and anxiety. As health care providers we need to show compassion towards individuals recovering from COVID-19. Listen to your patients, avoid dismissing their complaints, and provide an extra ounce of empathy. It’s been an exhausting and difficult year for everyone. Until we are all vaccinated
and have reached herd immunity
, we must continue to wear our masks, wash our hands, and maintain physical distance to prevent the spread of the virus.